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NHS Dentistry Services: Carshalton and Wallington

Volume 719: debated on Wednesday 7 September 2022

I beg to move,

That this House has considered NHS dentistry services in Carshalton and Wallington.

It is a pleasure to serve under your chairmanship, Mr Twigg. I start by paying tribute to the incredibly hard-working dentistry professionals in Carshalton and Wallington, and around the UK, many of whom dealt with extremely difficult circumstances over the pandemic. They were some of the, I think, unfairly less applauded heroes of the NHS and our healthcare system during those dark days. I want to make it clear from the outset that the concerns I will raise during this debate are not aimed at the professionals, but rather at the system at large. They are concerns that have been shared with me by local NHS dental professionals in Carshalton and Wallington.

It is a well-known saying from the 19th century that a quarter of all human misery is toothache. The modern equivalent for many residents in Carshalton and Wallington is trying to get an appointment to treat said toothache. Dozens of my constituents have been in contact with me recently to raise concerns about accessing an NHS dentist.

Those concerns broadly fit into four main categories. The first is access to NHS dental services as a whole, from all patients—including those who are registered with a practice. The second is the often huge waiting list to register with an NHS dentist. The third is the removal of some patients from the NHS register due to their understandable lack of using services as much since the first covid-19 restrictions were brought into place in spring 2020. The fourth is the cost of purchasing private dental healthcare in order to gain access to treatment when trying to go through an NHS dentist has failed.

NHS figures released this year have found that a quarter of all people who attempted to get an NHS appointment did not succeed. Of those who were new patients, or at least had not had an appointment in over two years, the figure shoots up to almost 75%— almost three in four new patients are unable to get an appointment. A HealthWatch report published in December 2021 showed that seven of the NHS’s 42 integrated care systems were reporting that they had no practices at all taking on new NHS patients. Of course, visits to the dentist did drop over the pandemic, and that was understandable. However, the percentage of the population recently seen by a dentist has been slowly falling for several years. The Care Quality Commission has stated that the core of this problem originated before the pandemic hit.

The long-term impact of decreasing access to NHS dentists should not be underestimated. Without regular and easily accessible dental treatment, smaller issues can grow into greater ones. That puts a greater strain on the healthcare service as a whole—not just on dentistry—including an increase in patients turning to A&E for urgent oral health problems that were not treated by NHS dental services earlier in the process. Many patients who have been treated for mouth cancer or diabetes, for example, were first diagnosed, or at least had symptoms highlighted, by dental professionals. These patients have much higher survival rates if these issues are caught earlier on.

As we continue to try and help our constituents through the storm of the cost of living crisis and of building back a better national health service, we are heading into a winter of huge energy price rises and inflation as a consequence of Putin’s war in Ukraine and of the pandemic. It is even more important to ensure that dental care can be received on the NHS.

The cost of NHS dental treatment to the patient starts at around £23.80, with the most expensive band of treatment capped at £282.80. However, if a patient takes a private route, they can expect this pricing to significantly multiply. I am not just talking about a few extra quid here or there; for complex treatment such as extractions, we are looking at hundreds of pounds when done privately. There are no set limits on what practices can charge for private dental treatment, and prices will of course vary from practice to practice. Such extra financial burdens on people during the current economic crisis is unrealistic.

Unfortunately, difficulty in accessing NHS dental treatment has led to some worrying reports of dental DIY, with people turning to extracting teeth at home using household items and tools. In fact, reports of DIY dentistry in England and Wales have not just been reported by the media here in the UK, but have made it worldwide. Such practices are not only bad for those committing the DIY dentistry, but put greater strain on the whole public healthcare system when they inevitably go wrong.

However, financial issues are not just limited to patients. According to local dentists, many concerns about access to NHS dental care are a result of the financial implications of the system in which dental practitioners operate. Dental practices are essentially small business, but they operate in a strict top-down system.

Since 2006, dental contracts have required dentists to complete a set number of units of dental activity, or UDAs. Treatments are assigned to a band based on complexity and urgency, and each band is given a UDA value. A course of treatment is assigned to one UDA value based on the most complex element rather than the number of different treatments involved. That means that treatment to fit one crown is assigned the same number of UDAs as the treatment to fit eight crowns. That makes it impossible for many practices to make ends meet from NHS contracts, particularly during the current economic climate.

Furthermore, dental contracts in England and Wales are based on NHS dentistry providers performing an agreed number of UDAs a year. This means that if the target number of UDAs is not met, the contracts provide for a clawback, also known as a fine. If the target is reached, patients must be sent elsewhere or else wait for a new quota. The system is almost universally criticised by dental practitioners. A 2022 survey by the British Dental Association found that 82% of practices have reported unfilled vacancies and cited the current contract as the key barrier to filling posts. The Government are of course aware of this and have described the current dental contract as the nub of the problem. I welcome the new Health Secretary’s ABCD approach—ambulances, backlogs, care, doctors and dentists—and was pleased that it specifically mentions dentists, because they sometimes feel like they have been forgotten.

The Government have also described the contract as “a perverse disincentive” for dentists to carry out NHS work, but despite attempts to review and reform the dental contract since its introduction in 2006, it remained largely unchanged until the reforms announced in July. Those problems have obviously only intensified since the covid-19 pandemic, and the BDA estimates that over 38 million dental appointments were missed as a result. That has had a huge knock-on effect, which the industry is still trying to deal with. I am pleased that the Government announced an additional £50 million in funding for dentistry in January to help with the backlog. However, the impact of the pandemic has only mixed with the pre-existing contractual problems to create a perfect storm in dental care, which will take greater work to correct.

The Government do seem to be taking steps in the right direction, and I welcome that progress. The Government’s announcement in July of proposed changes to the system is very welcome—the Minister will tell me if I am wrong, but as I understand it, they will mean NHS dentists being paid more for treating more complex cases, such as those who need multiple fillings. Dentists will now receive five UDAs for treating three or more teeth, an increase on the current level of three UDAs, which was applied to any number of teeth. Higher-performing dental practices will also have the opportunity to increase their activity by a further 10% to see as many patients as possible. That will help to address some of the concerns with the current UDA inconsistencies and their financial impact.

However, there are fears in the industry that the reforms will not go far enough to address—if you will pardon the pun, Mr Twigg—the root cause of the problem in dental care. The BDA has suggested that the UDA system is fundamentally flawed and needs a complete overhaul rather than slight improvements, which, although helpful, will have little impact on practices and patients in the majority of cases.

For many of my constituents, accessing NHS dental care can be like pulling teeth. I am incredibly proud of the Government’s record on healthcare and the NHS, and I look forward to working with the new ministerial team at the Department of Health and Social Care not just to deliver for NHS dentists, but to deliver the new £500 million hospital in my borough and improvements to St Helier.

When it comes to dental care, there needs to be greater consideration of the fundamentals of the system that need reform, in order to improve NHS dental care. There are long-standing system-led issues that span multiple Governments and multiple parties. The recent improvements are greatly welcomed, but I hope that the Minister will outline what further steps the Government can take to address the crux of the matter, which is affecting many residents in Carshalton and Wallington.

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

I congratulate my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) on securing this important debate on dentistry. I recognise the scale of the challenge that he described and we are committed to addressing the challenges of NHS dentistry. Those challenges continue to be real across the country, but, as he remarked, we have taken steps to address these issues. We are committed to improving dental access and making NHS dentistry a more attractive place for dentists and their teams to work.

I appreciate that access to NHS dentistry varies across the country, as my hon. Friend described, and that access was a big issue before the covid-19 pandemic. However, the pandemic further exacerbated those challenges, as we had to reduce the amount of care delivered, in line with the infection prevention and control measures that were introduced at that time. The activity thresholds for NHS dentistry were carefully set at that time by NHS England, and balanced access for patients against necessary infection prevention and control measures. At that time, dental practices were asked to prioritise urgent care and care for vulnerable groups, supported by over 700 urgent dental care centres, of which I think there are a number in his constituency.

Services have gradually been returning to normal levels, and I am pleased to say that in July 2022 NHS England asked dental and orthodontic practices to return to full delivery—that is, 100% of their contracted activity. The sector has worked hard to deliver as much NHS activity as it can, with many contractors already delivering 100% or more of their contracted activity for some time. As my hon. Friend mentioned, at the start of this year an additional £50 million was secured and made available for NHS dental services, to support the dental access challenges further and to provide patients with more dental appointments. That additional funding supported NHS dental teams in increasing capacity and giving more people access to vital dental care across England.

Those most in need of urgent dental treatment, including vulnerable groups and children, were prioritised for the additional available appointments that were made possible through that funding, with a third of activities being provided at the weekend and outside core hours. That funding meant that those with higher level of need were seen, with over two thirds of treatments being for the provision of urgent care. More than 64,000 additional patients were seen. I would like to pay tribute, as did my hon. Friend, to all the staff at dental practices and community dental services who went above and beyond to provide this extra care for patients.

We are beginning to see some improvements in NHS dentistry as we recover from the pandemic. The most recent NHS dental statistics report, published a few weeks ago, showed delivery of more than double the number of courses of treatment, compared with the previous year, an additional 539 dentists returning to NHS dentistry and an increase in preventative care provided to children.

As my hon. Friend said, it is clear we need to go further. We are pressing ahead with the package of measures that he alluded to, which we announced on 19 July. To go ahead with the dental reform package was one of the first decisions that I took as a Minister. We worked closely with NHS England, which negotiated with the British Dental Association, and engaged with many other stakeholders on these improvements. The changes include improving the criticised 2006 NHS dental contract to ensure that practices are more fairly remunerated for the care they provide to patients, and enabling practices to make better use of the range of dental care professionals in a practice.

We want to see all members of the team, including therapists, nurses and hygienists working their full scope in a practice, which will make it easier for more people to access care. Practices will be supported to adhere more closely to the National Institute for Health and Care Excellence guidelines on recall intervals, which indicate that a healthy adult with good oral health need see a dentist only every two years, and a child every one year. That will free up capacity to deliver additional care required by higher need patients.

The changes that were also alluded to will also enable NHS commissioners to have greater flexibility in commissioning additional services to meet local need and will enable improved and more responsive management of those contracts. The highest performing practices will be able to deliver beyond their contract and treat more patients.

We will also improve information for patients who are looking for care, which is why we will make it a requirement for dentists to update their information on the NHS website. In addition to those changes, which will increase dental access and recruitment and retention of the dental workforce, Health Education England is working to implement recommendations from its recent 2021 “Advancing Dental Care Review” as part of its four-year dental education and reform programme.

The aim of that work is to develop a skilled, multi-professional oral health workforce, more able to support patient and population needs within the NHS, by reforming dental education and training. The programme will help address inequalities in dental care access across the country, better targeting areas that are currently less well served.

We know that international dentists are a vital part of the UK’s dentistry workforce. To improve the recruitment of overseas dentists and to ensure that international dentists remain a vital part of our workforce, we are currently working with the General Dental Council on legislative proposals that will allow the regulator greater flexibility to expand the registration options open to international dentists. The changes will support alternative routes to the overseas registration exam where appropriate, as well as expand access to the exams.

We aim to introduce the legislative changes this year, subject to the outcome of the recent consultation on the parliamentary approval process. In the meantime, current arrangements ensure that UK regulators continue automatically to recognise relevant qualifications of dentists from the European economic area, and we want to continue to facilitate their vital contribution to the dentistry workforce.

I want to emphasise that the reforms that we introduced on 19 July are one step. I and the Government recognise that they are a first step in a reform programme. In the longer term, we are looking at committing to improve access to urgent care and at the necessity of further workforce and payment reform. We will continue to work with NHS England and the dental sector to consider what further long-term changes may be necessary.

Question put and agreed to.

Sitting suspended.