Access to NHS Dentists

– in the House of Commons at 10:42 pm on 12th September 2017.

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Photo of John Bercow John Bercow Speaker of the House of Commons, Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Commons Reference Group on Representation and Inclusion Committee 10:42 pm, 12th September 2017

Order. Before we start the Adjournment, it might be for the benefit of the House if I explained—because a lot of people do not seem to realise this, including sometimes Members who have been in the House for quite a long time—what the rules appertaining to participation in the end-of-day Adjournment debate are. Any Member can seek to intervene on the person whose Adjournment debate it is. Equally, the Member whose debate it is not obliged to accept the intervention, though he or she can. That process does not require any involvement by the Chair or the Minister. If, however, a Member wishes to make what he or she might call an intervention but what we would regard as a speech of two or three minutes or more, that is permitted only if the Member whose debate it is agrees, the Minister agrees, and the occupant of the Chair agrees.

I thought it might be useful to make that point at the outset of this Parliament, because I have often come across very experienced and sometimes distinguished Members who do not seem to be aware of the distinction between intervening and making a speech in such circumstances. I hope that is helpful to colleagues.

Motion made, and Question proposed, That this House do now adjourn.—(Stuart Andrew.)

Photo of Judith Cummins Judith Cummins Opposition Whip (Commons) 10:46 pm, 12th September 2017

In today’s NHS, the word “crisis” is sadly all too commonplace. Week in, week out, crisis grips our NHS. We see it played out across our front pages: in our money-strapped and creaking social care system, in our overflowing A&Es, and in the ever longer delays in accessing even basic procedures such as knee and hip replacements. For health professionals right across this country, it must be beyond frustrating that where the Government are concerned, it takes nothing less than a full-blown crisis before a Minister is willing to sit up and take notice.

What we see unfolding in NHS dental practices in communities right across this country is yet another crisis. The British Dental Association agrees. A BBC investigation last week revealed that of 2,500 dental practices listed on the NHS Choices website, half were not willing to accept new adult NHS patients—half of all practices.

Photo of Paula Sherriff Paula Sherriff Shadow Minister (Equalities Office) (Women and Equalities)

I have raised with the Minister and his predecessors for over two years now the terrible dental services in Dewsbury, and we have not yet reached any resolution. Does my hon. Friend agree that while looking at this issue we must try to achieve a resolution for the whole of West Yorkshire?

Photo of Judith Cummins Judith Cummins Opposition Whip (Commons)

Absolutely.

More disturbingly, 40% of practices were unwilling to take children as NHS patients. Millions of people each and every year are being left without access to an NHS dentist. The human cost of this crisis is huge. Families, parents and young children are suffering horrific, lifelong and extreme damage to their teeth and to their oral health. Stories of people resorting to pulling out their own teeth are increasingly commonplace. Images of young children—toddlers—with mouths full of rotten teeth are less and less of a rarity.

Photo of Tracy Brabin Tracy Brabin Shadow Minister (Education)

Does my hon. Friend agree that it is deeply worrying that 29% of five-year-olds in Kirklees have decayed, missing or filled teeth, and that in March 2017 NHS Digital told us that one in three children in Kirklees have not seen an NHS dentist for the past 12 months?

Photo of Judith Cummins Judith Cummins Opposition Whip (Commons)

I certainly do. I thank my hon. Friend for that intervention.

The physical damage is visible—it is easily understood—but just focusing on this physical damage would be to underestimate what we are facing in this country. Much of the damage is much less visible, as it is emotional, psychological and hidden beneath the surface, with a generation hobbled by insecurity and embarrassment. At a time when mental health parity receives the personal endorsement of the Prime Minister, I despair that so many, mainly young people, are facing emotional disorders for an entirely preventable reason.

It is difficult enough for adults left with irreparable damage, but when our children and young people are left embarrassed, deeply under-confident and self-conscious, the true scale of what is happening reveals itself.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health)

Is not the underlying problem that there is no preventive dental contract in England? That means that people are going when they are in crisis and dentists are unwilling to take them on. England needs something like the Scottish Childsmile scheme, which takes children right through childhood.

Photo of Judith Cummins Judith Cummins Opposition Whip (Commons)

I thank the hon. Lady for that intervention.

As children and young people are starting off in life, with their careers, social lives, and everything else ahead of them, they are being left damaged for entirely avoidable reasons. Sadly, identifying a crisis in our health services is not a rarity, but what we see in this crisis is that it is unfairly hitting the least affluent the hardest—those who are struggling to make ends meet, and those living in working-class areas.

The BBC interviewed a Bradford resident, Nazreen Akhtar, a mother of two children. She said it had taken her five years to find a dentist who would accept both her children.

Photo of Imran Hussain Imran Hussain Shadow Minister (Justice)

My hon. Friend will be aware that in Bradford 40% of people do not have an NHS dentist. Many of them have applied unsuccessfully. Does she agree that it is unacceptable that only one in 20 practices has its doors open to new patients?

Photo of Judith Cummins Judith Cummins Opposition Whip (Commons)

It is an absolute disgrace.

In the meantime, Ms Akhtar’s son had suffered chronic pain. His adult teeth had grown over the top of his milk teeth. I can only imagine the distress in having to watch your child facing chronic pain day in, day out, powerless and abandoned.

Low-income families face a double whammy: they are unable to find local NHS dentists with open lists, and more to the point, they are unable to afford the high cost of private treatment. That double whammy has left working-class areas hardest hit. Over the past seven years, the Government’s unspoken policy has been to force dental practices to rely increasingly on patient fees, and, more insidiously, to force dental practices to rely even more on patients who pay privately. Revenue from patient charges has grown by 66% over the last decade and totalled £783 million in 2016-17. Meanwhile, direct state investment has been in steady decline.

The British Dental Association analysis also reveals that the Government have only commissioned enough dentistry to treat around half the adult population. That is an absolute disgrace.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I congratulate the hon. Lady on securing this debate. Does she feel that the Minister and the Government should set aside the idea of patients per practice and set extra money aside so that more dentists can take on more patients?

Photo of Judith Cummins Judith Cummins Opposition Whip (Commons)

I absolutely do.

Dental practices in working-class areas, facing spiralling overheads and a decline in their income, are struggling to stay afloat. In better-off areas, dental practices have been able to cushion themselves through extra revenue from privately paying patients. That extra income makes a difference. In working-class areas, the realities of life are hugely different. After many families have paid their rent or mortgage, covered day-to-day essentials and put food on the table, a visit to the dentist has now become one of life’s luxuries.

Research by the BDA supports that idea. Figures reveal that four in 10 patients have delayed a dental check-up because of fears about the high cost of treatment. That is understandable when we realise that the patient charge for treatment in the highest band—such as crowns or bridges—is £244.30. Working-class people, such as those in Bradford, are being hit the hardest. They have been abandoned by the Government, and they suffer failing oral health and chronic pain day in, day out. Worst of all, they are powerless to do anything about it because they find it difficult to access an NHS dentist. There is a clear human cost of poor dental health, which affects every part of a person’s day-to-day life.

The BBC spoke to a Mr Oldroyd during their investigations. Mr Oldroyd, a middle-aged man, has been trying to find an NHS dentist for four long years, during which he had suffered from chronic pain caused by his terrible tooth decay. He told reporters:

“The state of my teeth has made me depressed and I’ve literally begged to be taken on by an NHS dentist, but every time I’ve been turned away.”

Mr Oldroyd told reporters that his pain became so unbearable that, in the end, he resorted to self-extraction. He pulled out his own teeth. This is simply unthinkable. Mr Oldroyd believes that his poor dental health has contributed to him being out of work. As he puts it:

“The tops of my teeth are gone. I’m on benefits and trying to get a job, and when someone sees my teeth they just think I’m another waster.”

This crisis has been a long time in the coming. It has not crept up on the Government; it has been visible and in plain sight. The Government were put on notice when they came to power in 2010. There have been repeated warnings from dental professionals working in the sector, from within Parliament, and from the British Dental Association. All have warned that inaction is not an option, but sadly that is what we have seen.

It was not long ago that I, and many other Members, spent the afternoon right here in the Chamber in a Back-Bench business debate about health inequalities. During my remarks I set out a number of simple, uncontroversial steps that promised to improve access to NHS dentistry. First among those steps was to expedite reform of the NHS dental contract. Time and again when challenged about the reform of this contract, the Government have done little more than lay the blame at the door of the previous Labour Government. With respect, if that excuse was ever persuasive, it is now threadbare following seven years of a Conservative Government, two Conservative Prime Ministers and three general elections.

Reform of the contract is critical, as it promises to spend taxpayers’ money more effectively. The current dysfunctional contract sets quotas on patient numbers, fails to incentivise preventive work, including effective public information campaigns, and implicitly places an ever-growing reliance on dental practices to pursue private charging as a means of staying afloat. This Government are forcing dentists to make a terrible decision: either to stop providing NHS services altogether and go private, disregarding those who have less ability to pay, or to provide overstretched NHS dental treatment to their patients—or a combination of the both. That is a toxic choice for the dental profession.

Since first being elected in 2015, I have campaigned for more funding for Bradford. The city has among the worst oral health outcomes in the country, despite the hard work of local public health officials. We have received additional funding, to the credit of the previous Minister, Alistair Burt, but frustratingly this was only temporary. Despite my efforts, the Government still have not announced whether any permanent funding will be put in place. That is simply unacceptable. Official figures reveal that a five-year-old in Bradford is four and a half times more likely to suffer from tooth decay than a child in the Health Secretary’s constituency of South West Surrey. According to figures, a third of children in Bradford have not seen a dentist for more than two years. Children should be given a check-up every six months.

Photo of Judith Cummins Judith Cummins Opposition Whip (Commons)

I am really sorry; I cannot give way because of the time.

One of the most shocking figures reveals that the number of children admitted to hospital for tooth extractions has risen by a quarter over the past four years. Some may think that tooth extraction is simply a part of growing up—a rite of passage for children. Some may recount their own personal memories of visiting the dentist. If anyone still holds that sentimental view, they should pause for a moment and rethink. The tooth extractions I am speaking of, which have gone up by a quarter in the last four years, mostly involve a general anaesthetic. A recent freedom of information request to Bradford hospitals sets out the scale of the crisis. In the short period from April to December 2016, 190 children were admitted to hospital to undergo a tooth extraction under general anaesthetic. What was also shocking about this request was the hospital’s admission that those figures were not available prior to April 2016. The hospital did not consider that the procedure warranted reporting.

Photo of Judith Cummins Judith Cummins Opposition Whip (Commons)

I am sorry, I do not have time.

One core theme that emerges time and again, as borne out by Bradford hospitals’ admission, is that the Government are paralysed by inaction when it comes to oral health and NHS dentistry. They are indifferent towards even the simple task of requiring a countrywide collection of the most basic statistics on how many children are being subjected to the dangers of general anaesthetic. Time and again, the only sensible conclusion that can be drawn is that this Government are paralysed by inaction. Oral health and dentistry services truly are the Cinderella service of our NHS.

Across our country, tooth decay remains the leading reason for hospital admissions among young children, despite being almost completely preventable. The Government should be ashamed of the fact that almost 40,000 children were admitted to hospital to have multiple teeth extracted under a general anaesthetic because of tooth decay in the last year alone. On the Department of Health’s own figures, the average cost of a tooth extraction is £834. Overall, the NHS is calculated to have wasted more than £50 million on tooth extractions. This crisis is wasting the NHS millions upon millions of pounds each and every year in tooth extractions for our children. As the saying goes, prevention is better than cure. That was never truer than in oral and dental health. The Government should be ashamed of the fact that, under their watch, tooth extractions are up by 25%. It is beyond doubt that that £50 million would be better spent on prevention activities. Spending the money in that way would free up scarce NHS time and limited beds, while saving tens of thousands of our children from the trauma of hospital admission and general anaesthesia.

I want to touch upon the real scandal at the heart of those 40,000 hospital admissions. NHS dental treatment is free for our children and young people. Every child and young person should be receiving good quality NHS dental treatment, but recent figures published by the Royal College of Surgeons faculty of dental surgery reveal that 42% of children did not visit an NHS dentist in the year prior to 30 June 2017, and a staggering 80% of children between the ages of one and two did not visit a dentist at all. That may perplex some Members. Why are so many of our children and young people not receiving the treatment that they are freely entitled to access under our NHS? A recent survey published by the BDA reveals the truth. The survey found that 25% of parents did not know that routine dental check-ups were free for their children. More to the point, seven in 10 parents were not aware that treatment for their children would also be free of charge.

In theory and in name, we operate an NHS dental system for our children and young people—one that is based on need, not on ability to pay. It is free at the point of need and free at the point of delivery. In reality, however, when seven in 10 parents are not aware that treatment for their children is free; and when, on the ground, 40% of NHS dentists are unwilling to take on children as new NHS patients, I ask this question: can we really say with any certainty that we continue to operate a free NHS dental system for our children in this country? Is it not true that, following seven years of inaction, the Government have, de facto, displaced our NHS dental system with a burgeoning private system?

Although the working class are, beyond doubt, being hit the hardest, the crisis in dentistry transcends social class, ethnicity and age. Although the people in my home city of Bradford are being hit hard by the lack of access to an NHS dentist, evidence from the profession, patients and the British dental association makes it clear that the crisis is a national one, which is hitting all areas of this country. Therefore, I ask the Government to get on with dental contract reform and, more broadly, to bring forward a coherent strategy to tackle the inadequacies and inequalities I have set out this evening. Indifference is not an option; Government need to act now to stop this crisis.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary of State for Health 11:03 pm, 12th September 2017

I congratulate Judith Cummins on securing the debate, which has come significantly earlier this evening than perhaps we had expected. I am sure that that is one of the reasons for the increased turnout, but the main reason is that this is a very serious and important subject, which affects lots and lots of our constituents. I thank Members for being here.

Of course, everyone should have access to a dentist, and those who want it should have access to an NHS dentist. It is a fact that the two main dental diseases—dental caries or decay, and periodontal or gum disease—can be almost eliminated by the combination of good diet and correct tooth brushing, backed up by regular examinations by a dentist. Let me acknowledge from the outset, therefore, the vital role that dentists play in maintaining and improving the oral health of all our constituents.

As hon. Members may be aware, NHS England has a statutory duty to commission services to improve the health of the population and to reduce inequalities. The hon. Lady spoke passionately about that, as she always does. In this instance, NHS England’s statutory duty is to commission primary NHS dental services to meet local need. I appreciate that, as she has highlighted, there are of course areas with access difficulties—to put it mildly—such her constituency of Bradford South, as well as those represented by other Members in the Chamber, but overall access continues to increase.

The January to March 2017 GP patient survey results were published in July, and I looked at them today. They showed that 59% of adults questioned had tried to get an NHS dental appointment in the past two years. Of those trying to get an appointment, 95% were successful. Looking, as I did today, at the latest figures for patients seen by NHS dentists, I can tell the hon. Lady that 22.2 million adult patients aged 18 and over were seen in the 24 months ending 30 June 2017. This equates to 51.4% of the adult population. The number of adults seen by an NHS dentist had increased by 19,000 compared with the period ending June 2016. To prove that I have indeed swallowed the numbers box, let me put on the record that 6.8 million children were seen in the 12 months ending 30 June 2017. This equates to just over 58% of the child population. Again, this was an increase of 75,000 compared with the period ending June 2016.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health)

It is not just a matter of seeing children if they are simply being seen for caries and fillings or other remedial work. The payment structure means that a dentist is paid only for a check, not for advice, cleaning or fluoride sealant, and the problem is that that structure does not drive prevention.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary of State for Health

I absolutely agree with the hon. Lady, and if she will bear with me, I will come on to that point.

Photo of Dr Caroline Johnson Dr Caroline Johnson Conservative, Sleaford and North Hykeham

As a doctor, I have seen the distressing circumstances in which children as young as two come in for teeth extractions. Children sometimes have all the milk teeth in their mouth extracted. Does my hon. Friend agree that there is more to preventing caries and such extractions than just dental treatment and having more dentists? The answer, particularly for the very youngest children, lies in extra education about oral care, as well as good diet and not drinking fizzy drinks and the like.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary of State for Health

Yes, there should be a package, and I will come on to mention one or two of those points. This is as much about self-care as it is about interaction with the dental profession.

To conclude the point I was making, at a regional level in the period to 30 June, the north of England saw the highest percentage of patients seen—56.8% of adults and 63% of children. Although these access numbers are encouraging, I know that the hon. Member for Bradford South will not be sitting there thinking, “That’s all okay, then.” I know that more needs to be done to reduce the remaining inequalities in access, including in areas such as Bradford South, which she represents, and NHS England is committed to improving the commissioning of primary care dentistry within the overall vision of the five year forward view.

There are a number of national and local initiatives in place or being developed that aim to increase access to NHS dentistry. Nationally, the Government remain committed to introducing the new NHS dental contract, which the hon. Lady rightly referred to often in her speech. It is absolutely crucial to improve the oral health of the population and increase access to NHS dentistry.

A new way of delivering care and paying dentists is being trialled in 75 high street dental practices. At the heart of the new approach is a prevention-focused clinical pathway. It includes offering patients oral health assessments and advice on diet and good oral hygiene, with follow-up appointments where necessary to provide preventive measures, such as fluoride varnish, that can help the prevention agenda. Importantly, and this is of most relevance in this debate, the new approach also aims to increase patient access by paying dentists for the number of patients cared for—let me restate that: cared for—not just for treatment delivered, as per the current NHS dental contract. Subject to the successful evaluation of the prototypes, decisions will be taken on wider adoption. The prototypes are being evaluated against a number of success criteria, but let me be clear that they will have to prove that they can increase dental access before we consider rolling them out as a new dental contract.

I appreciate that this is taking a long time. It is as frustrating for me as it is for right hon. and hon. Members and for the profession, but Members will understand that rolling out a new dental contract is complicated and complex. We have to make sure that it is right and that what we put in place is better than what was there before.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health)

I am very grateful to the hon. Gentleman for giving way again. Has he looked at the Childsmile project in Scotland? It covers dental care from zero to 18, including advice and education in nursery and in school, and therefore provides a whole package. It has reduced dental caries in Scotland—frankly, we have much worse teeth than you—by 24% and saved £5 million. That information is already there and it might help in the assessment of the Government’s plans for England.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary of State for Health

I thank the hon. Lady for that. No, I have not looked at that, as I am still relatively new to the brief, but I will certainly do so. I will make some progress and then conclude because time is limited.

Photo of Imran Hussain Imran Hussain Shadow Minister (Justice)

I welcome the review of the system, in particular the dental contract prototypes. As the Minister has outlined, one issue is that many of the contracts, as in Bradford, are ancient contracts that have not taken account of the demographic changes over time. Some of the most disadvantaged areas are hit the worst by that. Can he give a definitive time by which the prototypes will be completed and he will have the report that we have awaited for over a year?

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary of State for Health

I cannot give the hon. Gentleman an exact time. I know that is annoying and I am sorry, but I cannot. It will happen ASAP—as soon as possible—and I will let the House know when it does.

Let me wrap up my speech by covering the other points that I need to make in response to the debate. We are about to launch the much anticipated and much discussed Starting Well programme, which is aimed at children under five. I think that it borrows from some of the stuff that is going on north of the border.

Children’s oral health is better than it has ever been, with 72% of five-year-old children in England now decay free. However, vast inequalities remain, as we have heard today. To tackle those inequalities, NHS England has been leading the Starting Well programme, alongside Public Health England—I was in Warwick today, speaking to its annual conference—the British Dental Association and, of course, colleagues at the Department of Health. The overall aim is to improve the oral health of children under the age of five who do not currently visit a dentist in 13 identified high-priority areas. The areas that have been selected will be confirmed shortly. My officials will have heard a passionate bid from Opposition Members today.

I am sure that the House will welcome the initiative. The intention is to reduce the unacceptable oral health inequalities that exist for children in this country. We know that visiting a dentist early in a child’s life can help lay the foundations for a lifetime of good oral health.

Locally to the hon. Member for Bradford South, I am aware that NHS England ran an initiative to tackle the dental access issues in west Yorkshire. The aim of the dental access pilot was to improve access to primary care NHS dentistry in the Bradford City, Bradford Districts and North Kirklees clinical commissioning group areas.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary of State for Health

I will not because we are almost out of time.

The initiative was for patients requiring routine or urgent treatment who approached 111 to access a dentist. Patients were triaged by Local Care Direct according to need. Twenty-five practices participated in the pilot: nine in Bradford City, eight in Bradford Districts and eight in North Kirklees. In March 2017, an additional practice in Dewsbury was recruited into the pilot; Paula Sherriff is in the Chamber.

The pilot began in January 2017 and was due to end in March, but it was extended to the end of June 2017. Over the duration of the pilot, almost 7,800 appointments were made available for new patients. NHS England across Yorkshire and the Humber is currently reviewing the learning from the pilot and considering how it can improve access to NHS dentists in a number of areas across the region. I know that it would welcome representations from the Opposition Members who are present if they wish to feed into that process.

In closing, I would like to reiterate the commitment we made in our manifesto

“to support NHS dentistry to improve coverage and reform contracts so that we pay for better outcomes, particularly for deprived children.”

I hope that by setting out, in the very limited time we have for this Adjournment debate, the work being undertaken by the Department of Health, NHS England and Public Health England, I have been able to assure the hon. Lady and the House of the commitment we have and that I have personally. I hope there is no question that this is a huge priority for me. I want to improve access to NHS dentistry and I want to improve the oral health of our children, especially in England, and of the population for the future. That is in all of our interests.

I thank the hon. Lady for bringing this debate to the House. I am certain that this conversation will continue.

Question put and agreed to.

House adjourned.