My Lords, nationally, access to NHS dentistry remains high, with 22 million adults and 7 million children seen by a dentist in the 24 and 12-month periods ending 31 December 2018 respectively. However, we know that there are areas of difficulty and more work remains to be done. NHS England, in its role as commissioner, is responsible for commissioning NHS dental services to meet local need and is actively looking into dental access issues.
That is rather a disappointing Answer, although it certainly ties in with my experience: it was declared in Manchester that no children could have operations done under general anaesthetic because all slots were taken for the clearance of baby teeth. When I saw that, I wrote to the Mayor of Manchester, who has great experience in the field of health from when he was in the House of Commons. I did not even get an acknowledgement, so after a time I wrote again, saying that perhaps my letter never reached him so I was resending it, but to this day I still have not had an acknowledgement. The press reports get worse and worse about the shortage of these possibilities.
I am very sorry to hear of my noble friend’s experience with the Mayor of Manchester. Children’s oral health is now better than it has ever been, with more than 75% of five year-olds in England being decay-free, which we welcome. However, the number of children requiring tooth extraction remains a concern. It fell slightly between 2016 and 2017-18, which we welcome; however, we recognise that there is much more to do. That is why the NHS outcomes framework is working to ensure that we perform better, with much work being done to target improved oral health of young people, with the Starting Well core framework and Starting Well pilots in the 13 areas of greatest deprivation.
My Lords, in Portsmouth there are 20,000 patients without a dentist, due to the closure of three practices. In Cornwall, 22,000 people are on the waiting list, having to wait an average of 529 days before they get an NHS dentist. The noble Baroness is quite right that there are some serious problems to address here about access to NHS dentists. I should like to know exactly how those areas in desperate need, such as Portsmouth, will be tackled. Secondly, how many of the babies, children and young people included in those numbers currently have no dental care whatever?
As I said in my previous answer, children’s oral health is better than it has ever been. This is not to say that there is any complacency or acceptance of where we are. We recognise that while access has significantly improved, there are still areas where NHS England needs to do more to meet local need. NHS England is responsible for helping patients who cannot find a local dentist. Those in that situation should contact NHS England’s customer contact centre for assistance. Things that are being done to improve this include the introduction of new nationally flexible commissioning, which can help national commissioners commission a wider range of services from dental practices, and the testing of a new, reformed dental contract, which we think will make the profession more attractive for new dentists.
My Lords, patients’ dental fees in England have been increasing at an unprecedented rate. These charges are discouraging patients from seeking treatment; they are made to think twice before treatment. Delayed treatment means that they end up seeking free help for dental pain from their GPs and the local A&E, piling huge pressures on other parts of the NHS. Will the Government take urgent action and start proper investment in NHS dentistry to end these extortionate dental fee increases?
The noble Baroness raises an important point. Patient charges are an important contribution to the overall costs of the NHS, and they were driven by some really difficult financial circumstances in the NHS, but she is right that it is critical that no one be deterred from seeking care by the cost. As part of this year’s uplist, the Government and the department have committed to looking further at evidence as to whether patients are being adversely impacted so that this can be taken into account in next year’s—and any future—decisions.
My Lords, the Care Quality Commission recently published a pretty damning report on dental care for people in residential care and nursing homes; most of these people do not have access to a dentist. What are the Government doing to ensure that people in residential or nursing home care get regular dental treatment?
My friend the noble Countess, Lady Mar, raises a vital area. Overall care for those in care homes, whether healthcare, mental health care or dental care, must be provided in a suitable manner. This is being considered in the social care Green Paper.
My Lords, I declare an interest as a former chairman of the British Fluoridation Society. Does the Minister agree that prevention is much better than cure, and that you can prevent the need for dentists through a substantial increase in the use of fluoride in our water supplies? Is she satisfied with the progress being made on fluoridation of water? If not, what plans does she have to encourage it?
The noble Lord is quite right: prevention is always better than cure. That is why the programme for oral health improvement in both the NHS long-term plan and the dental contract being tested focuses on a more preventive approach to oral care. Water fluoridation is obviously a very effective way of improving oral health, particularly for children. According to the 2012 Act, it must be a local decision supported by Public Health England in the lead. We want to see more decisions. PHE’s guidance on delivering better oral health sets out clear expectations on this, but there are also other ways in which fluoride can get to children. One is through fluoride in toothpaste, which is now at effective concentrations; the other is that all dentists are expected to deliver fluoride to teeth directly, at clinically appropriate intervals, to all children in their care.