The statement made by Penny Mordaunt, the Leader of the House of Commons, on 21 October 2022.
I’ve been encouraged by support from colleagues who want a fresh start, a united party and leadership in the national interest.
I’m running to be the leader of the Conservative Party and your Prime Minister – to unite our country, deliver our pledges and win the next General Election.
The statement made by Jake Berry, the Chair of the Conservative Party, on 20 October 2022.
The statement made by Ben Wallace, the Secretary of State for Defence, on 21 October 2022.
As the Party starts the process of looking for a new leader, I would like to put on the record that I will not be letting my name go forward as a candidate. I am privileged to be the UK Defence Secretary and the current threat requires stability in that office.
The reasons I gave last time for not standing, have not changed. I will be looking to all candidates to recognise that you cannot have economic security at home without national security. This requires real investment for our Armed Forces and intelligence agencies.
The speech made by Will Quince, the Minister of State at the Department for Health and Social Care, in the House of Commons on 20 October 2022.
I thank the hon. Member for Denton and Reddish (Andrew Gwynne) for his kind words. He will be pleased to know that, despite what he said, I scribbled my own speech today and I can confirm that it will be a fudge-free zone. In fact, I have not had any fudge for about three years and I do not intend to start now—not least because it would not be great for my teeth.
I congratulate my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins) on securing time for this hugely important debate. I thank the Backbench Business Committee for allowing the time and all right hon. and hon. Members who have made constructive contributions to the debate. It would be remiss of me not to thank all those who work in NHS dentistry, not just for their work throughout the pandemic, but for the work that they continue to do serving people up and down the country.
In the relatively short time that I have available—I am conscious that there is another important debate to follow—I will endeavour to respond to as many of the points, themes and questions raised as possible. I hope that right hon. and hon. Members know me well enough already, however, to know that my door is always open. I have never turned down a meeting with a parliamentary colleague and I do not intend to start now. This is an important issue and I hope that we can continue to talk about it at length, even if not in this Chamber.
As the new Minister—or new new Minister—for primary care and therefore dentistry, I have spent the first few weeks in post learning more about NHS dentistry, including by meeting dentists; meeting people at the coalface and the grassroots is really important. Of course, I have my constituency experience too. Despite the events of today, I very much hope to be here for some time to come.
Let me say at the outset, in response to I think nearly all of the contributions made today, that I get it—I really do get it. I know that in many parts of our country access to NHS dentistry is difficult or far more difficult than it should be, and I want to make it clear that dentistry is an incredibly important part of the NHS. The Government and I are committed to addressing the challenges that NHS dentistry continues to face across the whole country, and as the hon. Member for Denton and Reddish rightly pointed out, it is in our ABCD strategy.
I turn to some of the themes raised. The first is access, which was raised by my hon. Friend the Member for Waveney, the right hon. Member for Knowsley (Sir George Howarth), my hon. Friends the Members for Mole Valley (Sir Paul Beresford), for Gloucester (Richard Graham) and for Salisbury (John Glen), the hon. Member for Bootle (Peter Dowd) and my hon. Friend the Member for North Devon (Selaine Saxby). Access to NHS dentistry varies across the country—we know that—and it was an issue, as the hon. Member for Denton and Reddish rightly pointed out, even before the pandemic, but the pandemic has exacerbated it and added further pressure to the system.
The Government are taking a number of important steps that will improve dental access for patients and make NHS dentistry a more attractive place for dentists and their teams to work in. I will outline just some of those. These changes include improvements to the current NHS dental contracts—I will come on to that in a moment—and of course to the recruitment and retention of dental professionals. I say dental professionals specifically because this is of course about far more than just dentists, as important as they are. As the hon. Member for Denton and Reddish pointed out, rightly, we have seen an additional 539 more dentists returning to NHS dentistry last year, which of course means they are able to treat more patients, but I recognise the point he rightly made, and we do need to go further and faster.
On the steps taken, notwithstanding the points made by the hon. Member for Bradford South, we made £50 million of extra funding available for NHS dental services at the end of 2021-22, which provided more appointments and increased capacity in NHS dental teams. I noted her points, and we have learned from that. Given that experience, I would certainly want to do things a little differently if we considered such a proposal again. We announced a package of improvements to the NHS dental system on 19 July, as a number of Members have pointed out, which was set out in our plan for patients. These are an important first step to system reform and are designed to improve access to dental care for patients, particularly patients with the most complex treatment needs.
A number of hon. Members raised the much criticised—and that is as far as I will go, the hon. Member for Denton and Reddish will be pleased to know—2006 contract. We are making improvements to ensure that dentists are more fairly remunerated, especially for more complex oral health needs. The one example we hear very often is of dentists getting paid the same for doing one filling as for six fillings. As numerous hon. Members have pointed out, we have also set a £23 minimum UDA value, notwithstanding the points made about the variation around the country.
My hon. Friend the Member for Gloucester raised accountability locally, including to Members of Parliament. In part the answer to that is their coming within the remit and purview of integrated care systems. I have no doubt that my hon. Friend is well aware of the chief executive of his integrated care system, and will know how to contact and meet them on a regular basis.
Richard Graham
The Minister is absolutely right: not only do we know the chief executive, but all Gloucestershire MPs have had regular meetings with them, including one specifically on this issue. That is why I raised the importance of their being given the opportunity to take responsibility, which I hope my hon. Friend will welcome.
Will Quince
I certainly do welcome that, because this is not just about commissioning, but about accountability and oversight.
Our changes will allow NHS commissioners to have more flexibility in commissioning, and I think that is really important, because if they have that flexibility in commissioning additional dental services, they are the ones who know the local need within their area. I want to see far more responsive management of contracts, so if they have underperforming practices and practices that can do more, we should enable such practices to do that. For example, a high-performing practice should be able to deliver beyond its existing contract to make up for the fact that a neighbouring practice is not doing so. That addresses some of the points made by my hon. Friend the Member for Waveney about the clawback of UDA funding at the end of the year, and then its not necessarily being spent on dentistry. As part of that, I also want and expect more transparency. We will make it a requirement for NHS dentists to update the information on their NHS website, so people can see which dentists are accepting new NHS patients for treatment.
On that point, I want to bust the myth about being registered with a dentist. There is no such thing as being registered with a dentist or a dental list. People approach an NHS dentist for specific treatment. They go on their list, register and have the treatment. They can have an ongoing relationship with a dentist, but anyone can book an appointment with any dentist with an NHS contract, regardless of where they live in the country. It is important to get that message out, because when our constituents say to us, “I can’t get a dentist locally”—I want to address that point—I want to ensure that they know that they could travel to a neighbouring town or city. They could travel half way across the country if they wanted to, for example if they had relatives there, if there was a NHS dentist who had capacity to see them.
Wera Hobhouse
Does the Minister recognise that because of the abnormalities of the dental contract, and dentists not knowing which patients they are getting, NHS dentists would rather take a patient whom they already know, and whose history of dental problems or otherwise they know, rather than taking somebody they have never seen? There is a disincentive to take on new patients, but there is a continuity for those who are already with an NHS dentist.
Will Quince
Of course I take that point—it is a fair one—and when those who seek NHS treatment have an ongoing relationship with a dentist, they are more likely to get seen. When considering reforms to the system we will certainly take that point on board.
Sir George Howarth
The description that the Minister gave of the existence, or otherwise, of lists is accurate, but when anyone seeking to get NHS treatment in a dental practice rings up, they are most likely to be told by the receptionist that the practice is not taking NHS patients. The difference between the two situations, while technically correct, is not there in practice. Before he concludes his remarks, will he address the issue I raised about the short-term measures that can be, and I believe should be, taken to improve the situation?
Will Quince
I am conscious of your advice, Madam Deputy Speaker, but I am certainly willing to meet the right hon. Gentleman to consider what short-term measures we can take.
There is so much I want to say about the contract and my ambitions for the future, but politics is the art of the possible and deliverable, and I will be honest and frank with the House, and with stakeholders across the sector, about what we can deliver. We will then work towards what is within the art of the possible. International dentists are a vital part of the UK’s dentistry workforce, and I am happy to meet hon. Members to set out exactly what we are doing. I hope to bring forward legislative changes later this year. On dental training, I would love to talk more about the Advancing Dental Care review and the centre for dental development, but that may have to wait for another day—you have advised me about the time, Madam Deputy Speaker.
Prevention and oral health has been raised by many Members and is an important part of our strategy. I am looking closely at what more we can do with other Departments, especially around supervised toothbrushing, but also fluoridation, which was raised by numerous Members. Access to urgent care is important, and if people struggle to get an appointment they should call 111. This is the beginning of our work to improve NHS dentistry, not the limit of my ambition. This is just the start, and we are committed to long-term improvements, including changes to improve access to urgent care, and further work on workforce and payment reform. In the meantime there is lots we can do to improve access to urgent care, provide better access for new patients, and make important changes to workforce and payment reform. With that short response I hope I have assured hon. Friends and Members that action is being taken now to address the challenges of access to dental care, especially around recruitment and retention. I also want to reassure Members of my personal ambition and passion for bringing about the medium to long-term positive change that we want for NHS dentistry.
The speech made by Andrew Gwynne, the Labour MP for Denton and Reddish, in the House of Commons on 20 October 2022.
I thank the Backbench Business Committee for granting this important debate, and congratulate the hon. Member for Waveney (Peter Aldous) and my hon. Friend the Member for Bradford South (Judith Cummins) on having secured it. We support the motion in the form in which it has been moved; there is nothing in it that we disagree with. If some of the political arguments are removed from the debate, I think there is consensus across the House as to what the problems are and what needs to be done.
Sir George Howarth
I am sorry to interrupt my hon. Friend so soon. I agree with him about the motion, but I did make the point that there were some short-term measures that could, and should, be taken within the three-month period that the motion envisages before the Government report back on progress.
Andrew Gwynne
My right hon. Friend is absolutely right. There is no reason why the Government cannot expedite action on the issues he mentioned in his contribution and get those improvements in place.
I pay tribute to my right hon. Friend and to my hon. Friends the Members for Blackburn (Kate Hollern) and for Bootle (Peter Dowd), as well as the hon. Members for Bath (Wera Hobhouse), for Mole Valley (Sir Paul Beresford), for Berwickshire, Roxburgh and Selkirk (John Lamont), for Gloucester (Richard Graham), for Salisbury (John Glen), for North Devon (Selaine Saxby) and for Loughborough (Jane Hunt), for their contributions.
I welcome the Minister to his place. I am not sure how long he is likely to be at the Department of Health and Social Care, but I hope he is there long enough to implement some of the changes. I am all for a bit of stability in the Department. He is a good person and a good friend, and I wish him well. However, when he comes to the Dispatch Box, he will no doubt seek to deflect from the situation that has been described my Members across the Chamber by saying that we are here today because of the pandemic.
The backlog has not helped—we all acknowledge that; it goes without saying—but the Government’s spend on general dental practices in England has been cut by more than a third over the past decade, with the number of NHS dental practices in England falling by more than 1,200 in the five years prior to the pandemic. My hon. Friend the Member for Bradford South (Judith Cummins) raised that, and it cannot be ignored. It creates the regional imbalances and dental deserts we have heard about. This is not a rural-urban thing; it is a rural and urban thing, sadly. My right hon. Friend the Member for Knowsley (Sir George Howarth), the hon. Member for North Devon (Selaine Saxby) and the right hon. Member for South Holland and The Deepings (Sir John Hayes) spoke about those dental deserts, which are very real.
The Minister’s next line of defence, if I were to guess what the officials have put in his red folder, will be, “It’s all because of the dental contract.” There is some truth in that. It is 16 years since that dental contract was introduced, and it was introduced for a perfectly good reason. There was no golden age of NHS dentistry before it. There is a reason why people of my age have a mouth full of fillings and my children do not. It is not because I did not brush my teeth as much as my children do, and it is not because I ate more sweets than my children do. It is because the emphasis for paying dentists prior to the introduction of the changes was on early treatment that was perhaps not necessary—“drill and fill” is what they called it. We recognised in 2010 that the contract had not worked in the way we hoped it would, and we proposed changes. Of course, we lost that election, but after 12 years of this Government, I am afraid the line will not wash that it is solely the contract, because they have had plenty of time to make changes to that contract and have not.
We hear about the ABCD plan, and I certainly welcome the “D” in it; at least there is a recognition of dentistry. However, like my right hon. Friend the Member for Knowsley, I worry that this kind of “Sesame Street” strategy does not come close to tackling the scale of the emergency that is gripping dental care. All we have heard from the Secretary of State is sticking-plaster solutions that tiptoe around the edges while failing to address the root cause. That is apparent in the Government’s “hit and hope” approach to dentistry. The £50 million of emergency funding announced earlier this year is a prime example. As my hon. Friend the Member for Bootle said, it is a time-limited, inaccessible pot of money that has done precious little to improve access. In fact, figures obtained by the British Dental Association showed that just 17.9% of that funding was drawn down. This is indicative of a sector that has completely lost faith in the Government’s ability to act, and to be frank, I do not blame them, because when we do see action, it does not meet the scale of the crisis, and in some cases it makes things worse.
As we have heard, the geographic, ethnic and socioeconomic disparities affecting access to NHS dentistry are becoming starker by the day. What does the new Health and Social Care Secretary do in response to that problem? She scraps the health disparities White Paper. It is beyond bizarre that in the face of such overwhelming evidence, the Government will not even consider possible solutions—let alone implement them.
I fully support what the hon. Member for Waveney and other hon. Members on both sides of the House have said about education. Dentistry in schools, a prevention strategy and an emphasis on good oral health is absolutely crucial. We would support the Government in implementing that—hopefully sooner rather than later. The consensus and mood is there to get that done, so I hope the Minister will take that up and get going on that opportunity.
As for many issues facing our NHS, much of the problem with NHS dentistry can be traced back to one thing: workforce. Several hon. Members raised that point. Any hope of an NHS recovery must be underpinned by a comprehensive workforce strategy. Where is that strategy? Was it accidentally shredded with the mini-Budget? I am sure the Minister will hail the fact that NHS stats show an increase of 539 dentists practising in 2021-22, compared with the year before. When we drill down beneath the surface, however, there is not much to be positive about.
Those stats are rendered worthless by the fact that a dentist performing a single check-up on the NHS in a 12-month period is weighted the same as one with a full cohort of NHS patients. BDA survey data shows that for every dentist leaving the NHS altogether, a further 10 are significantly reducing their NHS commitment. No matter how much Ministers might try to fudge the numbers, they simply do not add up. We cannot afford more bluff and bluster. We need action, which the Opposition will support.
The outgoing Prime Minister said that dentistry was in her top three priorities for her first 90 days. That now seems rather optimistic given that she is Liz of 44 days, but we really want the Government to act on that commitment. Can we have an update on how things are going?
The Labour party will fund one of the biggest NHS workforce extensions in NHS history. We will double the number of district nurses qualifying every year, train more than 5,000 new health visitors and create an additional 10,000 nursing placements every year. We will fund this transformative expansion by abolishing non-dom tax status. We will give dentistry the staff, equipment and modern technology it needs to get patients seen on time. Labour has a plan. Where on earth is the Government’s?
The speech made by Jane Hunt, the Conservative MP for Loughborough, in the House of Commons on 20 October 2022.
I congratulate my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins) on securing what is clearly an important debate.
I take this opportunity to thank those in the dental profession in Loughborough and across Leicestershire for everything they have done over the past few years and particularly for the way they adapted to implement the huge changes needed to ensure the safety of their patients throughout the covid-19 pandemic. This year I have met with nearly all the dentists in my constituency, who have highlighted a number of issues they face and the impact they have on the profession and the patient experience more broadly.
Richard Graham
The points my hon. Friend is making are particularly important to constituencies such as hers, which have towns but are also rural.
Jane Hunt
I thank my hon. Friend, who is a true hero in every way.
One concern is about the UDA system, with the recurring message being that the system in its current form is not fit for purpose. I welcome the package of initial reforms to the NHS dental contract announced in July, in particular the introduction of enhanced UDAs to support higher-needs patients.
However, the reforms do not address my local dentists’ concerns that the current system is based on rewarding reactive treatment, rather than preventive, meaning that dentists are driven to do the minimum necessary to meet the terms of the target. That is a source of frustration for some, who have expressed their preference for being remunerated for using their initiative and working in the best interests of their patients.
Furthermore, while it is welcome that a minimum indicative UDA value of £23 has been introduced, UDA payments are not rising in line with increasing overhead costs, which is devaluing contracts and, in some cases, leaving dentists out of pocket. That was highlighted recently during a conversation I had with Bupa in Loughborough. Bupa expressed that that is compounded by the fact that UDA payments vary geographically, so that a UDA is worth £36 in its Sheffield practices but only £24 in its Loughborough one. Finally, the reforms do not address the issue of dentists not being given leeway under their contracts for last-minute cancellations and no-shows, even though they can lead to missed targets. I ask that this be urgently reviewed, so that we do not punish dentists for trying their hardest to continue to provide the care needed.
It is clear that there is still a way to go to make NHS dental contracts more attractive, both in terms of the nature of the dentistry performed and the level of financial reimbursement received for services performed. I fear that if the Government do not continue to work at speed, we will lose even more NHS dentists through early retirement, a reduction in time spent completing NHS work, or a full move into private practice. That would be detrimental to patient care and the availability of NHS appointments. I know that the former Minister of State for Health, my hon. Friend the Member for Lewes (Maria Caulfield), was working hard to review UDA contracts, and I would welcome confirmation from her successor that they will continue that hard work.
As well as difficulties retaining dentists, I have been informed that locally, we are having difficulties recruiting them. One reason for that is that there is no dentistry school in the east midlands, our nearest being in Sheffield and Birmingham, and students are choosing to enter into the workplace close to where they study. That is causing supply issues in the NHS service, and has created a gap in the market that is being filled by private dentists with a focus on cosmetics. We therefore need to ensure we are training up enough dentists and providing them with incentives to move away from where they are studying to areas with greater demand. Bupa has also advocated for putting dental practitioners on the shortage occupation list in order to increase overseas recruitment and fill shortages, then upskilling those practitioners via short courses to meet UK standards. Could the Minister please comment on the actions being taken to increase the number of dentists from overseas?
I am very concerned that NHS England has proposed closing the intermediate minor oral surgery service in Loughborough, meaning that local residents will have to go as far as Leicester for treatment. That city is some considerable way away, and there has been a recent cut in bus services, the No. 2 bus service in particular. Loughborough is effectively Leicestershire’s county town, so there is more than enough demand there for that service. Closing the centre will only increase pressures on the Leicester centre, extending waiting times and further impacting on patient care. That centralisation of services does not meet the needs of the patient, and I ask that the Minister look with some urgency at local services’ availability throughout the country, especially throughout Leicestershire.
Having listened to the whole of today’s debate, it has been very interesting: there are a small number of points that need to be addressed, which have been made by Members from all across the Chamber and all over the country. I do not think this is an insurmountable problem to solve, and I feel sure that the Minister will be able to address it.
The speech made by Selaine Saxby, the Conservative MP for North Devon, in the House of Commons on 20 October 2022.
Like other colleagues, I have spoken out many times in this House about dentists, including in the debate earlier this year. Indeed, the very first letter that I wrote as an MP back in 2019 was about the dental contract, which was brought to my attention by one of the dental practices in Barnstaple. I cannot stress the severity of the dental desert that is now Devon, with not a single NHS practice accepting new patients. Not a week goes by without correspondence from a constituent in distress. As William Shakespeare himself said in “Much Ado About Nothing”:
“For there was never yet a philosopher that could endure the toothache patiently.”
And nor should they. It really is time that something is done. I thank the current Health and Social Care Secretary for recognising dentistry within the ABCD and that there is a problem. I thank, too, the current Minister’s predecessor for at least taking some steps towards redressing the issue of the contract, which is clearly the undermining problem. However, that is a long-term solution. The steps outlined there and the training of more dentists are not going to address the current situation.
Only last weekend, a friend, who was already registered at a dentist, told me that they had actually managed to get a dental appointment. When they got there, they were told that they needed to see the dental hygienist. They went to book an appointment and were told that there was a six-month wait to see the hygienist, who then told them that they needed to have a second appointment to do the other half of their mouth. They went to book, only to be given another six-month wait before they could see the hygienist, so it took a full year. As they said, it is a bit like cleaning the Forth bridge. This is not how our constituents’ teeth should be treated.
My concern extends to my younger constituents. The No.1 reason youngsters under 18 are admitted to hospital in my patch is linked to their teeth. At a time when our hospitals are under such duress anyway, could we not do something to help to ensure that people are able to see a dentist?
My frustration is extended by the fact that I have now managed to secure and find two separate methods for getting dentists into North Devon. Although I do not mind doing this for my constituents—indeed I welcome doing anything I can to help my constituents—I do not quite understand why it is coming down to us as individual MPs to deliver the dentistry that our constituents so desperately need.
Less than 13% of the covid catch-up funding in Devon was spent because there is no one to deliver the treatment. My NHS dentists who train up new dentists at the nearest dental schools advise that these youngsters do not wish to remain in NHS dentistry. We need to address that. Those who train to become dentists under the public purse should have to serve as NHS dentists for a certain period, but they wish to go on to do cosmetic dentistry, which pays much better. The good people of North Devon in the main are not looking for cosmetic dentistry. We are much more interested in fillings and dentures and in ensuring that our young people go on to have good-quality teeth when they get past the age of 10. I urge the Minister to push forward some of these changes, and I hope the new team remain in place long enough to do so.
We need dentists on buses or similar to get to remote rural communities and into schools, to enable every child to have the dental check-up they deserve and to provide emergency access for those people who have failed to secure a dental appointment—not because they have not tried or because of covid, but simply because there is not a dentist available to see them and many people cannot afford to pay for the treatment that they now need after waiting so long.
Sir John Hayes
My sons, who are now 21 and 18, have access to NHS dentistry, as I have, at the excellent Fen House dental practice in Spalding, but many of my constituents’ children do not, as my hon. Friend says. She talks about dental deserts in rural areas, and Lincolnshire is among the worst of those, with 38 dentists per 100,000 population. She is right both about young people and about the particular problems of rural areas. The Minister, for whom I have high regard, needs to give us very firm answers to those questions and a clear plan for what the Government intend to do about them. There is a plethora of private dentists, but too few NHS dentists.
Selaine Saxby
My right hon. Friend’s comments are wise, as always.
On international dentists, during the first lockdown, I had an Indian dentist come and meet me privately, and I forwarded that information back to the Department; apparently, there are many, many Indian dentists who would be delighted to come. We would welcome them to North Devon with open arms—indeed, we would welcome dentists from anywhere into North Devon, such is the need. I urge the Minister to look at what else can be done to speed up access for those people who are well trained internationally to come over and look at our teeth.
I will finish by reminding hon. Members how important our teeth are. I ask the Minister to do anything that can be done to help both our youngsters and those people who have struggled to see a dentist, so that we can again say that the dentist will see us now.
The speech made by Peter Dowd, the Labour MP for Bootle, in the House of Commons on 20 October 2022.
Where are we to begin with this? We have been here before, time after time. I thank my hon. Friend the Member for Bradford South (Judith Cummins) and the hon. Member for Waveney (Peter Aldous) for bringing us this debate. We have discussed this many times and we had a debate in Westminster Hall in the summer, but nothing has really moved on. Nothing at all seems to have changed.
I want to read out part of a letter I received from a constituent, and this is typical of the problem we are facing. I have received even worse horror stories, to the extent that one local dentist told me that they may close in the next few weeks. That is typical and symptomatic of this bigger problem. My constituent said:
“I wanted to take the time to get in touch with you over my experience of getting on the books for an NHS dentist. I have had no luck and have had to have private dental visits. I have luckily not had to have any treatment as I would not be able to afford it. I have reached out to a few dental practices in the area…to be told that they are only taking on children on the NHS.”
That is typical of the experience of everyone in this Chamber. I exhort Conservative Members to stop dealing with this in the abstract, as though it is only affecting individual Members of Parliament; it is a collective issue, and it needs a thorough review and a thorough push by the Government. It is not in the abstract. The hon. Member for Salisbury (John Glen) referred to covid. I completely accept that covid had an impact on the provision of dental services—it hothoused an already challenging situation—but dental services in all our constituencies were under huge pressure before covid. Let us not pretend that covid was the be all and end all of the dental health problem.
Sir John Hayes (South Holland and The Deepings) (Con)
I agree with the hon. Gentleman that there are systemic problems, part of which goes back to the contracts agreed with dentists donkey’s years ago, under the Labour Government—the same applies in respect of GPs. That genesis of the problem was there, but we then face the problem of training too few dentists, which I think we do, and the problems in particular parts of the country, including, Lincolnshire, which is among the worst affected. My constituents cannot get an NHS dentist and they need to have one. That particularly applies to young people and children. He is absolutely right on this.
Peter Dowd
I am grateful to the right hon. Gentleman, who reinforces the point that I am trying to make. We are being contacted by constituents, as I have just set out. We are being contacted by Bupa—I suspect that Members will have had a briefing. We have had a briefing from the British Dental Association. We have had contact directly from dentists. They are all saying exactly the same thing and the Government have to listen. Not only do they have to listen—it is dead easy to do that—but they have to act. The Government have to put their hand in their pocket. So let us stop pretending that £50 million just before the summer is going to do anything in any significant or substantive way to resolve this problem—it is not.
The hon. Member for Bath (Wera Hobhouse) referred to an existential threat, and there is one—dentists are telling us that, as is the BDA. In practical terms our constituents are saying that to us, because their experience shows that there is an existential threat. The contract is a discredited one and it needs to be put right; it puts targets ahead of patient care. But this is also down to the fact that, whether we like it or not, and whether the Government like it or not, cuts in dentistry have not had any parallel to any other cuts in healthcare. We are talking about cuts of more than 25% between 2010 and 2020. That factors in and it creeps up on us year after year until we get to the situation where access to dentistry is the No. 1 issue raised with Healthwatch.
Wera Hobhouse
I was pleased to hear that the mother of the hon. Member for Salisbury (John Glen) has had excellent NHS dental care in Bath, and of course dentists are excellent practitioners and professionals. The thing is that his mother will have been a long-term NHS patient and the problem is that dentists do not take on new NHS patients, because the dental contract completely disincentivises them to do so.
Peter Dowd
That is a point well made. Another factor is that there are deep inequalities in access to dentistry. In my constituency, it is difficult to get to see an NHS dentist for love or money. I am not blaming the dentists; they are doing a fantastic job in the circumstances. They are going over and above their duty. I put on the record my thanks—as I am sure we all would—to my dentist practice, which I have been with for over 45 years. Dentists are doing a fantastic job, but they have both their hands tied behind their back at the moment. That has to change.
Some 91% of people, including 80% of children, are not able to access a dentist, and 75% of dentists are reducing their NHS engagement. The new contract announced before the summer did not really do anything and there was no new money with it. There is a significant gap—potentially as much as £750 million—in the resources that dentists need.
Another aspect is dentists’ morale, with 87% having experienced stress, burnout or depression in the last 12 months. That is a dreadful situation to put a committed profession in. We have a scenario in our country in which dentists who trained for seven or eight years—possibly more—and practised for many years are now getting to the stage where the majority are stressed, burned out or depressed. That is dreadful. According to one study, half of them are considering changing career. Some of them are seeking early retirement or going fully private. They are getting stressed out because they just cannot move the dial. They are waiting for the Government to move it, but the Government are not moving it.
Children in my constituency are three times more likely to have their teeth extracted in a hospital because they do not have access to a dentist. My right hon. Friend the Member for Knowsley (Sir George Howarth) and the hon. Member for Bath referred to oral cancer. That is identified very early on—and who does the identification? Surprise: it is often the dentist. We need substantive support from the Government, not tinkering around with the contract. We need them to provide adequate funding.
Dentists must not be an afterthought. They are a vital component of the health of the nation. We must build on the historical commitment to prevention; that is key—as the saying goes, prevention is better than cure. Dentists have had enough; they are under pressure. My constituents have had enough; they are under pressure. The Government have to do something about it.
In the debate before the summer, I referred, in relation to the lack of substantive action by the Government, to a rejigging of what Ian Fleming said about crisis: if once is happenstance and twice is coincidence, three times is friendly fire and four times is enemy action. We are now in a situation where the Government are perceived as the enemy because of their lack of action.
Rachael Maskell (York Central) (Lab/Co-op)
I apologise that I was not able to be here for the whole debate; I have been in a Bill Committee. In York, people have to wait six years to see a dentist. Of course that is completely unacceptable, but my real concern is that, with the transition of dental services into integrated care systems, ICSs will not have the powers—the levers—to make the difference on training, funding and the contract and, ultimately, dentistry will be pushed into a tug of war between ICSs and the Government.
Peter Dowd
I am glad that my hon. Friend raised that matter because it is something that I was going to raise. The health service, because of the reorganisation, is in an element of flux. It is feeling under a bit of pressure. Potentially, people are having to reapply for jobs in the broader sense in the NHS because of the reorganisation. That is a fact. I am not sure whether we should be having a reorganisation of the NHS in the post-covid environment, but that is a different argument for a different day. The broader dissonance in the system now multiplies the problems that we are having in dental practices, because they are getting pushed further away, which is why practices need representation on these boards. I am glad that my hon. Friend highlighted that point.
As I said in the debate before the summer, we do not want any more excuses from the Government. We do not want any more prevarication, any more procrastination, any more pretext or any more self-exoneration. I hope the Government and the Minister, whom I welcome to his place, really get the sense of the frustration and, in certain situations, anger in the Chamber today. They really must pull their finger out—if not people’s teeth.
The speech made by John Glen, the Conservative MP for Salisbury, in the House of Commons on 20 October 2022.
I rise to speak on behalf of a number of dentists in my constituency. Nicola Jones, an oral surgeon at Salisbury District Hospital, contacted me to say that the lack of available NHS dentists is causing significant challenges in the constituency. I recognise that from my mailbox over recent weeks. I met Matthew Clover, a specialist orthodontic practitioner, in February. He took me through the challenges of the “units of dental activity” model: it does not discriminate properly when it comes to the classification of the different activities that he has to undertake.
The challenges derive primarily from the lockdown two years ago and the interruption to supply: 38 million appointments were lost. I welcome the Government intervention earlier this year to provide the additional £50 million and 350,000 additional dental appointments. I also welcome the Government’s statement in July, but this is an opportunity for the new Minister to challenge his officials and work with industry representatives to find a deeper and more enduring set of changes that address some of the ongoing challenges that have existed for a very long time.
I would not suggest that I have anything like the expertise of my hon. Friend the Member for Waveney (Peter Aldous), the hon. Member for Bradford South (Judith Cummins) or, particularly, my hon. Friend the Member for Mole Valley (Sir Paul Beresford), who has a lifetime of experience at policy level and as a practitioner. But I am aware that since 1951 there has been a model of co-payments, in which dentists act as independently contracted professionals to the NHS but also typically receive an income from private practice work as well.
Wera Hobhouse
The hon. Gentleman makes a very good point that, basically, private patients have been cross-financing NHS patients, but that model is no longer sustainable.
John Glen
I respectfully say to the hon. Lady that my mother is a resident of Bath and has received excellent service from her NHS dentist. Although I recognise this problem exists in different spots of intensity across the country, it needs a comprehensive solution.
The fundamental point is this: how can the model of rewarding dentists incentivise the maximum amount of engagement? All dentists start their professional life wanting to help people and wanting to do as much good as they can. I totally embrace what my hon. Friends the Members for Mole Valley and for Gloucester (Richard Graham) said about the need to deal with the oral health and education of young people, including how to clean their teeth at an early age. There will need to be a focus on how those practices can be embedded in a funding model that has to pay some respect to the geographic coverage of a dentist, while ensuring that each cohort of the population has access to basic dentistry.
The proposed new dental contract goes some way towards dealing with some of the challenges of the UDA model, but it probably does not go far enough. I urge the Minister to go beyond what his officials may be suggesting to him, to think radically and to take this opportunity to ask, “How can we reset after the dislocations caused by covid?” I urge him to come up with something that incentivises dentists to offer an holistic service to people of all means and to help those communities that have cold spots of dentistry supply.
I would like to make a few observations about supply and, again, my hon. Friend the Member for Mole Valley made some very good points about streamlining bureaucracy to ensure more people qualify as dentists in this country. Of course, it is right that we have ongoing quality assessments through the CQC, but that organisation’s focus, as across all industries, needs to be on where there are vulnerabilities and risks. When we think about NHS medical and dental services, I feel we are continually trying to be perfect and to remove all the risk, which sometimes has a cost because it involves using resources to fill in bureaucratic processes that might not necessarily, in most cases, give us much return.
My message to the new Minister is to build on the good start made by his predecessor in the summer, but to consider a more radical and fundamental review of the UDA funding model, to consider the volume of patients and to consider the real dynamics of the choices a dentist makes about how to maximise the number of patients they see who cannot afford to make a contribution.
I feel hopeful that the enthusiasm to provide the service I saw from my dentist in Salisbury means there will be a solution. I wish the Minister well, and I acknowledge the contribution of my hon. Friend the Member for Waveney, who showed a mastery of this subject.
The speech made by Wera Hobhouse, the Liberal Democrat MP for Bath, in the House of Commons on 20 October 2022.
I have been horrified—honestly horrified—to hear reports of people pulling out their own teeth because they are unable to see a dentist. Unfortunately, that is now a reality as a result of Government underfunding of dentistry over many years. In my constituency, only three in 10 patients have seen an NHS dentist in the past two years and only six in 10 children have been able to see a dentist in the past 12 months, although the NHS continues to recommend that all under-18s see a dentist at least once a year.
The way in which the Government have let the NHS dentistry system collapse is a national scandal. Nearly a quarter of all British people have failed to secure a local NHS dentist appointment in the last year. Of those, one in five have resorted to what we now call DIY dentistry, which is terrible. Our public services are so starved of funding that people are being forced to stop trying, or to pay for private treatment. The British Dental Association says that we are facing an “existential threat”. People’s health is at risk if they do not have access to dentistry. Tooth decay is the No. 1 reason for hospital admissions among young children. Oral cancer is one of the fastest-rising types of cancer, and claims more lives than car accidents in the UK: we should remember that.
People in deprived communities are the most likely to suffer. Healthwatch research shows that those on lower incomes are worst hit by appointments shortages. The problem has been made worse by the pandemic, which increased the backlog, but the problem was there before. Limited access to such primary care means that problems cannot be caught early. People should not be facing a choice between being left in pain and paying for private care as we head into this difficult winter. We must do all we can to make sure that they can access the right services and that we address these profound health inequalities.
One of the major reasons for the backlog is staff shortages in the NHS. The number of NHS dentists is falling: one in eight is approaching retirement and 14% are close to leaving the profession. My constituents have been particularly affected: nearly 15% of dentists have been lost from Bath clinical commissioning group since 2016. At a time when demand for NHS services is increasing, we urgently need a strategy to plug these very big staffing gaps.
The Government admit that they do not know how many dental practices applied to access the extra £50 million of funding announced earlier this year. To me, that means that they are asleep at the wheel. The Government must make sure that we have enough dentists if support for the sector is to be effective. We need increased numbers of dentist training places in the UK and continued recognition of EU trained dentists’ qualifications. Dentists must be incentivised to take NHS payments and there needs to be more funding for the sector to meet patient demand. Everyone in the UK should be able to access a dental health check-up on the NHS. Proper workforce planning for health and social care must be written into law, including projections for dentists and dental staff.
The crisis facing NHS dentistry is on an unprecedented scale. Although it has been worsened by the pandemic, the emergency is not new. Most importantly—I am repeating what many have said this afternoon—the Government must reform the NHS dental contracts, which create absurd disincentives for dentists taking on new NHS patients. A review was promised earlier this year. Where is it? Oral health cannot be treated as an afterthought and my constituents cannot wait any longer.