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NHS Dentistry

Volume 818: debated on Monday 31 January 2022


Asked by

To ask Her Majesty’s Government, further to Healthwatch England’s report What people have told us about NHS dentistry, published on 20 December 2021, what steps they are taking to address the issues faced by those attempting to access NHS dental care.

Practices are currently prioritising patients based on clinical need, and a new activity threshold has been set at 85% to safely increase access. A one-off additional £50 million, recently secured for NHS dental services this financial year, will urgently give more people, including children and others who are vulnerable, access to vital dental care. We are working with the NHS, Health Education England and the British Dental Association to improve access through dental system reform.

My Lords, the £50 million one-off payment for 350,000 appointments is a drop in the ocean compared to the 38 million appointments that have been lost during Covid. The Healthwatch report shows that parents are having great difficulty accessing NHS dentistry for their children, who may be suffering pain and unable to eat, and we know about adults who are indulging in self-care because they cannot find an NHS dentist. When will the Government get to grips with this problem and develop a proper strategy for dealing with it?

As the noble Lord will know, anyone can have access to an NHS dentist—they do not have to be registered with the practice in question—and when they are unable to find a practice, they can ring 111 to get information. In addition, over 700 urgent dental care centres remain open across the country.

My Lords, dentistry is facing an unprecedented challenge. We will not overcome the enormous backlog of treatment and the rising wave of dental staff leaving the NHS unless dentists have a seat at the table and a voice when commissioning decisions are made which affect them and the millions of patients they treat, especially children, for whom tooth decay is the number one reason they are admitted to hospital. Will the Minister tell us whether and how dentists will be represented in the new integrated care systems?

I thank the noble Baroness for that question. Following the Bill there has been a debate about the integrated care system—both the integrated care boards, and who should be there as a right, and the integrated care partnership, which works with local authorities and others, including place-based organisations and primary care organisations. We hope that they will all have a voice via the ICP.

My Lords, is the Minister aware that so many of the major hospitals are now closing their dental facilities after hours? These facilities were for parents of children who suddenly develop pain—many children hide problems with their teeth until it is so painful that they cannot stand it anymore. It is not good enough: the hours that dentists are able to work and the fact that, on the whole, there is only one dentist per surgery, mean that, every time, they must wait at least six minutes after they have finished with a patient before they can even consider seeing the next one. If more of them could work together, something could be done about this limit on vacancy time—I have brought this up before. The dental people brought forward the idea that, if a certain type of oxygenator were provided, the other would not be needed. Can something more be done?

My noble friend raises a very important point. I am sure many people understand that, when we first became aware of Covid, one issue was that, by its very nature, dental care can generate aerosols from the mouth, which presented a specific risk for dental activity. Once more was understood about Covid and its airborne spread, practices reopened in 2020 and were asked to provide urgent dental care. In addition, we have opened 700 urgent dental care centres to help patients in urgent need. You can also call 111. We are also looking at the longer-term reform of dental practice, and are in conversation with the BDA and others.

My Lords, the target-based NHS system was already unfit for purpose before Covid-19 and is completely incompatible with providing safe and sustainable services to patients as we emerge from the pandemic. Does the Minister agree that dentistry and the state of people’s mouths is becoming a serious issue which shows health inequalities? We are heading towards people who cannot afford dentistry, and their children, having rotten teeth. This is what the Minister must acknowledge and build into the health Bill that is before the House now.

We are very concerned about the potential inequalities. NHS England and NHS Improvement are very mindful of the risks of widening health inequalities. That is why, in their guidance, they specifically ask dentists to focus on providing urgent treatment for vulnerable groups and children and to delay planned care. NHS England has provided a flexible commissioning toolkit to local commissioners to help focus the available capacity on those who need it most and to reduce oral health inequalities.

My Lords, an important point arising today is the absence of dental care for children. This problem has worsened. What specific measures have the Government got in mind to accelerate dental care for children?

My noble friend raises a very important point. We have asked NHS dental practices to meet as many prioritised cases as is safely possible. They are currently prioritising urgent care for vulnerable groups, including children. We hope that the £15 million of additional funding that was recently announced will be targeted at those most in need, including children. If they cannot get access to urgent dental treatment, they can call 111 for assistance and look at the NHS website to identify an NHS dentist.

My Lords, the report of Healthwatch England states that, of all the areas in the country with lack of access to NHS dentistry,

“the worst affected is Devon, as there are currently no practices showing as taking on adult or child patients.”

Can the Minister assure the House that, as part of the Government’s levelling-up policy, rural communities in Devon and elsewhere will not be further disadvantaged and will have access to NHS dental services?

I am sure the right reverend Prelate will acknowledge that one of the things we have learned from Covid, the lockdown and its subsequent impact has been about the health inequalities that exist across the country. Both my right honourable friend the Secretary of State for Health and I believe strongly in tackling inequalities; that is one of the reasons why we are keen that this comes to the forefront of the forthcoming Health and Care Bill. But we acknowledge the inequalities and are working with the NHS and the BDA to address them.

My Lords, is the Minister aware that, as a child of a working-class family in the 1940s, I was given a periodic free check on my teeth, as were all children alongside me at my school? Is it not a shame now, when we talk about inequalities and levelling up, that such a facility is not available for working-class children in this country? When will the Government, with their policy of levelling up, set out a programme that ensures an annual check on the teeth of all schoolchildren, regardless of their background?

I thank the noble Lord for that suggestion, which I will take back. The BDA, the NHS and the Department of Health and Social Care are well aware that we need to tackle a raft of health inequalities in this country, including in dental care. The Covid pandemic has highlighted some of those inequalities, and so we can focus on them.

My Lords, I welcome the Government’s much-needed boost and the extra £50 million. I particularly welcome the allocation to my area, the north-east and Yorkshire, of over £9 million. One of the six aims of the national contract reform is regarding dentists. With the current contract, how will the Government set a date for the end of the UDA framework? When might it be rolled out to help with recruitment and retention of NHS dentists, as there is urgent need for reform?

We are looking at long-term reform and are in conversations with the BDA, especially around looking at the current UDA system and understanding its complexities. We have a number of different plans for dentistry, looking not only looking at its contracts but at recruitment and retention of people locally and from overseas, where it is ethical to do so.

My Lords, at present, very few dentists in Cornwall take NHS patients at all. There is very poor public transport and travel distances to access a dentist are invariably more than 20 miles. When does the Minister anticipate patients in Cornwall—and in Devon, as we heard—being able to access NHS dentistry?

The briefing I have is that, if you are unable to access an NHS dentist, you should be able to access one at one of the 700 urgent dental care centres or ring 111 for advice. If that is not happening, I hope noble Lords will write to me, so I can look into it.