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Dental Services: East of England

Volume 732: debated on Tuesday 16 May 2023

[Sir Mark Hendrick in the Chair]

I beg to move,

That this House has considered dental services in the East of England.

It is a pleasure to serve under your chairmanship, Sir Mark. I am particularly pleased to have the opportunity to introduce this debate on dental services in the east of England, as I have been applying to Mr Speaker for a debate on the subject for several months. I am sure that I am not alone among hon. Members in finding that the subject of access to a dentist is one of the largest in my constituency postbag and inbox. It has been the topic of numerous Back-Bench debates in recent times. I pay particular tribute to the efforts of my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins), who have jointly sponsored a trio of debates in the last year or so, most recently on 27 April. My hon. Friend the Member for Broadland (Jerome Mayhew), who is also present, led an Adjournment debate on the need to establish a dental training college in East Anglia on 11 October last year. I will not say much more about that, but I ask the Minister to reconsider the Government’s position on it, because my hon. Friend made some very good points in that debate.

There have been many other interventions on many occasions by many hon. Members from both sides of the House. Indeed, another of my parliamentary neighbours, the hon. Member for Norwich South (Clive Lewis), secured question No. 1 in Prime Minister’s questions last week and asked about dentistry. He also managed to include a rather third-rate joke—something to do with rotten teeth and rotten Governments—but before he is tempted to repeat that, should he grace us with his presence, I point out to the House that I have a fourth-rate joke just for him. Colleagues may have noticed that the debate was scheduled to start, and indeed did start on time, at tooth-hurty pm.

Given the—[Laughter.] It got there eventually. That is Lincolnshire for you, Sir Mark. Given the enormous cost of dealing with the pandemic, and the inevitable financial consequences and constraints that it imposed, I think that the Government have done rather well, but that is not to say that they cannot do better. We all expect them to do better, as do our constituents. The Commons Health Committee has studied the reform of dental services and noted concerns that the Government have

“transferred financial risk from the NHS to dentists”,


“The fixed-term contract may make dentists reluctant to make long term investments in their practice.”

The Committee observed that the chief dental officer appeared in evidence to argue that if commissioners and dentists

“acted more flexibly and used common sense and good will the new arrangements would work”,

but it concluded that

“we see little evidence that this will happen.”

The Committee also reported that the total number of dentists working for the NHS and the activity that they have provided has fallen, and that the total number of patients seen by an NHS dentist has fallen by 900,000. The conclusion of the Health Committee was that the contract was

“failing to improve dental services measured by any of the criteria.”

If hon. Members find any of those conclusions eerily familiar, it would not surprise me, because they are from the Health Committee’s report in July 2008, when the Committee had a Labour majority and a Labour Chair, and there was a Labour Government. I hope that we can all agree that this is a long-standing problem that is not confined to any one Government or party.

There is widespread agreement that the dental contract introduced in 2006 lies at the root of many of the problems that we see today. The old item of service method that existed prior to the 2006 contract may have had some issues, but as one dentist said to me:

“It was a system that allowed you to be entrepreneurial”.

A dentist could set up a dental practice, put a sign outside and get on with it. Under the old NHS contract, dentists were paid for each item of treatment that they provided—an examination, a filling, a crown or a denture. Now they are paid per course of treatment, irrespective of how many items are provided, thus a course of treatment involving one filling attracts the same fee as one containing five fillings, a root treatment and an extraction. As the Duke of Norfolk is rumoured to have said about the rhythm method of contraception, there is only one problem: it “doesn’t bloody work”. We have had this problem since 2006. We have a contract that is, effectively, not fit for purpose.

In fairness, the problems go back beyond 2006. Indeed, my hon. Friend the Member for Waveney said in his last debate on the subject on 27 April:

“The fundamental causes of the collapse of NHS dentistry”

—I do not like saying that as a supporter of the Government, but I do not think the “collapse of NHS dentistry” is too extreme when we see what is happening; I hope that the Minister notes that—

“go back over 25 years with a gradual withdrawal of funding by successive Governments and the poorly thought-through 2006 NHS contract.”

My hon. Friend added:

“Covid was the final straw that brought the edifice crashing down.”—[Official Report, 27 April 2023; Vol. 731, c. 995.]

The problems in NHS dentistry have been so well canvassed in so many recent debates that I do not want to rehearse them again. I will, however, reprise one story from my constituency. The Manor House dental practice in Long Stratton in South Norfolk was run for many years by a respected and successful dentist called Dr Mark Ter-Berg, who, after many years of service, retired and sold his practice. After a period, the new managers of the practice got into financial difficulty and the business went under, owing money both to its corporate owners and the NHS. Dr Ter-Berg offered to come out of retirement and take over his old practice. He was quoted as saying in a local newspaper:

“You would have thought that”—

NHS England—

would have bitten my hand off”.

After months of making the offer and getting nowhere, I intervened on his behalf with NHS England, but it did not make much difference.

Dr Ter-Berg finally gave up waiting and decided instead to set up an entirely separate new dental practice in Long Stratton. I drove past it the other day, and there was a sign that read, “Open from 4 May”. I spoke to him yesterday and he is now very busy. He does not have an NHS dental contract; it is all private work and he is extremely busy—and Long Stratton is not by any means the most prosperous part of my constituency.

As Allison Pearson wrote on 10 August 2022 in The Daily Telegraph, which is not a notable bastion of left-wing journalism:

“I can’t think of a better example of a two-tier NHS than the one that currently exists in dentistry.”

Indeed, I understand that the providers of dental plans—for example, Practice Plan, which styles itself

“the UK’s leading provider of practice-branded dental membership plans to help you leave NHS dentistry or switch providers”—

are so busy that they are rushed off their feet.

Colleagues will have seen the British Dental Association briefing for this debate, which references a much-reported BBC investigation showing that no dental practice in Norfolk, Suffolk or Cambridge was taking on new adult NHS patients, and that this was also true of nearly all dental practices in Hertfordshire, Bedfordshire and Essex. At the end of March, Bupa announced that it will close many dental practices across the country; 85 practices were to be affected, with 38 set to close immediately. That includes two in Norfolk, with one in Harleston in my South Norfolk constituency—although I understand that Bupa is hoping to sell that practice to a new owner and that it will not close on 30 June as previously expected. The truth is that successive Governments have made NHS dentistry a place where dentists increasingly do not want to work. We need to focus on that, and we would all like to know what the Minister will do about it.

Let me say a word about money. The thing that struck me most in preparing for this debate was how little money the NHS spends on dentistry—indeed, how little is spent on dentistry at all compared with what it spends on other things. The figure is currently about £3.2 billion a year—that fluctuates a bit—and about 20% to 32% of that is actually paid through patient charges, paid by the patients themselves.

A recent National Audit Office study showed NHS spending rising from £123.7 billion in the financial year that ended in 2020 up to £151.8 billion—more or less £152 billion—at the end of the financial year that just finished. Further big rises are expected and planned—going up to £162.6 billion—by the end of the financial year 2025. Those are huge sums. In comparison, the annual cost of dentistry is tiny. I tend to compare anything under £3 billion with the NHS national programme for IT in the health service—one of the less successful parts of the last Labour Government. The Health Committee and the Public Accounts Committee studied that extensively at the time, and showed that the electronic patient record element, which cost £2.7 billion, had achieved basically nothing. The Public Accounts Committee’s report—this was its third report on the issue—from around August 2011 stated:

“The Department is unable to show what has been achieved for the £2.7 billion spent to date on care records systems.”

In other words, that nearly £3 billion achieved precisely nothing. I know that this is not quite comparable, being an annual number, but talk of a few hundred million or a couple of billion pounds means a few failed Government computer projects, in terms of the quantum. Compared with the £124 billion or £152 billion or £160-something billion that we are talking about, £2 billion or £3 billion here or there is of very little account.

I am sure that the Minister will refer to the fact that the Government are aware they need to reform NHS dentistry and that he is working on a plan. Some hon. Members might press him for a date on that plan, but I will not do that. I am much more concerned about ensuring that, when he gets the plan, it is right. I do not think it is any one Government’s responsibility that this has gone wrong. In fairness to the Labour Government of the mid-00s, in 2006, they were trying to correct what they thought was a big problem—that the item of service method led to a bill that was difficult to control. It was more akin to annually managed expenditure in the social security Department.

My hon. Friend is making some very good points, and I congratulate him on securing the debate. He will recognise that there is a tension between payment by activity, which is not necessarily a desirable way to manage health—be that dental or physical health—and moving towards a more preventive model, which was the aim, if not the reality, of the changes to the 2006 contract and subsequent changes. What does he think about finding a way to lock in dentists to the NHS for maybe five years, post-graduation, to ensure that they pay back some of the training that cost the taxpayer many hundreds of thousands of pounds?

My hon. Friend makes several good points. We did payment by activity for acute hospitals, and we got a huge amount of activity in acute hospitals. Mental health was then the Cinderella service, with what little was left. Of course, there are tensions, and my hon. Friend, as a practising hospital doctor, will know that better than most. How that needle can be threaded to get the desired results has confronted Governments for many years.

On my hon. Friend’s specific point, having gone through medical school or dental school and come out the other end, junior doctors and, I am sure, junior dentists are at the moment struggling in the way that many others are—including young professionals—to afford anywhere to live. We have hundreds of thousands of acres of public land, including Ministry of Defence land, NHS land, railway land and church land, which has a quasi-public flavour to it. Norfolk County Council alone owns 16,000 acres of land. I would say to these people, “Come and work for the NHS for a few years full time. Commit yourselves completely to this, and we will help you design, build and rent from us at a decent rent. And then, depending on the calibrated loyalty package, which I am sure we can easily work out, you will get the chance in future to buy the house that you have designed for yourself.”

To go back to the point that my hon. Friend the Member for Broadland has made, getting people to stay in a particular area has proved difficult, not least because we do not have a dental training college. However, this is also about people understanding that the area they are going to work in is particularly attractive. That is true of much of the east of England, except people do not realise it because not enough of them, certainly in dentistry, are educated there. There is a huge opportunity for the Government to get this right, and I am more concerned about ensuring that the plan that comes from the Minister in the next few weeks or months is correct.

The fear I have is the potential downside. My constituent who, before Christmas, booked an appointment for her children for 9 May but found out recently that it was cancelled in a text message from the Harleston Bupa practice—she has been phoning to find out what is going on—will not care or know about the interstices of the 2006 dental contract, which was perhaps well intentioned but is deeply flawed and has led to many of the problems we are grappling with. She will just care that she cannot get an appointment.

Although the Opposition have not been particularly fleet of foot in recent years, even they can see that this will become a very salient issue at the next general election. We have our five points: halving inflation, growing the economy, reducing the national debt, cutting NHS waiting times and stopping the boats. Those are fine, but they are not a programme for Government. We need to do those things to restore confidence after the events of last autumn and—it might be best if I quote Mark Twain—to try and draw a veil and hope that not too many people remember them. However, the fact is that we need a better programme for the election, and I am sure we will have one.

The hon. Member for Denton and Reddish (Andrew Gwynne) will be sitting there with his chums, thinking, “What are our five points going to be?” If we do not get this right—mark my words, Sir Mark—the Opposition parties will say, “They have had 13 years to talk about it. It started with the 2006 dental contract, but they have had long enough and have not yet sorted it.” It will then become one of their five points. We are talking about such piffling sums of money compared with the overall cost of the NHS that it is simply incomprehensible that we would not deal with this properly.

The issue of dental care has been of growing concern to our constituents for many years, and the concern has only grown as successive Governments have failed to grapple with the issues properly. On present trends, it will continue to get worse—much worse—unless the Government make a decisive step change and match that decision with the right resources in the right places within a contractual framework that incentivises the right behaviour. That is what the Government need to do.

I congratulate my colleague and good friend, my hon. Friend the Member for South Norfolk (Mr Bacon), on an excellent and passionate speech. I agreed with every word that he said.

I, too, am a veteran of these debates. I dusted off the speech that I made on this subject—probably in this very chair—on 10 February 2022, and things are not better, so I am back, as we all are. It is the duty of Back-Bench Members of Parliament to speak out on behalf of constituents. In February 2022, I had been told a month or two before by NHS England that of the 47 dental practices in my constituency, six were taking NHS patients, but I do not think that was accurate because it was not the experience of my constituents. When NHS England told me that it had done a search on dentists available to take NHS patients in my constituency, I do not think that it had knocked on doors and gone in and asked them. I think it had sat and looked at what an out-of-date website said, and that is not good enough. For a public service that matters, it should not look at an out-of-date website and give Members of Parliament inaccurate information.

The situation is still not better. If we look at the figures from the House of Commons Library briefing on the percentage of children who have seen a dentist, just before the pandemic in September 2019, it was not high enough—it was 58.5%, so just under six out of 10 children saw a dentist every year. The pandemic has a lot to answer for in a lot of areas of our national life, and the latest figures that we have from the Library show that in June 2022, the figure for children seeing a dentist in the last year had declined from 58.5%, which was not high enough anyway, to 46.2%. Less than half of the children in England see a dentist every year, yet we know how important it is for them to do so. Children go to hospital to have teeth taken out, and so on, but regular trips to the dentist, proper prevention and proper brushing could prevent that.

The situation is no better for adults. We have similar figures for adults going to see a dentist in the last two years; I am not sure why it is two years for adults and one for children. In September 2019, just before the pandemic, 49.5% of adults had been to see a dentist in the past two years. That has crashed down and, as at June 2022, is now barely more than a third at 36.9%. Just over a third of adults in England go to see a dentist every two years.

Serious work clearly must be done, because oral health matters. It matters for young children, as I have said, far too many of whom turn up in hospital having to have teeth taken out. It is important that we teach children to brush their teeth well, and we all need to be reminded of that. A Radio 4 programme that I was listening to the other day reminded us that we should not rinse the toothpaste out of our mouth but should only spit it out. You might think that is rather piffling, Sir Mark, but if it helps the nation’s teeth to be a bit healthier by leaving the fluoride on our teeth, it is actually quite important information. There is a job to be done of educating the whole nation about how to look after our teeth properly.

I am passionate about dental care for older people as well. With busy adult social care staff, it can get forgotten, and in nursing homes and care homes it has not always been given the priority that it needs. I had a debate in the main Chamber a while ago on this subject and domiciliary care. The care needs to be there, because poor oral health can contribute to a whole host of other problems and can make them worse. For example, someone might have a low-level bacterial infection in their mouth because they do not have good dental hygiene. We need to get this right.

I was very taken with the suggestion from my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) about NHS dental students giving some time to the NHS. I think five years was suggested. I am conscious that, unlike when I went to university, there are grants and that students leave with quite a lot of student debt, but there is something we could and should do there. If someone is training to be a doctor or a dentist, they receive a large amount of taxpayers’ money, and taxpayers can reasonably ask what they are getting back in public service. Whether we could do something on the amount of debt they have, or vary or pause the interest rate, if they gave those five years to the NHS, that would be worth looking at, and having a greater supply of dentists would make a significant difference.

I come back again to say that the situation is not as I would want it to be. I want my constituents to be able to see a dentist easily. I spoke to the Minister before the debate, and I know the Government are earnestly working on the subject and will come up with a plan in the next few months. I have particular confidence in this Minister—sparing his blushes—because he has been incredibly helpful to me on general practice provision in my constituency. He is an outstanding Minister: highly intelligent, does the detail, delivers and asks the questions that need to be asked. I have hope and confidence in him, but I say to him today, as all hon. Friends do, that this is urgent and it matters. Please deliver—deliver properly and deliver quickly.

It is a pleasure to serve with you in the Chair, Sir Mark. I congratulate my hon. Friend and neighbour the Member for South Norfolk (Mr Bacon) on securing and leading the debate. That said—some faint praise there—it is easier for an MP to secure a debate on NHS dentistry in this place than it is for one of our constituents to actually see an NHS dentist.

As we know, the east of England is the most arid region in the country. That is certainly the case with rainfall and probably also with NHS dentistry. As we have heard, it has been the No. 1 item in many of our inboxes over the past two years. There are no signs of that abating, though, from what the Minister has said, I get the sense that the first steps are being taken to provide an improved service. There is much work to do and I await the Government’s plan for NHS dentistry. I am very much aware of the hard work that my hon. Friend has been carrying out and I hope he will be able to provide a publication date when he responds. I want to highlight what I believe should be included in the NHS dentistry plan, with a slight slant towards the east of England.

The first item is, of course, that NHS dentistry requires fair funding. The British Dental Association has estimated that we would need £1.5 billion a year to restore budgets to their 2010 level. I recognise that that will not be achieved overnight, but there does need to be a meaningful start.

I want to highlight two further points on funding. As I understand it, the annual budget for NHS dentistry is of the order of £3 billion; just over 10% of that is due to be clawed back because it has not been spent. I do not know whether the Minister has given an assurance elsewhere, but that money must remain ringfenced for NHS dentistry. The fact that there is money not being spent shows that the whole system is broken. We saw that at the beginning of January 2022, when the Government announced £50 billion of funding for what was described as a dentistry treatment blitz; only 30% of that was spent. There is a lot of work to do on the funding side.

I turn to funding issues from the east of England perspective. The British Dental Association carried out some work before the pandemic that showed that spending on NHS dentistry in England lags way behind that in Scotland, Wales and Northern Ireland. Homing in on what is happening in England, some recent research commissioned by the University of East Anglia and carried out by Health Economics Consulting very much showed that the east of England is the poor relation compared with the rest of the England.

The research showed that, for 2018-19, in the midlands, spending on NHS dentistry was £78 gross expenditure per head. In the north-west, it was £75; in the north-east and Yorkshire, £70; in London, £69; in the south-east and south-west, £69. The east of England is the tail-end Charlie, at £39 per head. There are a great many steps that we need to be taking to address that particular inequality.

My second point is about contract reform. The 2006 contract is discredited, and needs to be replaced. From what I can gather from what the Government and the BDA say, we have moved beyond what I would describe as the “talks about talks” phase of negotiations, and they are in meaningful discussions. This must not just be a tinkering with the contract—it must be a complete root-and-branch reform.

Some of the ingredients we need for a new contract include a clear break with the units of dental activity system of funding; and we must discard the straitjacket on how many patients NHS dentists can see. If they do not see enough, they get fined; if they see too many, they have to pay for it. We must also ensure that more complex and lengthy treatments are properly rewarded and that NHS dentists are not discouraged and penalised for performing them; we must prioritise prevention; and, particularly from the east of England’s perspective, somehow we must find a way of motivating NHS dentists to come and work in rural and coastal areas.

My third point is about recruitment and retention. Another plan that we are awaiting is the Government’s workforce plan for the NHS and the care sector, and dentistry must feature extremely prominently in that plan. In the short term, we need to recruit more dentists from overseas. We have a situation in the Lowestoft area—actually, it is in Beccles, where there is an NHS dental contract with a group called the Dental Design Studio. That group has been trying for some months to recruit three dentists from overseas. I think they are moving forward, but progress on the overseas registration examination, as carried out by the General Dental Council, is fairly slow. I have liaised with the Minister on the issue in the past and there is a backlog of applicants that needs to be addressed as quickly as possible.

Moving on from that, we need to train our own dentistry practitioners, which means hygienists and support staff as well as dentists. With that in mind, the University of Suffolk has set up a community interest company with the objective of carrying out both treatment and training, with the creation of hubs. The initiative is up and running, but it needs additional funding so that it can be rolled out further across the region. I ask the Minister to do all he can to provide that funding.

In the longer term, there is the issue of a dentistry school; we do not have one in the east of England. Both the University of Suffolk and the University of East Anglia have thrown their hats into the ring. What the Government need to do is just to assess strategically which regions need dentistry schools, but I believe there is a very big vacuum in the east of England. UEA and the University of Suffolk probably need to get together to come forward and put one case, rather than competing with each other.

My fourth point is about prevention. As we have mentioned, the new NHS dental contract must have an emphasis on prevention and the NHS needs to work closely with local councils in promoting better public health. I will quickly highlight fluoridisation. It is not a particular issue in the east of England, but I remember that in one of the many debates that we have had on NHS dentistry in this very Chamber, my hon. Friend the Member for Mole Valley (Sir Paul Beresford), who is a practising dentist, highlighted the situation in Birmingham, where he, as a dentist, can tell which part of the city someone comes from by looking at their teeth, because he knows whether the water is fluoridated in that particular area. Fluoridisation is a compelling issue that needs to be addressed.

Let me also highlight children’s dental health. Two years ago in Lowestoft, an organisation called Lowestoft Rising got together with some local councillors and bought toothbrushes and toothpaste for the under-sevens. It was an extremely successful project and very quickly parents were coming back and saying, “Can we have more?” Unfortunately, more was not available, but it was suggested to me that we should perhaps consider zero-rating toothbrushes and toothpaste for under-sevens. Longer term, we need to look at that very closely.

My final point is about accountability and transparency. There needs to be improved accountability and transparency with NHS dentistry. We have made a significant step forward with the transfer of procurement from NHS England to the new integrated care boards. In the Norfolk and Waveney area, that happened from 1 April, and it is important that dentistry is properly represented on those ICBs. Judging from the feedback that we have had from the Norfolk and Waveney ICB, it is very much getting to work on the problem. It is producing a one-year plan for short-term interventions and next March it will look to produce its long-term dental strategy. From my perspective, I can cite one major improvement. If I have a complaint about NHS dentistry, I can now go to the local NHS commissioners, who I go to on other issues and who give me very good, quick and proactive responses.

To conclude, in geographical terms East Anglia is probably the largest dental desert in the UK, and we need, metaphorically at least, to bring in the irrigators and sink the boreholes with immediate effect. There has been some preparatory work that will enable us to improve the situation, but we need the Government NHS dentistry plan as soon as possible. The plan will cover the whole of the UK, but it must also address the specific problems in the east of England—our historical poor funding, the challenge in recruiting and retaining dentists in our region, and the lack of training facilities. I look forward to the Minister’s response. He impressed me with the way he went about this task, but the plan that he produces needs to be ambitious, visionary and innovative, not just a sticking plaster.

One of the unifying features of the speeches today is that we have heard them all before. Not only have we all heard it before, but we have all said it before, so I will try—I may fail—not to do that. However, I do have to highlight some elements of the problem, which has been ably covered by my hon. Friend the Member for Waveney (Peter Aldous).

Access to NHS dentistry in Norfolk, which is the worst in the east of England, was surveyed in 2020 to 2021, and of the 150 sub-regions of the country, Norfolk came 147th. As I said to the Minister in a previous speech, we have to follow the money. As my hon. Friend the Member for Waveney pointed out, the best areas spend nearly £80 per mouth per year on dentistry; in the east of England, the figure is £39—a full 50% less. Does the Minister have an explanation for that? I genuinely struggle to understand how spending on NHS dentistry in the east of England is so far below that in the rest of the country. It seems to be without explanation.

More locally still, in Broadland the lack of dentists of any description is profound. I was lucky enough to persuade the Department to advertise a new contract for NHS dentistry in Fakenham last year. The money was available and the contract was advertised; not a single organisation applied for the contract, and it is still vacant. In Sheringham, in the constituency of my hon. Friend the Member for North Norfolk (Duncan Baker), who is unable to speak in this debate, there is a dental practice that is owned by an organisation that has an equivalent practice in London. The organisation has been advertising consistently for a new private dentist in Sheringham for 10 years, and it has yet to fill the role, whereas during the same time multiple positions in its London practice have been advertised and filled. It is therefore not just a regional issue; geography really matters.

I am sorry to say that just last week the latest in long and ignoble line of announcements came when Brundall Dental Practice, which is an NHS practice, contacted patients to say that it would no longer be accepting adult NHS patients from 1 September this year. People are being asked to move on to monthly subscriptions for dental care, which are between £150 and £400 a year. I struggle to know what to say to the many constituents who have contacted me, because not a single NHS practice in the county of Norfolk is currently accepting new patients under an NHS contract. The £11 a month is only for check-ups and hygienists; it is not for dental care, which is an extra charge.

People might say that many can afford to pay for dentistry if they have to, but we have to also consider those who are excluded from paying dental charges because of their financial circumstances. What are we asking of those constituents? Where are they to turn not a single provider in the county of Norfolk is accepting NHS dentistry? The answer, of course, is that they will go to the Norfolk and Norwich University Hospital when their dental problems become acute, and we merely transfer the problem from the dentistry budget to the NHS and acute budget. The problem will be so much worse, and so much harder and more expensive to treat, because we are not nipping things in the bud but dealing with acute emergencies. That cannot be the right answer.

The reason I do not want to prolong the agony of discussing the problem is that I know that the Minister gets it. If he was not educated before, he has certainly been educated on numerous occasions, either here or in the main Chamber, by many of the Members present—the problem has already been fed back. Government Members have great confidence in the Minister and in his grip, grasp and focus on the issue. We know that a dentistry plan is imminent—the sooner that it is published, the better, and more power to the Minister’s elbow—but there are a number of suggestions I hope will find their way into the plan.

In the short term, we need additional improvements to the current dentistry contract—other Members have spoken eloquently about that, and I would highlight it as being very important. As regards the medium term, we have had reference to centres for dental development. The University of Suffolk has progressed far in its application, and there is a necessity for a similar venture at the University of East Anglia, or at least similar work in Norwich. However, in the long term, we simply have to train more dentists. We have to open the market to allow people to access a lucrative and fulfilling career that is currently not being explored in the east of Anglia and in Norfolk, in particular.

We need to train people in the east of England. The University of East Anglia has put forward proposals for a dental school. The medical school it founded in Norwich about 10 years ago knows definitively, from surveying all its graduates each year, that about 40% go on to take their first job locally. The single act of setting up a dental school in Norwich, linked to the Quadram Institute and the research work at the Norwich Research Park on the human microbiome, is the long-term solution.

I hope the medical plan will look beyond the national numbers. I was told by the NHS that roughly the right number of dentists are being trained each year, but I dispute that. It has been seven years since it surveyed what those dentists are up to. It has no idea whether the dentists notionally on its books have retired, gone abroad, are working in the NHS, are working part-time in the NHS, are working privately, or none of the above.

My hon. Friend is making a powerful point about the link between where people train and where they work. I would gently make the point to the Minister that the east of England is quite a large area. Norfolk and Suffolk are deeply wonderful places, with which I have a great affiliation, but they are quite a long way from Bedfordshire, which is also in the east of England. If we were to think that it was job done because we had trained dentists in Norwich or wherever, I would want to know what that meant for the good people of Leighton Buzzard, Dunstable, Houghton Regis and the surrounding villages. I put that marker in the Minister’s mind.

That is fair enough. However, if someone grows up in the east of England, whether in Norfolk, Suffolk or even Bedfordshire, there are only two places where they can train: Birmingham and London. There is no other place in the entire east of England where they can train, so is it surprising that we have a dearth of dentists? Is it surprising, particularly in rural areas, that we do not attract dentists who are newly qualified and therefore likely to be in their early to mid-20s? Do they wish to relocate in large numbers at that stage to a rural location? Many do not, so we need to bring the beauties of East Anglia, including Bedfordshire, to trainees so that we can benefit from the stickiness of tertiary education and location.

Finally, my hon. Friend the Member for Waveney raised the issue of fluoridation, which I wish to develop. There is no fluoridation in Norfolk at the moment, and perhaps it shows. The data suggests that the level of decay across the teeth of Norfolk is not universal but is substantially located towards west Norfolk and King’s Lynn. All sorts of factors may account for that, but areas of higher dental decay correlate with those that have reduced natural levels of fluoridation in the water, with the lowest levels around King’s Lynn. I raise that as an issue that I hope the plan will address.

I congratulate my hon. Friend the Member for South Norfolk (Mr Bacon) on securing the debate. Although my constituents use the facilities of the east of England, I welcome his hospitality in the debate as well. This is a shared issue, especially for many in the southern part of my constituency.

I wanted to speak today because, as we have heard from many other hon. Members, this is not just a top issue, but the top issue, in the postbag and particularly on social media. We all feel the immense frustration of our constituents on this important issue. In Lincolnshire, nearly a quarter of five-year-olds are suspected to have tooth decay. Last year, a dozen Boston children had teeth removed. The problems we have heard about in the east of England are present in my part of the world too, and the burden of that partly falls on the services provided in the east of England, which is why it is relevant for me to speak today. These are real problems.

I asked my office to do what I called a secret shopping exercise because, like my hon. Friend the Member for South West Bedfordshire (Andrew Selous), I did not trust the data NHS England had provided. On that secret shopping exercise, we see that just a single NHS practice is offering access to new patients and, even then, only to children. There are huge problems with local provision. When I spoke to the ICB, which has recently taken on the responsibility, it said that there are particularly acute issues in coastal and rural areas and, as we have heard, that there are no silver bullets. However, it raised a few issues, which I will use to augment previous speakers’ excellent contributions.

First, there is the enormous backlog in the General Dental Council exams. I gather that 1,700 people are seeking to take the part 1 exam and that the GDC website does not even say when it plans to put another one on. When it does, it is likely to put just 150 people through it. I know that the GDC is an independent body, but will the Minister do all he can—I know he is already doing so—to encourage the GDC to pull its finger out?

Secondly, on the issue of having a dental school in the east of England, there is a medical school in Lincoln; if it were to train dentists, that would benefit the broader area. As we have heard, there is a clear need for many more dentists to be trained across the country, so perhaps we could do something for East Anglia and see benefits for the whole region from having Lincoln-trained dentists.

Thirdly, the issue of fluoridation affects my constituents as well. I do not think anyone, except those on the outer edges of the internet, could possibly argue against fluoridation, and we should encourage it as quickly as possible. On the outer edges of the internet, I give way to my hon. Friend the Member for Broadland (Jerome Mayhew).

I try not to inhabit that area. Does my hon. Friend not think that it is surprising that only 10% of the country’s drinking water is fluoridated?

It is a surprising number. As I am sure my hon. Friend knows, the water companies have raised issues that are legitimate to some extent, but the overall public good from increasing that number is obvious and would pay real dividends relatively quickly. It would be public money well spent.

In this place, fluoridation is recognised, but the feedback I get from water companies is that conspiracy theories on the internet cause them concern. Does my hon. Friend agree that there is a need for the Government to lead a public awareness campaign on the benefits of fluoridation to dispel these urban myths?

I was the Minister responsible for 5G during covid, and we all remember that, apparently, 5G caused covid—I should be very clear that it did not. However, there is a clear dilemma for the Government as to how much they engage with genuinely fringe conspiracy theories and risk giving them a degree of salience and credibility that they simply do not deserve. I encourage the Minister and his colleagues in the Department for Environment, Food and Rural Affairs simply to get on with it and engage, where necessary, with people who are genuinely worried. However, we sometimes have to acknowledge that the extremities of the internet are not a place where rational debate can always be had, be it on 5G and covid or on fluoridation and tooth decay.

I will make two other points before I end my jaunt to the east of the England. The first is that I know the Minister is looking—as we do with GPs and the NHS more broadly—at what work can be done by people who are not fully qualified dentists to help the nation’s oral health. Along with the expansion of people who have trained abroad, I think that would be welcome and could make a difference, but it is not a silver bullet either.

My final point is that, although my secret shopping exercise was valuable and instructive, it is a huge sign of failure, because the data about which dentists are accepting patients should be freely and easily available so that constituents can easily see which practices are offering help. Given the structure of NHS dentistry, we will always have some dentists with open lists and some with closed lists, even in a healthy system. Easy access to that information would benefit our constituents and NHS England.

I know that the Secretary of State is a huge fan of data and is making such information as open and as easily available as possible, and I hope it can form part of the eagerly anticipated dentistry plan, which is coming “soon”—I think that is the current Government parlance. In a world where the autumn runs into February, I would hope that “soon” is well before the summer. I know it will make a difference in the medium term, but the biggest frustration for all our constituents is the fact that there is no silver bullet.

I hope the dentistry plan includes, for instance, the experimental ways of employing dentists that some trusts are using up and down the country, because that will provide some of the interim measures that I hope will come before the opening of the three dental schools that we have secured in this debate alone. Those will make a huge difference, but it takes time to train dentists, and constituents need solutions as quickly as possible. In pursuing that, we will save people from turning up at A&Es and emergency dental appointments, which will come as a consequence of failing to deliver the basic services I know the Minister is keen to offer as quickly as possible.

As ever, it is a pleasure to serve under your chairmanship, Sir Mark. I commend the hon. Member for South Norfolk (Mr Bacon) for securing this important debate and for setting out some really important points not just for the people of the east of the England—although it has been impressed on me in the course of the debate that there is a specific issue that is pertinent to that area—but for the whole of England, because dentistry is nowhere near where we would want it to be in any part of the country, notwithstanding the differences in regional funding and access that we have heard about.

We have had a really good, thorough debate, and there has been consensus across the Chamber on the state of NHS dentistry. I thank the hon. Members for South Norfolk, for South West Bedfordshire (Andrew Selous), for Broadland (Jerome Mayhew), for Waveney (Peter Aldous) and for Boston and Skegness (Matt Warman) for the veritable tour of the east of England and south Lincolnshire that I have been sent on. I am well aware that south Lincolnshire is not in the east of England, although it is close to it and uses lots of public services within it. That is not least because my wife is from Bourne, in Lincolnshire, so I know how the area connects into Cambridgeshire and beyond.

I want to mention the hon. Member for North Norfolk (Duncan Baker), because he will have constituency issues that he would have dearly loved to raise in the debate. Having been a parliamentary private secretary myself, I know that they must be seen and not heard—it is one of the curses of the job. The great part of the job is getting to work with wonderful Ministers and being able to lobby them behind the scenes on all these issues. The downside is that constituents do not see the benefit of their MP most of the time. In addition, I thought the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) made some really important interventions.

It has been said already that we have been here before. I recently participated on behalf of the shadow health and social care team in a Backbench Business debate, which the hon. Member for South Norfolk co-sponsored. I spoke about people having to remove their own teeth, patients waiting over three years to access dental care, and individuals becoming addicted to painkillers because they cannot get treatment. I could go on and on with examples, but they all point to a simple fact: NHS dentistry is in crisis and is not working for the people who need to access treatment now. We have all heard from constituents at a loss about what to do, who are waiting day in, day out in utter agony and crying out for action on NHS dentistry.

As the hon. Member for South Norfolk made clear, the problem is particularly acute in the east of England. In 2022 no dentists were registering new patients in the whole of Suffolk, Norfolk or Cambridgeshire. In Norfolk, and indeed Waveney, there are only 38 NHS dentists per 100,000 people. It is little wonder that we hear stories of DIY tooth extraction, of Norwich hospital treating more people than ever before for opiate addiction and, in some parts of Norfolk, of 40% of under-fives suffering from dental decay.

We cannot go on like this—nationally, across England or in the east of England. Over the last decade, net spend on dental practices in England has been cut by over a third, with 2,000 NHS dentists quitting in 2021 alone. It is not just about this Government; there have been issues for a long period of time, and those have been compounded over a long period of time.

The hon. Member for South Norfolk and others mentioned the 2006 dental contract. As I pointed out in the Chamber in the Backbench Business debate, there was consensus on the effects of the 2006 contract by the 2010 general election.

The last Labour Government recognised that the dental contract needed reforming and pledged to do so in their election manifesto of 2010. So too did the Conservative party in its election manifesto in 2010. It would be remiss of me not to make this point, as the hon. Gentleman indicated I would: you guys have had 13 years to fix that dental contract. It is of deep frustration that in a decade and three years, that has not happened.

I have said this before: there was not a golden era of NHS dentistry before the 2006 contract. The hon. Member for South Norfolk mentioned that before 2006, dentists were paid for each treatment. That worked in the interests of dentists, but not always in the interests of patients. I have also said this before: there is a reason why my mouth is full of metal—crowns and fillings—and it is not because I ate more sweets than my children did or because I brushed my teeth less well. It is because dentists were incentivised to maximise the amount of work they did because that is how they got paid—drill and fill—and that was not always in the interests of public health or the patient.

It was not a bad thing that the Labour Government sought to make changes to bring NHS dentistry more in line with private dentistry, where the emphasis was on prevention rather than on drilling and filling, but it did not work—I make no bones about it. That contract needed to be reformed.

In a similar vein, there is still no sight of the NHS workforce plan—I say that at every opportunity when I face this Minister or others in his Department. We know it currently resides on the Secretary of State’s desk, despite the fact that 90% of dental practices with a high NHS commitment still find it difficult to recruit a dentist, so the key question to the Minister is: what does he plan to do to address the crisis in dental care across England? How do the Government plan to tackle the dental deserts that are causing misery to millions of people, particularly in the east of England? I would also appreciate an update on why the Government are yet to publish the workforce plan in full and when we can expect its release.

It is also important that the Minister recognises the extreme health inequalities that are widening to record levels. Children living in the poorest parts of England are around three and a half times more likely to have rotten teeth removed than those in more affluent areas. That problem is set to get much worse, with families unable to access basic oral hygiene products because of the cost of living crisis. I was very interested to hear of the project in the constituency of the hon. Member for Waveney. Such projects can make a big difference for a small amount of cash at a very local level.

What steps is the Minister planning to take to address the growing inequalities, and what assessment has he made of the continued impact of the cost of living crisis on families who are unable to access oral hygiene products? Labour Members have been clear since 2010 that tackling the crisis in dentistry has to be an absolute priority for any incoming Government, and I include the possibility of an incoming Labour Government. We have a big job of work to do across the whole NHS.

I understand the predicament that the current Government are in, but the previous Labour Government brought waiting lists down across the NHS from 18 months to 18 weeks, and we will do the same again. We want to secure the future of NHS dentistry, and we would provide the staff, equipment and modern technology needed to ensure patients get the care they deserve.

The hon. Member for South Norfolk was absolutely right: if the Government do not move on this territory, the Labour party is there. We have set out how we will pay for the next generation of doctors, nurses, healthcare workers and dentists, with our workforce investment paid for by abolishing the non-dom tax status. We can begin to chip away at the dreadful oral health inequalities that we see across England. We will train 5,000 new health visitors who work closely with families to promote and prevent ill health. We already know that health visitors have the potential to improve dental attendance and oral health in the families who are least likely to engage with dental services—a role that cannot be overlooked.

People in the east of England and across the nation deserve much better NHS dental services than they are getting. Slowly but surely, we are seeing the creation of the two-tier system that the hon. Member for South Norfolk set out in his opening remarks, where those who are able to pay are receiving essential care, and those who are not are languishing in utter agony, unable to find an NHS dentist. The next Labour Government stand ready and waiting to act to rebuild NHS dentistry. Until then, I urge this Government to get to work. Too many people are suffering, and the current state of crisis must not be allowed to become the new normal.

I start by thanking my hon. Friend the Member for South Norfolk (Mr Bacon) for securing this important debate. It was reminder of what a brilliant speaker he is. Dentistry is the number one issue that I am working on; I have had two meetings on it already today. It is something that we are working on at pace. I know there are challenges accessing dentistry across the country, and recently there have been particular issues in my hon. Friend’s constituency. We are committed to tackling those issues, not only in the east of England but right across the country.

My hon. Friends are quite right about the scale of the challenges, which are particularly acute in the east of England. Colleagues who are here today, and others from the east of England, are first in my mind when I think about those who are contributing ideas to our forthcoming dentistry plan. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) talked about how we get students to do more for NHS dentistry. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) talked about how we must encourage preventative work, particularly for children—I completely agree with him.

My hon. Friend the Member for Waveney (Peter Aldous) talked about the challenge of under-delivery, the need to have proper rewards for complex types of treatment and how we incentivise dentists to move to areas such as the east of England. Those are all things that we are working on. My hon. Friend the Member for Broadland (Jerome Mayhew) talked about the unjustified variations in coverage and investment around the country, frozen in time by the 2006 contract. He also talked about the imbalances in training in different parts of the country. I was glad to hear various hon. Friends and Members talk about the importance of fluoridation. Across last year, we legislated to enable that to make progress for the first time since the 1960s.

My hon. Friend the Member for Boston and Skegness (Matt Warman) talked about how we must bust the backlog at the GDC. I met the GDC again yesterday to work on that. He also talked about the importance of accountability and greater transparency. Again, that is something that we are working on now. It would be remiss of me not to mention my hon. Friend the Member for North Norfolk (Duncan Baker), although the rules of this place do not allow him to speak in this debate. Hon. Friends from the east of England will not be surprised to hear that he, as the son of a dentist, is playing a leading role in pressing us forward to move even more quickly on dentistry.

My hon. Friend the Member for South Norfolk talked about fundamental reforms of the NHS dental contract. He is correct that we need to go further, but we have started to reform the contract for the first time since 2006, with the package of changes that we brought in last July. Those are an important first step in addressing some of the challenges facing the sector. We know, of course, that we need to go further. Those initial reforms have been received well by the profession and are starting to have a positive impact.

We created more UDA bands to better reflect the fair cost of work and incentivise NHS work. We introduced the first ever minimum UDA value to help to sustain practices where UDA vales are particularly low—the east of England is a good example of a place where that is the case. We allowed dentists to deliver 110% of their UDAs for the first time, to encourage more activity from those who want to do more. We made it a requirement for dentists to keep their availability for NHS patients up to date on the NHS website, which is an issue that a number of hon. Members have mentioned.

We also started the process of making it easier for dentists to come to work in the UK, and last month there came into force legislation that enables the General Dental Council to increase the capacity of the overseas registration exam, as hon. Friends have argued for in this debate. As some people have mentioned already, plans for a centre for dental development in Ipswich are advancing, and further plans are emerging elsewhere, including in Norfolk. We are also doing longer-term preventive work on expanding fluoridation; changing the law last year was part of that, and we also secured funding to expand fluoridation first across the north-east, subject to consultation later this year.

The reforms to split band 2 have been welcomed by the profession, as has the introduction of the 110% option. I am pleased to say that the proportion of the new band 2Bs is increasing and dentists are using the new flexibilities we introduced to prioritise those with higher needs. In terms of delivery, the number of patients seen in the year to March is up by nearly a fifth on a year earlier, but we must go further, and the changes we have made are just the start—I am under absolutely no illusion that there are significant challenges to address. The reforms that I have talked about and the forthcoming dental plan will draw on the ideas that hon. Members have put forward in this debate and offline. They will build on those initial banding changes and improve the payment model; ensure that we continue to improve access, particularly for new patients; look at how we address historical UDA variations; and look to make NHS work more attractive to ensure that NHS dentists are incentivised to deliver more NHS care.

The delegation, or devolution, of dentistry from NHS regions to ICBs, which various hon. Members have pointed out, is an improvement. It provides an opportunity for much closer integration with other local care services and much more accountability and transparency. People can much more easily go to see the person responsible for delivery in their area, and our dentistry plan will build on that.

I thank my hon. Friend the Member for South Norfolk for securing this important debate. I hope he is reassured that we have started to reform NHS dentistry and to improve services not just in the east of England, but in all areas. We will continue to build on those reforms in our plan for dentistry, on which we are working at pace.

I enjoyed listening to the remarks of every contributor, including my parliamentary neighbour, my hon. Friend the Member for Waveney (Peter Aldous). I was going to say “the Member for Aldous”—going around my constituency, one finds quite a lot of Aldouses; I have not yet established whether they are all related, but if one scrapes under a stone in East Anglia one quickly comes across an Aldous. He gave us a tour d’horizon—a tremendous summary of the expertise that he has gathered over the last few years. Together with the hon. Member for Bradford South (Judith Cummins), he has led the way in drawing the issue to the attention of other hon. Members. I pay tribute to him for that, and I am deeply in his debt, because reading his speeches was a great way to read my way into the subject—one that I was drawn to not because of any expertise, but because of my constituency postbag. We have heard that the same is true for all hon. Members.

Opinion pollsters are sometimes behind the curve on what is a salient issue, but hon. Members on both sides of the House know that this is the top issue facing us. My plea to the Minister is not to go so fast that he gets it wrong, but to bide his time and ensure that he has taken everything into account. He should talk to his Secretary of State, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay)—an east of England MP who has the same problems in his constituency postbag—and come up with an answer that is attractive and provides lasting change. That is what we want to see.

My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), another of my parliamentary neighbours, raised the interesting point of how we encourage people who have had money spent on them by the NHS to stay in the NHS, even if they are paying fees themselves, as my hon. Friend the Member for South West Bedfordshire (Andrew Selous) said. I would be open to a wide variety of methods for doing that, including forgiveness of part of or perhaps all student loans. We need to make radical changes.

My hon. Friend the Member for Broadland (Jerome Mayhew) quoted a startling statistic: £80 per head is spent on dentistry in the areas that have the best dental care, and only £39 in parts of the east of England. What annoys me more than anything else is that, outside London and the south-east, the east of England is the fastest growing area of the country. It contributes the most gross value added to the economy outside London and the south-east. That is an argument that MPs in Norfolk and elsewhere in the east of England have been making for many years. We have been saying for years, “Give us the infrastructure, give us the broadband, give us the rail connectivity and give us the mobile telephony that actually works, without the need to go 100 yards down the road, stand on one leg and hope there is an “r” in the month to get a mobile telephone signal. Then we will provide the economic growth.”

Going back to the Prime Minister’s points, I seem to remember that one of them is about economic growth. Here we are contributing so much to the economy and yet not getting our fair share back, when the opportunity in the east of England is unrivalled in the UK. A golden triangle could exist between the economic heat, innovation and intellectual firepower of Cambridge; the Norwich Research Park in my constituency, where scientists look at world-leading advances in genomics and plant science; and technology in Ipswich at the BT labs at Martlesham. That golden triangle represents an extraordinary opportunity for the whole United Kingdom.

I was recently at the Cambridgeshire Development Forum, where I heard people talking about east-west rail and comparing themselves with Boston and Silicon Valley, but saying that they do not have enough room to grow. I say to my hon. Friend the Member for Boston and Skegness (Matt Warman) that that is, of course, Boston in America. The obvious answer is, “You have got loads of room to grow. You have got the whole of the east of England.” To an investor from Dubai or Shanghai, it all looks like Cambridge. We have a huge opportunity, but we need not only the infrastructure but the world’s best medical and dental services.

In an uncharacteristic slip and momentary lapse of memory, my hon. Friend forgot to mention the world-leading research in Cranfield, which I am sure he was going to add to his golden triangle of opportunities in the east of England. I am sure that that slipped his mind accidentally.

It might make it more of a pentagram, but I did mean to mention Cranfield, of course. My hon. Friend knows that in South Norfolk we speak of little else. I do not want to take up too much time, although we are slightly ahead.

My hon. Friend the Member for Boston and Skegness said that he is not technically in the east of England. I had a mad great-great aunt who lived in Brigg in Lincolnshire, and Lincolnshire has always been in the east of England, as far as I am concerned. He is very welcome at this debate, and I had a great interest in what he said. However, if it is true that the wilder fringes of the internet have got worse in recent years, and if my hon. Friend was responsible for 5G, to whom should we attribute the extra growth in the wilder fringes of the internet, if not to him? I only pose the question.

The hon. Member for Denton and Reddish (Andrew Gwynne) surprised me. I remember when he was shadow Secretary of State for the Ministry of Housing, Communities and Local Government portfolio. He mostly appeared at the Dispatch Box like an angry avenging angel. The fact that he is capable of sounding rather rational and sensible was a surprise to me. I am afraid he also confirmed my worst fears—

As the hon. Member for Denton and Reddish said, dentistry definitely needs to be improved. He has confirmed my worst fear, which is that if the Minister does not focus on this sufficiently, the hon. Member and the Opposition will. They will produce a solution which—whether it is delivered or not—too many people will find attractive, I fear.

Fortunately, we have in the Minister someone in whom several colleagues have reposed confidence, and have said so publicly. On one occasion, when we were both on holiday, I bumped into the Minister in a second-hand book shop in Hay-on-Wye. I know he is a cerebral fellow who thinks carefully about these issues, and I take seriously the assurances I have had from colleagues that he is looking at this extremely closely.

I say one thing to him in conclusion, and this is the acid test. If he produces a dental plan that can be delivered speedily, and if he negotiates successfully not just with his Secretary of State and east of England MPs, but with the Treasury, to produce the resources required to do that, he will quickly give our constituents reassurance that NHS dental provision can be a place where dentists want to work, thrive and have successful careers. If he can do that, he will make a significant contribution to our success at the next general election. Not to put any pressure on him, but I believe that getting this right—reflecting on what I said about the issue being such a salient one—puts on his shoulders the enormous burden of getting the right answer so that our constituents have dental provision that works.

Question put and agreed to.


That this House has considered dental services in the East of England.

Sitting suspended.