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Children’s Oral Health

Volume 630: debated on Tuesday 31 October 2017

I beg to move,

That this House has considered childhood oral health.

Good morning, Mr Bone; it is a pleasure to serve under your chairmanship today. I am glad that we have been granted this debate by the Backbench Business Committee, because child tooth decay represents a much bigger public health issue than appears to have been recognised so far. It is a problem affecting millions of children, including some of the most vulnerable. It should be a real concern to us all.

As well as thanking the various parties for their help in raising this matter, I also want to thank the Faculty of Dental Surgery at the Royal College of Surgeons and the British Dental Association for their efforts in helping to bring this issue to Parliament’s and the public’s attention.

Public Health England reports that 25% of all five-year-olds in England experience tooth decay in at least three to four of their teeth, and that in some parts of the country it can affect as many as 50% of all five-year-olds. Perhaps not surprisingly, there is a link between deprivation and childhood tooth decay, with the poorest areas suffering the worst levels of oral health and the least contact with dentists. A report, shortly to be published by the Nuffield Trust and the Health Foundation, shows that five-year-olds eligible for free school meals are significantly less likely to attend dental check-ups and have more difficulty in finding an NHS dentist.

If we look at the scale of the problem, we will see that more than 45,000 children and young people aged 0 to 19 were admitted to hospital in England over the past year because of tooth decay. They included 26,000 five to nine-year-olds, making tooth decay the leading cause of hospital admissions and emergency operations for that group. Last year more than 40,000 hospital operations for tooth extractions were performed on children and young people, which is the equivalent of about 160 operations every single day.

My hon. Friend is making an excellent speech. Does he agree that it is extraordinary that it appears that more children go into hospital because of poor oral health than because of broken arms, whereas when we were children it was definitely the other way around?

I absolutely agree with my hon .Friend. That gives us some sense of the scale of the problem.

Those 160 operations every single day are not only detrimental to the health and wellbeing of the children; they are also costly to the NHS. In the financial year 2015-16, more than £50 million was spent on tooth extractions for those aged 0 to 19. The average cost of a tooth extraction for a child up to the age of five is approximately £836, and there were some 8,000 such procedures during 2015-16. Dental treatment is a significant cost to the NHS, with spending in England amounting to £3.4 billion on primary and secondary dental care.

In Birmingham, 29% of five-year-olds suffer from tooth decay, which is significantly higher than the national average. Five-year-olds in Birmingham are three and a half times more likely to suffer tooth decay than those in the South West Surrey constituency of the Secretary of State for Health, and yet Birmingham is a city with fluoride in the water. In Manchester, where the water supply is non-fluoridated, the percentage of five-year-olds with tooth decay is 4% higher than in Birmingham. Hospital admissions related to tooth decay for those under the age of 18 in Birmingham have almost doubled in the past four years.

The way in which data are collected and the regional nature of the information sometimes mask the scale of the problems in the same towns and cities. We know that 20% of five-year-olds have tooth decay in south-east England, compared with 34% in north-west England. In Sutton Trinity ward in the Sutton Coldfield constituency, the figure is less than 10%, but the figure for another part of the same city—the Selly Oak ward in my own constituency—is 47%, which is almost twice the national average. Shocking as those figures might be, tooth decay is almost entirely preventable.

Many health experts now agree that early tooth decay can have a broader impact on health and wellbeing, affecting physical and mental health, and impacting on the child’s development and confidence. Poor oral health can also cause children problems with eating and sleeping, which often results in time away from school. Public Health England has conducted research on the number of school days lost due to tooth decay in north-west England. It shows that the average number of days lost per year was three, but many children missed as many as 15 days owing to dental problems.

Some might wonder why childhood tooth decay matters, because children lose their primary teeth which are replaced by new, permanent teeth. The issue is that a high level of disease in primary teeth increases the risk of disease in the permanent teeth. The child’s self-confidence may also be damaged. More than a third of 12-year-olds said in a recent survey that they are embarrassed to smile or laugh because of the condition of their teeth, and that can often make it harder for them to socialise.

So what can we do? There seem to be three crucial steps to addressing the problem: getting children to brush their teeth twice a day; ensuring they see a dentist regularly from a young age; and reducing the amount of sugar that children consume.

Scotland has been running an educational programme called Childsmile since 2001, which has been credited with making a significant improvement to children’s oral health. The programme supports supervised tooth brushing sessions in primary schools and nurseries, as well as providing twice-yearly fluoride varnishes. Perhaps we will hear more about that later.

A similar initiative, Designed to Smile, was introduced in Wales in 2009. Teeth Team, which is supported by Simplyhealth, has invested £137,000 in a dental programme that takes dental education directly to children in local primary schools in the city of Hull.

Teeth Team has visited one of the schools in Brownhills in my constituency. Does the hon. Gentleman agree that we need to further consider such innovative new schemes and other ways to educate children on dental health and tooth-brushing?

I absolutely agree with the hon. Lady. An education programme for young children and their parents is crucial. I want the Government to play a bigger role, but there are other approaches, too. As I have said, Simplyhealth is supporting the venture in the city of Hull and in East Riding of Yorkshire, as well as in the hon. Lady’s constituency.

A pilot programme called Starting Well is about to commence in 13 areas of England, although none of those pilots will be in Birmingham or the west midlands. I would be grateful for details of the pilot. How long will it run? How will it be evaluated? How were the 13 areas selected? It would also be useful to know exactly how the programme is being funded.

A new initiative by the British Society of Paediatric Dentistry, “Dental Check by One”, is seeking to raise awareness of the importance of getting young children to attend the dentist from an early age. It is supported by organisations across the dental professions. I am pleased to report that it is due to launch in Birmingham tomorrow, despite some torturous negotiations about funding. It seems likely that funding issues will prevent it from being implemented by other regional NHS teams.

What else might be done? Has any consideration been given to proposals from the Faculty of Dental Surgery to use school breakfast clubs to deliver supervised tooth brushing sessions? Analysis by Public Health England has suggested that if public health professionals such as health visitors are involved in supporting oral health improvement programmes, that can lead to significant improvements and long-term savings. Health professionals who have regular contact with children, such as midwives, health visitors, school nurses, pharmacists and early years practitioners, are all ideally placed to help identify children who may be at risk of tooth decay.

Equally, dentists look at all the soft tissues in the mouth and are often able to help identify a number of conditions, from diabetes and Crohn’s disease to oral cancer. According to recent figures on dental attendance, 42% of children aged 0 to 17 did not visit an NHS dentist in the 12 months to 31 March 2017.

Does my hon. Friend share my concern that a cursory review of the NHS Choices website yesterday showed that there are many areas of the country, including Keighley, where there is no advertising at all of dentists who are available to take on new children as patients? Might one answer to the age-old problem of poorer areas having fewer dentists be an expansion of salaried dentists in the NHS?

There is certainly an issue with access to dentists in some areas, although it is probably also true that some parents need to realise that visiting the dentist is free for children. There is certainly a question about how we incentivise dentists and provide better coverage.

As I was saying, 42% of children did not see an NHS dentist in the 12 months to 31 March 2017; in Birmingham, that figure is 47%. The Faculty of Dental Surgery has reported that, in the same 12 months, 80% of children aged between one and two did not see a dentist, but official advice recommends that children begin dental check-ups as soon as their first teeth come through, which is usually at around six months.

We may need to reconsider certain elements of existing dental contracts to see if we can better incentivise some dentists to pursue a preventative dental strategy with children. At present, three visits for fluoride treatment equal one unit of dental activity, which is roughly worth about £60 to the dentist. Perhaps we should look at that again. I am sure that both the Minister and local authority public health officials will be keen to remind me about money if I urge greater activity, but I remind hon. Members that parliamentary questions have revealed a clawback of £95 million through undelivered units of dental activity in 2013-14, rising by 36% to £129 million in 2016-17.

Dentistry remains a highly siloed service in the NHS and has been largely neglected from future NHS plans, such as the five year forward view and sustainability and transformation plans. As I have said, education programmes and regular visits to the dentist are needed if we are to begin to tackle the problem, but we also need action to tackle sugar consumption.

There are question marks over how likely the soft drinks industry is to meet the targets agreed under the voluntary reformulation programme. Earlier this year, the Food and Drink Federation announced that it was unlikely to comply with the optional 20% reduction in sugar content by 2020. It has also been revealed that it will be March 2018 before we even know whether the industry has achieved the first target of a 5% reduction by August of this year.

We desperately need to make significant progress towards reducing the amount of sugar in soft drinks and other products. The Government need to look again at their obesity strategy. As luck will have it, it is Sugar Awareness Week. What better time could there be for the Government to seriously consider the suggestion of the Local Government Association and others that we introduce teaspoon labelling on the front of high-sugar products? We should certainly look at advertising, and consider a ban on two-for-one offers and other price promotions on high-sugar products.

Childhood tooth decay is a problem that affects millions of children. It can be extremely painful and it often results in costly tooth extractions under general anaesthetic. Addressing tooth decay is not complicated; we know what works, and the actions I have outlined today could make a real difference. I hope that the Minister will consider those arguments, and that he is in a position to tell us that the Government are considering a series of preventative measures so that good oral health can be enjoyed by all our children.

Order. It might help the House to know that the wind-ups should start at about 10.30 am and seven Back Benchers are trying to catch my eye. I do not intend to impose a time limit, but perhaps Members will be aware of that.

I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on going through all the statistics, which means that I can cut my speech down immensely; I will put him up for an honorary degree as a dental therapist.

The hon. Gentleman is right: the statistics on child dental health are horrific. Deciduous teeth, or baby teeth, are particularly susceptible to decay as they have thinner enamel than permanent teeth. That is a contributing factor, but the problem is basically one of education, and it has gone on for decades. When I first practised dentistry in this country, in the NHS in east London in the early ’70s, I was struck by the appalling state of child dental health. Every Thursday afternoon, either I or a principal of the practice, with an anaesthetist, ran general-anaesthetic sessions. When I look back on them I am horrified, because the risks were considerable and such treatment is now banned. The children would all go to hospital now.

Those sessions were packed, and were almost entirely about extracting teeth from little children. It is appalling to think of it, but not as appalling as seeing those little children coming in, in pain after sleepless nights due to dental decay. If one wandered down to the local supermarket in east London, the stacks and racks of biscuits and sweets were considerable; the stacks and racks of what we would call wholesome food were minuscule. It was an education problem.

Prevention must be the way forward, because of the cost reductions. If one realises that Britons eat around 700g of sugar a week—an average of 140 teaspoons—one can see that reduction is needed. The intake is not spread evenly; it is higher in the north, lower in the south-east, and teenagers have the highest intake of all age groups, consuming some 50% more sugar on average than is recommended. That is another education issue.

The hon. Member for Birmingham, Selly Oak mentioned Childsmile—the set of Scottish tactics and methods for teaching kids—and that is very successful: more than 90,000 nursery schoolchildren take part. It is a programme of supervised tooth brushing, which has made some quite staggering gains; it has been mimicked in Wales and now here. England has an enthusiastic new chief dental officer, Sara Hurley. She and I will be arranging for every English MP to be invited, region by region, to meet her and others to discuss tooth decay problems among children and understand how we can move forward.

I have a few suggestions for the Minister, some of which have already been mentioned. We need a national oral health programme, such as that in Scotland, which should target poorer areas and areas of poor health, although this is not about poverty—it is about education. Sara Hurley is well on the way with a number of campaigns and areas where that is working. She, I and others have been working with local health and wellbeing boards to move into schools to run a check system that ensures that children, particularly in primary schools, visit their dentist once a year. If children had a little book, every child could be required by the head of the school to come back with an appointment card signed by a dentist to show that they had been once or twice a year. That should be a standard policy in schools.

Not just dental healthcare professionals but all healthcare professionals, such as midwives, health visitors and pharmacists, need to be given training. I remember an occasion when one of my kids visited a healthcare professional. The child was tiny. My wife had to listen to the healthcare professional say that fluoride and fluoride toothpaste were poisonous. I could not believe the ignorance!

Dental associations and groups should wake up—they are starting to—and should help dentists to help tooth-brushing campaigns and programmes. Such practices could be and sometimes are adopted in schools. The dentist does not have to go, but the hygienist and the nurses can. Toothbrushes and toothpaste can come from providers for free, and education can be linked. Kids—little kids especially—love brushing their teeth. Sara is trying to bring that into primary schools and nurseries, and perhaps to children as young as between one and two.

Far and away the biggest proven method of reducing tooth decay among children, and ultimately adults, is fluoridation of the water supply. As part of the health professional programme, the use of oral fluoride for children should be promoted by health workers. It is not, and it should be, because it makes a dramatic difference. My father was a dentist in New Zealand. I remember him saying that before fluoride arrived, trying to treat children with tooth decay was like trying to fill a bath with the plug out. Fluoride has dramatically changed the situation, and education and tooth brushing will change it even further.

In the United Kingdom, approximately 330,000 people have naturally occurring fluoride in their water supply at the optimum level. In addition, some 5.8 million people in different parts are supplied with artificially fluoridated water. That is about 6 million, out of a total population of 64 million—about 10% of the population. The percentage in the United States is 74%; in Canada, it is 44%; in Australia, it is 80%; and in New Zealand, it is about 70%.

The answer has to be a combination of fluoride in the water supply, fluoride in toothpaste—especially where there is none in the water supply—and, as the hon. Member for Birmingham, Selly Oak has said, using the opportunity to get out into schools and teach the kids. If we teach the kids, we teach the mothers. Dental decay is preventable; let us prevent it.

I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing this debate. As always, it is good to have the pleasure of the vast experience and knowledge of the hon. Member for Mole Valley (Sir Paul Beresford) on this subject. I thank him for his contribution.

I am the Democratic Unionist party spokesperson for health, so this issue is very much on my radar. I will give some stats—the hon. Member for Birmingham, Selly Oak gave some, but I will give different ones. That does not make me any more of a statistician or an honorary member of any statistical organisation, but they are important for me because they are from my own region.

I can remember, as a child, my mother taking me to the bathroom and scrubbing the life out of my teeth; we can all probably remember something similar. When I was old enough to brush, but perhaps not old enough to know the importance of brushing, there were mouth checks, which reminded me of checking a horse’s mouth to see the health and age of the horse. Rather than understanding why it was essential that we brushed our teeth, I was probably more afraid of not having my teeth brushed and my mother doing it for me. The hon. Member for Mole Valley mentioned an increase in that among young children, which is good news. I am afraid that we do not see all the stats and realise the importance of that in Northern Ireland.

I believe that we are all fearfully and wonderfully made, as it says in Psalms, and that the intricacy of our body does nothing other than point to our creator God. Why else would we have two sets of teeth—the baby teeth that we probably abuse, which decay and fall out, and then the adult teeth? I know some adults who probably wish that they had a third, and possibly even a fourth, set of teeth.

I commend the previous Health Minister, David Mowat, who launched the new programme in January this year. I look forward to the present Minister’s response, which I know will be equally committed. A briefing I received for the debate made very interesting reading, and it all points to prevention. Tooth decay is the most common reason why five to nine-year-olds are admitted to hospital. In Northern Ireland, some 5,300 children were admitted to hospital for tooth decay and extractions, with 22,000 baby teeth removed. Moving on to 12-year-olds and teenagers, the signs of decay in permanent teeth are significant.

The hon. Members for Birmingham, Selly Oak and for Mole Valley have both referred to the need to control the intake of sugary drinks and foods. As a diabetic, I am well aware of the need to control sugar. Coca-Cola used to be one of my favourite drinks, but it is not any more—not because I dislike it, but because it was doing more harm than good and I had to stop drinking it. We need to have that control, and parents have a role to play.

There are significant regional and socio-economic differences in dental health across England—the numbers of those with tooth decay in the south-east compared with the north-west, for example; the difference is almost double. Perhaps the Minister will reply on that north/south difference. In some areas, seven times as many children are affected than in the best performing areas, where only 8% are affected.

Northern Ireland is at the bottom of the league table for oral health. I am not at all proud to say that, but it is a fact of life. We have a lot to do, in what is a devolved matter in Northern Ireland—at least until we find out where the Assembly is going, in which case the role over here might become greater. The 2013 children’s oral health survey showed that Northern Ireland had the worst oral health outcomes in the UK, and highlighted the difference in the figures compared with outcomes in England. Some 72% of 15-year-olds have signs of decay in Northern Ireland, compared with 44% in England and 63% in Wales. We have a lot to do, and we need to start that in primary school. The hon. Member for Birmingham, Selly Oak suggested education at primary school breakfast groups as a way of doing that. I think that would be excellent.

Of the 4,000 parents questioned in the Simplyhealth professionals oral health survey, 51% said that getting their child to brush his or her teeth for the recommended two minutes twice a day was a challenging task. Well, I think children are always challenging, but that is certainly one of the things that we need to do. The view has been echoed by members of my staff, who said it is as tough to get the seven-year-old grandchildren to do a good job as it is the two-year-old. That is a battle many parents face and they will do many things to try to encourage children. There are even such things as singing toothbrushes, as one method that may encourage children. It may help set the timespan, but the quality of brushing during that time could be questionable. To listen to the sound of a singing toothbrush is one thing, but brushing teeth has a purpose and we need to focus on that.

Children who experience high levels of oral disease, and are treated with fillings and other restorations, will require complex maintenance and treatment of new oral problems as they grow older. We are all aware that dental treatment is a significant cost to the NHS, with spending in England amounting to £3.4 billion. Some £2.3 billion is spent on private dental care. The NHS spends £50 million on tooth extractions for children, the majority of which are due to tooth decay. Shockingly, 42% of children did not visit an NHS dentist in the year ending 31 March 2017, even though such check-ups are free. The National Institute for Health and Care Excellence recommends that children see a dentist at least once a year, but 80% of children between the ages of one and two did not visit a dentist in the 12 months to the end of March. Those statistics are important, because they show us where we need to focus our attention.

I am conscious that other hon. Members wish to speak, so I will conclude with this. Drastic action must be taken, but for that to happen we need a funding regime so we can do more for children in schools and through the healthcare system. More needs to be done in socially deprived areas, because there is a north-south divide when it comes to those affected by tooth decay. We must ensure that parents prioritise oral healthcare and are able to access a dentist for their child easily and without fear that they will be judged or told off. Something needs to be done. We must ensure that there is not another generation of people in agony due to their teeth. Having had toothache, I know my heart goes out to those who suffer from it. Tooth decay is preventable, so we must do all we can to prevent it in our children. We should start as we mean to go on.

On a point of order, Mr Bone. I was so enthusiastically carried away by the opening speech that I cannot remember whether I declared that I am a very part-time dentist. If I did not, I have now done so.

I think hon. Members knew that, but thank you for putting it on the record. We have got about half an hour to go, and five Back Benchers wish to speak. I work that out to be roughly six minutes each.

I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing a debate to highlight this important issue.

We cannot overstate the fact that, as the hon. Gentleman said, oral health problems are the most common cause of admission to hospital for children aged five to nine. I am a children’s doctor—a consultant paediatrician—and I am responsible for the children on the children’s ward in Peterborough City Hospital. They often come in not because they are unwell but because they have had too much sugar and have not had their teeth brushed effectively; their teeth have become rotten, painful and uncomfortable and need to be removed.

As my hon. Friend the Member for Mole Valley (Sir Paul Beresford) said, behind the statistics there are children who are in pain and discomfort, and whose teeth are hurting. They may not want to eat—children who have tooth decay are lighter. There are other reasons for that, but in part it is because they do not want to eat because it hurts when they do. They cannot sleep, which affects their educational performance. As they get older, they do not want to smile because of the embarrassment and discomfort it causes, and that has an impact on their ability to socialise with other children. Perhaps most worryingly, more than 8,000 pre-school children are admitted to hospital each year to have teeth removed. Those children are not responsible for brushing their teeth and do not choose what they eat. Their parents or permanent care-givers are entirely responsible for all aspects of their dental health.

There are two ways to tackle this problem. First, we should address the issue of sugar. I welcome the Government’s proposed sugar tax, because it will encourage children to drink water, which in many areas is fluorinated and better for teeth, rather than sugary fizzy pop, which, as well as containing high levels of sugar, is strongly acidic and therefore detrimental for teeth. It would help if the tax were directed towards sugary drinks, and not spread out across the different drinks that the manufacturer makes.

Secondly, schools should educate children about what to eat. Last week, I went to Washingborough Academy in my constituency, which has an innovative programme for improving school meals for its primary school children. It has a vegetable patch and a fruit orchard in the school playing field, where the children grow their own food and learn about where their food comes from.

The hon. Lady is making some excellent points. When I was a council leader, I introduced free school meals for all children up to the age of 11 in all of our primary schools. That increased the take-up of free school meals to 90% across the borough and improved oral health.

That is an interesting point. The hon. Lady is right that it is important that our children’s school meals are high quality and as healthy as possible.

There are other issues relating to the mechanism by which children consume food. In my profession, I have seen pre-school children given Coca-Cola to drink not in a cup but in a sippy cup or even in a baby bottle with a teat. That is particularly harmful for children, and there should be more education about the fact that it damages teeth. Once children get past 12 months, they should be encouraged to move from bottles and sippy cups on to proper open cups, so that sugary drinks are in contact with their teeth for a shorter period.

If the child is of pre-school age and the parents do not take them to a dentist for whatever reason, health visitors can provide some of this education. It should be part of a health visitor’s role to encourage good oral hygiene in children.

I do not whether I am ageing myself here, but I remember being given disclosing tablets at school and rushing off into the school lavatories to brush my teeth to see what the horrible blue dye had done to the inside of my mouth. I was horrified because, although I thought I had done a great job of brushing my teeth, there was quite a lot of blue staining. That powerful tool should be available to all of our children. My children have recently come home with toothbrushes, toothpaste and some of those lovely tablets. Hopefully, they will have a good effect.

In my reading for this debate, I came across some research in health journals that suggests that the strep mutans and streptococcus sobrinus bacteria increase children’s likelihood of getting tooth decay. In families in which the diet and the amount of sugar consumed is the same and the amount of tooth-brushing is similar, some children get more tooth decay than others. Research suggests that that is due to those bacteria, so we should aim to reduce their presence in the mouth. I will be interested to hear the Minister’s thoughts on that point.

I am pleased that the hon. Member for Birmingham, Selly Oak secured this debate. I congratulate him on raising this issue.

It is a pleasure to serve under your chairmanship, Mr Bone. I recently led a well-attended Adjournment debate on the growing crisis in NHS dentistry, and I was encouraged that that critical topic received such wide-spread support. I thank my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) for securing this important debate.

I believe that momentum is building for a change in Government oral health policy. The injustices in child oral and dental health provision deserve greater prominence in debates about this country’s faltering health services. For too long, oral and dental health has been overshadowed by understandable concerns about other areas of the NHS, but addressing wider issues in our NHS should not mean that we forget to take action elsewhere. For too long, oral and dental health has been the Cinderella service of our NHS. That must end.

During my Adjournment debate, I spent considerable time setting out the growing crisis in NHS dentistry for our children and young people. I highlighted the BBC’s recent investigation, which laid bare the scale of the challenges. Shockingly, two in five of the 2,500 dental practices registered on the NHS Choices website were unwilling to accept children as new patients.

NHS treatment is so important. For our children and young people, it can be life-defining. It can be a springboard to a life marked by enduring oral health and wellbeing. It can be the bedrock of successful, healthy and prosperous lives through childhood and into old age.

The unnecessary financial cost of our children’s poor oral health to the NHS is staggering. At a time of huge pressure on our NHS, the Government are wasting a forecast £50 million each year on tooth extractions for our children and young people. The average cost of a tooth extraction is £834. Last year alone, almost 40,000 children were admitted to hospital for multiple tooth extractions, which is shocking as it is an entirely preventable condition. Sadly, that situation is getting worse and tooth extractions are up by 25% in recent years. Across the country, tooth decay is the No. 1 reason for children being admitted to hospital.

Following my Adjournment debate, I was grateful to meet the Minister. I felt that we had a constructive meeting and that there was a good chance that at least some progress would be made to improve the availability of NHS dentistry in my constituency and the surrounding areas, where the need is so clear. Three weeks on from that meeting, however, and some six months on from the conclusion of an NHS pilot in Bradford designed to improve the availability of NHS dentists to the people I represent, I am still waiting to see the official assessment of the pilot.

I asked about the report on the pilot in a recent written question, and yet it remains elusive. I suspect that the official report remains so because it confirms more than a few inconvenient truths: that the take-up of the additional NHS dentistry appointments under the pilot was overwhelming—I understand from the previous Minister that take-up was 92%, even on an unadvertised pilot—and that there is therefore overwhelming evidence that NHS dentistry provision in my constituency is abysmal and requires a huge funding uplift. Indeed, a freedom of information request submitted to the Bradford hospitals trust revealed that, in the short period of April to December 2016, 190 of our children were admitted to hospital to undergo multiple tooth extractions.

I ask the Minister again to reflect on such disturbing figures and, as I have his attention, I reiterate my request that he shares with me the official assessment of the recent pilot in Bradford as a matter of urgency. Once again, therefore—twice in a few short months—I am urging the Government to act, because each year 40,000 of our children are undergoing multiple tooth extractions in our overstretched NHS. I urge the Minister to take action; it is long overdue, and inaction is not an option. Our children and young people frankly deserve better.

It is a pleasure to serve under your chairmanship, Mr Bone.

As several speakers have said, this issue really matters, and it matters throughout people’s lives. A poor set of teeth can affect confidence, which can affect life chances significantly. It is shocking that the most common cause of hospital admission among five to nine-year-olds is tooth decay. According to a recent parliamentary answer, in 2015-16 some 917,346 tooth extractions were performed on children.

I note that in a recent publication the Royal College of Paediatrics and Child Health called for a child’s first dental check-up to be recorded in their personal child health record—that is supposed to happen by the age of one—and for paediatricians to include oral health in the assessment of all-round children’s health. If the first check-up happens by the time the child is one, we can set good habits in place and parents will carry on, knowing that dentistry is free for children.

On fluoridation of the water, which the hon. Member for Birmingham, Selly Oak (Steve McCabe) and my hon. Friend the Member for Mole Valley (Sir Paul Beresford) talked about, I will quote from a Public Health England document published on 14 June 2017. It says:

“An authority considering fluoridation will be met with claims that it does not work and that it causes harm. Both statements are untrue. PHE’s Water fluoridation: health monitoring report for England 2014 concluded that fluoridation is an effective community-wide public health intervention.”

We must be guided by the science in this issue. Many years ago, when I stood for election in Sunderland North, my Labour opponent came out with totally unscientific and untrue statements. We must be guided by the evidence, and I am pleased with what the hon. Gentleman and my hon. Friend said. The evidence seems to be clear that fluoridation is effective. Given the scale of the problem, we should do something about it.

Schools should be sugar-free zones as much as possible. I back banning the advertising of sugar products before 9 pm and would like to see an accelerated product reformulation programme. It is concerning that the reformulation data from August this year will not be made available until March next year. That is an area the Select Committee on Health is taking a close interest in.

As a nation, we have to wake up to the importance of child oral health and not be leisurely about it. It is a public health emergency and there is a degree of urgency to the issue that I want to see reflected in the Department of Health. We could ensure that all sports, education and health settings refused to put sugary drinks in vending machines.

The hon. Gentleman is making some excellent points. Does he agree with me that the amount of sugary drinks and products for sale in leisure centres and hospitals seems to send a mixed message?

I agree with that. Some of the food companies set a lot of store by their links with sport. Of course sport is a good thing—we should all take more exercise—but the key is good oral preventive hygiene and consuming less sugar. When we consider that five-year-olds are consuming their own weight in sugar, we begin to see the scale of the problem. I agree with the point made by the hon. Lady.

I have the pleasure of serving on the Health Committee with the hon. Member for Central Ayrshire (Dr Whitford), who will shortly be speaking for the Scottish National party. She has often told us that Scotland has got certain things better than England, and some of the time she may have been right. On this issue, we can learn from what is happening in Scotland, as my hon. Friend the Member for Mole Valley said as well.

Chapter 3 of the report from the Royal College of Paediatrics and Child Health, which I quoted from earlier, includes some graphs that show improvement in children’s oral hygiene. Somewhat irritatingly, the graphs end in 2013, but the rate of improvement in Scotland is clearly shown to be superior to the rate in England, Wales or Northern Ireland, as a result of the Childsmile programme, which I understand costs £17 per child. Set that cost against the £836 average cost of a child tooth extraction and, for my money, I would rather put more focus on prevention. I want to see the English treated as well as other parts of the United Kingdom.

The hon. Gentleman cites a figure of £17. That is an average and is obviously not how the money is spent. It is very much targeted at children in areas of deprivation.

I am grateful to the hon. Lady for that clarification.

We now have a number of breakfast clubs before school, and the introduction of tooth brushing in them would be a good idea. I was pleased to hear my hon. Friend the Member for Mole Valley talk about the importance of education. Only a few years ago my own dentist told me about the importance of interdental brushes, which I do not think any other Member has mentioned yet. I do not know how effective they are for children—perhaps the Minister’s officials know and he will tell us when he winds up. Mouthwash is also important. Just getting the best possible prevention practice out there, including what we and in particular children should do, is really important if we are to make progress.

It is a pleasure to serve under your chairmanship, Mr Bone.

I congratulate my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) on securing this debate on child oral health and tooth decay. I agree with all his comments, in particular those about sugar consumption and supermarket offers on high-sugar products. Anyone who has been in a supermarket over the past couple of weeks will have seen the huge amount of Halloween offers on sugar products for children for trick or treating—“two for one” or “buy one and get four free” and so on.

Poor oral health is an extremely important yet too often ignored issue that represents a major public health challenge, both in relation to its adverse impact on our children’s health and wellbeing and to the NHS budget and wider resources. We have already heard that when it comes to oral health, too many of our children quite literally have nothing whatever to smile about. Every area of the country is affected by poor childhood oral health to varying degrees, including Coventry, the city that I represent. The proportion of five-year-olds in Coventry with tooth decay stands at almost 30%, which is considerably higher than the England national average of 25%. Worryingly, the proportion of hospital admissions for tooth extractions in the city has increased by a massive 60% since 2010.

Children with poor oral health are likely to have decayed, missing and filled teeth that can cause severe pain, infection, sleepless nights, weight loss and developmental problems. But not just their physical health is adversely affected; they also often experience psychological problems such as low self-esteem, a lack of confidence, conduct disorders, reduced school performance and social functioning, and an increase in bullying. These physical and psychological problems combined are likely to have a huge impact on a child’s life and even on their long-term life chances, as we have heard.

There are significant pressures on NHS services and finances. Tooth decay is the leading cause of hospital admissions for young children and the NHS wastes hundreds of hours and millions of pounds each year dealing with the consequences of the problem through tooth extractions that range from a single tooth to full mouth clearances—a dreadful thought in children so young. All that proves that the economic costs of childhood tooth decay are as unsustainable for the NHS as the human costs are unacceptable for the child.

We can stop tooth decay in its tracks, because it is almost entirely preventable, as we have heard. We can tackle the problem by providing better oral health education, by improving public awareness of and access to children’s dental services and by addressing poor diet—particularly excessive sugar consumption. I agree with all the measures to prevent tooth decay that have been mentioned. But clearly, the statistics show that more needs to be done. Simple preventive steps and accessible information can mitigate the impact of poor oral health both on the individual and on our health services. Surely we can all get behind that.

It is a pleasure to share my thoughts and experiences under your chairmanship, Mr Bone. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing this debate. As he said, it is Sugar Awareness Week, so this debate on tooth decay is timely.

It is well recognised and accepted that the amount of sugar that children eat has an impact on both oral health and obesity rates, and that there is a link between poor oral health and some of the most deprived parts of the country. Poor oral health and obesity are both issues of health inequality. Tooth decay and obesity also represent major public health issues. If we put measures in place to tackle one, we will tackle the other at the same time.

Tooth decay is the leading cause of hospital admissions for young children. Local data show that one in five children in Erewash suffers from tooth decay by the time they are five years old. That is better than the national average of one in four, but children in my constituency are still twice more likely to have tooth decay than their peers in the parts of the country with better performing local authorities; even though the data are better than the average, they are still not good enough.

In the last five years, 170 children in Erewash have been admitted to hospital to have their teeth extracted under general anaesthetic. That is 170 too many. Nationally, about two thirds of such hospital extractions are due to extensive tooth decay. When I looked further into local data, I found that almost half of children in Derbyshire did not see an NHS dentist in the year to April 2017. I find that extremely disturbing because children should have check-ups at least once a year. Tooth decay is 90% preventable; as has already been said, NHS dentistry is free for under-18s, so there is no excuse. Stopping tooth decay would prevent a great deal of pain and stress for children and the potential for bullying. If tooth decay was made a priority for the NHS, a great deal of money would be saved.

I am extremely concerned about the impact of sugar on our nation’s teeth, but I want to expand a little about the impact of sugar generally. Almost a year ago, Cancer Research UK revealed that, on average, teenagers drink almost a bathtub full of sugary drinks a year. Hopefully, such a visualisation—a bathtub full of sugary drinks—will shock some teenagers into changing their habits rather than suffering the consequences that we have heard about. The average five-year-old consumes their own weight in sugar every year. That is horrendous. There is no doubt that such sugar consumption will have an impact on dental health, but also it will have an adverse effect on the current and future health of our nation.

Sugar, tooth decay and obesity are linked. Obesity is now recognised as a major cause of type 2 diabetes, which is now a disease seen in teenagers rather than just the elderly. Obesity is also a major cause of cardiovascular disease and cancer. If young people’s sugar consumption continues and our young people manage to escape tooth decay, there are other health issues waiting for them down the road.

As a member of the Health Committee and chair of the all-party parliamentary group on adult and childhood obesity, I was disappointed by the “Childhood obesity: a plan for action”, published by the Government in August last year. The Committee asked for bold and brave action, but sadly we did not get that. Tackling obesity also tackles tooth decay, so I welcome the sugary drinks levy and the ring-fencing of the moneys raised from that for children, but I want to go one step further. Could some of that money be dedicated to teaching children how to clean their teeth—perhaps through the breakfast clubs some of that money will be dedicated to?

The levy is only a drop in the ocean. I want to take the opportunity to ask the Minister, first, to work with retailers to limit price promotions on high-sugar food and drinks and to encourage the removal of those products from the point of sale—to consider legislation if necessary. Secondly, will the Government update broadcasting regulations, to ensure that high-sugar products cannot be advertised on TV before the 9 pm watershed? Thirdly, will the Government build on the new rules from the committee of advertising practice, to prevent high-sugar products from being advertised in non-broadcast children’s media and to close the loopholes?

Let us really show that we care about both the dental health and the general health of our future generations, and take action now.

Let us admit that, before Childsmile, Scotland’s children started with much worse teeth than those in England and Wales—seeing people in Glasgow with no teeth at all was a common sight. I was quite shocked when I attended a dental health meeting in Parliament after being elected: I met a dentist carrying a bag of more than 100 children’s teeth that she had removed that day. That was when I first realised the difference between the approaches in Scotland and in England and Wales.

Although there were some pilots and proposals in 2005-06, the Childsmile programme kicked off in December 2007, so we are coming up to the end of the first decade. It has transformed dental health in Scotland, although there is no question but that we have further work to do. Overall, extractions have gone down by a quarter, while extractions in England have gone up by a quarter in the past decade. That has to be looked at. Children losing their teeth must be seen as a health failure.

The core Childsmile programme consists of all nursery school children undergoing education about cleaning their teeth, and undergoing supervised teeth cleaning every single day. Provision of 30 hours’ childcare in Scotland is being rolled out to all children, not just the children of working parents, and that gives us access to even more children, including vulnerable two-year-olds.

The core programme, which, as was mentioned, includes 90,000 children, is the main driver, but we also have a practice programme, which involves all NHS dentists in Scotland. That programme links dentists with health visitors and public health nurses. If a health visitor is aware that a family is not registered with a dentist and is not active in preserving its dental health, they can refer that family and its children to a dental health support worker, who will follow a child up from the age of three months and ensure that they attend a Childsmile-registered dentist. That is crucial.

We hear that 80% of one to two-year-olds and 42% of children aged 16 and 17 in England do not attend a dentist, even though the advice is that children must have attended by the age of one and that they should get an annual check. It is crucial that that changes. It is also important that, as well as their dental check, children access twice-yearly fluoride varnishing, which makes a key difference.

Glasgow, which had the worst teeth in Scotland and probably the worst teeth in the UK, has improved dramatically. We still have more work to do—there is still inequality, and there are still more caries-free five-year-olds in England than in Scotland—but the proportion of caries-free five-year-olds in Scotland has improved by 50%, from 45% to 69%. There has been a one-third improvement among primary 7 children, who have their second teeth, from 59% to 77%. Inequality has reduced. Some 56%—more than half—of children in the most deprived areas of England have caries at the age of five. That just is not acceptable, and it needs to change.

It is important to drive education and to improve dental health, but the underlying problem is the difference in contracts. Since 2006, dentists in England have been paid for units of dental activity. There are three bands, from simple activity such as examinations, cleaning and advice, up to complex work at band 3, but dentists get only one payment for a band 1 unit of dental activity no matter how much they do. They are paid the same rate for doing an examination, providing advice and doing fluoride varnishing as they are for doing only a check-up. That means that they are not rewarded for prevention, whereas dentists in Scotland are paid for doing fluoride varnishing and fissure sealants. That situation in England undermines the basic principle.

In Scotland, there are also additional payments for children with disabilities or learning difficulties, because we know that they take dentists more time. Those payments mean that dentists invest in those children to try to prevent future dental ill health. Children with learning difficulties in particular tend to have very poor teeth, because we cannot just educate them to clean their teeth; the people around them need to commit to doing that.

Lack of registration is another issue. In England, people are not registered with a dentist for the long term, so why should a dentist invest in someone? Children turn up and try to access a dentist when they have problems. Recent BBC articles suggest that 40% of children in England are unable to access a dentist. If a dentist is paid the same for one filling as they are for 10 fillings, they will not want to take a child who clearly already has very poor dental health. Again, there is no sense of investing in the future.

I hear what the hon. Lady says. The success in Scotland has been dramatic, and the importance of dentists is dramatic—I would have barbs in my back if I said anything else, as she can imagine—but the biggest success has been the prevention programme with schools, nurseries and so forth. That outweighs everything else. That has been the reason for the Scottish success.

I thank the hon. Gentleman for that intervention. I was not trying to give any other impression. I said that the core programme is the education of 90,000 children about how to clean their teeth and discussions with their parents about that. The problem is that we waste an opportunity if we stop there. There needs to be a link between health visitors, nurseries and dental practices, and there certainly needs not to be a contract that punishes and penalises dentists for investing in patients. The fact that dentists do not have long-term registered patients means that they do not look at patients with a long-term view and say, “If I do more work now, they will have better dental health later.”

In Scotland, 92% of the population is registered; the number of people who are registered has risen from 2.6 million to 4.9 million. Registration is actually higher in deprived areas than in rich areas. Unfortunately, attendance is not always higher, but people are at least already registered with a practice.

The hon. Lady is making an excellent speech. I am conscious that this debate is about children’s oral health, but does she accept that, given the growth in the elderly population, the problems that she has indicated will only get worse if we do not have better registration and intervention?

I totally agree. In so many areas, the health of an adult—even an elderly adult—is actually laid down in their first five years. That is nowhere clearer than in dental health. Laying down good foundations in childhood is critical to allowing many more older people to have healthy teeth and, in particular, healthy gums—in the end, more tooth loss is due to gum disease—and to hang on to their teeth. Registration is important, because it gives people a relationship with a dentist. For people who are frightened of the dentist, knowing their dentist and having access to extra support such as hypnosis, if that helps, is valuable.

Childsmile costs £12 million a year in Scotland in terms of total dental health, but it has saved £5 million in dental treatments and extractions. We heard from the hon. Member for Birmingham, Selly Oak (Steve McCabe) about the money that is coming back. That could be used to set up a programme in England. I welcome the pilots, but those are in only 13 of the 23 worst areas in England. Why do the UK Government feel that they need to pilot? The evidence is there from 10 years of Childsmile in Scotland. If they just looked at the data and designed a national programme for England, in the end they would save not just money but children’s dental health.

It is a pleasure to serve under your chairmanship, Mr Bone. I am grateful to my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) for bringing this important issue to the House’s attention. This debate is long overdue, as has been said by Members on both sides of the House. There is much agreement, and it has been really useful to hear from experts in the field—our dental and paediatric colleagues in particular.

We cannot say too loudly or too often how shocking the current state of affairs is. The hon. Member for South West Bedfordshire (Andrew Selous) quite rightly said that we have a health emergency. We cannot stress too often the truly shocking statistics that have been touched on. The biggest cause of hospitalisation for five to 10-year-olds in England—bigger than broken arms, asthma, appendicitis and all the other things that we think about children being taken to hospital for—is teeth extractions. Up to 160 children a day are undergoing general anaesthetics in our hospitals for what is preventable, and a quarter of all our five-year-olds have decaying primary teeth. In some areas of the country the situation is far worse. Deprived children are seven times more likely to suffer from tooth decay than their peers. Indeed, in some areas of Lancashire, 56% of children are affected.

Another shocking statistic I came across in preparation for the debate relates to the shortage of dentists. The hon. Member for Erewash (Maggie Throup) rightly said that NHS dental checks are free for under-18s, but accessing an NHS dentist is not easy in many parts of the country. Only this week, Cornwall has reported a backlog of 14,000 people waiting to access an NHS dentist. Some people are having to travel 70 miles to see a dentist.

What effect is that having? We have heard extensively from Members of all parties about the effect on children. There is obviously suffering in terms of the pain of dental decay, and we have heard about the effects on childhood confidence. We have also heard about time lost from school. This goes beyond the suffering of children. We cannot afford to ignore the issue, given its effect on our economy. Even if we wanted to ignore the effect on our children—I am sure none of us does—all the evidence suggests that last year 1.2 million working days were lost as parents took time out of work to care for children who had oral health issues.

Of course, we cannot ignore the pressures on the NHS. We hear every week in this House about funding issues in the NHS and how it does not have the funding it so desperately needs. This preventable issue costs the NHS £5 million a year. That cannot go on—it makes no sense.

What are the answers? There are no quick fixes. Many Members have raised interesting ideas, and I think the answer lies in a combination of them. I hope the Minister will talk about his plans to reform the dental contract and that that will result in a dental contract in England that has prevention and public health at its heart and that builds in an element of sustainability for dental practices. I hope we will adequately fund more dentists. There is a massive shortage of NHS dentists, and Health Education England has cut funding to train dentists by 10%. Dentists have raised concerns with me about that this week. In particular, 17% of our NHS dentists come from the EU, and agencies that supply them to our NHS are already reporting a 90% fall in EU-citizen dentists willing to sign up to support our NHS.

As has been said, we desperately need a public health education programme. It was heart-warming to hear about the work done in Scotland through the Childsmile programme. I would like to see us go further in England, and I hope the Minister will assure us on that. It could be done in an affordable fashion by reinvesting the savings and ensuring that every health professional—everyone who comes into contact with a child from their earliest days, such as the midwife—plays a part in making sure that parents fully understand the oral needs of their children. We must ensure that every nursery schoolteacher is reinforcing that message. And, yes, in the same way as has happened in Scotland, and in some cases in Wales, toothbrushes and toothpaste, as well as fluoride washing, should be provided in the more deprived areas. We have heard about the positive impacts that fluoridisation can have, but that in itself is not an answer.

The wider benefits are hard to measure, but the impact on the NHS and on child wellbeing is crucial. As the chair of the British Dental Association said:

“These shocking statistics are rooted in an abject failure by government to tackle a preventable disease.”

I look to the Minister to assure us on those points and to tell us that we will go beyond pilots. As many Members have said, the evidence is there. This is an urgent situation. For the sake of our children, our NHS and the wellbeing of future generations, we need to tackle this as a matter of urgency.

I thank everyone who has spoken and the hon. Member for Birmingham, Selly Oak (Steve McCabe) for securing the debate via the Backbench Business Committee. He has proved once again that he is on his mettle. There are a number of things I want to get on the record and there are lots of things I want to respond to. We know that, as many Members have set out, poor oral health for children can lead to pain, poor sleep, days missed at school—the hon. Gentleman said that three days are missed on average, but the figures can be much higher—and impaired nutrition and growth. It is a serious business and we take it seriously.

The shadow Minister spoke passionately about the subject and the risk to our economy. I am glad that she recognises that there are no quick fixes. If there were, I suspect many of my predecessors would have quick-fixed.

It is a fact that the two main dental diseases of decay and gum disease—dental caries and periodontal disease—can be almost eliminated by a combination of good diet and correct tooth brushing, backed up by regular examinations by a dentist. They are preventable. It is worth putting it on the record—it is not all doom and gloom—that children’s oral health is in fact better than it has been for years. The most recent data from 2015 show that 75% of five-year-old children in England are now decay-free. That is good, but it clearly leaves 25% who are not. Between 2008 and 2012, the numbers of five-year-old children who showed signs of decay fell by approximately 10%. Improving children’s oral health and that of the adult population is a priority for the Government. Indeed, our manifesto earlier this year set out our commitment to improve coverage and achieve better outcomes, especially for children in deprived areas.

Does the Minister recognise that total dental clearances in children, of which there are approximately 25,000, have seen an 11% increase in the past five years, so it is not possible to claim that dental health in England is getting better?

I said that there is clearly a long way to go, and the hon. Lady also said that about Scotland. I am just putting it on the record that there are some positive stats; it is not a counsel of despair.

In explaining what I started to say, let me talk about the extensive work being led by Public Health England as well the wide range of activity nationally in reforming the dental contract, which a number of Members asked about, and locally, in initiatives such as “starting well” run by NHS England, which a number of people referred to. First, it is important that I, as the Minister, acknowledge the vital role that dentists play in this. They are a brilliant part of the NHS. There are just over 24,000 dentists currently providing NHS dental care and their commitment and contribution is vital to delivering our wider health and public health aims. Overall, access to NHS dentists continues to increase in England. In the latest figures for patients seen by NHS dentists, 6.8 million children were seen in the 12-month period ending 30 June this year, which equates to just over 58% of the child population. Looking at adults, this year’s January-to-March GP patient survey results showed that, of those adults trying to get an NHS dental appointment, 95% were successful.

Although those numbers are an encouraging start, clearly more needs to be done—I am not pretending that it does not—to reduce the inequalities in access and oral health that remain as a result. Nationally, Public Health England has an extensive work programme to improve oral health, particularly of children. Improving that and reducing inequalities in oral health is a priority for PHE, which I meet regularly. It was in the office just last week, when we discussed this subject. So many Members have mentioned the sugar levy, which addresses some of the root causes of dental disease.

May I make a brief intervention on the sugar levy? Will the Minister at least undertake to look at health trusts—that is directly in the gift of the Department of Health—and at what they are promoting by means of cabinets that sell sugary drinks and products?

Yes, and I will write to the hon. Lady about that. That is a good point well made.

The sugar levy addresses some of the root causes of dental disease, and other action has included ensuring that the “red book” that all parents receive after the birth of a child has clear messages about the importance of good oral hygiene and early dental attendance—that point was made by my hon. Friend the Member for South West Bedfordshire (Andrew Selous). All new parents will therefore receive clear messages about the importance of oral hygiene and early dental attendance, and I will follow up his point about recording that first appointment in the book. That should be happening; I will follow that up. I thank him for raising it. Public Health England is working alongside local authorities in all our constituencies that are responsible for commissioning oral health improvement programmes.

The hon. Member for Birmingham, Selly Oak, the hon. Member for Central Ayrshire (Dr Whitford), and the hon. Member for Burnley (Julie Cooper) mentioned contract reform. Our manifesto sets out the Government’s continued commitment to introducing a new NHS dental contract that will improve the oral health of the population and increase access to NHS dentistry. That change will provide the foundation on which we will support other improvement activities.

A new way of delivering care and paying dentists is currently being trialled in 75 high-street dental practices. At the heart of that new approach is a prevention-focused pathway that includes offering all patients an oral health assessment and advice on diet and good oral hygiene, with follow-up appointments where necessary to support patients’ self-care and carry out further preventive treatments. That new approach aims to increase patient access by paying dentists for the number of patients cared for, and not just for treatment delivered, as per the current NHS dental contract—a number of Members raised that point. An evaluation of the prototype agreement scheme is due by the end of this year, and it will set out detailed findings from the first full year of testing that new system.

However, we feel that a single year is too short a period in which to make final decisions about whether the new system, when combined with the revised clinical approach, is viable for wider adoption as a new NHS contract. We have therefore decided to extend the prototype agreement scheme to allow it to run for a further two years, to allow for further testing. The prototypes will continue to be subject to evaluation to determine whether they can maintain access and improve oral health, including that of children, in a way that is sustainable for practices, patients and commissioners, before any decisions are taken on wider national adoption.

The important Starting Well initiative was recently launched for children under five, and as a number of Members have mentioned, the programme will work in 13 high-priority areas, with the aim of supporting dentists to see extra children under the age of five who do not currently visit a dentist. It will provide a model that ensures that when they are seen, the focus is on reducing their risk of future disease, as well as treating existing problems. The aim of Starting Well is to reduce the unacceptable oral health inequalities that exist for those children. The hon. Member for Birmingham, Selly Oak asked how long it would run, how areas will be selected and how it will be funded. It will run for as long as is needed locally—that is a decision for local commissioners. I will give him a bit of detail about how the areas will be selected. Selection of the 13 areas was based on 2015 oral health survey results that identified the number of decayed, missing or filled teeth—DMFT, as it is known in the trade—in those under five. To select the areas for Starting Well, a cut-off of 1.6 DMFT was the established marker, and that identified 13 upper-tier local authorities that would benefit from the Starting Well approach. Areas that scored below 1.6 DMFT were not selected, as it was agreed that those resources should be directed to areas where oral health had either declined or remained static. NHS England is funding the programme locally in those areas through underspends and, where the NHS chooses, the prioritisation of funds. I hope that that answers the hon. Gentleman’s questions on Starting Well.

Alongside that, NHS England, together with the chief dental officer—she has been mentioned a number of times; I have worked closely with her and she is excellent—is looking at ways to make the principles of that approach more widely available to all commissioners, and I want to talk to her about that in more detail. The aim is to ensure that commissioners have a clear framework within which to work when considering ways to increase access to dental services for very young children.

The hon. Gentleman was disappointed that Birmingham was not selected for the Starting Well programme, and I set out some of the reasons why we selected the areas that we did. I am, however, happy to say that NHS England is taking forward its own oral health initiative to raise awareness of the importance of early dental attendance, and that will be linked with wider NHS England national work, which I know is particularly championed by the chief dental officer, to encourage greater attendance.

I wanted to touch on so many other points. My hon. Friend the Member for Erewash (Maggie Throup) gave us the charming image of a bath tub full of sugary drinks. What an image—horrendous! That is why our sugary drinks levy is so important. We know that sugar is the leading cause of tooth decay, and the sugary drinks industry levy and the sugar reduction programme will reduce the amount of sugar consumed by children. We keep the childhood obesity plan under constant review. That is important to me, and something I am responsible for.

I did not know that this was sugar awareness week until that was mentioned by the hon. Member for Birmingham, Selly Oak—indeed, the irony of that, with tonight being Halloween, and the children with buckets of sweets, is not lost on me. My children will be attending an altogether different event this evening that does not involve buckets of sweets. It is a “let in the light and shut out the darkness” event—that is something that my wife likes to champion, so she will be pleased with the mention.

The hon. Gentleman also mentioned school dental clubs, as did the chair of the all-party group for dentistry and oral health, my hon. Friend the Member for Mole Valley (Sir Paul Beresford). Outreach, including to schools, is important for reaching children who do not normally attend a dentist, as part of Starting Well and other initiatives being taken forward to reach children in schools. Sure Start centres will also be commissioned locally to be part of the Starting Well programme.

My hon. Friend said that kids love brushing their teeth, but that is not entirely my experience at home. The hon. Member for Strangford (Jim Shannon) mentioned singing toothbrushes. I am not aware of them, although I am aware of singing while brushing. My children are encouraged to hum “Happy Birthday” twice while brushing, so that they brush for longer, and they love me for it. I responded to the hon. Member for Bradford South (Judith Cummins) in an Adjournment debate on this subject. She has been to see me, and I understand that she is meeting the NHS in her area on 9 November. I urge the NHS to share the findings of the pilot with her, and if it does not, she should let me know. My hon. Friend the Member for South West Bedfordshire made a point about the first dental check being placed on the record, and I take his point and will follow it up. On schools being sugar free zones and the advertising ban before 9 pm, I said that we would keep the childhood obesity strategy and the measures within it under constant review. My hon. Friend should continue to work with me on that; it is important that Members vocalise their support to go further on that strategy.

In closing, we have had a good debate. I hope that in setting out some of the work done by Public Health England, the Department of Health and NHS England, I can reassure Members about our commitment to improving children’s oral health for the future. There is an awful lot of good news, but an awful long way to go. I am happy to learn from anywhere in the United Kingdom where such work is going well, and conversations with the hon. Member for Central Ayrshire (Dr Whitford) are always illuminating and useful.

I thank the Minister and all Members who have taken part in a thoughtful and well-informed debate. I think that £130 million a year clawed back by the Treasury in unused units of dental activity could be put to much better use, and I wish the Minister well in his battle with the Treasury on that.

I was pleased to hear what he said about the dental contract, although I think that two years is a bit long when so much more coverage is required. Obviously, I would like education programmes to be rolled out as quickly as possible across the country, because that is key to what we are trying to achieve. I personally think that we need an even bigger push on sugar, and particularly sugar promotion, as that will make a massive difference to all children.

Question put and agreed to.


That this House has considered children’s oral health.