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NHS Dentistry: Bristol and the South-west

Volume 707: debated on Monday 24 January 2022

Motion made, and Question proposed, That this House do now adjourn.(Craig Whittaker.)

I am grateful to have secured this evening’s Adjournment debate on access to NHS dentistry in Bristol and the south-west. Over the past few months, many of my constituents have told me how difficult it has become to find and access an NHS dentist in and around my constituency of Bristol North West. Their accounts have been wide-ranging, from having their NHS treatment left in limbo following the closure of a local practice to having to look as far as Gloucester to try and register as a new patient with an NHS provider.

In particular, last year an NHS dental surgery in Southmead in my constituency unexpectedly closed to patients. Many of my constituents were left without an NHS dentist, often mid-treatment. One constituent explained that they had paid for NHS treatment prior to the closure of the dental surgery but had been unable to secure another appointment with a local dentist. Their dental work remains incomplete. Another constituent described contacting nine dental practices across Bristol to try and resume their treatment as soon as possible, only to be told that none was accepting NHS patients.

I am grateful to my hon. Friend for securing this important debate; I have similar stories from my constituents. Does he agree that we also need to think about pregnant women, for example, who have free access to care but are also being denied access to dentistry at a really important point of their life?

I absolutely agree, and I thank my hon. Friend for her contributions, not least as a leading voice on healthcare policy, knowing that prevention is more important than cure.

A third constituent of mine rang over 25 practices across the south-west, but was unable to secure an appointment as an NHS patient—something that has affected patients who were pregnant as well as everyone else. Southmead in particular is now left without any NHS dentists at all.

The number of child patients nearly halved in 2021 compared with 2019, with a 42% decrease in the south-west, including my constituency and his. Is the hon. Member as concerned as I am that the most worrying part of these statistics concerns the loss of access to dental treatment for children?

I do share that concern, because we know that children in particular are seeing the dentist on a fewer and fewer occasions, and I understand that the tooth extraction rate for children is increasing significantly because of a lack of prevention.

Some 3,925 teeth were removed from Plymouth children under anaesthesia in 2019-20. The figure was lower last year because of the pandemic, but does my hon. Friend agree that we will not solve this crisis until children get to keep the teeth in their mouths through better oral health, and that we will not get that until the dental crisis is properly addressed by Government?

I thank my hon. Friend for his intervention; as ever, he is a strong advocate for his constituents. He identifies that children are ending up having teeth extracted in emergency situations instead of seeing the dentist in the first place.

While the three cases that I have referred to have stemmed from the closure of the same dental practice in Southmead in my constituency, their stories serve to highlight the difficulties faced by those across Bristol and the south-west in accessing NHS treatment.

The hon. Gentleman highlights Southmead; may I highlight another important case for the record? The closure of the Frampton dental practice has left many of my constituents unable to secure any type of dental support at all. He is therefore quite right to say this is an issue right across the region and to bring it to the Minister’s attention, so may I offer him my full support in this debate? Although we are grateful for the NHS’s medium-term response, there are lots of people seeking treatment now who cannot access it. I therefore offer him my support and call on the Minister to meet me to discuss the issue in further detail.

I thank the hon. Member, because it sounds as if his constituents are suffering the same problem as mine. Many have rung eight, nine or 10 NHS service providers, to be told that they could be accepted only as a private fee-paying patient. Going private is simply not an option that many of my constituents can afford. Some have been left with no other choice and others have just not been able to see a dentist at all. Outside of emergency cases, it seems that dentistry in our country has become merely a private healthcare service, with all the unacceptable inequalities that that presents.

In many cases even emergency appointments are simply not available, given the number of people asking for them. The waiting time to get an NHS dentist in Exeter is currently two years. We have thousands and thousands of people in Devon as a whole with no access to an NHS dentist. They cannot afford to go private and they cannot get access, in pain, to emergency treatment. It is an absolute disgrace, and for the last eight years this Government have done nothing about it.

I agree, and I thank my right hon. Friend for raising the case in Exeter, which seems similar to the many other cases we are hearing about this evening.

When I surveyed my constituents, 79% of those who responded said that they did not feel that they could access a timely dental care appointment when they needed it, while 60% had not had any form of dental treatment during the past year. Twenty five per cent. detailed that they had contacted 11 or more dental practices to try to register for NHS treatment but were unable to do so.

Information compiled by the Association of Dental Groups puts those conclusions in context. The ADG highlights that 43% of patients across Bristol alone were unable to book an appointment when they wanted to do so. That figure increases to over 50% of patients when considering the south-west altogether.

In its 2021 “Great British Oral Health Report”, mydentist found that those in the south-west who have had a dental appointment in the last year lived, on average, over 5 miles away from their closest surgery. More concerningly, those who had not had a dental appointment in the last 12 months were twice as likely than the national average to live over 30 miles away from their closest surgery. That seems to suggest that there is a correlation between someone’s proximity to an NHS dentist and the amount of time that has elapsed since their last appointment, adding geographical inequality to income inequality in the often privatised dental care system—no doubt a levelling-up priority for the Government.

This is a growing problem, with increasing numbers of NHS dentists closing and a shortage of dentists available to do the work. For those familiar with the south-west’s regional news, Thursday’s BBC “Spotlight” reported that the number of NHS dentists practising across the south-west had fallen by more than 200 between 2017 and 2021. Across the country, 45% of patients have been forced to pay for private care due to the closure of a local NHS dentist.

The good news is that there are several actions that the Minister can take to address these issues. First, the Government should consider measures to reverse the decline in the number of dentists offering NHS services. Research from mydentist shows that nearly 1,000 dentists ceased providing NHS treatment in 2020-21, and in response to a survey, 47% of the British Dental Association’s membership said that they were considering reducing the provision of NHS dentistry due to the pressures being faced. I understand that the Government have announced a south-west dental reform programme. I would be grateful if the Minister could provide some detail as to how it could be deployed to increase dentistry numbers.

Secondly, the Government should look again at how they recognise international dentistry qualifications. The overseas registration examination has only 500 places available annually in the UK. The ADG has recommended that part of the examination could be taken in the candidate’s home country as a way of reducing some of the pressures, and that the overall number of places available should be increased. Furthermore, both the ADG and mydentist have recommended that the Government take swift action to reduce the impact that Brexit will have on those who have received their training in the European Union but whose qualifications are not recognised in the UK, and therefore on the number of dentistry providers in the UK. At present, the Government have agreed to recognise dentistry qualifications achieved in the EU until the end of the year, but given that 22% of dentistry care and treatment is provided by dentists from the European economic area, it is vital that certainty about the future is provided to those dentists and their patients as soon as possible. It is ridiculous that Ministers would prevent EU dentists from being able to work in the UK. I would be grateful if the Minister could update the House on that particular issue.

Finally, and most importantly, the Government need to bring forward long overdue reforms to the NHS dental contract, which was established in 2006. Local dentists in Bristol North West have contacted me to highlight their frustration with the current contract, which prevents them from seeing NHS patients when they need to be seen. They have explained that they have been expected to meet higher patient targets due to local closures, despite the need for covid-19 safety measures and without the full payment usually required to see those extra patients. Those pressures are in addition to the backlog from the pandemic, with more than 350,000 dental appointments lost in Bristol alone between April 2020 and November 2021. Reforming the NHS dental contract is vital to solving the underlying issues with access to NHS dentistry, and I would welcome an update from the Minister on the status of that work.

In the round, NHS dentistry is broken and the problems are getting worse. The system works only for those with dental emergencies—and that is if they are lucky—while everyone else is left largely to pay private fees in a private dental system that costs significant sums of money. The closure of so many NHS dentists is adding geographical inequalities to the income inequalities created by the private sector-led dentistry system, and the shortage of dentists in the country is being exacerbated by a failure to recognise European Union dentists and an unwillingness to make it easier to welcome dentists from other countries around the world.

From my experience with Ministers and officials, I get the sense that dentistry in this country is now nothing more than an afterthought, placed in the “too difficult for Government action” box.

I do not know whether my hon. Friend has written to Ministers about this. I have written to Ministers on behalf of constituents who are in pain and need emergency surgery, but cannot come up with thousands of pounds to pay for it. It is so frustrating when the response we get is a link to a site where they can check where their nearest NHS dentist is, or similarly useless bits of information. Does he share my concern that the Government are totally complacent about the crisis we face?

I thank my hon. Friend for her contribution and I agree entirely. I know from my own experience of trying to get access to ministerial time following the closure of an NHS dental practice in Southmead that it took ages to get a response. I then had time with officials, who tried to be helpful but could not resolve the problem, and we had local briefings in Bristol where, I am afraid, the presentations and information were completely inadequate. That confirms my point that dentistry seems to be an afterthought, not a priority, for this Government.

I am grateful to my hon. Friend for giving way again. Could he add one extra ask of Ministers—to keep the dentists we train in the west country in the west country? The last Labour Government opened a dental school in Plymouth that trains enormous numbers of high-quality dentists, but then they have to spend time in practice and they go into a national shuffle. If there was a regional shuffle to keep those dentists in the south-west, it is more likely that they would stay in the west country, providing additional services, rather than being spread across the country. Does he agree that would be a good idea?

That sounds very sensible, and no doubt it would be a great levelling-up opportunity for the Government to ensure that dentists trained and qualified in the south-west stay there. I do not want to put particular pressure on this Minister, because this has been a long-running failure over many years.

I have an interest here, clearly, but why should dentists, or any profession, be forced to stay and practise in the area they trained? No other profession has that. It would be a very unfair liability and tie on the dentists.

I am not sure that was the suggestion from my hon. Friend the Member for Plymouth, Sutton and Devonport (Luke Pollard); it was merely an opportunity for those who train in the south-west and who wish to stay there to do so, and I would support that.

Ministers’ long-running failure to tackle this issue is resulting in hundreds of thousands of people across the country, not least many thousands of children, being unable to access NHS dentistry until it becomes an emergency and a hospitalised problem. That is unacceptable; it no doubt costs the Government more to treat problems instead of trying to prevent them, and I call on them to put in the work to fix this problem now. I look forward to hearing the Minister’s responses to my questions.

I listened with interest to the hon. Member for Bristol North West (Darren Jones). He mentioned the word “prevention”, but did not go into the prevention the Government are doing at the moment. There is enormous work being undertaken in schools, not just in England, but in Wales and Scotland, and the results are very positive. They are teaching children, from a very tiny age right through to infants school, how to look after their teeth, how to brush their teeth, what a toothbrush is, what toothpaste is, how to use fluoride and so on.

The hon. Gentleman failed to mention the fact that the Health and Care Bill currently going through the House of Lords will introduce an opportunity for fluoride and fluoridation. The roughly two-year payback will make a dramatic difference. Rather than complaining now, he should be campaigning as hard as he possibly can to ensure that fluoride is brought into his area as soon as possible. That will make a dramatic difference.

Finally, the hon. Gentleman mentioned dentists coming in from overseas. Those in the Commonwealth, new and old, will now be in a position to come here, once the immigration Bill is through and the General Dental Council gets the slight change in legislation it needs to bring the dentists in. They will come here, because this is an attractive area to work in national health, privately and in research.

It is a pleasure to respond to this important debate and I thank the hon. Member for Bristol North West (Darren Jones) for securing it. I acknowledge many of his points but reassure him that dentistry is an absolute priority for the Government. He said he has previously tried to make contact with Ministers; he has not formally asked me for a meeting but I am happy to meet him should that be of assistance.

Let me touch on two of the main reasons why patients up and down the country currently struggle to see dentists. The first relates to covid. This is not a lame excuse for why there are currently difficulties: dentistry and dental services have gone above and beyond during covid. I am sure my hon. Friend the Member for Mole Valley (Sir Paul Beresford), who is a dentist, will back me up when I say that many dentistry procedures are aerosol-generating, so significant infection-control measures have been in place to protect patients and dentists and their teams.

At the start of the pandemic, when we first went into lockdown, only urgent procedures were allowed, so no routine procedures could be carried out. It was not until 8 June 2020 that infection-control measures allowed the reintroduction of some routine care. Even then, dental practices were able to work at only 20% of normal activity. That has of course had knock-on effects throughout England in respect of patient access to routine care.

Later that year, infection-control measures allowed up to 45% of normal activity, but it was not until last year that that proportion went up to 60%. Just before Christmas, NHS England and the chief dental officer wrote to practices to say that they could go up to 85% of normal activity and 90% of orthodontic activity. They are still not up to 100% of activity so they are literally treading water to try to keep the service going. I pay tribute to all those who have done such significant work to try to deliver services to the patients who have needed them.

Urgent care has been back at pre-pandemic levels since December 2020, so the backlog is in respect of routine services, whether fillings, caps, crowns or routine dental-hygiene work. Covid has significantly contributed to that backlog.

I understand from the dentists I speak to in my Bath constituency that the Government funding provided per patient just covers hygiene, not any of the repairs or dental work the Minister has just mentioned. Can she confirm or deny that?

I will come to that in a moment, but let me first conclude on the impact of covid on dental services. The hon. Member for Bristol North West may be reassured to hear that the proportion of adults and children accessing dentists in Bristol, North Somerset and South Gloucestershire remains higher than the average for access to dentistry in England. It is probably no consolation to his constituents, but access is slightly higher.

I have been clear that covid means we are not yet operating at 100% of normal activity. We need to get back to pre-covid levels, when the majority of patients were able to access a dental appointment and around 28 million people saw an NHS dentist every 24 months. That is where we need to get back to but we will struggle, because of infection-control measures due to covid, to get there until we are at 100% of activity.

I reassure the hon. Gentleman that NHS England is supporting local commissioners. There was an intervention about helping to get more service provision; provision is commissioned at a local level, not by the national Government. National Governments provide the funding and then local commissioners commission the services. It is important that Members talk to their local commissioners to understand what services are being commissioned. NHS England provides flexible commissioning toolkits to local commissioners to help to focus the available capacity.

Does the Minister recognise that local commissioners can only commission dental services if the NHS dentists exist and are willing to provide NHS dental services? The core of my debate this evening is not about the impact of the covid pandemic, which we all recognise; it is about the underlying issues of the dental contract and the shortage of dentists. Does she recognise that?

I will come on to the contract, which was developed in 2006 under the last Labour Government, and highlight the impact it is still having on dentistry—

This Government are always clearing up the mess of the last Labour Government. I am hoping to have a constructive debate but obviously Opposition Members are not willing to engage in that.

Despite all our efforts to increase services, we know that patients are experiencing difficulty gaining access to dentists. There are a number of options that are helping patients to locate their nearest dentist. Patients can call 111 to find out which dentists are taking on patients. [Interruption.] If Opposition Members are not serious about this and make funny head-in-hands gestures, it is really not helpful.

No, I will not give way. The right hon. Gentleman is obviously not interested in my response.

In Bristol, North Somerset and South Gloucestershire, a dental helpline has been set up to help patients to find an NHS dentist for routine care and to arrange urgent treatment. In addition, we have written to dental practices asking them to update their online information on the website. It is really important that this is available so that patients can find out which dentists are taking on NHS patients and which are not. It is crucial that that is kept up to date because it does change on a significant timescale.

Dentists are also being asked to maintain a short-notice cancellation list so that they can proactively contact patients who are on their waiting list if a patient cancellation occurs. All these measures help with the underlying problem of gaining access to NHS dentists. Later this week, there will be an announcement on some extra funding so that local commissioners will be able to commission services, because in some areas there would be more capacity if extra funding were available. Colleagues across the House will see the details of that in the coming days. My hon. Friend the Member for Thornbury and Yate (Luke Hall) intervened on a similar point. I am happy to meet him to discuss the issue around Frampton Cotterell, as I am happy to meet all Members if they want to raise specific local issues around dentist availability in their constituencies.

To get to the crux of the long-term issues, we hope to get to 100% capacity at some point post the pandemic. However, as mentioned by many colleagues, there is an issue with the dental contract, which has perverse disincentives within the UDA—units of dental activity—system, which dentists struggle with because they are paid similar rates when they are taking out one tooth or doing one filling as compared with doing extensive dental work. This is a disincentive to dentists to take on NHS patients, or sometimes to hand back NHS contracts.

Work has already commenced on dental contract reform. The Department and NHS England are working with key stakeholders, including the British Dental Association, to look at alternative ways of commissioning services, because only when we address the fundamental of the contract that dentists are working on will we get to the crux of the matter of the poor uptake of dental contracts and the reluctance of dentists to take on NHS work. Our aim in contract reform is to improve patient access, reduce health inequalities and make the NHS a more attractive place to work for dentists, making them feel more valued and helping to recruit and, more vitally, retain the experienced dentists who do so much to protect and promote oral health in this country. I am sure that the hon. Member for Bristol North West will welcome that. We are making some building blocks in terms of work that is already happening.

A number of Members touched on the issue of recruitment and retention of dentists. Only in September last year, Health Education England published its “Advancing Dental Care” review report on a four-year programme of work to recruit, retain and train not just dentists but dental teams. We have identified more effective ways of utilising the skills mix in the dental workforce. We are widening access and participation to training, we are allowing more flexible entry routes, including for overseas dentists, and we are developing training places for dental professionals, not just dentists; we want to upskill dental technicians and dental associates by providing them with more skills so they can provide a greater range of services. We are also looking at providing training in areas where we have dental deserts—where we do not have dental provision that local commissioners can commission. Importantly, we know from GP trainees that those who train in an area are more likely to stay in the area. We want to facilitate that. Health Education England is doing a huge amount of work to make that happen.

I thank the Minister for her answers. One specific question I asked was about the recognition of EU qualifications and the 22% of dentists in the UK who originate from the EU. Can she answer that specific question please?

Absolutely. We want to encourage everyone who wants to come and work in the United Kingdom to be able to do so, and we are working with the General Dental Council to make sure that happens. Currently a period of continued automatic recognition is in place for dentists with EEA and Swiss qualifications wishing to work in the UK and we want that to continue. Those with qualifications which were previously automatically recognised will continue to be recognised in the UK. I have heard from dentists from abroad who want their qualifications to be recognised here and we will work hard as part of the contract reform to make sure that that process is easier than at present.

On preventive work, my hon. Friend the Member for Mole Valley was absolutely right to point out that, as well as dealing with dental issues, oral health is crucial, and the Health and Care Bill is introducing proposals that will transfer the power to bring forward the new water fluoridation schemes, which will transform the oral health of many in the most deprived parts of our country, and could reduce the level of decay among five-year-olds by up to 28%. Simple measures such as that will make a big difference.

Although tonight I am unable to present colleagues with a quick-fix solution, I want to assure them that we are dealing with the issues covid has brought to us and we will be announcing further funding in this financial year to help to deal with some of that backlog, but there are issues with the current dental contract that unless addressed will continue some of the problems Members have raised this evening.

I thank the Minister for giving way one last time. Might I gently suggest that the advice the Minister has this evening given my constituents in Southmead and across Bristol and the south-west who cannot get access to an NHS dentist is to call 111—they have tried that; it has not worked—to try to find a local NHS dentist, which they have tried too, and has not worked, and to wait for reform of the NHS dental contract, which has been in place since 2006 and this Government have been in office since 2010? They have been waiting for many years for that and I am not sure they are going to see it any time soon. I have constituents who are in pain waiting for dental care, and children who are not being seen. What are the immediate interventions the Minister can make? She has not offered any this evening.

I would strongly disagree with the hon. Gentleman. He wants to work in a constructive way to deal with the issues facing his constituents, and he has already said that he wanted to meet the Minister, but he has never made an approach to meet me ever—

I will not give way any further; I think the hon. Gentleman has made his points fairly clear. I have said to him that we are issuing a range of help. I have said there will be announcements later this week about funding in this financial year to help patients to be able to access dentists. I have also said that we are—

It is for clarification and for guidance, which I think is a point of order, if I may, Madam Deputy Speaker? My question to you is: the Minister suggested I had not been in touch with her to arrange an appointment, but it was the previous Minister. I wanted to ask if I was able to clarify that on the record.

That is not a point of order for the Chair, but I understand why the hon. Gentleman wanted to clarify that. [Interruption.] Order. We will not have any more shouting from people who are sitting down.

I think it is very disappointing for the right hon. Member for Exeter (Mr Bradshaw) to say that there is no point in meeting or that it would be a pointless meeting. That is the sort of constructive engagement that Labour MPs in Bristol have. I have been very constructive and very open in offering to meet—my very first line in the response to this debate was that I was willing to meet—the hon. Member for Bristol North West to discuss that. If he was not serious about it, it is a shame that he has not been more constructive this evening. However, I am very clear that we are offering a range of options for patients. I have put on record and I have not shied away from the fact that patients are struggling to see their dentist. I have not shied away from the fact that dentists are not happy with the current contract, and we are instigating contract reform. I have not shied away from the fact that, with the current infection control measures, restrictions are still in place. However, as the Minister responsible for dentistry, I remain committed to playing my part to ensure patients can access NHS dentistry no matter where they live.

Question put and agreed to.

House adjourned.