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Reforms to NHS Dentistry

Volume 731: debated on Thursday 27 April 2023

I beg to move,

That this House has considered progress on reforms to NHS dentistry.

I thank the Backbench Business Committee for once again granting this important debate, and my co-sponsor, the hon. Member for Waveney (Peter Aldous), for all his work in helping to secure it.

When preparing for the debate, I thought it was useful to consider and reflect on the foundations of our NHS in the Beveridge report, which was published 80 years ago last November. Although it would be an understatement to say that the world has changed since its publication, the identity of this country is still proudly centred around our national health service—an idea so powerfully contained in the pages of the report. For the great British social reformers of the 20th century, dentistry was not some Cinderella service of secondary importance. Beveridge concluded that no one could seriously doubt that a free dental service should become as universal as a free medical service. Eighty years after the report’s publication, it is time that the House reaffirmed our commitment to universal dental care in this country.

It is worth noting that the Beveridge report, in its proposition for universal access to NHS dentistry, was published by a multi-party coalition Government. As I stand here today, Members on both sides of the Chamber will agree that the crisis in NHS dentistry deserves the same cross-party attention that it was afforded 80 years ago, because the system has decayed: access has fallen to an historic low, and inaction over the past 13 years has caused untold damage. There can be no more half measures or excuses. Now is the time to establish a new preventive dental contract that is fit for the 21st century.

The words of my campaigning over the past eight years now serve as a compendium of forecasting doom. In 2016, I warned of a mounting crisis and drew the Government’s attention to a digital report warning that half of dentists were thinking of leaving the profession. Between 2017 and 2019, I warned that 60% of dentists were planning to leave NHS dentistry. In 2020, after years of repeated warnings, I once again informed the Government that 58% of the UK’s remaining dentists were planning on moving away from NHS dentistry within five years. The Government once again fudged and ignored, and more than 1,000 dentists left the NHS.

This NHS dental crisis has been a devastating slow-motion car crash of the Government’s own making, yet year after year, Minister after Minister, they have assured me of their commitment to reform. Last year, when I pressed the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), for action on this matter, she informed me that she had started work on a dental contract reform. However, just yesterday, we became aware that after 13 years in power, the Government are once again starting with an announcement of a plan to publish a new plan to improve access to NHS dentistry—a plan for a plan.

We would all welcome further clarification on what that plan might involve. I can only hope that sustained campaigning on this issue by me and other Members will mean that the plan will result in positive change for my Bradford South constituents.

I congratulate my hon. Friend on securing this excellent and incredibly important debate. In Newcastle, where NHS dentistry access has become almost impossible for so many of my constituents, a whole generation of young people and children are growing up without access to an NHS dentist. Does she agree that that is causing immense suffering now and storing up not only pain and suffering but additional costs for the future?

My hon. Friend makes an important point. I will specifically cover access to NHS dentistry for children later in my remarks.

On the Government’s plan for a plan, experience suggests that positive change for my constituents may well be wishful thinking. My constituents are suffering and take no solace whatever from the Government’s commitment to plan for a plan for reform. The contract has been in place since 2006, and the Government have been undertaking a review of the process since 2011. After 12 years, it is still a work in progress.

The British Dental Association has shown that over half of dentists have reduced their NHS work since the start of the pandemic. Official workforce data counts people, not how much NHS work they do compared with private work. Does she agree that it is important that the Government collect that data?

I absolutely agree with the hon. Member’s important remarks. Collection of data is paramount for solving the issue.

The dodging of responsibility for more than 12 years is nothing short of a disgrace. Now, we all bear witness to the human consequences of this crisis. The victims of Government negligence are—as they almost always have been—the most vulnerable people in our society. In Bradford, 98% of dentists are now closed to NHS patients. As I informed the Prime Minister just last month, 80% of practices are now refusing to accept children as new NHS patients.

The lack of access is having crushing consequences. In the financial year of 2021-22, 42,000 NHS hospital tooth extractions were carried out for 0 to 19-year-olds—an 83% rise on the previous financial year. A dental nurse has recently spoken of routinely extracting up to 10 teeth from a single child, so children are routinely losing half their teeth. This dental crisis is now ultimately a crisis of inequality. The rate of tooth extraction is more than three times higher in Yorkshire and the Humber than in the south-east of England. Children living in our country’s most deprived communities face an extraction rate three and a half times greater than those living in the most affluent areas.

In care homes for the elderly, the access crisis has been just as devastating. In 2019, 6% of care homes reported that they were unable to access NHS dental care services, but by 2022, that figure had risen more than four times to 25%—a quarter of all care homes.

As this Conservative Government continue to mull over minor reforms, they fail entire generations of people, who deserve a reasonable standard of care. No more are the cradle-to-grave principles of the NHS.

A 21st-century Britain requires a 21st-century approach. We need more than mere revision of the contract. My right hon. and learned Friend the Leader of the Opposition has spoken of the need for a new healthcare system that is just as much about prevention as about cure. It is a concrete fact that no dental treatment is stronger than protecting a healthy and original tooth, but in 2021-22 tooth decay was again the most common reason for hospital admission of children between six and 10 years old. For zero to 19-year-olds, hospital tooth extractions cost our NHS a shocking £81 million a year. In 2022, instead of children visiting the dentist on a regular basis, it cost our NHS an average of more than £700 for a single minor extraction of a child’s tooth in hospital.

We are paying for the cost of catch-up with our failure to prevent tooth decay, so prevention should be at the heart of our Government’s agenda for dental reform. We owe that to the generations of people currently being let down by the system. This country once had a strong school dental service. With the current shocking rates of tooth decay among children, now is the time to resurrect that policy as an interim prevention measure. It is not only the right thing to do but a sensible option for the country’s finances. Care homes would benefit from a dental contract that commissions stronger community dental services, as used to happen.

By using integrated care systems, upskilling care workers, and further involving local authorities, access can be increased and the pressure on dental services reduced. Prevention really is better than cure. We have a duty to ensure that taxpayers’ money is spent effectively in areas right across the country. A decade of savage cuts by the Tory Government has left long-term damage. An estimated £880 million a year is now required just to restore to 2010 levels of resources. There will be no escaping the need for more investment, but it must be thoughtful investment. One answer could be the introduction of a prevention-focused capitation-type system, where lump sums are provided to NHS dental teams to treat sections of the population.

Successful targeted investment is possible, and in 2017 I developed a project in Bradford with the former Health Minister, the hon. Member for Winchester (Steve Brine). I thank the hon. Member, who is now the Chair of the Health and Social Care Committee and who is present in the Chamber. He worked with me on the pilot scheme, which invested over £250,000 of unused clawback over three years into my constituency of Bradford South. That went straight back into local services and ensured that patients were able to access roughly 3,000 new NHS dental appointments in an area with high dental deprivation—targeting extra resources straight into an area where they were needed.

Although that was never meant to be a long-term solution, it proved that targeted investment is possible. Where there is a will, there is a way. With a staggering 10% of this year’s £3 billion national budget for NHS dentistry set to be returned, the system is clearly broken. Taxpayers’ money is returned not because people are not desperate for NHS dentists, but because the Government continue to push an underfunded and unworkable system. They lack the will to act and to find a way forward to protect dental health in this country. Now is the time to put “national” back into NHS dentistry.

The Government may once again list the challenges that stand in the way of re-establishing a truly universal dental care system. We are in a time of extraordinary change, with unprecedented cost of living crises, war on the European continent, and a society impacted by a deadly virus. Our health system is undoubtedly challenged, but 80 years ago the Conservative-Labour coalition Government published a guiding principle of NHS dental reform, just as this country fought for its very freedom and independence. In Sir William Beveridge’s own words:

“A revolutionary moment in the world’s history is a time for revolutions, not for patching.”

It is time for real change, not empty promises. This is the time for a Government dedicated to acting in the public good, to revitalise and resurrect NHS dentistry once again, ending the shoddy record of this Government’s patching of our NHS dental services.

It is a pleasure to follow the opening speech of the hon. Member for Bradford South (Judith Cummins), who has brought back many happy memories of our time together when I was public health Minister. She has been consistent on this issue over many years.

Today’s debate is timely; it comes in a week when the Health and Social Care Committee, which, as you rightly say, I am privileged to chair, Mr Deputy Speaker, held a crucial oral evidence session with the Minister, who is in his place on the Front Bench.

Dentistry is a subject close to my heart from my time serving as public health Minister in the Department of Health and Social Care. It is also one of the Select Committee’s top priorities. We launched our inquiry on the subject shortly after I became Chair in November last year. We are looking at what steps the Government and NHS England should take to improve access to NHS dental services, and at further reform of the NHS dental contract. Rarely has an inquiry been more needed or welcome. It is clear that there are huge problems facing NHS dentistry. I am sure that every colleague, whether in the Chamber today or not, is familiar with stories of constituents having trouble accessing NHS dentistry. I am no exception to that, as a constituency MP; neither are my family, as patients.

One of the many submissions that the Committee received talked about people extracting their own teeth with pliers, something that should not happen in the 21st century. The problem is particularly acute in some areas of the country—we will hear talk today about dental deserts, I am sure—and among some groups of people, but challenges and capacity issues are experienced across the board. Our inquiry received a wide range of written evidence, including from nearly 30 local Healthwatch groups. We also held two detailed oral evidence sessions examining the problem and, of course, potential solutions. We heard from Healthwatch that the majority of complaints that it receives at the moment are about dentistry. Day in, day out, local Healthwatch groups receive emails and calls about problems accessing an NHS dentist. That is reflected in other evidence that we received; I know it is not easy for some to hear this, but as a Select Committee Chair, I can only follow the evidence that I receive. We have also heard again and again about the challenge of recruiting and retaining NHS dentists.

The Government have, I am pleased to say, started to act, and to pick up where some of the previous tinkering reforms left off—reforms for which I take some of the credit, and some of the responsibility; I did not fundamentally reform the dental contract during my time as dental Minister, either. In July last year, the Government announced several changes to the 2006 dental contract, including a change to the way that units of dental activity are awarded. They also advised longer recall intervals for adults with good oral health, in line with National Institute for Health and Care Excellence guidelines.

In our first evidence session, we heard from Shawn Charlwood from the British Dental Association, who told us that the reforms to the dental contract represented tweaks, rather than the fundamental reform that is needed. He said:

“In essence, what we are doing at the moment is rearranging the deckchairs on the Titanic while the service slowly slips into the sea.”

To be fair to the Minister, for whom I have a lot of respect, and who spoke really well before the Select Committee earlier this week, I was delighted to hear him acknowledge in that session that he wants “quite fundamental reform” to the dental contract; that has to be right. He argued that the existing reforms were “welcomed”, but noted that they were “only a start”. That was good to hear, and it was well covered by the media on Tuesday evening. I worry, though, that even if significant reforms to the NHS dental contract were made tomorrow, it would be too late, or an extreme challenge, to bring back those dentists who have already left the NHS dental workforce. It is really hard for people to make that decision; they came into dentistry to work in public service. I fear that once they have made the change, it will be final for them, and it will be very difficult to get them to change their mind. I touched on that with the Minister earlier this week. Perhaps he can tell us a bit more about what he will do to address that issue of return.

In our session, I asked the Minister about his ambition for NHS dentistry. Tony Blair famously said in his 1999 conference speech that his ambition was for everybody to have access to an NHS dentist within two years. It never happened, but it was a clear ambition; I give him credit for that. The Minister said that “the No. 1 thing” on his mind was improving access to a dentist for those who do not currently have that access—quite right. But when I pressed him on whether that meant that everyone would have access to an NHS dentist, he said that he wanted everyone who needed an NHS dentist to be able to access one. That is welcome; it is a repeat of that ambition. It is good that the Government have that ambition—although the key, obviously, is whether and when they deliver on it. I will ask him to expand on that when he sums up.

The Minister also talked about making NHS dentistry more attractive to dentists, which is clearly crucial. He said that the problem is not a shortage of dentists per se, but a shortage of dentists undertaking NHS dentistry. The figures certainly bear that out. Our work has highlighted the point that there is a problem with data as well. There are headcounts for the number of NHS dentists, but we do not know whether they are part-time or full-time and how much NHS activity they do. That gap needs closing.

We need to know about the workforce available to deliver the Minister’s ambition; until then, it is unlikely to be achieved. The Minister reminded us this week that the Government are in the final throes of drawing up their workforce plan, which I understand will include dentistry. That is good. I hope that that plan will be published in the not-too-distant future—maybe once we get past a certain electoral event next Thursday.

I also want to touch on overseas recruitment. According to the General Dental Council, almost a quarter of dentists registered in the UK gained their dentistry qualifications overseas. That is fine, but for those dentists the primary means of assessment is the overseas registration examination, or ORE. The pandemic created a backlog in the number of overseas dentists waiting to take their exams—that is the good part. The ORE is subject to practical and legal constraints that make it difficult to adapt capacity to meet changing demands for places. A recent list of changes should help ease the problems, but are unlikely to make a significant difference in the short term; the Minister can correct me if I am wrong.

One of my constituents, Christopher Hilling of SpaDental Group, who has spoken to me about the subject on several occasions, has outlined the difficulties he is facing. He has a number of dentists waiting for the opportunity to sit the ORE exam, but he has struggled in the past to get accurate information about when the exams will even take place. He is concerned that he might lose more of his overseas dentists due to a lack of exam opportunities and of General Dental Council communication about when those dentists might be able to practise in the UK. Given the delay in the taking effect of changes to overseas registration, what are the Government doing to support the GDC, especially with regard to clearing the backlog of applications?

I was encouraged to hear this week the Minister and chief dental officer Sara Hurley talk in our evidence session about the importance of driving forward work on prevention. That is a passion of mine, and colleagues will know that it is a major inquiry that the Select Committee is undertaking. One of our witnesses at this week’s session talked about the importance of early prevention work, focusing on young children. The expression she used was “getting gums on seats”, and that is a great place to focus. We must get more gums on seats, Mr Deputy Speaker—that is the catchphrase for today’s debate.

Finally, I want to talk about integrated care systems, on which the Select Committee has also done a lot of work. We heard in our session about some of the changes that have come into effect as a result of integrated care boards taking responsibility for commissioning dental services. Some were early adopters, including the Hampshire and Isle of Wight ICB that looks after my constituency. But the boards do not include dentistry. I asked the Hampshire ICB representative, who appeared as one of our witnesses this week, about that. They said that they do not want to make their boards too big. I find that disappointing, surprising and unhelpful. To be fair, some ICBs have managed to include dentistry on their boards without any problems; if they can do it, all should. It sends a strange message to the dental profession if it is not included on integrated care boards. It is a great opportunity for flexibility in commissioning, which is why we created the boards. Dentistry needs to be within them.

To conclude, the picture is bleak, but it does not have to be—it is also improving and there are grounds for optimism. We have a Minister who understands this subject inside out and is committed to providing access to NHS dentists for everyone who needs it and a thorough overhaul of the current system and the contract, as he confirmed to us this week. In integrated care boards, we have the possibility of being able to target local services to local needs. But the time for action is running out. I hope the Minister can outline in his response to the debate that he recognises the urgency of the situation, and that, when my Committee produces its report on dentistry, he will read it and act promptly on our recommendations.

Order. I do not intend to put a time limit on the debate at this stage. Colleagues will have noticed that the Chairman of the Select Committee was commendably brief; if everyone emulates that, it should be possible for everybody to have their say without putting a time limit on. However, there is another debate that it is intended should follow this, and I hope that that will have a hearing as well.

Sadly we have been here before, time and again, and this Conservative Government still refuse to act, consigning yet another public service to the scrapheap. Once again my constituents are paying more and getting less under this Tory Government. I thank my hon. Friend the Member for Bradford South (Judith Cummins) and the hon. Member for Waveney (Peter Aldous) for securing this very important debate. We need this crisis to be urgently addressed.

It cannot be denied any longer: we face an existential crisis in NHS dentistry. It really is at breaking point. The latest area in my constituency to be affected is Pennywell in Sunderland, where the Bupa branch will close its doors in June, affecting 7,800 NHS patients. Not a week goes by without correspondence from a constituent in dire need, in despair and often in acute pain, unable to find an NHS dentist and unable to afford a private one. The nearest NHS practice accepting new patients for those constituents is in South Shields, nearly an hour away from Pennywell on public transport. That is completely unacceptable.

We cannot accept dental care becoming a luxury available only to those who can afford it. To add insult to injury, during this Conservative cost of living crisis the Government have hiked dental care prices by 8.5%. Those choices are being made by the Prime Minister and his billionaire buddies, who have never had to worry about the cost of anything such as this and do not understand the effect that that record increase will have on the cost of living pressures facing ordinary people in my constituency and across the north-east. The hike will not put a penny into NHS dentistry, either; it will just force millions to reconsider whether they can afford necessary dental treatment. We risk the horror of DIY dentistry becoming the norm.

Across 13 years, the Conservatives have chosen millions of pounds of short-term cuts, but the long-term cost of health inequalities is a price my constituents will pay for generations. The Government chose not to listen to dentists and they knew that the woefully inadequate NHS dentistry contract was not fit for purpose. That is not a new problem. Make no mistake, not only are the Conservatives allowing this crisis to worsen, but their inaction suggests to me that this is actually the result they desire.

My constituents are furious, as am I. They are either forced to pay over £100 more for the exact same NHS care they could get under a Labour Government in Wales or they are left unable to access any treatment at all. We need a Labour Government who will prioritise healthcare access for all, clear up 13 years of Tory underfunding and mismanagement, and abolish the Prime Minister’s precious non-dom status in order to provide the treatment and dental care that the British people deserve. The people of Sunderland and Washington should not have to suffer because of Tory chaos and managed decline that leave dental care a luxury for the few.

I thank the Backbench Business Committee for granting this debate. It is the third in a trilogy that the hon. Member for Bradford South (Judith Cummins) and I have secured, and that in itself tells a sad and sorry story. Complaints about access to NHS dentistry have been the No. 1 item in my inbox for getting on for two years and, while there is a particular challenge in Suffolk and Norfolk, I am conscious that this is very much a national crisis.

The fundamental causes of the collapse of NHS dentistry go back over 25 years, with a gradual withdrawal of funding by successive Governments and the poorly thought-through 2006 NHS contract. Covid was the final straw that brought the edifice crashing down. The challenge now in front of us is to put NHS dentistry on a secured long-term footing, but in a way that enables our constituents, many of whom are in acute agony, to see a dentist straight away.

I thank my hon. Friend for his part in securing successive debates. On emergency dentistry, in my constituency people are asked to travel an hour and a half by public transport for emergency treatment. Great changes have happened in the last three months, but we must improve on that in the next three months so that that no longer happens.

I think we all have tales of constituents who have had to go a long way to see an NHS dentist, if they can find one at all. In Lowestoft, people have had to travel to Basildon, which is not straightforward by public transport.

The task of delivering the plan for NHS dentistry is on the shoulders of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien). From my perspective, the purpose of the debate is to be constructive and to provide him with ideas and suggestions that could be included in his plan. It should be ambitious, visionary and innovative, not just a sticking plaster to get us through the immediate crisis.

To achieve that, and to ensure that our constituents are able to see a truly local NHS dentist quickly, three immediate short-term challenges need to be addressed. First, the up to £500 million due to be clawed back into the main NHS budget should remain available exclusively for NHS dentistry this year. Secondly in the short term, there is a need to recruit more dentists from overseas to address the acute shortage of NHS dentists. I acknowledge the measures that the Government put in place, as the Minister set out in his answer to my question on Tuesday, but more needs to be done to eliminate the queue as quickly as possible. Thirdly in the short term, the 2006 NHS contract needs replacing, and we must move completely away from the discredited UDA system.

In the longer term, the ingredients for rebuilding NHS dentistry and transforming it into a system fit for the 21st century of which we can justifiably be proud, are as follows: first, as I mentioned, we need to put in place that new contract, and address the current contract’s fatal flaw. It should facilitate a focus on prevention and should motivate dentists and dental practitioners to work in rural and coastal areas such as Suffolk and Norfolk. Secondly, a long-term fair funding system should be put in place. I acknowledge that Governments do not like ringfencing, but NHS dentistry must be provided with an assurance that the funds are available to make the long-term strategic investment that ensures that service will be both resilient and robust.

Thirdly, the recruitment and retention arrangements need to be significantly improved. Dentistry must feature prominently in the Government’s forthcoming NHS and social care workforce plan. Many colleagues, including myself, have highlighted the need for dentistry schools in their areas. Locally, both the University of East Anglia and the University of Suffolk have come forward with proposals. In East Anglia, my sense is that a vacuum must be filled, but I am mindful that a strategic approach right across the country needs to be pursued on where dentistry schools are best located. I would be grateful if my hon. Friend the Minister could commit to carrying out such an assessment. In the meantime, I urge him to immediately support the University of Suffolk’s dental community interest company, which has the twin benefits of providing much needed NHS dental treatments and training in such areas as dental therapy and hygiene.

There is also a need to improve the accountability and transparency of NHS dentistry. The move to integrated care boards that happened throughout much of the country on 1 April, including locally with the Norfolk and Waveney integrated care board, is very much a step in the right direction. In our local area it is taking steps to put in place a long-term plan and to ensure proper representation from dentists.

Finally, at the heart of any health strategy must be prevention. Such an approach will help spare people from hours of agony and ultimately impose less of a burden on the public purse. I will briefly outline three possible strands to intervention. First, the Government must press ahead with plans to fluoridate the water supply. All the evidence is that that will bring significant results. Secondly, we must come up with a strategy for promoting better oral healthcare for children. In 2021, with support from local councillors, Lowestoft Rising provided free toothbrushes and toothpaste to the under-sevens. The take-up was high and the feedback was extremely positive, and it recommended that such products should be exempted from VAT. I urge my hon. Friend the Minister to promote that policy with the Treasury. Thirdly, as we have heard, we must not forget the elderly, particularly those in care homes, and that must be covered in the new dental contract.

In conclusion, the emergence of dental deserts across the country, which are now joining up to create an area of Saharan proportions, is a crisis that must be tackled head-on with proper funding, root-and-branch reform and bold and imaginative policies. My sense and my hope is that the Minister is up for the challenge, and I look forward to the publication of the Government’s NHS dentistry plan. As I have said, this is the third Backbench Business Committee debate that the hon. Member for Bradford South and I have secured, and I hope that a fourth will not be necessary.

I congratulate my hon. Friend the Member for Bradford South (Judith Cummins) and the hon. Member for Waveney (Peter Aldous) on their persistence. Let us hope it starts to pay off and they do not need that fourth debate on the subject.

As my hon. Friend the Member for Bradford South has said, NHS dentistry is in crisis. There is a recruitment and retention crisis, which the Government have allowed to develop and grow to the point that many of my constituents in Hull North have been left with no access to an NHS dentist. We all know what needs to be done to fix the problem, but the Government have continued to drag their feet over the need for a new dental contract, for new dental schools and for expanding the number of dentists that we have in this country. It is almost like they have hoped that those who can afford to do so will go private, and those who cannot will just sit and let their teeth rot.

Right now, people in Hull North are paying for the Government’s time wasting with their dental health. One constituent has told me of waiting lists at a local NHS dentist of more than 1,500 people, and another has tried to call every NHS dentist within 30 miles, but the earliest appointment they have available is January 2025. A concerned parent tells me that their 11-year-old has not seen a dentist since they were six years of age, and their four-year-old has never seen a dentist, despite being on several waiting lists across Hull since they were a baby. I have had headteachers tell me that children do not go to school because of dental pain and being unable to get access to a dentist.

In Yorkshire and the Humber, as my hon. Friend referred to, in the year ending 2022, 4,560 children under the age of 10 were hospitalised for tooth extractions. That shocking figure includes more than 1,500 babies and toddlers under five with cavities so bad that they have had to have their teeth removed. The situation is shocking and considerably worse in Yorkshire, the Humber and the north-east than elsewhere in England.

What we need are more NHS dentists. We need to recruit more NHS dentists, and if we want to tackle the dental recruitment problems, we obviously need to train more NHS dentists. Years ago, the University of Hull, in partnership with the University of York—I am very pleased to see in her place my hon. Friend the Member for York Central (Rachael Maskell), who represents that university—put in a joint bid for a dental school.

It was to go alongside the brilliant Hull York Medical School, which had been established under the Labour Government when there was a real need for more doctors to be trained. The idea was that we would “grow” our own doctors from the area where the medical school was based. Let us imagine what would have happened and the situation we would be in today if we had been allowed to have that Hull York dental school.

After all the dither and delay that we have been talking about, we can correct our course today. There is plenty of existing support and the capability to deliver a high-quality training facility in the Humber area, which could directly serve one of the worst affected regions in the country, but we need the Government to step up to give us the resources and provide the funding for places.

I am, however, grateful to the Under-Secretary of State for Health and Social Care, the hon. Member for Harborough (Neil O’Brien), for agreeing to meet me after I raised this issue in Tuesday’s Health questions. I also commend him for the speed with which his office contacted mine to arrange that meeting. Getting a ministerial meeting that quickly is unusual these days, so I thank him for that. A Hull dental school could be part of a long-promised workforce plan for the NHS. It could mean that we have sufficient UK-trained, highly qualified dentists and, with the necessary changes to the dental contract, a decent reward for their hard work. We also need to remember that we are competing in a global market for dentists. I was struck by the fact that if a dentist goes to Canada, they receive a £63,000 golden hello and the offer of residence. That is clearly tempting for many dentists who train in this country and feel they are overworked and get too little pay.

To date, the Government have been missing in action, dentists have been voting with their feet and patients in Hull have been paying with their teeth. We need more NHS dentists. Let us train them. Let us get on with it and do it now, and let us do it in Hull.

I, too, thank everyone involved in securing this important debate, including the hon. Member for Bradford South (Judith Cummins), who so eloquently laid out the terrible state of NHS dental services in this country today and the desperate need for reform of that terrible Labour 2006 contract, which, in effect, destroyed NHS dental services in the UK. That is why I welcome the general direction of the Government’s plans for NHS dental reform, as outlined in the statement on 19 July last year. It is a good start, but we must do more. We must take this opportunity to not only put NHS dentistry back on track after disruptions during covid, but ensure we create a long-term sustainable plan to enable good NHS dentistry for all who want it.

I wholeheartedly agreed with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), when she said that

“the contract is the nub of the problem; it is currently a perverse disincentive for dentists to take on NHS work.”—[Official Report, 14 June 2022; Vol. 716, c. 135.]

That contract is the primary structural issue in NHS dentistry at the moment and has been since 2006. I have spoken to a dentist who owns 17 NHS practices across England, including two in my constituency. They are struggling financially to keep those practices going, but are totally committed to providing NHS dental services to my constituents and so push on despite the difficult environment.

No, I want to make progress.

That dentist’s many problems include the unfair way UDA rates are calculated, which ironically disadvantages areas such as Hartlepool, which have severe health deprivation. That has knock-on effects on their ability to employ staff at competitive rates and leads to a reliance on expensive locum dentists, further stretching the viability of the business. Dentists find a way to make their practices work with access contracts, but the lack of certainty they face because of the difference in competences between different integrated care boards adds further issues. For example, under one ICB’s access contract they were provided with clarity for a two-year period, but under our ICB they were still waiting to hear at the end of the month whether a contract would be renewed four days later. Not only did the survival of the practice and the jobs of 30 staff depend on that contract, but the dental care of 20,000 patients also depended on it. Thankfully it was renewed, but it is unacceptable that the ICB provided them with no indication of whether the contract would be renewed so close to its end. No business can run like that.

For areas such as mine that have a desperate need of NHS dental services, we should be fully valuing and supporting good dentists like that to ensure the survival of their essential services. I urge the Minister to consider radical reform of the way in which NHS dental service contracts are remunerated, so that established NHS dentists continue to offer NHS services to new patients. I would also like to see changes to stop newly qualified dentists being tempted into private work. It costs the taxpayer a significant amount of money to train a dentist, but they are not then required to work in the NHS. It is only fair on working people who have subsidised these professionals to train in their chosen career to expect a degree of payback. I would therefore welcome the Minister looking into the possibility of a staggered mandatory amount of NHS work per year for the first few years after qualification.

Good dental care starts with good preventive care, and I want to see a day when everyone who wants it can access NHS dental services for all routine procedures and check-ups, not just emergencies, without the difficulties that my constituents are currently facing.

Across Durham and the whole country, dentistry is in crisis. It is a system in need of urgent reconstruction, not tinkering. To be clear, the problem has not been caused by NHS workers or dentists. It has been caused by the Conservative Government, who have ignored the concept of prevention rather than cure. Dentists have told me that the key issue is the chronic underfunding of NHS dentistry. Let us not forget that it has been subject to cuts unparalleled elsewhere in the NHS.

There is a real recruitment and retention crisis in the workforce, but the situation cannot be improved by simply recruiting more dentists. The fact is that NHS dentists are made to work in a fundamentally flawed system that does not have prevention at its heart. I fear that if NHS dentistry continues down this road, England may have an entirely private dental provision, and the facts speak to that. In August last year, the BBC showed that eight in 10 NHS practices were not taking on children as patients, nine in 10 practices were not accepting adult patients, and a third of council areas were not taking on adult NHS patients. How can we have a preventive approach if my constituents cannot get to see a dentist? In addition, tooth decay is the most common reason for A&E hospital admissions in young children. That is a disgrace.

Nothing could reflect the current crisis more than DIY dentistry. People are fitting their own fillings and extracting their own teeth without anaesthetic or professional training. This week alone, I have been contacted by eight constituents who have performed DIY dentistry. The situation is compounded by the cost of living crisis, which is blighting the lives of ordinary people. If someone needs to choose between eating and heating, they will probably not want to fork out for an expensive root canal; they will probably choose to have an extraction instead or do it themselves. This is a stark example of health inequalities.

I have some questions for the Minister. When will the Government adopt a preventive approach to health and social care, particularly to dentistry? When will the Government provide NHS dentistry with the funding it desperately needs? Has the Department had meetings recently with the Treasury to discuss funding? When will the Government work with the British Dental Association to reform the current dental contract, to stop the exodus of staff from the NHS?

In 1948, Labour recognised that it was vital to integrate dentistry within the NHS and that oral health is not an optional luxury but integral to our national health and key to the NHS. How we tackle it must therefore be a priority, not an afterthought. Only a Labour Government can save dentistry from the rot and decay that has set in under the Tories’ watch.

Like many colleagues, I have received a large volume of communications from constituents in Broxtowe regarding the ongoing problems with securing an NHS dentist appointment. Polling conducted by YouGov on behalf of the British Dental Association has shown that one in four adults in England have already delayed or avoided much-needed care due to cost. I am aware that improving access to NHS dentistry is one of the Government’s key priorities for our health service. It is evident that waiting times have been affected by the infection control measures required during the pandemic. Despite these pressures, dental services in many parts of England have been slowly recovering, which is good to see. However, much more must be done to reduce waiting times and ensure that appointments are available. As my hon. Friend the Member for Winchester (Steve Brine) said, we need more gums on seats.

The BBC recently contacted every NHS dental practice in England and found that 91% were not able to accept new adult patients and 80% were not able to accept new child patients. This is not acceptable. Oral health inequality is rising, and we must act now to ensure that we focus on retaining current dentists, recruiting new ones and ensuring that adequate funding is in place.

My constituent Sacha told me about the difficulty she has had. Not being able to book a dentist appointment has caused her great stress and anxiety. She will potentially lose her teeth if a dentist is not found. Sacha has gum disease and is supposed to see a dentist four times a year. She faces great pain and does not have the option of visiting a private dentist. I have heard many cases like hers, and a private dentist is often not an option. People should not have to turn to private dentists. Sacha is currently waiting for a response from NHS England.

Another constituent, Joan from Toton, recently shared her difficulties with me. She rang multiple practices in her area but was told there are no NHS dentists available. Joan is 70 this year and should not be unable to get basic dental care. It is essential that we fix this problem by ensuring that new NHS dentists are entering the workforce and that we retain the ones we currently have.

The Government have rightly been holding talks since 2021-22 with the British Dental Association and other stakeholders on reforming dental contracts. Through these talks, a number of steps have been and are being taken, including improving financial incentives for dental practices, supporting new practices to take on patients and supporting people with dental costs, but more must be done.

The Department of Health and Social Care has stated that it will publish a plan for dentistry in the coming months. I welcome that announcement and look forward to receiving the plan. In the meantime, I implore the Minister to do all he can for those, such as Sacha and Joan, who face not being able to access dental treatment.

I thank my hon. Friend the Member for Bradford South (Judith Cummins) and the hon. Member for Waveney (Peter Aldous) for securing this debate, and I thank other hon. and right hon. Member for their persistence in pursuing this matter and ensuring it remains a priority. It is worth repeating that this debate is about the progress on reforming NHS dentistry. The two colleagues I mentioned made the case for this debate:

“Underfunding and the current NHS dental contract are to blame for long-standing problems with burnout, recruitment and retention in NHS dental services. Morale amongst NHS dentists is at an all-time low and we are facing an exodus of dentists from the NHS. Reform of the dysfunctional NHS dental contract is a matter of urgency—a reformed service won’t work if there is no workforce left by the time it’s finally introduced.”

To solve the problem, it is crucial to accept that there actually is a problem, and it is important to recognise the extent of that problem. The first question I want to ask the Minister is whether he accepts that there is a problem with access to NHS dental services.

I am pleased that the Minister nods and recognises that. The second is whether he acknowledges the extent of the problem with access to dental services. What progress has actually been made—that is what the debate is about—and has it been significant enough? The Minister accepts that there is a problem, but I am still not convinced, on the evidence we have, that the progress has gone far enough. That is my view. The hon. Member for Hartlepool (Jill Mortimer) talked about the 2006 contract, which we all know needs to be redesigned. The Labour Government recognised, in good faith, as early as 2009 that it had to change. We are now 13 years on, so we have to get to grips with it now. I do not point the finger in that regard, but that is the context for the debate today. Actions speak louder than words. Have there been sufficient actions to resolve the problem that the Minister recognises? I am not convinced there have been.

We had a debate in Westminster Hall on 10 February last year—over 12 months ago—in which I asked Conservative Members to

“press the Minister and ask the Secretary of State and the Prime Minister—their colleagues—to listen to the facts, because, unless Members opposite can get that message across to an indurate Government, things can only get worse.”—[Official Report, 10 February 2022; Vol. 708, c. 473WH.]

Let us take a rain-check a year or so on. Have things stayed the same? Have they got better? Have they got worse? In my view, and that of many others, things have not stayed the same and they have not improved substantially, so it does not take Hercule Poirot to work out that things have deteriorated. I accept, in good faith, that Conservative Members have lobbied the Government, but I am sorry to say that, looking at the situation on the ground in my constituency—and, no doubt, in other Members’ constituencies—their exhortations have fallen on nearly deaf ears, or at least have not been listened to sufficiently.

From Monday gone, there has been an 8.5% increase in NHS patient charges for dentistry in England—during a cost of living crisis. That increase will hit millions of people on modest incomes, including patients in my constituency, and that is those who can actually get to see a dentist. Many statistics have been mentioned today and I could rehearse them, but I will not do so for purposes of brevity. Everybody gets the gist that things are in a grim state.

One statistic I will mention is that dentistry is now the No. 1 issue raised with Healthwatch, with four in five people—79%—who contact it saying they found it difficult to access timely dental care. The British Dental Association has said:

“The Government’s support package for NHS dentistry launched in November consists of marginal changes that will do little to arrest the exodus of dentists from the service or address the crisis in patient access.”

On top of that, we have low morale in the service and dentists quitting in great numbers. I do not think it goes too far to say that we are facing meltdown. The BDA sees an existential threat; I say meltdown—we all get the gist.

Despite the £3 billion dentistry budget, some 10% of the money allocated will be returned, not because of lack of demand but because of dentist shortages. That is the irony. The money is returned, but that must be set in the context of underfunding over many years, on top of which is the poor contract. Retention issues are borne out of burn-out and consequent recruitment issues in NHS dental services. The BDA is right to say that marginal changes will not sort out the problem. I am pleased that the Chair of the Select Committee is on board on that.

First, fundamental reform of the contract is needed. Despite discussions between the BDA and NHS England, the fact remains that unless there is a substantive and substantial change to the contract, matters will continue to deteriorate. Second is the question of resources. It will take up to half a billion pounds annually to restore the funding of NHS dental services to 2010 levels. After a decade of attrition, that is the situation. In real terms, net Government spending on NHS dental services was cut by a quarter between 2010 and 2020. Again, I am not finger-pointing; it is just something that we have to factor in as we try to resolve the problem. Of course, as has been mentioned, the question of prevention has a crucial role to play, as it always does in health services. That, too, must be a priority for the Government.

Having heard what hon. Members, the British Dental Association and the NHS Confederation have said, and what constituents in their droves are telling us, I really hope that the Minister will take action and get to grips with this major problem with provision in this crucial part of the NHS. I started with the issue of progress being made. The question is: can we really say that we have made sufficient progress after three Backbench Business debates? Alas, at this stage, I do not think that we have done.

I thank the hon. Member for Bradford South (Judith Cummins) and my hon. Friend the Member for Waveney (Peter Aldous), and of course the Backbench Business Committee, for securing this important and necessary debate—the third in this trilogy of dentistry debates; and, we hope, the last.

My constituents tell me that dental care in Milton Keynes is failing to meet demand and the complex needs of many families dealing with challenging circumstances. That is, quite frankly, unacceptable. For instance, an unpaid carer with three disabled children told me that her local NHS dentist would no longer be able see children for NHS treatment. In her case, the alternative is to pay £4.75 a month per child for their dental plans; doing the maths, that works out at £171 a year. The only other option for her family is an NHS dentist over 12 miles away from their home. She explained how the children require one-to-one support and can therefore not access family appointments, so in effect this option would mean going to and from the dentist three times every six months. Factoring in fuel costs and other things, is either option more favourable than the other? The last thing that people caring for three children with disabilities need is further pressure on the family budget and schedule. Many families such as hers are faced with similar difficult choices.

Access to NHS dental care should not be determined by a postcode lottery. Another constituent told me a similar story. They moved to Milton Keynes recently and inquired as to their nearest NHS dentist, but were told that the closest NHS dentist was in Bedford. Once again, their only alternative would be private dental care.

Dental care in Milton Keynes, not for a lack of policy and plans from the Government, is on the rocks—mainly, as Members have said, due to the contractual situation dating back decades. For too many, dental care is out of reach and too difficult to access. Without serious change, the consequences for patients and our health system are severe. In fact, when we talk about policy reform, we often forget to pair the reform of the material improvements with our infrastructure and capacity. As a result, the good work that we in Parliament do to reform the system can fail to have an impact on the situation on the ground in the way that we want. What makes this debate so important for me is that it speaks to that wider, broader constellation of dental care reform issues that remain overlooked. I have touched on that previously with the Minister in regard to a different healthcare area.

In my constituency, the Labour-Lib Dem coalition that runs Milton Keynes City Council has given developers permission to build thousands of extra houses as part of the MK East development. Those in surrounding towns such as Newport Pagnell and Olney are already seeing more traffic and more pressure on their public services, including GP surgeries and dentists. I will continue to hammer away at that issue. Who thought about the impact on local services and on people who struggle even now to get dentist appointments for themselves and their children? That level of incompetence makes it difficult for Government reforms to have the desired impact. Let me be clear: it is always expansion before infrastructure when it comes to Milton Keynes City Council—short-term wins instead of planning for the longer term. This is why we plan and have planning departments. We should always put infrastructure before expansion.

I am convinced that there was little to no foresight of the effect on vital public services such as dental care, which are already spread dangerously thin. Ultimately, the knock-on effect of that ill-thought-out planning and reckless over-expansion is a significant and long-term problem for my constituents. We are already seeing the consequences. Yet by getting the infrastructure right, we can make dental reform far more effective.

I welcome the fact that the Department of Health and Social Care will publish a plan for dentistry in the coming months, and I look forward to seeing how it will help my Milton Keynes constituents. I hope that, with the right changes, we can create a system to ensure that the most vulnerable families can access dental care without having to make costly travel arrangements. I am keen to see dental care access improve across my constituency and across England, and I am in no doubt that many others across the House feel the same.

The ever-growing despair has left York and North Yorkshire a dental desert. Thousands of my constituents cannot even get on a waiting list. If they are lucky as they phone around, they may be put on a list, but they then have to wait a minimum of five years to see a dentist. Children are having their teeth pulled out, and adults are getting the pliers out. Although this Government have to own the last 13 years, I want to look forward, not back, because we have a crisis to solve.

Dentistry being left like this is a reminder of what things were like before the NHS was created, and before Labour stepped in and demanded equality of health for all. The model does not work; the system of payment does not work. We need radical reform—not tweaking of the system of units of dental activity. In my constituency, three dental practices have withdrawn from NHS contracts and, over the past four years, 126,130 UDAs have gone. We know that that crisis is deepening. In fact, by the coming June, Bupa NHS—an oxymoron in itself—will have seen a loss of 6,000 more NHS dental spaces. My community cannot get dental healthcare, and they are suffering and struggling because of that.

I, too, sit on the Health and Social Care Committee, and I listened carefully to the Minister, as well as to the chief dental officer, who I thank for her candour and for restoring my hope. She set out a programme of how it can be possible to deliver a future NHS dental service creatively through the integrated care boards, as did the chair of my local dental committee and the associate postgraduate dental dean for primary care dental foundation training in my constituency. They set out a vision which is practical, with purpose and can deliver. If I mesh that with my dental charter, which I have given to my ICB, starting with the ambition to have a children’s dental service within a year, we can start building back. The second year could aim to help older people and those in care homes, as well as those who live in the greatest deprivation. In years 3, 4 and 5, we could build back for the rest of the adult population so that people can get their timely oral health appointments.

However, we need co-operation from the Government, who have now become the servants, with the ICBs as masters. In particular, we need Government support to train more professionals. I too welcome the meeting with the Minister about the proposed York dental school, and I have met the University of York to prepare the way for that. It is important that we train more dentists, but it is also an opportunity to embed a centre of dental development in our city. The ambition is there and the vision has been created.

In addition, we need to ensure that we have good foundation training. I recognise what the hon. Member for Hartlepool (Jill Mortimer) said about having a training bond, because if we are spending £100,000 on dental training, we need to see a return on that investment. A foundation training programme that consolidates practice will upskill dentists in a more coherent way, with supervision and mentoring to ensure that they are the very best professionals. I have to challenge the GDC about its oversight of the dental profession particularly in primary care, and say “Up your game.”

On top of that, we need to ensure that our whole communities can have confidence in what is being created. Through prioritising our young people and ensuring that we take a preventive and proactive approach to dental healthcare, we will start to see other people taking on those competencies and drive that through a public health agenda.

Listening to the opportunities set out by our chief dental officer, the professional on the pitch, it is clear that the Government are not up to the job, and in some places they have been an active block. She has the ideas and the formula, and, my goodness, she has the drive and the energy. Just meeting her and hearing her set out that vision gave me hope that I can go back to my constituents in York and say that there are some people who can really deliver the national dental health service that we need for the future.

I thank the hon. Member for Bradford South (Judith Cummins) and my hon. Friend the Member for Waveney (Peter Aldous) for securing this timely debate. Hopefully, as my hon. Friend the Member for Milton Keynes North (Ben Everitt) said, this is the end of the trilogy. I am glad to see the Minister in his place; I asked him about the issue only a few days ago at Health and Social Care questions.

To set this in context, in Barrow and Furness we are not well served by our dental provision. We have excellent dentists, but we do not have enough of them. We also have a problem with practices closing. Bupa in Barrow has announced its closure, as has mydentist in Dalton. One dental practice in Millom, just outside my constituency but serving my constituents, has closed, and Avondale in Grange-over-Sands has handed back its NHS list. So I now have constituents who have not seen a dentist in years and who are in a very poor situation. There are pregnant mothers who are unable to make their appointments, constituents who are self-medicating every night because they cannot find care, seven-year-olds who have never seen a dentist and constituents performing their own dental care with packs they buy from Boots the Chemist. That simply is not good enough.

Before the first of the practices in Furness closed, because of the volume of constituents who came to see me to discuss their frustrations at being placed on waiting lists for waiting lists, or not being able to be seen at all, I hosted a couple of roundtables with local dentists. They were candid with me about their concerns—candidly frustrated, to be honest. I also met the senior management at Bupa and mydentist and spoke to local healthcare leaders, before our ICB came into force.

In those discussions, two issues came up repeatedly. They have been well rehearsed in the debate already, so I will not labour the points. First, there was the inability to recruit the dentists we need to deliver NHS care. Bupa told me that half of its 85 practices currently have vacancies that have been open for over 6 months. It needs over 150 dentists nationwide to provide the kind of NHS care that it would like to provide. In rural, isolated areas such as mine, recruitment is compounded by the additional challenge of trying to draw people into those areas.

Dentists also raised the issue of recruitment from abroad. I fully recognise that we would like to be sustainable and grow our own. I have heard a few pitches for dental colleges in the debate, although I am not asking for one. When demand is outstripping supply, we have to be realistic. I am told that the overseas registration examination does not meet demand, while the process for registering performer numbers is long-winded and overly complex, which puts off some dentists who might be attracted to the UK. We have to look at reforming that.

The second issue raised is that dentists are often put off from practising NHS care in more deprived areas, where the work is more complex and more expensive to deliver. I know we have all seen this. It leads to ever-decreasing circles of care: poor dental health leads to worse provision, which leads to a lack of appointments, which leads to even worse dental care and dental health. I could go on and on, but I am sure Members get the picture. There was hope that the reforms to the UDA system would address this, but practices are telling me that they do not go far enough, certainly in rural and isolated areas such as mine, to address the disparity in the system. The fact is that since the announcement of these changes, I have seen a further two practices close, which I think is testament to the challenges that these issues are throwing up. Following the most recent announcement of closure, I wrote to the Minister, who kindly responded very quickly, saying:

“We are aware that we need to go further in improving the NHS dental system. We are planning further reforms…and discussions are underway with dental stakeholder groups, including the BDA and patients, to improve NHS dental services further.”

I would welcome an update from the Minister on those plans and details as to how my remaining dentists can feed into that process, because they certainly have things to say.

Before I draw to a close, I must say that it is not all doom and gloom. I am incredibly grateful to the current Minister and his predecessors for engaging so openly and actively seeking to find solutions. The movements on UDA pricing are welcome—although they can go further, as can contract reform—and the aspiration to make visa schemes more workable is music to my ears. I am keen to hear what the Minister has to say on that.

However, as I said at the start, what was a bad situation is now a dire one for my constituents in Barrow. We need to act quickly, improving UDAs, streamlining the visa process and working on recruitment as priorities. It is not an unreasonable expectation to hope for dental care to be available closer to where we live. We often chance our arm in here and ask for big projects to come to our constituencies. This is a minor but crucial ask, and it is one that I very much hope we will soon be able to deliver.

May I say what a pleasure it is to speak and give a Northern Ireland perspective to this debate, as I do in every debate I attend? The Minister has no responsibility for Northern Ireland—he knows that; I know that. Nonetheless, I would like to add a Northern Ireland perspective, which will back up the comments that others have made.

This is a matter of increasing concern as more and more dentists are refusing NHS clients and leaving a wide number of people without access to basic dental care. I will give two examples. One constituent came to see me after her front teeth bridge had fallen out, and we could get her a dentist only outside of the constituency, because there are no NHS dentists prepared or able to take that work on. It took one of my staff more than an hour to find someone accepting NHS dental charges, as all dentists have switched to a pay monthly plan. It is clear that covid-19, Ukraine and the rising prices are all taking their toll as the pressure lines up against dentists as well. Another lady come to see me who was in her 80s. She told me that because she does not do online banking, she had to pay a year in advance to stay on her dentist’s books. I find that reprehensible to say the least. While that lady did have the wherewithal to do so, not everyone does. With this happening, I believe that we can see the end of free NHS dental care. It cannot be that those on a low income ignore a loose filling until they lose a tooth, and yet that is what is happening.

Having said that, I have to make it clear that I am not saying that the dental industry is greedy. I am saying that I believe the Government must step in and devise a new scheme that will adequately compensate dental practices and allow people to access the dental service they so desperately need.

I received an interesting briefing from Denplan that highlighted the fact that more than 19 million dental appointments were lost over the course of 2020. Some 70% of Denplan member dentists reported concerns about the future financial stability of their practice, while

“the pandemic also exacerbated issues with mental health and wellbeing.”

The surveys included in the briefing

“indicated that dentists believe there is a misunderstanding of the industry in general”

—this is what the industry itself is saying—

“which has manifested into a relatively poor relationship between policymakers and the dental profession over the years. Member dentists who responded to the October 2020 survey, indicated dental services are often treated as an afterthought, with the government’s communication with the sector considered to be lacking.”

If I were to take one ask from today’s debate, that would be it. I know that this is a Minister who understands: he is always easy to speak to and engage with, and he understands things very well. May I ask him now to engage with the dentistry sector to come up with some ideas about how to move forward? That is what they desperately need.

The briefing states that

“67.52% of respondents to the 2020 survey, said they ‘strongly disagreed’ with the statement ‘the government understands the dental sector’.”

It is clear that the Government do not understand it. Moreover,

“36% of respondents said the pandemic had affected their oral health—with 50% of those who had seen a decline in their oral health, saying that they had had appointments delayed, or were unable to book any dental appointments with their dentists… According to our data, the pandemic also changed…attitudes towards dental treatment, with 29% saying that following issues during Covid-19, they now value their oral health more and are more likely to visit a dentist.”

That, at least, has been a plus factor. However, the briefing continues:

“Nonetheless, existing backlogs and an exodus of staff is preventing patients from accessing the dental care they need”.

Others have mentioned that.

I am very conscious of the timescale that is expected of me, Mr Deputy Speaker, but I want to make a very quick comment. On Tuesday morning, I saw a television programme—we probably all saw it—about a lady who, because she could not access a dentist, removed 12 of her teeth. That had all sorts of impacts, affecting her social engagement and causing her anxiety. A dental charity then stepped in and restored all her teeth. Today she is engaging with people again, and is back at work.

Sometimes people resort to doing things that they really should not do, and would not normally do. According to the briefing, some 41% of people in Britain said that they

“would be willing to undertake DIY dentistry”.

That worries me as well. Among younger people the figure was 48%, and among seniors it was some 28%.

Let me end by quoting Ciara Gallagher, chair of the Northern Ireland Dental Practice Committee. She has said this:

“In the meantime, practices need help, they need hope, and they need urgent action from the department to know that they have a future. They need support so that they are not being financially starved out of the NHS.”

I join all my colleagues who are present today, on both sides of the Chamber, in asking for better liaison with the dental industry, and increased funding to shore up NHS dental access throughout this great United Kingdom of Great Britain and Northern Ireland.

I congratulate the hon. Member for Bradford South (Judith Cummins) and my hon. Friend the Member for Waveney (Peter Aldous) on securing the debate. Together they have acted like a veritable tag team, securing debate after debate, this being the third.

The problem we are discussing is obviously not getting better, and it is not going away. It is clear from what we have heard from Members today that it is becoming a bigger issue in our casework, and that is certainly my experience. I have taken some desperate phone calls from constituents, and have been shocked by what I have heard. It has led me to get on the phone straight away to beg dentists nearby to see some of those constituents. One, an elderly resident of Wilmslow, was losing his teeth and had abscesses. He needed to have his teeth removed and dentures fitted, but he could not find a dentist. When he rang the emergency dentist, there was a recording saying “No appointments”, and then the phone was just ringing out. He was pointed in the direction of a practice in Buxton, but found that it was no longer taking NHS patients, and one in Northwich which had a two-year waiting list. Other constituents who thought that they were fortunate enough to have an NHS dentist found that the Mobberley Road practice in Knutsford was no longer taking NHS patients either, and that they were no longer registered there.

Healthwatch, the independent statutory body, says that this is the No. 1 issue raised with it by NHS patients, and that four out of 10 people who contact it say that they are having difficulty accessing dental care, which is exactly what I am hearing from my constituents. The system is bad and decaying, and has been for some time. Lockdown made things significantly worse. With dentists shut down for the first few months of the pandemic, 50 million appointments were lost, and 3,000 dentists stopped providing NHS dentistry because the restrictions through lockdown made it financially unviable for practices, meaning NHS dentists are disappearing at a rate of knots. Some 90% of practices are closed to new patients, 80% will not even accept children, and in 37% of local authorities there are no practices accepting new adult NHS patients. Reform needs to be radical.

Tatton dentists have reached out to me and told me the current payment system of units of dental activity, introduced by a Labour Government back in 2006, has never worked and subsequent tinkering has not worked either. The Minister will probably know how it works, but others might not: a check-up with X-rays counts as one unit; adding a filling or several could count as another two units; and providing a full set of dentures is seven. It does not pay: the formula does not work, which means that dentists lose money, particularly when treating the neediest patients—those who really need their care and attention. Those figures never have stacked up and tweaks will not make a difference. In a nutshell, the business case is broken and a new one needs to be brought forward.

NHS dentistry is not attractive; we need to make it appealing. Interestingly, the number of qualified dentists is at an all-time high, but the number doing NHS work has fallen significantly. Last year, a British Dental Association poll found that 45% of dentists in England were doing an average of 25% less NHS work since the start of the pandemic. The poll also shows that 75% of dentists are thinking of reducing their NHS commitment this year, with almost half considering either a change of career, early retirement or turning fully private.

Bupa, which provides both NHS and private services, recently reinforced these figures, stating that it intends to merge or sell 85 of its 450 practices across the UK because of rising running costs and lack of dentists willing to deliver NHS care. This means nearly half a million more patients could lose their dentist.

Making NHS dentistry appealing is, therefore, a matter of high importance. Some suggestions have been handed to me and I will put them forward—and I know the Minister will be coming forward with bold plans. One suggestion was getting rid of student debt for newly trained dentists; might we remove that if they move into NHS provision? Also, what extra funding will be given and how will we move away from units of dental activity? We all want this to work; it is vital that it works and I certainly do not want to be taking calls from desperate constituents who need urgent dental medical care.

I, too, extend my thanks to the Backbench Business Committee, the hon. Member for Bradford South (Judith Cummins) and my hon. Friend the Member for Waveney (Peter Aldous) for this debate. A number of speakers have covered the general points around dentistry and the issues many of our constituencies are facing and have outlined many of the things that need to happen and need to be in the forthcoming action plan from the Government, so, rather than labour the point on those, I will focus on the matter facing my constituency.

My right hon. Friend the Member for Tatton (Esther McVey) and my hon. Friend the Member for Barrow and Furness (Simon Fell) have mentioned the situation regarding Bupa and the 75 practices it is either closing or selling at present. One of them is in Bolsover town centre and the closure of this practice was announced with absolutely no consultation whatsoever. They were kind enough to give me 12 hours’ notice, which they seemed to be very proud of when I met them, but that is a completely insubstantial amount of time for people to prepare, and although the practice is not due to close until 23 June the situation has been exacerbated.

I had already been to see the Secretary of State last year about dentistry and my concerns about provision in Bolsover; I have spoken to Ministers about this on a number of occasions, and indeed raised it at Health questions previously with the Minister, as I did this week. The situation is now of great urgency, because Bolsover was already bottom of the regional league tables for dentistry provision, the worst in Derbyshire and one of the worst in the east midlands, and we will have no NHS practices accepting new adult patients once the Bupa practice is closed. The Minister is aware of that situation, because we have had a number of conversations this week, but I do not want Bolsover to be a dental desert.

I have already met the integrated care board for my region to start having conversations about what can be done for patients locally. The first port of call is to look at dispersal and see whether other practices can take patients on, perhaps using a different UDA figure and pricing structure for those patients. However, the BUPA practice is quite a large one and dispersal will be difficult, since a number of the other practices, as I have already alluded to, are not taking on patients. I have encouraged my ICB to look at all the options available to it and perhaps to be bold. My request to the Minister is that he commit to working with the ICB, with me, to ensure that we get some sort of solution quickly.

I will end with a point that my hon. Friend the Member for Milton Keynes North (Ben Everitt) alluded to earlier. Bolsover is very lucky to have new housing coming into the area, and it is helping the area, but the question mark for many who have lived there for a long time is this: what are the benefits of that new housing? What comes alongside it? We cannot have new housing without the appropriate infrastructure, whether that is roads—we have had plenty of questions about roads—school places, GP practices and additional GPs, or dentistry. One difficulty I have in justifying the development is that we are losing a dentist practice while gaining several thousand new homes. I strongly encourage the Government and my local authority to look at that situation in a more holistic way.

I will try to keep my contribution short, as many points have been covered already by hon. Members on both sides. The simple problem is that the dentists do not feel that they can function on their current contract, so asking them to do 110% of their contract when they do not want to do the initial 100% of their contract is not a way forward.

We need to look at the UDA contract to make it more financially viable, because at the moment dentists are taking on private work to subsidise their NHS work. The UDA contract is a problem across the board. If there were one or two dentists across doing it, we could say, “Well, maybe that’s their business plan.”, but it is not. It is happening across the board, and we need to look at the contract.

We also have a problem with dentists coming through. We need more dental places. As colleagues have mentioned, we ought, maybe, to look at a bursary for dentists who commit to stay in the NHS for at least five or 10 years, so that we have the dentists within the system to cope with the demand that is out there.

I am not 100% certain about taking dentists in from abroad. I always think when we pull the lever of immigration it goes against the grain of a Conservative Brexit MP such as myself, but there is also the fact that we are taking skilled people from other countries. If that is what we need to do to cover the backlog, then fair enough; I can understand a certain amount, but I always believe in training our own people and training them well, and I think that is what we should do.

Finally, I thank the dentists in my constituency. John Gatus is a fantastic chap and he has explained a lot about what we are dealing with now. I know the Minister is a good Minister. I know he has listened to everything that has been said in this debate and I know he wants to get this sorted out, but I ask him and everyone in this House to remember what it is like to have toothache.

We all need to remember that. Let us all cast our minds back to those 24 hours when we could get no sleep and we were in pain. It is dreadful, and an awful lot of my constituents are in that position now—or, what is worse, seeing their children go through it. We need to jump on this problem and we need to jump on it now. I am hopeful that the Minister will deal with this today.

As more people want to speak, and we have the wind-ups to come, it is sensible to continue with this debate. We will try to reposition the debate that should have followed.

Access to dentists in North Devon is an issue that I was aware of before I became an MP. When I moved there, it took me over 18 months to find a local NHS dentist. Since I was elected, the issue has topped the casework league in my inbox most weeks. I have constituents in dire need. A recent case concerns a lady who is recovering from bowel cancer and a full hysterectomy. She had chemotherapy that made her teeth rot. She managed to see a dentist, but unfortunately is unable to afford what was supposed to be the “affordable” private treatment, because due to her other treatment, she is unable to work.

Another constituent, having phoned almost all the dentists in North Devon, has been told that there is a seven-year wait list to even see an NHS dentist. Many surgeries state in their recorded message that they cannot help anyone who is looking for NHS assistance. My constituent found a dentist, only to be told that the work needed was close to £2,000. They say:

“I am entitled to free NHS dental treatment which means absolutely nothing if it is not available. I cannot express how distressing and painful this is for me.”

The changes to dentistry contracts to allow more flexibility in who performs certain procedures are important and welcome steps, but unfortunately, in North Devon, we just do not have enough dentists. I have spoken before about the need to facilitate more international dentists’ coming to the UK. Recent legislation allowing the General Dental Council to amend its registration processes for international dentists is a step in the right direction, but we need to look at why we have dental deserts—and at how the practice of naming them “dental deserts” exacerbates the problem; it is not worth dentists taking on work when it is clear that each patient is likely to have significant issues, as the remuneration structure then does not reflect the work involved.

One key reason why we struggle to recruit more dentists to North Devon is the lack of affordable housing; that affects recruitment across all our health services. As we work to bring more dentists to North Devon, I hope that the Department will look at more creative solutions, such as including accommodation in employment packages. Alternatively, the Department might consider expediting our hospital redevelopment—it is one of 40 hospital redevelopments—the next phase of which involves nurses’ housing. Given that dental issues are the No. 1 reason why under-18s in North Devon end up in our hospital, it must be possible to join some of the dots together.

I am most concerned about the availability of dental care for our children. Good dental habits can set them up for a lifetime of healthy teeth. In the year up to June 2022, only 44% of children in Devon had seen a dentist in the last year. While the Department works to improve access to dental care in the long term, will the Minister look in the short term at the possibility of bringing dental buses or temporary dentists into areas such as North Devon, so that people can have their problems dealt with sooner, and the next generation can get their teeth checked before any issues cause them long-term harm?

My first constituency surgery appointment after being elected to this place was on dentistry. I want to get things done for North Devon. I have raised this matter with every dentistry Minister, every Health Secretary, my integrated care board and my council, yet nothing seems to change. Even the suggestion that charitable dentists be used is given a “Computer says no” response. There is immeasurable frustration at the fact that, three and a half years later, the situation with dentistry in my constituency is worse, not better. Please can an urgent solution be found that gets the excess dentists in some parts of the world to North Devon, and can some compassion be shown to those who desperately need dental treatment now?

We have had a full debate today. This is the third Backbench Business debate on the subject, but not the third debate on dentistry; I have had an Adjournment debate on dentistry, for example. The subject is well rehearsed. The reason why so many people are keen to speak today is that the issue affects areas right across the country. We all know that there is a problem with NHS dentistry, that the Government are focusing on it, and that they are coming up with a dental plan. We anxiously look forward to its publication in the next two to three months. In the few minutes available to me, I will not focus on the national problem so much as recognise that within the national difficulties, there are regional crises. In rural areas such as North Devon, but also in the east of England and Norfolk in particular, we can see that what is already a challenging picture nationally is exacerbated. To identify the issue, we have only to follow the money. I will look at funding for the east of England, then I will talk about recruitment and retention.

I know that funding has been impacted by covid, and the ability to undertake units of dental activity was restricted because of the covid pandemic and the aerosol activity of much of dentistry. I also know that funding has subsequently been increased because of the catch-up bid, so the numbers for the year 2018-19 give a more accurate reflection of the level of investment by the Government in dentistry in the region. The national average gross spending per mouth in England was £66 in that period. The best performing region was the midlands, which received £78 of expenditure per mouth. The figure for the east of England was £39 per mouth. That is exactly half the amount of money spent on dentistry per head of the population in the midlands. Now, there are many unconfirmed rumours about the number of fingers and toes that we have in Norfolk, but we do not have half as many teeth as those in the midlands—not yet, anyway.

My request to the Minister is to follow the numbers, to look at where the expenditure has been taking place and, more importantly, to look at the places where the expenditure has not taken place, and then to ask the question of his officials, “Why is that?” Why is it that even though in many parts of the east of England we have the worst dental health, the expenditure by the Government is fully half what it is in the midlands, and £20 less than the national average per person?

Looking to recruitment and retention, a potential answer to my first question is that there are physically not enough dentists in the east of England to carry out the work. The national average number of dentists per 100,000 of the population is 43. In the east of England, we have just 39. That compares to Devon, where there is a dental training school, which has 49. Why is it that people do not want to be dentists in Norfolk? The answer is because it is rural, and for those who grow up there, the nearest place they can train is Birmingham.

People cannot train to be a dental technician or a dentist anywhere in the east of England. It is the only region of the country, other than the south-east, which is next door to London, that has no dental school at all. People can go either to London or Birmingham. Is it surprising, then, that we do not have an indigenous population of would-be dentists growing up, training to be dentists in Norfolk and then staying there for their working life? We are reliant entirely on people relocating to the east, and to Norfolk in particular, to supply our dental needs.

When people qualify as a dentist in their mid-20s, the overwhelming majority do not wish to move to a rural location. Even though it is without question the best place in the country in which to live, to grow up, to learn and to bring up a family, it is not immediately attractive. A policy that relies on importing foreign-qualified dentists does not satisfy the need in rural locations either, because overwhelmingly the data tells us that when we import, say, South African or Australian dentists, they relocate to the cities. They set up their new life where there are already expat communities. They do not move to Fakenham, and the problem is very real in Fakenham. I persuaded the NHS to write a wholly new NHS dental contract for Fakenham. That contract went out, and not a single organisation bid for it. The money is there, but there is physically no supply of NHS dentists.

The issue goes further than that, because the lack of dentistry spreads out into the private sector as well. There are many examples right across the county of where private dental practices, whether in my constituency or in those of my hon. Friends the Members for North Norfolk (Duncan Baker) and for North West Norfolk (James Wild), have been advertising for years—in one case I am familiar with, for a decade—and are yet to fill the place. While the short-term answer to the national issue may well be to improve access to international dentists, the medium and longer-term solution for the east of England, and Norfolk in particular, surely is to establish dental training in the county. There are two ways to do that.

There are two ways to do that. In the short term—the very short term, I hope—there is a bid by the University of East Anglia to create a centre for dental development: a postgraduate training establishment that would help to draw in newly qualified dentists from other parts of the country. The hope is that if they do their postgraduate training in the east, a percentage of them will remain. There is also what I hope is not a competing but a complementary application from the University of Suffolk in Ipswich. Those bids should not be in competition; they should be working together to improve access in both Suffolk and Norfolk.

However, the real solution in the medium term is to unite with the University of East Anglia and its existing medical school to create a dental school at UEA, which already has the Quadram Institute—the world’s leading centre for the study of the gut biome, which of course begins with the mouth. The Norfolk and Norwich University Hospital is right next door. We would then have the ability to bring people in and train them in the city of Norwich; as evidence from the medical school demonstrates, a percentage of them would remain thereafter to develop their careers.

The hybrid nature of the UEA bid would mean that even in the first year of the five-year training period, people would be spending at least a day a week working in practices, helping work through the dentistry backlog, and developing community relationships that will make them more sticky to the region once they qualify. All that will go towards the long-term solution to the dental desert in Norfolk.

I very much look forward to the publication of the dental plan in the next few months, but it would be the most monumental wasted opportunity if that plan did not include training for dentistry in Norfolk.

I am pleased that this Backbench Business debate has been allowed time; I thank the hon. Member for Bradford South (Judith Cummins) and my hon. Friend the Member for Waveney (Peter Aldous) for securing it. I almost feel that I am about to sum up all the issues that have been discussed, but I want to pick out some of the challenges that I have faced as a constituency MP.

I am sure that all in the House agree that toothache and tooth-related issues can be extremely painful—for our constituents, unfortunately, getting to see an NHS dentist can itself feel like pulling teeth. I am pleased that one of the Government’s immediate priorities is to deal with the backlog, but I cannot stress enough how important it is that we pick up the pace and go even faster. Like many in the House, I was pleased to welcome last year’s announcement that the Government would provide £50 million for up to 350 additional dentist appointments in England. I am also pleased that they are continuing to have talks with the British Dental Association and other stakeholders to reform dental contracts, increase the incentives for dental practices to take on more NHS work, and help get on top of the backlog in dental treatment.

As my hon. Friends the Members for Waveney and for Hartlepool (Jill Mortimer) identified, the contract originally established back in 2006 is the real nub of the issue that all our constituents are facing today: simply not enough NHS dental work is being carried out. That is a huge issue in my constituency.

Over the past year, there has been a significant increase in the number of constituents writing to me in frustration because they cannot secure an NHS dentist appointment. Only last week, one constituent had to make an appointment 50 miles away in Sheffield, as she could not get a local NHS appointment and could not afford a private one. Another constituent kindly contacted me, dismayed at the fact that they had been contacting local dentists listed on the NHS website as available and taking patients—it turned out that they were not. My constituent tried to contact another dentist, which was only accepting children. My constituent ended up having to pay up to £80 up front for them and their three-year-old to see a local dentist. That is not acceptable. I checked it out for myself. The NHS England website said that the dentist was accepting patients, but when I clicked on the link and followed it, it said that

“this dentist surgery has not given an update on whether they’re still taking NHS patients. Please contact them directly to ask.”

That is simply not acceptable, because it instilled a false sense of hope in my constituent who has dental pain and needs to see a dentist as soon as possible.

As we all do, I recently held a surgery. A lady came and explained that she had been an NHS patient all her life with a particular practice in Keighley, as had her partner and her children, only to receive a letter to say that it would now only accept private appointments for her family. Again, that is not acceptable.

The Government are well aware of the issues and the scenarios that we have put forward today, but I urge them to look at some key points. Demand is there, but we are not recruiting enough dentists and we are not allowing those dentists enough space to support the demand. As my hon. Friend the Member for North Devon (Selaine Saxby) said, it is important to focus on early prevention work, particularly for younger people. As my hon. Friend the Member for Broadland (Jerome Mayhew) said, recruitment, retention and training in the early years are incredibly important. I want to pick up on the point that all integrated care boards must have dentistry represented on them, to ensure on a geographical basis that contracts are awarded for NHS providers and can be delivered on the ground.

The big issue is the contract reform that must take place. As we have all identified, units of dental activity are not keeping up to speed with demand. That is my constituents’ No. 1 priority. I hope that the Minister will ensure that appropriate action is taken to alleviate the pressures on NHS dentists and the dental pain that my constituents are suffering.

We have had a full and thorough debate this afternoon on NHS dentistry—something that really matters not just to us as Members of Parliament, irrespective of the party we represent, but more importantly to our constituents. I, too, commend my hon. Friend the Member for Bradford South (Judith Cummins) for securing this debate along with the hon. Member for Waveney (Peter Aldous). The way that they both put the case before the House has been compelling. It is incumbent on us all to try to find a way through the morass that is NHS dentistry. I also pay tribute to my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), my right hon. Friend the Member for Kingston upon Hull North (Dame Diana Johnson) and my hon. Friends the Members for City of Durham (Mary Kelly Foy), for Bootle (Peter Dowd) and for York Central (Rachael Maskell) for their contributions.

I also thank the hon. Members for Winchester (Steve Brine), for Hartlepool (Jill Mortimer), for Broxtowe (Darren Henry), for Milton Keynes North (Ben Everitt) and for Barrow and Furness (Simon Fell), the right hon. Member for Tatton (Esther McVey) and the hon. Members for Bolsover (Mark Fletcher), for Don Valley (Nick Fletcher), for North Devon (Selaine Saxby), for Broadland (Jerome Mayhew) and for Keighley (Robbie Moore) for setting out their own perspectives and the issues that their constituents have raised about NHS dentistry, which are not that dissimilar from the issues that my constituents raise.

It is not a party political point to say that NHS dentistry has been in crisis for a very long time. As we have heard today, patients are being failed on an unprecedented scale. Many are having to suffer through unending pain and misery because they cannot access the care that they so desperately need.

In preparation for this debate, I spoke with people right across the country, and I will share some of the cases that highlight the sheer scale of the crisis. In Darlington, local people have been told that it will take two years for the current backlog in dental care to be cleared, and some are being forced to wait over three years to access treatments. Some residents are being forced into removing their own teeth, in what has been dubbed “DIY” tooth extraction. I shudder to think what state someone’s dentistry services are in when they have to extract their own teeth. Reports have exposed gums becoming infected and individuals becoming addicted to opiates, and unintentionally overdosing on pain relief.

We heard from the hon. Member for Bolsover, but somebody I spoke to raised the fact that local Bupa practices in Bolsover are closing due to a lack of NHS dentists, and patients are being told to glue crowns back on themselves with denture paste because there is no other way of accessing care. The same is true in Corby, where patients are being left stranded after the closure of the Oakley Vale Bupa dental care centre. I could go on. In Loughborough, one resident said that they have been unable to register with an NHS dentist since moving to that part of the country in 2019, and nationally tooth extraction is now the biggest single reason for hospital admissions of under-10s, with 73 children a day having to receive emergency care to remove rotting teeth. When parents try to get appointments for their children, they are turned away.

In Bassetlaw, one resident told local councillors that when she tried to sign her son up to a local NHS dentist she was informed that there was a waiting list of 2,000 people, and that they would have to go private—something that she cannot afford. Local people in Ilkeston have been told to sign up to dentists in Derby because no local surgeries are taking on new patients. The same is true in Darwen, where people are being told that the nearest dentist they can see is in Salford. In Swindon, one parent looking for a dentist for her two-year-old was directed to the only practice that she could find that was taking patients. The problem was that it was 90 miles away in Birmingham. Such stories are commonplace. We have heard them in contributions from Members on both sides of the House.

It would be wrong to pretend that there was a golden age of NHS dentistry in recent years. There was no utopia. There is a reason my teeth, and I hazard a guess those of many Members in the Chamber, are full of fillings. It is not because we failed to brush our teeth as well as our children brush theirs, or because we ate more sweets than our children; it is because the financial incentive in the past was to drill and fill, whether someone required that filling or not. The contract, which is a big part of the problem today, was brought in with the right intention: to move NHS dentistry more towards prevention. However, it did not work. As the right hon. Member for Tatton set out, the issue of funding through units meant that many dentists were just not incentivised to take on NHS care. Tinkering will not work either. It is incumbent on us all to work out a system that will both work and put the capacity back into NHS dentistry, so that patients get the care that they need and deserve, and dentists get the appropriate financial recompense.

I will pose a few questions to the Minister, because we know that a plan is coming. Will he set out, first and foremost, what steps the Government will take in that plan to immediately improve access to dental treatment in the so-called dental deserts? Additionally, given that a recent BDA member survey showed that more than nine in 10 owners of dental practices with a high NHS commitment found it difficult to recruit a dentist, what is he doing to fill the widespread vacancies across the sector? I assume this information exists in the NHS workforce plan, which is still sitting on the Secretary of State’s desk. Will the Minister update the House on why the plan is yet to be published and when we can expect the Government to release it?

We know that NHS dentistry has not worked for a very long time. Governments of all colours are responsible for where NHS dentistry is today. I am not bothered about the past. People with toothache or oral health issues want help today, so it is incumbent on all Members to make sure NHS dentistry is fit for the future, because the stories and statistics that Members on both sides of the House and I have communicated in this debate are simply not acceptable. The Opposition stand ready and willing to help the Government to build the NHS dental services this country needs and, when the time comes under the next Labour Government, to make those NHS dental services the best they can be.

I thank my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins) for securing this important and timely debate as we work on our dental plan and the NHS workforce plan. We have had some excellent and useful contributions, and all the ideas that have been put forward are extremely timely.

The hon. Lady said it is time for real change, not patching, and I completely agree. The Chair of the Select Committee, my hon. Friend the Member for Winchester (Steve Brine), made too many important points to list, but he made an important point about the need for greater transparency on data and delivery, and I completely agree.

The hon. Member for Washington and Sunderland West (Mrs Hodgson) listed some of the problems that are firing our ambition to fundamentally change the system. My hon. Friend the Member for Waveney made a series of important points, and I am grateful for his contribution not only today and in previous debates but outside the Chamber. He has many thoughtful observations to make about ringfencing, changing the UDA system, fluoridation and so on, and all those ideas are flowing into our work. The right hon. Member for Kingston upon Hull North (Dame Diana Johnson) was the first in this debate, but not the last, to emphasise the importance of where dentists do their training and foundation training to getting more dentists into under-served places, which we are looking at.

My hon. Friend the Member for Hartlepool (Jill Mortimer), like my hon. Friend the Member for Waveney, talked about the perverse effect of the contract bands. That was brought home to me by the conversation she engineered for me with some of her local dentists. I found that conversation incredibly useful. Their passion for NHS work and dentistry shone forth, and it brought home the central role of local commissioners in making the choices of the kind she raised in this debate.

The hon. Member for City of Durham (Mary Kelly Foy) talked about the importance of prevention, not just treatment, and we are thinking about that. My hon. Friend the Member for Broxtowe (Darren Henry) raised the important issues for Sacha and Joan, and I am happy to meet him and his local ICB to talk about how we can address those cases.

The hon. Member for Bootle (Peter Dowd) asked whether we have gone far enough. No, we have not, hence the need for a dental plan. My hon. Friend the Member for Milton Keynes North (Ben Everitt) emphasised the need for housing plans to take better account of the need for primary care facilities and dentists, which we have discussed outside the Chamber. Some places do it well, but that does not happen everywhere, including in his local authority.

The hon. Member for York Central (Rachael Maskell), as always, made interesting comments about prevention among young people, which we are certainly looking at. My hon. Friend the Member for Barrow and Furness (Simon Fell) was the first person to mention that the overseas registration exam is much too long-winded, and that it takes people much too long at the moment. The legislation to enable that to change came into force last month, and we now need the GDC to move quickly to address the backlog and those problems.

It is always a pleasure to hear the hon. Member for Strangford (Jim Shannon) speak in a debate to bring a UK-wide perspective, and he asked a straight question about how we are engaging with the profession. We are generating these ideas by talking directly to dentists. My right hon. Friend the Member for Tatton (Esther McVey) said that dentists had told her that the 2006 contract had never worked, and I have certainly heard that from many dentists.

I am happy to meet my hon. Friend the Member for Bolsover (Mark Fletcher) and his ICB to discuss the recommissioning of services. He raised the issue of Bupa, and I agree that having a three-way meeting would be useful. My hon. Friend the Member for Don Valley (Nick Fletcher) got to the nub of the issue when he talked about basic incentives.

When I visited my hon. Friend the Member for North Devon (Selaine Saxby), I was once again reminded of the particular challenges of coastal communities, and that is especially true in dentistry. We have talked about this before and are thinking about how to get dentists to go places that are historically under-served.

My hon. Friend the Member for Broadland (Jerome Mayhew) raised the same point, as well as a deep question about the historical allocation of funding in dentistry. We are certainly looking at that. I reassure him that we are also looking at the whole issue of centres for dental development, and the proposals emerging in his area are extremely interesting.

Last but not least, my hon. Friend the Member for Keighley (Robbie Moore) mentioned our new requirement for dentists to keep their records on the NHS website up to date. We are keen to drive that forward and to ensure that records are accurate for exactly the reasons that he mentioned.

Dentistry was hit much harder than most other health services because of its fundamental nature: dentists are looking down people’s throats and creating a lot of aerosols, so of course during the covid pandemic the sector was particularly hard hit. We allocated £1.7 billion of funding to carry NHS dentists through the pandemic, which enabled many to survive, but dentistry was clearly hard hit, and it is a hugely important part of the NHS, as many Members have said.

The package of changes that we brought in last July were an important first step—only a first step—in addressing the challenges facing the sector. We have started to reform the contract, with the first significant changes since 2006, to make NHS dentistry more attractive. We have created more UDA bands to better reflect the fair cost of work and to incentivise NHS work. We introduced for the first time a minimum UDA value to help sustain practices where values are lower, and to address unfair and unjustified inequalities in UDA rates, which are now based on quite historical data. We have enabled and allowed dentists to deliver 110% of their UDAs for the first time to encourage more activity and to allow those who want to deliver more NHS dentistry to do so. We have also made it a requirement for the first time for dentists to keep their availability up to date on the NHS website.

We have also made it easier—a number of hon. Members have made this point today—for dentists to come to the UK. The legislation came into force last month to enable the GDC to increase the capacity of the overseas registration exam. As of 1 April, people will no longer have to pay the charges that they used to pay. The Chair of the Select Committee stressed how important it was for the GDC to respond to those increased flexibilities and to work at pace to get through the backlog, and we are actively in discussions with it about how best to do that. Plans are advancing for centres for dental development, as a couple of different hon. Members have mentioned, not just in Suffolk or Norfolk, but further afield, such as in Cumbria. We are watching those plans closely and working with local partners to see what is possible.

Hon. Members raised the matter of prevention. We have already started the process of expanding fluoridation across the entirety of the north-east, which would—subject to consultation—encompass about 1.6 million more people. We will be launching that consultation this year in order to provide the benefits of fluoridation to a large new area for the first time since the 1960s.

All these changes are starting to have some positive effects. In the year to March, about a fifth more patients were seen compared to a year earlier. In total there are about 6.5% more dentists doing NHS work now than in 2010, and UDA delivery is going up from that huge hit it took in the covid pandemic, but of course we must go further; I am the first person to say that. I can see that some of the reforms are working. The proportion of dentists making the new band 2b claims is increasing and it is great to see that practices are prioritising those with higher needs. But this is absolutely just the start and I know that we must go further.

Will the Minister set out with great clarity the data that is required, so that we do not just measure how many people are working in NHS dentistry, but we understand the number of sessions they are providing, and we marry that up with need and demand in order to understand what gap is there?

The hon. Lady is right; in dentistry, not only do we have headcount measures showing that six and a bit per cent. more dentists are doing NHS work, but we can see the amount they are delivering and we can see those UDA rates starting to go back up again. Of course, we want them to go up further, and I am keen to start publishing more data so that there is greater transparency about what is being delivered where.

There are further changes we must make. We are trying to drive activity back up to at least pre-pandemic levels and to address the fundamental shortfalls that were there even before the pandemic. When I speak to dentists, they have a keen sense of whether the payments they are offered under the 2006 contract make work profitable or unprofitable. Often, for some of those bands, they feel that they are not being fairly remunerated for the cost of the work they are doing. We need to make sure that they do feel fairly remunerated so that they are more attracted to doing NHS work. We could go further in addressing some of those historical, and potentially now unjustified, variations in UDA rates. In particular, the move to ICBs and away from regional commissioning provides an opportunity for not just more transparency, but much more accountability. Instead of a remote regional body, hon. Members will be able to talk to their local ICB about what it is doing to drive up delivery. When we arm Members of this House with greater transparency and greater data, they will be able to have those conversations about what we are doing collectively to drive up the levels of delivery.

I am listening intently to what the Minister is saying. When I go back to speak to my local dentists, what do I tell them about the “when”? He is saying all the things that we would like to do and the Government would like to do. We want to see all that happen, but when will this contract that has needed changing since 2010—[Hon. Members: “2006!”] We had it in our manifesto to update it in 2010. We had said we would update it in 2010. The Government have had 13 years to fix this, so when is it going to happen?

I have mentioned some things that are already changing—some of the first reforms to the contract since 2006 that we have started to bring in. We are working on the plan at pace. There is no date for its publication yet, but we are working on it at pace because we are conscious of the urgency.

I thank the hon. Member for Bradford South and my hon. Friend the Member for Waveney for securing this important debate. I hope they have been assured that we have started to reform dentistry, that we are seized of the importance of the issue, and that we recognise that we can and must go further to further strengthen NHS dentistry.

Thank you, Mr Deputy Speaker. I thank all 19 Members for their contributions and interventions, for which both I and the hon. Member for Waveney (Peter Aldous) are immensely grateful. Although the contributions are too numerous to mention, I will highlight the one from the hon. Member for Winchester (Steve Brine), the Chair of the Select Committee, which encapsulated many of the common themes. He spoke on a wide range of issues, including the lack of access to NHS dentistry and the problems, not only in his constituency, but right across the country, of the retention of NHS dentists and the lack of transparent data. He also talked about the need to have dentists represented on ICBs.

Many Members raised those common issues of access, including my hon. Friend the Member for Bootle (Peter Dowd), who spoke of a lack of funding. He posed two crucial questions: does the Minister accept that there is a problem?; and, if so, what progress has he made in resolving it? My hon. Friend then concluded that the situation has worsened since last year. Clearly, the need for full-scale reform has been recognised right across the House today, as we all know that change is needed. The fact that 90% of NHS dentists are no longer accepting new adult patients reflects the severity of this crisis. We have reached the point where the patching of our services is no longer possible and many of our constituents are simply suffering with the inadequacies of the current system. We need fundamental NHS dental reform now, not a plan for a plan. Minister, the promise of reform and this plan must come with real action and a firm date of publication.

Question put and agreed to.


That this House has considered progress on reforms to NHS dentistry.

We were going to come to the debate on reducing plastic pollution in the oceans. I said that it would be repositioned, but that is clearly not the right word, because it will still be here. “Rescheduled” is what I was grasping for, and I have now finally found the word. We hope that it will be rescheduled in the not-too-distant future, because it is a very important debate, and it was right not to truncate it in the way that was going to happen.