NHS Dentistry

– in the House of Commons at 12:37 pm on 9 January 2024.

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Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care 12:48, 9 January 2024

I beg to move,

That this House
recognises that NHS dentistry is in crisis, with eight in 10 dentists in England not taking on new NHS patients and vast parts of the country considered so-called dental deserts, where no dentists are available;
regrets that this has led to people resorting to DIY dentistry or attending A&E to access urgent care;
is concerned that tooth decay is the most common reason children aged six to 10 are admitted to hospital;
and therefore calls on the Government to provide an extra 700,000 urgent appointments a year, introduce an incentive scheme to recruit new dentists to the areas most in need and a targeted supervised toothbrushing scheme for three to five year-olds to promote good oral health and reform the dental contract to rebuild the service in the long-run.

Happy new year, Mr Speaker.

After 14 years of Conservative neglect and mismanagement,

“NHS dentistry in England is at its most perilous point in its 75-year history.”

That is the conclusion of the Nuffield Trust think-thank, and who can blame it? Eight in 10 NHS dentists no longer take new patients. According to the NHS, no dentist is taking on new adult patients in entire constituencies such as Broxtowe, Bolsover, Stoke-on-Trent South and Stroud. Five million patients tried but failed to get an appointment in the past two years. Millions more needed dental care but did not bother trying to book an appointment because they knew it would be impossible. Tooth decay is now the No. 1 reason why children aged six to 10 end up in hospital. We face the moral outrage of one in 10 Brits saying that they have been forced to attempt dentistry themselves because the NHS was not there for them when they needed it. This is Dickensian—DIY dentistry in 21st-century Britain. Is there any greater example of the decline that this country has been subjected to under the Conservatives?

Photo of Sarah Champion Sarah Champion Chair, International Development Committee, Chair, International Development Committee

May I add Rotherham to the list that my hon. Friend is quoting? To give an example, one of my constituents has been trying for more than a year to register with an NHS dentist. He has now had to go private for the consultation, which said:

“Your teeth are in a very poor condition with most of your remaining teeth decayed and unsaveable. All your teeth except 2 …need extracting.”

He has been living for more than a year on painkillers and soup. I have raised this with the Minister and got no satisfaction. This is what Tory Britain is doing to dentistry.

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

I totally agree with my hon. Friend. We have heard so many heartbreaking stories like the one she mentions from her constituency. A service that once was there for all of us when we needed it is almost gone for good.

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

I will, so that the hon. Gentleman can explain why that is the case.

Photo of Anthony Mangnall Anthony Mangnall Conservative, Totnes

Is there any greater landmine of a Labour legacy than the 2006 contract that it designed, which is pulling us down? Labour Members need look no further than their own designs on the NHS. We are sorting out their mess.

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

The sound you can hear, Mr Speaker, is the scraping of the barrel. How has the hon. Gentleman got the brass neck to stand up, after 14 years of his party in government, and say that a contract agreed in 2006 is the problem? If only the Conservatives had been in government for 14 years to sort it out.

Here is the other rub: we do not pretend that everything was perfect under the last Labour Government. In fact, reform of the NHS dentistry contract was in Labour’s 2010 manifesto, because we recognised that it needed to change. Had we been elected in 2010, we would have delivered. It was also in the Conservatives’ 2010 manifesto and 2015 manifesto. It was probably in the 2017 and 2019 manifestos, too, and they have not delivered. We have 14 years of Conservative failure. How dare the hon. Gentleman have the brass neck to stand up and blame someone else.

Photo of Jamie Stone Jamie Stone Liberal Democrat Spokesperson (Armed Forces), Liberal Democrat Spokesperson (Digital, Culture, Media and Sport)

It is of great interest, is it not, that there is not one Member from the governing party in Scotland present for this debate? I can tell the House that dental services in my constituency in remote Scotland have gone backwards in a big way, and I am shocked that none of them are here to hear this.

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

It is deeply disappointing. Let me assure the hon. Gentleman that as with the last Labour Government—13 years that created a rising tide that lifted all ships across the country, when we had an NHS with the shortest waiting times and the highest patient satisfaction in history—the next Labour Government will deliver a rising tide to benefit people across the country.

Photo of Alex Cunningham Alex Cunningham Shadow Minister (Justice)

The British Dental Association highlights that:

“Hormonal changes during pregnancy can make gums more vulnerable to plaque”, and:

“Changes to dietary habits, and morning sickness” can also impact on oral health. After being told of the importance of seeing a dentist after suffering multiple miscarriages, a constituent tells me that she has been struggling for three years to see a dentist within a 50-mile radius of her home. Dentists say that they are going private and are helping only with emergencies. Surely that is evidence of a colossal failure of Tory Government dental policy, and even the most vulnerable are suffering.

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

I wholeheartedly agree with my hon. Friend. In fact, he has the ability, as the Labour MP for Stockton North, to speak for his residents. If only other people across the country had MPs standing up for them. Chris Webb, Labour’s candidate in Blackpool South, reported to me that pregnant mothers have been telling him they cannot get an NHS dentist, despite being entitled to free NHS check-ups and treatment. Alice Macdonald, Labour’s candidate in Norwich North, reported similar conversations to me. Expectant mothers have told her that they have been travelling hundreds of miles to see a dentist when we know that pregnant women probably need that support more than many others. What an indictment of 14 years of Conservative Government.

Photo of Ben Bradshaw Ben Bradshaw Labour, Exeter

Did my hon. Friend see the report in today’s Times that showed that NHS dentists are performing only 75% of the procedures they are contracted to do? In Devon and Somerset, where the situation is the worst in the country, it is only 26.5% and 30%. Not only have this Government delivered an NHS desert in Devon and Somerset, but they are wasting masses of public money. What is my hon. Friend going to do about it when he is Health Secretary?

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

I strongly agree with my right hon. Friend. Things are so desperate. He mentioned the south-west in particular, and Devon and Cornwall have been particularly poorly served. Jayne Kirkham, Labour’s candidate in Truro and Falmouth for this year’s general election, reported to me that a local dentist handed their contract back before Christmas, meaning that 3,000 people lost their NHS dentist overnight. There are currently no dentists in Truro and Falmouth taking on adult NHS patients. Contract reform is urgent, so where is it? They have had 14 years, so where is the recovery plan that the Health Secretary mentions in her amendment?

Several hon. Members:


Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

I must make some progress.

Turning to other parts of the country, Keir Cozens, Labour’s candidate in Great Yarmouth, has been running a campaign on the state of dentistry in Great Yarmouth. He has heard heartbreaking stories of broken teeth left for months with people in pain, of children unable to be seen, of at least one person a day going to accident and emergency with dental issues, and of people performing DIY dentistry at home after buying kits from Amazon. No one should be doing that, but people are desperate. DIY dentistry does not work, and before you know it, people are back in A&E waiting for expensive emergency dental treatment. I have heard similar stories from Kevin Bonavia, Labour’s candidate in Stevenage. He tells me that people turning to DIY is shockingly common.

No one voted for this. None of the five Conservative Prime Ministers, the seven Conservative Chancellors or the eight Conservative Health Secretaries told the public that this was what the future held, but this is what they have done to dentistry. It is the way all our public services are going, and it is why the Conservative party cannot be allowed five more years to finish the job.

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

I thank the shadow Secretary of State for bringing this debate forward. The stats from the British Dental Association cannot be ignored. In its survey, 41% of practice owners and 38% of associate dentists said that they would like to leave NHS dentistry as soon as possible. This debate will resonate with many people out there. Does he agree with the chair of the Northern Ireland Dental Practice Committee that now is the time for the funding allocation to pay for a better contract and for training more dedicated dentists who will commit to the NHS, rather than private practice?

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

I agree with the hon. Gentleman about the urgency of the situation. There is a different path available to us. We can revive our public services and give our country back what we used to take for granted. Labour’s plan would take immediate steps to rescue NHS dentistry, with 700,000 more urgent appointments and the recruitment of new dentists in the areas most in need. We would also take the necessary steps to rebuild NHS dentistry over the long term, including reforming the dental contract and introducing supervised toothbrushing for three to five-year-olds in primary schools, so that poor oral health is prevented and demands on the service reduced.

In fact, some of my Labour colleagues are not even waiting for the general election to start making a difference. Labour’s candidate in Stroud, Simon Opher—himself a GP—has spearheaded a campaign working with local dentists and the integrated care board. From opposition, he has more than trebled the number of emergency appointments available each day across Gloucestershire, pioneered a new dental stabilisation scheme for people not known to a local practice, opening up more than 130 appointments a week, and introduced supervised toothbrushing in 14 local primary schools. If that is the difference Simon is making in opposition, imagine what he will be able to do as a Labour MP working with a Labour Government. That Government cannot come soon enough.

Photo of Catherine West Catherine West Shadow Minister (Foreign and Commonwealth Affairs)

My hon. Friend is making an excellent speech. Does he agree with me and my constituent in Crouch End who has not had a check-up since 2019 that the link between poor oral health and oral cancer is serious? That could be contributing to the terrible problem we have with cancer waiting times.

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

I totally agree with my hon. Friend. Prevention is better than cure. It is a truism, and it is also the foundation pillar of what would be Labour’s 10-year plan for reform and modernisation of our national health service. A part of that plan is before the House today, and Government Members will have to explain to their constituents, only months, if not weeks away from a general election, why they are refusing to support it.

The Government’s amendment to the motion promises that the dental recovery plan is coming soon, but it was due last summer; now, they cannot put a date on when the plan will arrive, when it will be implemented or even say what it is. Conservative Ministers have taken a look at the state of NHS dentistry, at the millions of people across the country who cannot get an appointment to see a dentist and at children in their own constituencies whose teeth are rotting, and their conclusion is: what is the rush? Let me tell them why they should get their skates on.

A 17-year-old boy in Plymouth had to undergo emergency surgery on an abscess in his mouth last year. He spent two months trying to book an NHS dentist—he said that he was on hold for about three hours per day. According to figures on the NHS website, no dentists are taking on new NHS patients in the Plymouth, Moor View constituency. It was left too late, and when he finally got the healthcare he needed, he required emergency surgery, which has left him scarred for life.

In Worthing West, Labour’s candidate Dr Beccy Cooper told me of an 82-year-old great-grandfather on pension credit who told her that he will not be going back to an NHS dentist before he dies. He tried to get an NHS dentist in Worthing, but no one will take him on the NHS to receive low-cost treatment. Dr Beccy Cooper also tells me that residents who cannot get a dentist are being told to look for one in Hampshire, more than 60 miles away from where they live.

Photo of Ian Lavery Ian Lavery Labour, Wansbeck

On that important point, a couple who moved into new housing in my constituency tried to get an NHS dentist for over a year without any success whatsoever. They have got two options: they either go private or use their previous dentist, who is 20 miles away. That is wholly unacceptable. Will my hon. Friend simply explain how Labour’s plan will eradicate this unacceptable issue?

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

My hon. Friend is absolutely right. We will have: 700,000 appointments, making a difference straightaway; supervised toothbrushing for three to five-year-olds to reduce future demand on NHS services; and reform of the NHS dentistry contract so that we can rebuild an NHS dentistry service worthy of the name. That change cannot come soon enough.

Photo of Emma Hardy Emma Hardy Shadow Minister (Flooding, Oceans and Coastal Communities)

My constituent Amy has been in contact with me about the difficulties that she and her five children have had getting NHS dentist appointments. She explained that her husband was in the military and therefore they had to move home frequently, and each time they moved they found it harder to get an NHS dentist. Does my hon. Friend agree that that is a shameful way to treat people who have served and given so much to our country?

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

I agree. I am afraid that when it comes to serving personnel and veterans, there is a gulf between what the Government say and promise and what they do; that is not the only example.

One thing not in the Government’s amendment to Labour’s motion is a pledge to protect the NHS dentistry budget. That is odd, because the Prime Minister promised to do exactly that 18 months ago. The truth is that the Prime Minister broke that pledge in November when he gave the go-ahead for dentistry underspends to be raided, effectively waving the white flag on the future of the service. Can you believe it? Despite everything we have heard, there are dentistry underspends, and the Prime Minister thinks that other things are greater priorities than this crisis. The consequences of that decision are now being felt. The budget in some areas of the country is running out and dentists are having to stop NHS work for the remainder of the year. It is so deeply frustrating.

NHS dentists want to do more NHS work; it is the Government who are standing in their way. The Nuffield Trust’s stark report into the crisis suggested that NHS dentistry may have to be scaled back and made available only to the least well-off. Such an approach would be the end of NHS dentistry as a universal public service, yet that is exactly the approach that the Government are piloting in Cornwall. Children, the over-80s and those with specific health needs are given treatment; everyone else has to go private or go without. They will not admit it, but this is the future under the Tories: further neglect, decline and patients made to go without.

Worse still, NHS dentistry is the ghost of Christmas yet to come under the Tories. That is not partisan overreaction on our part; that is according to the lead author of the Nuffield Trust’s report. He wrote:

“For the wider health system, the lessons are troubling: without political honesty and a clear strategy, the same long-term slide from aspiration to reality could happen in other areas of primary care too.”

What has happened to NHS dentistry under the Tories is coming to the rest of the NHS if they are given another five years. That is not the continuity that the country is looking for—it is looking for change with Labour.

Photo of Wera Hobhouse Wera Hobhouse Liberal Democrat Spokesperson (Transport), Liberal Democrat Shadow Leader of the House of Commons, Liberal Democrat Spokesperson (Energy and Climate Change)

My Bath constituency is also described as an NHS dental desert. The only option for people is to go private. The hon. Member has already said that it is Dickensian. Does he agree that it is not just a health problem but an equalities issue that the Government fail to recognise?

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

I totally agree. In fact, Claire Hazelgrove, Labour’s candidate in Filton and Bradley Stoke—next-door to the forthcoming by-election—was telling me about problems in her constituency and that exact challenge of people being left without or having to go private. One patient told her that her dental practice was now only seeing private patients. That same patient cares for her 84-year-old dad with dementia, who needed a tooth removal to allow him to eat. His appointment was also cancelled. That is what is happening before our eyes.

What of those who cannot afford it? Anna Dixon, Labour’s candidate in Shipley, told me of a woman in her town who had been turned away as an NHS patient and could not afford to go private. She was struggling with pain, it was affecting her eating, and she was at her wits’ end. With the Tories, if you have not got the money, you have not got the care.

Photo of Kerry McCarthy Kerry McCarthy Shadow Minister (Climate Change and Net Zero)

As a neighbouring MP, I thank my hon. Friend for mentioning Claire Hazelgrove, our candidate in Filton and Bradley Stoke, who is doing tremendous work on this. I have done a survey of my constituency and have found that about 98% of Bristol NHS practices are not taking on new patients. One issue I have also come across is that, even when people do have access to an NHS dentist, they cannot afford even those lower fees, and as a result they are being removed from the active patient list and losing access to that. We can understand how, during the cost of living crisis, people might delay a check-up for a few months because there are so many other pressing demands on their budgets.

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

I totally agree, and I do not think we should be complacent about this as a country. The NHS is already becoming a two-tier healthcare system, where those who can afford to go private are paying and the rest are left with an increasingly poor service for poor people. Government Members protest now, but they admit their goals once they leave the Department for Health and Social Care. The Health Secretary’s predecessors may not have said it when they were in her place at the Dispatch Box, but, as soon as they were out the door of the Department, the right hon. Members for West Suffolk (Matt Hancock) and for Bromsgrove (Sir Sajid Javid) said what they really believe: patients should be charged for GP appointments. Well, why stop there with this Conservative philosophy? Why not go further? That is the future for the health service if the Conservative party is given another five years. That is the risk facing patients across the country, and that is the choice facing voters at the next general election: further neglect, mismanagement and decline under the Conservatives or change with Labour and a decade of national renewal.

On NHS dentistry, the need for change could not be clearer. By the Conservative party’s own admission, it does not have a plan—just the vague promise of one coming in the future. All it does have is a record of 14 years of failure. If we stick to the current path, full universal access to NHS dentistry may be gone for good. The Conservatives may be happy to wave goodbye to this vital public service, but that is not the Labour way. With Labour, there is a clear plan, with immediate steps to tackle the crisis and long-term reform to rebuild dentistry. There will be more appointments, more dentists, more support for children and long-term reform to put the service on a sustainable footing, paid for by abolishing the non-dom tax status. That is because Labour believes that people who live and work in Britain should pay their taxes here, too. It does not matter whether they live on Downing Street or any other street: if they make their money here in Britain, they should pay their taxes here, too.

Photo of Lloyd Russell-Moyle Lloyd Russell-Moyle Labour/Co-operative, Brighton, Kemptown

My hon. Friend is making an excellent speech. Abby Lane, in my constituency, has contacted over 30 dental practices. Not one is accepting her and her one-year-old child, who desperately needs dental treatment. Is it not the case that we now need to reform the system so that local commissioners can ensure that dental commissioning is happening in local areas where there is need, and not just have this patchwork system where dentists are fleeing because it is not paying well enough?

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

I totally agree. The tragedy is that if we look at the system as a whole and think about the pressure the whole system is under, and if we got NHS dentistry right, we would not only be saving patients untold pain, but saving the NHS money. As Lucy Rigby, Labour’s candidate in Northampton North, reported to me, in 2022 tooth decay forced 625 of her local patients to A&E—worse for them and more expensive for the taxpayer.

If Tory Members disagree with charging non-doms their fair share, maybe they could explain in their own contributions why they disagree. I am sure that their constituents would love to hear their defence of the non-doms, and we would be happy to give them space on Labour leaflets to quote their arguments back at them and let the public decide. I would particularly like to know why the Prime Minister is so wedded to this tax break for the wealthiest.

While Tory Members are set to oppose Labour’s rescue motion today, I understand that our plan on supervised toothbrushing for three to five-year-olds has received an endorsement from an unlikely source. On his podcast, former Conservative Chancellor George Osborne said:

“That really is the nanny-state in action.”

Coming from the Chancellor who introduced a sugar tax, I am sure George meant that as a compliment. Of course, Conservative Members may not see it the same way, just as they do not agree with Labour’s proposal to phase out smoking for children. Don’t worry, we have the Prime Minister’s back on that one; it is, after all, our proposal. But I ask those who attack our plan as nanny-state, what is the alternative? If a child cannot see a dentist and their parents will not do the responsible thing and make sure they clean their teeth, then should we just shrug our shoulders and do nothing while children’s teeth rot?

The problem for the small-statists on the Conservative Benches is this. Too many children today are not cleaning their teeth. Their teeth are rotting and they end up having them pulled out in hospital, which is worse for them and more expensive for the taxpayer. Last year, the NHS spent £80 million on tooth extraction. Toothbrushing in schools would cost a fraction of that, yet the Conservatives choose to waste taxpayers’ money, burning through taxpayers’ cash on the altar of ideological dogma and putting children through unnecessary misery, because it fits their confused ideology.

That is the irony of the Conservative party. Tories say that they believe in a small state and low taxes, yet they have left our country with the highest tax burden since the 1950s. The NHS receives £169 billion a year, yet it is going through the biggest crisis in its history. Because they do not understand that prevention is better than cure. Because they have refused to undertake meaningful reform. Because they treat taxpayers’ money with utter carelessness and contempt. And so they have left us with an NHS that gets to people too late, delivering worse care for patients at greater cost to the taxpayer. We are paying more and getting less. That is Tory Britain. No wonder Tory candidates are so worried.

Before this debate, I happened on a letter on Facebook from Peter Gibson who is, happily, in his place. First he talks about the state of dentistry in his constituency—we obviously agree with him there—and then he says:

“I was shocked to learn at the end of last year that little to no progress has been made by the Health Board in our region who are responsible for commissioning this service to you.”

Let us assume it was in anticipation of Labour’s motion, which he is going to vote against because the Whip has been cracked. He goes on to say:

“I have today written to the Chief Executive following on from the meetings I had last year, and will be raising this issue in today’s dentistry debate in the House of Commons.”

What that is, and what voters will see it for, is just one of what will no doubt be countless examples of Tory MPs and Tory Ministers, after 14 years of their failure and mismanagement, pointing the finger of blame at someone else, hoping that voters in Darlington and elsewhere will blame local NHS managers and local NHS commissioners for 14 years of failure. If it is really the case that his integrated care board is to blame for why people in Darlington cannot get a dentist, why are people struggling in Newcastle-under-Lyme? Why are they struggling in Northampton North? Why are they struggling in Shipley? Why are they struggling in Filton and Bradley Stoke? Why are they struggling in Worthing West, Stroud, Stevenage, Great Yarmouth, Truro and Falmouth, Blackpool South, Stockton South and every other constituency in the country? Stop blaming other people for your Government’s failures.

Photo of Peter Gibson Peter Gibson Conservative, Darlington

I am very grateful to the hon. Gentleman for giving way and I appreciate that he gave me notice that he was going to mention my constituency. What he failed to do in his contribution was read out the letter in full. He has also not anticipated the full content of my speech, which highlights all the work I have been doing in my constituency to tackle the failure by the ICB to deliver the missing contract.

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

I could quote the full letter, but it does not help the hon. Gentleman. He misses the fundamental point. This is not just a failure in Darlington. This is not just a problem in the north-east of England. It is the south-west of England, it is the south-east of England, it is the west midlands, it is the east midlands, it is the north-west, it is Cumbria—it is right across the country. In fact, even in London, my city, which has the best NHS dentistry provision in the country—so much for levelling up—dentistry is still in a poor condition. That is why people in Darlington are looking to Labour and, I hope, Lola McEvoy, to take responsibility, show some leadership, back good Labour policies and rescue NHS dentistry in Darlington. The general election cannot come soon enough.

The choice is clear. Under the Tories, NHS dentistry is dying a slow death. The only chance for survival is change with Labour. Labour’s plan will deliver: 700,000 more dental appointments a year for those most in need; new dentists recruited to dental deserts where there is not a single dentist taking on new patients; toothbrushing in primary school for three to five year-olds to promote good health and prevent demand on the NHS; and reform of the dental contract after 14 years of failure, so that once again every patient who needs a dentist can get one. Politics is about choices. Labour chooses to rescue NHS dentistry, not give the wealthiest a tax break. Labour’s plan is fully costed, fully funded, and will make a real difference to people across the country. The Tories have left our country toothless. Labour will give our country its smile back and give its NHS back, too.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care 1:18, 9 January 2024

I beg to move an amendment, to leave out from “House” to the end of the Question and add:

“recognises the impact of a once-in-a-generation pandemic on NHS dental services, with 7 million fewer patients seen in England across 2020 and 2021; notes these challenges were reflected in both Scotland and Wales;
acknowledges the steps already taken to recover services in England including the introduction of a minimum rate and increased payments for complex dental activity to better reward dentists for their work;
welcomes the publication of the Long Term Workforce Plan which committed to expanding dental training places by 40 per cent;
and supports the upcoming publication of the Government’s plan to further recover and reform NHS dentistry and promote good oral health throughout life.”

It is a pleasure to update the House on the work the Government are doing to strengthen NHS dentistry across the country. We are reforming our NHS and social care system to make it faster, simpler and fairer. Dentistry is a vital part of our NHS and improving dentistry is one of my top priorities. Wes Streeting represents a deeply urban seat, so I am pleased that he has presented me with an excuse to boast about the fact that I represent, and am very proud to represent, a rural and coastal constituency. That is why fairness is one of my three priorities for our NHS. I know the challenges that rural and coastal communities face when it comes to accessing an NHS dentist appointment, and the disparities in health that we see between rural and coastal communities and city centres. I will come to some statistics in a moment.

I am determined to fix these issues, and the other problems facing NHS dentistry, so that anyone who needs to can always see an NHS dentist, no matter where they live. Indeed, one of my very first acts as Secretary of State was to respond to the Health and Social Care Committee’s recommendations on dentistry. We agreed to the majority of those recommendations, and we stand firmly behind the ambition that NHS dentistry should be accessible and available to all who need it.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I am going to make a little progress, but I promise to give way later.

The whole House understands that the pandemic placed a long-lasting and heavy burden on NHS dentistry. [Interruption.] I hear groans from Opposition Members, but they cannot ignore the fact that some 7 million people did not come forward for appointments during that long period of the pandemic because dentists had to shut, and we were unable to accommodate those needs within the system because of the severe strictures under which we were all placed as a society. We shepherded the sector through the pandemic with £1.7 billion of direct support to compensate for NHS activity that could not be delivered. As we recover from the pandemic there are no quick fixes, but our recovery is well under way. Let me give the latest statistics, because the hon. Member for Ilford North missed them out in his speech. The Government delivered 6 million more courses of NHS dental treatment in 2022-23 than in the previous year. [Interruption.] In the two years to June 2023, the number of adults seeing a dentist increased by 1.7 million compared to the number in the previous year, and 800,000 more children saw a dentist in the year to June 2023.

Opposition Members cannot have it both ways. While I was reading out those statistics they were saying, “You cannot make those comparisons because of the pandemic”, but that is the point: people did not come forward during the pandemic, so, as we must all know from experience in our own constituencies, there is a backlog that dentists around the country are having to work through—and they are making progress.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

In fairness, I will give way to Helen Morgan first, because she rose earlier.

Photo of Helen Morgan Helen Morgan Liberal Democrat Spokesperson (Levelling up, Housing and Communities), Liberal Democrat Spokesperson (Local Government)

Like the Secretary of State, I represent a rural community, and the reason dentists are handing back their NHS contracts where I live is that they cannot recruit another dentist to come and help them. They have not had a day off, they cannot meet their commitments under their contracts, and they cannot recruit. They have offered golden hellos of 25%, but they have not been able to get anyone to come and work with them. What will the Secretary of State do to recruit the dentists whom we need to see the people in dental deserts such as North Shropshire?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

As I have explained, in relation to dentistry but also in relation to wider healthcare, the long-term workforce plan, which was requested by NHS England and by clinicians, is the means of laying those foundations for the future of the NHS. I will now give way to Dame Angela Eagle.

Photo of Angela Eagle Angela Eagle Labour, Wallasey

I thank the Secretary of State. I wanted to intervene earlier when she was talking about the pandemic. In my constituency many people were thrown off their dentists’ lists during the pandemic, often with no notice, and then found that they could not register anywhere else. That is what happened, I believe, all over the country. Can the Minister explain what she is going to do about it? It was not that people were not visiting their dentists; they were denied access.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

The hon. Lady has raised an interesting and important point, because, of course, dentists are independent contractors to the NHS, and I have to work with the levers that are available to me. As I have said, we have already invested £1.7 billion to try to help with the recovery, and the House will, I hope, look forward to our dentistry recovery plan when it comes to other ways in which we can improve that. The important point, however, is that because those dentists are independent contractors, we must work with the profession to encourage them back to the NHS to offer the services that we all want to see.

Photo of John Hayes John Hayes Conservative, South Holland and The Deepings

Is not the root of the problem the contracts that the NHS has with dentists? The roots of that, of course, lie with the previous Government, a Labour Government, rather as they do with the GP contracts. Does my right hon. Friend not need to revisit the genesis of this problem, as well as training more dentists here in the UK?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I thank my right hon. Friend, and indeed my friend, my Lincolnshire neighbour, who knows as well as I do the pressures that we face in ensuring that our constituents receive the same quality of care that we expect across England. He was right to draw attention to the—I would argue—badly drafted contract of 2006, but he also touched on the complexity involved in finding systems that would work better.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I cannot wait to reach the part of my speech that will deal with the hon. Gentleman’s suggestions, but first I will allow him to intervene, because I enjoy this back and forth.

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

So do I. The Secretary of State is far more entertaining than her predecessor. Given that she is painting a picture of improvement, how does she explain the story in The Times which revealed that NHS dentistry activity is now falling in 2023-24 compared with 2022-23? Is it not the case that things are going backwards rather than forwards? How does the Secretary of State explain that, and when are we going to see her plan?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I am grateful to the hon. Gentleman for raising that point, because according to the latest statistics available to me, 18.1 million adults were seen by an NHS dentist in the 24 months up to 30 June 2023. That is an increase of 10%, and what does it mean in reality? It means that over 1.7 million more adults were seen than in the previous year. I know that we are all concerned about the health of children; some 6.4 million children were seen by an NHS dentist in the 12 months up to 30 June 2023, an increase of 14%, which means, in real terms, an increase of 800,000 on the previous year.

I accept, of course, that there is more to do, and we will be setting that out in our dental recovery plan shortly, but this is not just about big numbers. [Interruption.] The hon. Gentleman asks when “shortly” will be. As he knows full well, “shortly” is a little shorter than “in due course” and a little longer than “imminently”.

We have introduced several simple and effective measures to improve the nation’s dental health. The Health and Care Act 2022 made it simpler to expand water fluoridation schemes, because raising the fluoride level to 1 mg per litre is a straightforward way to prevent tooth decay. It has proved effective in parts of England as well as Canada, the United States, Ireland and Australia, and the chief medical officer has concluded that there is “strong scientific evidence” that water fluoridation can drive down the “prevalence of tooth decay”.

Photo of Anthony Mangnall Anthony Mangnall Conservative, Totnes

I congratulate the Secretary of State on the progress that has been made, while, obviously, recognising that there is more to be done. I wonder if she will help me to ask the shadow Minister to correct the record. He said that in 2010 and 2015 Labour had a plan for dental practice, but there is no mention of that in the Labour manifestos. I will come back and correct that if necessary, but the hon. Gentleman is out there stating that Labour has had a plan for dental recovery since 2010, and that is not in those manifestos.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

My goodness me! My hon. Friend has identified a “cavity” in the shadow Minister’s so-called plans.

Several hon. Members:


Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I am going to make some progress.

I am very pleased that, subject to a public consultation which will be published shortly, we have secured funding to expand water fluoridation schemes across the north-east of England. [Interruption.] The hon. Member for Ilford North may be interested to know why we have identified the north-east, given that he read out so many constituency names in his speech. The north-east was chosen because natural fluoride levels there are among the lowest in the country, and the proportion of five-year-olds with teeth extracted because of tooth decay is among the highest. We have wanted to address that very real health inequality to ensure that more than 1.6 million people in the area can benefit from this expansion, subject, as I have said, to a public consultation.

Supervised tooth brushing has been raised. That has indeed been proven to drive down oral health inequalities, which is why we have already introduced a toolkit that local authorities are using to introduce supervised tooth brushing across schools, nurseries and family hubs. We have been clear that we want to see that happening in more areas. I would encourage any colleague who is concerned about that, rather than waiting for some mythical date in the future, to ask our local authorities whether they are using these toolkits, because they are freely available, and they can and should put them in place.

Photo of Catherine West Catherine West Shadow Minister (Foreign and Commonwealth Affairs)

The Secretary of State rightly talks about prevention, but what about the opposite, where rates of oral cancer have gone up because prevention has not been in place? What assessment has she made? If she does not have the data to hand, will she write to me with the assessment that the Department of Health and Social Care has made of the link between failure on prevention and cancer?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I thank the hon. Lady, and particularly for the constructive tone of her intervention, because she is right. This is not simply about teeth health; it is also about the conditions that dentists check for—probably without anyone quite realising that they are doing so. I will take the hon. Lady up on her invitation to write to her on the figures, but that is why we are looking at health inequalities across the country and, importantly, focusing on encouraging dentists to re-register with the NHS if they have left, because it is vital for tackling much wider health conditions in addition to the pain and discomfort that tooth decay can bring.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

No, I will give way to my hon. Friend James Wild and then I will make some progress.

Photo of James Wild James Wild Conservative, North West Norfolk

My right hon. Friend mentioned levers. One issue facing recruitment in North West Norfolk is the time involved in getting on to the NHS performers list. Newly in post, will she look at that issue and bring forward proposals as part of the plan to speed up that process and boost recruitment?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I am extremely grateful to my hon. Friend. His intervention shows the level of detail that colleagues on the Conservative Benches have gone into in trying to address the understandable concerns that local NHS providers are voicing. I will look into that. I am very keen on my three words: faster, simpler, fairer. I want to make it as simple as possible for dentists to rejoin and join the NHS. I will say more on that later.

The choice of whether patients are offered NHS exams and treatment lies with the dentists, who are independent contractors to the NHS. As well as making simple, common-sense changes, in July 2022 we announced a package of far-reaching reforms to make NHS work more attractive to dentists. We have created more bands for units of dental activity, so that dentists are properly rewarded for taking on more complex care, and the best-performing practices can see more NHS patients.

Previously, regardless of the amount of time the dentist took on each patient, they received the same payment for every individual treatment package in band 2, which covers fillings and tooth extraction. Perversely, that meant they received the same payment for doing one filling as for three. That left many dentists unable to afford to take on patients who had not seen a dentist for some time and therefore needed extensive treatment. That needed to be put right for the sake of both patients and dentists. Thanks to our reforms, dentists now receive five units of dental activity when they treat three or more teeth, which is a significant increase from the old maximum of three. Root canal treatment on molar teeth is now rewarded with seven units of dental activity, as opposed to three, meeting one of the British Dental Association’s key demands.

We also recognise the barriers that too many communities have faced when accessing NHS dentistry, with people left phoning around practices to see who was taking on NHS patients. That is why we have made it a contractual requirement for dentists to update the NHS website regularly, making it clear whether their practices are taking on new patients, as well as explaining the services that they offer, thus making it easier for patients to find a dentist that can deliver the care they need. These reforms have improved access to dentistry and ensured that the system better supports dentists and their teams, so they were well received by dentists, their representatives and patient groups across England, with Healthwatch’s national director recognising that these reforms show that the Government are listening to patients and taking action, and these reforms can help ensure that dental care is accessible and affordable to everyone who needs it.

Photo of Wera Hobhouse Wera Hobhouse Liberal Democrat Spokesperson (Transport), Liberal Democrat Shadow Leader of the House of Commons, Liberal Democrat Spokesperson (Energy and Climate Change)

I am pleased to hear about some of the reforms that we have raised in this Chamber many times, particularly on changing the dental contracts and units of dental activity, but may I raise another point? In official workplace data, dentists who do just one NHS check-up a year are counted the same as an NHS full-timer. Does the Secretary of State recognise that that is a problem, because that workplace data hides the scale of the problem?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I am extremely grateful to the hon. Lady, who makes a fair point about measuring within the system how much work NHS dentists are doing. As I say, we are looking at all of this in the work that we are doing on the dentistry recovery plan. I repeat that I want to make it as simple as possible for dentists to register with the NHS, to continue offering the care that we all want them to, so I am grateful to the hon. Lady for her intervention.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I am going to plough on, I am afraid.

Earlier, Labour Front Benchers—perhaps not understanding that they were doing so—set out the philosophical difference between our two parties on how to grow the economy. As our economy grows, we on the Conservative side of the House want to attract the best and the brightest from around the world to work in our NHS, in our tech sector, in our life sciences industry, in our movie industry—hon. Members may know that it filmed “Barbie” this year—and in many other thriving industries. Labour, however, apparently wants to shut the door by taxing such people on earnings they make outside the UK. I speak, of course, of non-domiciled tax status.

If I may correct the hon. Member for Ilford North, because I appreciate that he has not spent any time on the Front Bench, last year alone non-domiciled taxpayers paid £8 billion in UK taxes on their UK earnings. That is equivalent to more than 230,000 nurses. Labour wants to put that at risk and put the UK at a disadvantage in the highly paid, highly competitive, highly mobile international labour market. This really is yet another branch of the magic money tree that Labour has always been looking for, to which they apparently want to add £28 billion a year of taxes or increased borrowing and increased inflation.

How they want to spend this money is interesting as well, because in 2022 Labour promised that their non-domiciled taxation would fund a workforce plan. Last September, it became breakfast club meals. Then, by October, it had morphed into 2 million hospital appointments and MRI and CT scanners. Now, apparently, it is funding a dentistry plan. One wonders how all these magic branches on the magic money tree will add up to all the promises made so far.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I will resist, but only because I am going to ask the hon. Gentleman to intervene in a moment—he should be careful what he wishes for. I also notice that he talked about reform of the dental contract but did not give any detail. Government is not as easy as selling a book. It cannot be cut and pasted from Wikipedia, as some on the Labour Front Bench seem to like to do. It is about being clear on what you would do differently. Now, Labour in Wales is of course running the Welsh NHS. They do like to do things differently. People there are almost twice as likely to be waiting for health treatment as in England.

Photo of Virginia Crosbie Virginia Crosbie Conservative, Ynys Môn

The Leader of the Opposition states that the Labour Government in Wales is a blueprint for what Labour can do in the UK. Given that 97% of high street dentists in Wales state that Labour’s reforms are not working, does the Secretary of State agree that NHS dentistry is being destroyed by Labour in Wales, and that if Wales is their blueprint for UK dentistry, we should all be very afraid?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I thank my hon. Friend, who represents a Welsh constituency. The chair of the British Dental Association wrote to the Labour Welsh Government to complain about their plan and, I understand, used words such as “toxic mix of underinvestment” and “untested targets.” The picture in Wales, if it is the Leader of the Opposition’s blueprint, is perhaps not as convincing as the shadow Health Secretary would have us believe.

The fundamental difference between the current systems in England and Labour-run Wales is that Wales has a capitated list system for dentistry. I am willing to give way so that the shadow Health Secretary can clarify whether he wants to bring in that system.

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

I cannot believe that is meant to be the right hon. Lady’s big “Gotcha.” She cannot even tell us when she will bring forward her plan, let alone what is in it. They have had 14 years to come up with a plan. This is absolutely astonishing. As much as I enjoy these partisan knockabouts at the Dispatch Box, the sight of the Health Secretary giggling and laughing at her own jokes will be of small comfort to people who are literally pulling out their own teeth.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

Just to cut through all the froth, the hon. Gentleman has not, in fact, answered my invitation. Does he wish to have a capitated list system, as they have in Wales, or does he have other plans? Could he please answer?

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care

Like any responsible Government, we would consult the dentistry profession, the BDA, and come up with a serious programme for dentistry reform. If the right hon. Lady wants to ask me questions and have me answer them, the Government should call a general election and I will happily oblige.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

Again, cutting through the froth, the hon. Gentleman called this debate and has not set out his plan. He knows full well that this is an Opposition day debate and I am responding to Labour’s motion by moving an amendment. He has no plan on dentistry. When I asked him to clarify whether he will follow the capitated system in Wales, he declined to answer. I assume that is because he knows we tested a prototype system based on the Welsh capitation approach here in England, and the results were clear. It worsened access and widened oral health inequalities.

The hon. Gentleman quoted the Nuffield Trust, placing great emphasis on it, in his opening speech. As he agrees so much with the Nuffield Trust’s report, does he also agree with its former chief executive who said that his ideas on general practice represent

“an out of date view” and “will cost a fortune”?

It is becoming increasingly clear that the Labour party’s approach to our NHS is empty words about reform followed by the phrase “funded by non-doms.” We are very lucky in this country—on this side of the House we consider ourselves blessed—to have incredible dentists working across the NHS.

Here are some facts for Opposition Members. There are now 1,352 more dentists working in the NHS than 14 years ago, thanks to the stewardship of this Conservative Government. I thank them and their colleagues for everything they do, and we are backing them to build a brighter future for NHS dentistry by taking concrete steps to improve recruitment and retention. That is why our long-term workforce plan, the first in NHS history, will expand dentistry training places by 40%, providing more than 1,100 places by 2031, which will be the highest level on record under any Government.

Over the same period, this Government’s plan will also increase training places for dental therapists and hygiene professionals to more than 500. The importance of the long-term workforce plan to dentistry’s future was recognised across the sector, and Professor Kirsty Hill, who chairs the Dental Schools Council, backed our plan:

“Expansion is a significant and positive development, and we commend the government for recognising the importance of increasing dental hygiene and dental therapist positions. These roles play a vital role in enhancing capacity and improving care.”

Photo of Debbie Abrahams Debbie Abrahams Labour, Oldham East and Saddleworth

I find it absolutely extraordinary that the Health Secretary lectured the shadow Health Secretary on calling a debate to hold this Government to account. Twelve million people are not able to access dental care, including thousands in my Oldham constituency.

Photo of Debbie Abrahams Debbie Abrahams Labour, Oldham East and Saddleworth

You are the Government, unless you want to call a general election.

Photo of Rosie Winterton Rosie Winterton Deputy Speaker (First Deputy Chairman of Ways and Means)

Order. The hon. Lady knows that she must not refer directly to other Members.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I think Debbie Abrahams was raising her voice at me, but it was not me who heckled her. I recognise the passion she brings to her intervention, and I simply made the point that this is an Opposition day debate. The hon. Member for Ilford North understandably set out some of his plans, which is his job, and I was merely questioning him on the detail of those plans. Sadly, he was not able to provide that detail.

The long-term workforce plan is about not just training more staff but delivering value for hard-working taxpayers. Currently, around a third of dentists do not carry out any NHS work. This simply is not fair on the taxpayers who fund their training, which is why, through the long-term workforce plan, we are exploring the introduction of a tie-in period that encourages dentists, after they graduate, to spend a minimum proportion of their time delivering NHS care. We have also made it easier for experienced dentists from around the world to come to the UK to ply their trade, which is apparently something with which Labour Members do not agree.

Last year, we brought forward legislation to give the General Dental Council greater flexibility in administering the overseas registration exam. The Government welcome its decision to triple the capacity of the next three sittings of part one of the ORE, from August last year, and to increase the number of sittings of the second part of the exam from three to four, creating an additional 1,300 places. Ministers will continue to meet the GDC to discuss how we can make these flexibilities as effective as possible, to get more dentists into the NHS workforce delivering care for patients.

Photo of Seema Malhotra Seema Malhotra Shadow Minister (Education)

I thank the Secretary of State for giving way. It is worth repeating that the Nuffield Trust has warned that NHS dentistry is at its most perilous point in its 75-year history. That goes alongside recent Healthwatch polling suggesting that one in 10 people in England have ended up paying for private dental treatment in the last 12 months because they could not find an NHS dentist. It has been the same in my constituency, where the majority of dental surgeries are not taking on new patients. Can the Secretary of State explain how on earth things have got this bad?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I trust that the hon. Lady has been listening to the whole debate, because I set this out in some detail at the beginning of my speech. I will not repeat the impact of the pandemic, but I hope she has taken on board the £1.7 billion of investment that has already seen a sizeable increase in the number of adults and children being treated by NHS dentistry.

I do not pretend that this is the full stop at the end of the sentence. We have a plan and I look forward to our debate when that plan is published, because I suspect it will be welcomed across the House.

Photo of Dominic Raab Dominic Raab Conservative, Esher and Walton

I commend my right hon. Friend for her powerful speech. The plan will improve financial incentives for NHS dentists and support practices to take on new patients, but to what extent will she and the plan take on board high operating costs and, indeed, the high cost of living in areas where there is high demand for NHS dentistry?

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I thank my right hon. Friend for his intervention. I can imagine that the concerns he outlines are very pressing in his constituency, and one important priority behind the dental recovery plan work is addressing health inequalities. Although I have spoken about rural and coastal areas from a constituency perspective, we also understand, of course, that there are differing cost of living pressures in different parts of the country. He makes an important point about the costs for NHS dentists operating in very expensive parts of the country, such as his constituency, and I thank him for doing so.

Our workforce is not just made up of dentists; dental care in England could not function without the vital contribution of dental and orthodontic therapists, dental hygienists, dental nurses and clinical dental technicians. We recognise the importance of harnessing the skills and knowledge of all those professionals. They can support dentists to carry out first-class care, and we must empower them to take on more responsibility and to work at the top of their licences. That is why last year we issued guidance to NHS practices, supporting them to make the most of everyone in the dental team and make a difference to patient care. Since then, NHS England has made it clear that dental therapists and dental hygienists can provide patients with direct care, provided they are appropriately qualified, competent and indemnified. We have also run a consultation to enable dental therapists and hygienists to deliver more treatments. That will boost access to care for patients and support dentists, and we will be setting out our next steps shortly.

Photo of Victoria Atkins Victoria Atkins Secretary of State for Health and Social Care

I am conscious that Opposition Members will want time today, so I am going to bring my remarks to a close. It is my mission, as Health and Social Care Secretary, to build an NHS that is faster, simpler and fairer, and of course I include dentistry in that work. We have taken the long-term decisions that will improve access to dental care. Delivering 6 million more courses of treatment, expanding dentistry training places by 40% and making it easier for patients to find a dentist to deliver the care they need are just some of the ways in which we are going to achieve that. Of course, we must make sure that dentists are properly rewarded for all the work they do. Through our soon-to-be-published dentistry recovery plan, we will go further, to make NHS dentistry accessible and available for everyone who needs it, no matter where they call home in this great country.

Several hon. Members:


Photo of Rosie Winterton Rosie Winterton Deputy Speaker (First Deputy Chairman of Ways and Means)

Order. As colleagues will see, this is a very well-subscribed debate, so I am going to impose an immediate time limit of six minutes, which I hope will allow everybody to have roughly the same amount of time. I have been able to tell the first two speakers that I am doing that.

Photo of Gill Furniss Gill Furniss Shadow Minister (Work and Pensions) 1:52, 9 January 2024

The crisis in NHS dentistry is plain to see and it is affecting so many of my constituents. I am therefore grateful for this opportunity to shed light on this emergency and to support Labour's plan to rebuild our broken dentistry. People are finding it impossible to find an NHS dentist for themselves and their children, which is leading to serious consequences for public health. It is also exacerbating health inequalities, and creating a divide between those who can afford private dentistry and those who cannot. The proportion of children with dental decay in the most deprived areas is more than two and a half times greater than it is in the least deprived areas, and the gap is widening. That has led to a public health crisis: 169 children each day are undergoing tooth extraction; rotting teeth is, shockingly, the No. 1 cause of hospital admissions among six to 10-year-olds; and one in 10 people have even attempted their own do-it-yourself dentistry, which just does damage and puts even more pressure on the NHS. That reads like a Charles Dickens novel, but it is the harsh reality of 14 years of Conservative government. Nowhere is that more apparent than in my constituency, where not one of the seven dental surgeries that recently provided an update was accepting new adult patients and only one was accepting new child patients.

Although those figures are appalling, they are not surprising. I am regularly contacted by constituents who cannot find an NHS dentist and cannot afford to go private. They ask me, “What am I supposed to do?”. Without radical reform, there is no answer I can give them. We often talk about crumbling dental services, but in my constituency they have already crumbled; the services simply are not there for the people who need them most. One constituent has contacted more than 25 dentists in Sheffield, with each telling her the same thing: they are not accepting new NHS patients at this time. The best she has been offered is to be put on a waiting list, which could last years. She cannot afford to go private, so she and her young child are stuck without any access to a dentist. We have also seen the provision of community dental services grind to a halt. Those services are a vital safety net, providing specialised treatment when other dentists cannot accommodate the needs of disabled people and people with long-term health conditions. That safety net is no longer there for all too many people. Research shows that, nationally, more than 12,000 children were on a waiting list for community dental services at the start of 2023, and they could face waits of up to 80 weeks for tooth extractions. Healthwatch has heard from many people and their carers who cannot access community dentistry, leaving them without treatment.

The basic provision of NHS dentistry has been worn away on this Government’s watch. The warning signs of this crisis have been stark for years, but Ministers have continued to bury their heads in the sand. Funding has been cut in real terms, meaning that dentists are leaving the NHS in droves and areas such as mine have become dental deserts. It is clear that this Government are not willing to provide the radical changes needed to bring NHS dentistry back from the brink. In April last year, Ministers promised a new dental recovery plan; but we are still waiting for it to see the light of day. I urge the Minister to tell us when that will happen and not just say “soon”. Labour has formulated a fully costed plan that will get NHS dentistry back up and running. The best treatment is prevention, which is why Labour will introduce a targeted, supervised toothbrushing scheme for three to five-year-olds, encouraging lifelong good dental hygiene. Labour will also provide an extra 700,000 urgent appointments per year to help the most vulnerable access the services they need and introduce an incentive scheme to bring more dentists to dental deserts. I am proud to say that all of that will be paid for by abolishing the non-dom tax status. Those tangible steps will bring NHS dentistry back to constituencies such as mine, where services have disappeared. Where this Government have failed, Labour will step in and help all our constituents to access the NHS dentistry they need. I will be proud to support Labour’s plan in today's vote, and I urge all colleagues, including Conservative Members, to vote with us.

Photo of Steve Brine Steve Brine Chair, Health and Social Care Committee, Chair, Health and Social Care Committee 1:58, 9 January 2024

Last July, the Health and Social Care Committee, which I chair, published an important report on NHS dentistry, and I urge colleagues to read it if they have not already done so—it has been mentioned a few times. That inquiry was more necessary than ever, and I would argue that the issues our constituents face in accessing an NHS dentist now are a greater challenge for my Front-Bench colleagues than the much higher-profile health promise to “cut the waiting list” that features in the Prime Minister’s five pledges. I say that because every Member faces this challenge. The Secretary of State’s amendment rightly references the pandemic and the massive impact it has had on dentistry; to ignore that is to ignore basic facts. Our Committee concluded that NHS dentistry is facing a crisis of access—no understatement—resulting in a decline in oral health.

Our report was described by the British Dental Association as

“an instruction manual to save NHS dentistry.”

Based on the evidence—I stress the word evidence—received by the cross-party Committee, it sets out what the Government should do to address the crisis. I thank the Secretary of State for coming before the Committee just before Christmas and for ensuring that we received a formal response to our report, albeit a few weeks later than I would have liked.

The motion proposed by the Labour party today contains some reasonable parts: it is obvious that some people are resorting to DIY dentistry and it is a fact that some people are attending A&E because of dental challenges. The Opposition talk about the provision of 700,000 urgent appointments a year, but I cannot support the motion because I hear no detail or explanation about how that will be done, who the dentists are who will fulfil all those appointments or where they will happen. The Opposition talk about recruiting new dentists to the areas that are most in need but, as the Secretary of State said in her opening remarks, we are increasing dentistry training places by 40% as part of the NHS long-term workforce plan, which is the biggest expansion of places on record. That is important and should be recognised, as it was from the Government Dispatch Box.

When giving evidence to the Select Committee’s inquiry, the then Parliamentary Under-Secretary, my hon. Friend Neil O’Brien, described the Government’s ambition for NHS dentistry, saying:

“We do want everyone who needs one to be able to access an NHS dentist—absolutely”

The Committee welcomed that ambition but, if I am honest, we were surprised by it. In their most optimistic reading of the reality on the ground, what leads the new ministerial team to believe that that is deliverable? When she sums up, will the Minister repeat that ambition, as her predecessor did?

Do not get me wrong, Madam Deputy Speaker: I absolutely believe that everyone should be able to access an NHS dentist when they need one, wherever they live, but given the reality of where we are now, I question whether that is possible. In our report, we asked the Government to set out how they intend to realise that ambition and the timeline for delivery as a matter of urgency. They accepted the recommendation, but the detail, as we have heard, is still lacking. Now is the time, please.

Let me touch on the dental contract. It is right to recognise that action has been taken. Some initial changes were made to the dental contract in July 2022, and we had assurances of fundamental reform from the then Minister, and again from his successor as Minister responsible for dentistry, my right hon. Friend Dame Andrea Leadsom, who is on the Treasury Bench.

My Committee believes that a fundamentally reformed contract must be implemented at the earliest possible stage. It has to represent a full move away from the current system of units of dental activity—UDAs—in favour of a weighted capitation-based system that provides financial incentives for seeing new patients and those with greater dental need, and in turn prioritises prevention and person-centred care. Failure to do so risks more dentists stopping NHS work, or not starting it, and exacerbating the issues that my constituents are experiencing with accessing care.

As I have said in the House before, my dentist recently gave up NHS work, which was a big, emotional decision for her. Any reform to the contracts now is too late for her. The Opposition and the Government have to work out how they are going to get people to come back to NHS dentistry, and reform the contract to stop more people accessing the exit door.

It is not just about contract reform: workplace reform is greatly important. We did not get significant acknowledgement of the lack of accurate data about the dental workforce in our report, so will Ministers revisit that? There were many other recommendations that I do not have time to go into today, but the report is available, as is the Government’s response.

The Secretary of State has made a good start and said she has begun to lay the foundations of change. I am encouraged by that but, to my Committee’s continued frustration, there is still no date for the publication of the dental recovery plan. If we do not solve this crisis, we will continue to hear about it in the House and from constituents. The crisis places additional pressures on already stretched services. Today is too late for dentists who are thinking of leaving and for patients who have run out of options. We need a short-term set of actions for constituents who are suffering pain today, and we need a fully reformed dental recovery plan hot on its heels. There cannot be any further delay.

Photo of Judith Cummins Judith Cummins Labour, Bradford South 2:04, 9 January 2024

The Nuffield Trust recently announced that without radical action universal NHS dentistry was “gone for good”. Some 90% of practices across the UK no longer accept new NHS patients. For 14 years this Conservative Government have brought about the decay of our vital NHS dental healthcare services, so now is the time for a clear strategy, a recommitment to the future of a universal NHS dental service, and a Government who are determined to provide the care that people across this country, and their children, deserve.

The crisis of NHS dentistry has been entirely predictable. In fact, I have been at the forefront of these predictions over many years. Just last year, in a debate that I led in this place, I described the path of NHS dentistry as a “slow-motion car crash”. In 2016, I warned of a mounting crisis and drew the Government’s attention to a report warning that half of dentists were thinking of leaving the NHS. In the following years, I again warned that the number of dentists intending to leave the NHS was rising even further and, in 2020, after years of repeated warnings, I once again informed the Government that of those remaining, some 58% of the UK’s dentists were planning to move away from NHS dentistry within five years.

Last year, the then Minister assured the House that he was planning to publish a plan to reform dentistry, but the limited reforms proposed in July did little but paper over the growing cracks. More than 1,000 dentists have left the NHS since the pandemic, and the number of treatments completed each year is now 6 million lower than it was before the pandemic. Even before the pandemic, access was poor, with only enough dentistry commissioned for around half the population in England. As it stands, the future is bleak. A BDA survey shows that 75% of dentists are thinking of reducing their NHS commitments this year.

In Bradford, a shocking 445 people had to be treated in hospital for dental-related issues between 2022 and 2023. This cannot be the future of NHS dentistry: extractions and emergency care, but only for those who cannot afford private dental care. One dentist in my constituency said:

“I've been saying it for years: the NHS dental contract needs fundamental reform. Without immediate action, there will be no Universal NHS Dentistry.”

But NHS dentistry is not yet “gone for good”. That claim would leave swathes of people in this country destined for a future of rotting teeth and poor dental health. We cannot stand by and let the principle of NHS dentistry in this country be eroded. The decline is not irreversible or inevitable—it is a political choice.

I know that targeted investment is possible. In 2017, I worked on a project in Bradford with the then Health Minister, Steve Brine, who is now Chair of the Health and Social Care Committee. The project invested £250,000 of unused contract clawback in my Bradford South constituency, and ensured that patients were able to access roughly 3,000 new NHS dental appointments in an area of proven high dental deprivation. Although that provided a short-term solution, it did not address the wider long-term issue of access to NHS dental care. We can still save NHS dentistry, but we need a Government who are committed to reform and to the NHS.

It right that the Labour party puts NHS dentistry front and centre alongside plans to build an NHS fit for the future. Labour has committed to provide an extra 700,000 urgent dental appointments and to real reform of the NHS dental contract. As the Leader of the Opposition, my right hon. and learned Friend Keir Starmer, has made clear on many occasions, healthcare must be as much about prevention as it is about cure.

In 2021-2022, tooth decay was, shamefully, the most common reason for hospital admission for children between six and 10 years old. This country once had a strong school dental service, and with such shocking rates of child tooth decay, it is time to look again at that policy, and at the role of dental therapists in the NHS. It is the right thing to do to catch up on a generation of lost dental health. NHS dentistry is not “gone for good”, but it stands on the edge of a new era. There is one clear solution: the Government must recommit to a universal NHS dental service that will care for every person, from the cradle to the grave.

Photo of Derek Thomas Derek Thomas Conservative, St Ives 2:09, 9 January 2024

I listened carefully and with interest to what the shadow Secretary of State said in his opening remarks. I like the man, but he clearly sees this matter as a potential political football, which comes as no surprise to me. As for me, my interest is in the constituents I represent. They do not care so much about the bickering between us, but they do care about their oral health.

I am glad to have the opportunity to speak in this debate. As we have heard, every constituent will need access to dental activity during the course of their lives. I have taken a great interest in this matter and spoken about it to hundreds of constituents and several dentists. In fact, over the weekend I spoke to some dentists who do not support Labour’s plans and want to see the Government advance their reforms—I was glad to hear more about those reforms today. I have raised the matter of NHS dentistry several times in the House with two separate Prime Ministers, including in January 2022, June 2022, April 2023 and September 2023, and also with several Ministers, including the one on the Front Bench, and the Secretary of State.

The Secretary of State’s predecessor said it was a priority to increase the number of dentists in specific parts of the country, and mentioned the south-west in particular. We are seeing some early green shoots appear. None the less, people in the south-west and Cornwall are struggling to get access to a dentist. I still receive weekly emails from constituents who are not getting the treatment that they need, or who are spending their time and money travelling to NHS practices in Manchester or London, or even abroad, to pay for private care. I have witnessed dental practices giving up NHS contracts, or vastly reducing NHS treatment, forcing some people to fully fund their own care and others, who cannot afford that, to go without treatment. I have raised this issue with the Health Secretary in the Chamber quite recently.

When I spoke to people in dental practices, they said they were as frustrated as I am. They have a contract with the NHS to provide thousands of units of dental activity, but the funding allocation is clawed back by the NHS if they cannot deliver those units. They cannot deliver the units, as we have heard already, because the value is too low to attract the staff that they need. Last year, a practice that I was working with paid more than £132,000 in clawbacks to our integrated care board. That is enough funding to treat 1,600 patients.

Nationally, underspend in the NHS dental budget could reach £500 million. We know that the NHS dental contract needs reform: it does not work for dentists and it certainly does not work for our patients. None the less, I am pleased that integrated care boards are taking ownership of dentistry and driving the delivery of dental care in our regions. In Cornwall, the ICB has already gripped the issue, using what resources it has to increase capacity. I was disappointed by the shadow Secretary of State’s reference to the work going on in Cornwall. The ICB does not see the work that it is doing as restricting NHS dentistry just to children, the elderly and vulnerable people. That is absolutely not the case. What it is doing is looking at where the shortages are and seeking to address them with the resources it has. The truth is that one third of adults in Cornwall are still accessing NHS dentistry. We have seen new NHS dental provision in Helston and in St Ives—two of my major towns—and there is a real ambition among dentists to take on more once they are allowed to do so.

The workforce plan needs to set out not just the number of dentists, dental nurses and other dental professions, but where they are located. We have a brilliant dental suite in Truro, but graduates rarely stay in the south-west once they have been trained. We are seeing a slight improvement, with dental practices offering foundation placements for graduates in Cornwall, including in St Ives, where the potential is greater.

I recognise that the Minister is just as keen as I am to empower the entire dental team to work to their full potential for NHS patients, but there remain barriers to fully implementing direct access in NHS-funded dental care. As I understand it, medicines can be administered by dental care professionals when they provide care to patients who pay privately, but this does not apply to NHS dental patients. On a recent visit to a practice in St Ives, the owner explained to me the impact of this disparity.

We have therapists in most locations in the south-west ready to increase NHS access, especially for young children, as most of the work for that patient cohort is within their scope of practice. It is disappointing that we cannot use those therapists fully. Dentists are reluctant to sign off prescriptions because of time issues and because of not understanding the process. Our therapists are doing only hygiene work, and some of them are leaving because of the lack of work.

My understanding is that a statutory instrument is required, which is in the gift of the Minister. This simple piece of legislation would provide the opportunity for NHS dental practices to use the full skillset and competencies of their dental staff to increase the delivery of desperately needed dental care. Will the Minister indicate today whether she is able to bring such an SI to the House and unleash an army of dental professionals to do what they believe they are trained to do?

Finally, in 2021-22, £4.5 million of unmet dental care was returned from Cornwall to the NHS. It is now lost in the NHS system. Will the Minister assure me that never again will that kind of money be grabbed or stolen from Cornwall’s dental patients, returned to the NHS and not used to deliver the dental care that they need?

Photo of Navendu Mishra Navendu Mishra Labour, Stockport 2:15, 9 January 2024

I receive a large amount of correspondence on dentistry. Since my election just over four years ago, I have had several people come to see me, I have visited practices in Stockport, and I have often received communications from people on the issue. I thank the British Dental Association for all the work that it has done on NHS dentistry over the years, and the Nuffield Trust for providing excellent briefings for this debate, and for its commitment to highlight the issues with NHS dentistry across England.

It is shocking that 12 million people were unable to access NHS dental care last year. That is more than one in four adults in England. The crisis in NHS dentistry is having a disproportionate impact on low-income people and vulnerable groups. This is a class issue. If a person is on a low income, they are much less likely to have access to NHS dentistry than if they lived in a more affluent area.

As has been mentioned, oral cancer is one of the fastest-rising cancers. The reality is that people from deprived communities are significantly more likely to develop it and die from it. It is shameful and unacceptable that the Government are not doing enough to tackle this issue. Dentists are often the first health professional to spot symptoms of oral cancer. This dentistry crisis means that fewer cases of oral cancer will be detected early, adding even more pressure on to the NHS, and, more importantly, detrimentally impacting people’s health.

As I said, this is a significant issue in my constituency. A few months ago, I wrote to every single dental practice in my constituency and included a small survey that they could fill out. The responses that I received from dentists and dental workers did not make for positive reading. I will quote from one of the contributions that I received. The dentist in question wrote:

“The whole service has been underfunded for years. I receive a very low UDA rate compared to other practices in the area. In 2006, I was paid £22 UDA and now it is £27. Patients need to know that we are not just greedy dentists. There is a shortage of dental nurses so they are demanding more money. Where am I supposed to find that extra funding?”

That is just one of the contributions that I received back following my survey. It is a significant issue. People on lower incomes and people with complex health issues often tend to miss out on NHS dentistry. I am glad that the shadow Health and Social Care team has secured this debate today and that the shadow Secretary of State highlighted just some of the key things that Labour will deliver in government, including significantly more appointments, significantly more dentists in the NHS service, and supervised toothbrushing in primary schools.

In April last year, the Government pledged to provide a recovery plan for NHS dentistry. The plan has yet to be published. May I ask the Minister, through you, Madam Deputy Speaker, when it will be published? Why are the Government being so shifty about this? Why will they not address this issue and tell us whether and when it will be published? It seems that, in Stockport and across England, the Government are failing patients badly not just when it comes to dentistry, but with record waiting lists for the NHS. Sadly, the reality is that people’s lives in Stockport and England are being held back by this Government.

Photo of Richard Foord Richard Foord Liberal Democrat Spokesperson (Defence)

The hon. Member mentions the so-called NHS dentistry recovery plan cited by the Government. I am playing a game of NHS dentistry bingo, provided to me by the BDA. One of the 16 things that we were to listen out for today was:

“Our Recovery Plan will be published shortly”.

I have checked that off several times this afternoon. Does he agree that it is dishonest for the Government to claim that NHS dentistry is some sort of universal service?

Photo of Navendu Mishra Navendu Mishra Labour, Stockport

I agree with the hon. Member and thank him for his contribution. I think the BDA tagged me on Twitter in its dentistry bingo. I have not managed to play yet but will definitely be checking it out. He makes the point that the Government are being dishonest. The Government are being more than dishonest; they will not tell us if and when the plan will be published. They clearly do not have a plan to address the backlog in NHS waiting lists or the crisis in NHS dentistry in England. The next Labour Government will tackle the issues of NHS dentistry and the millions of people rotting on the NHS waiting list. They will also improve people’s quality of life in Stockport and across Britain.

Photo of Anthony Mangnall Anthony Mangnall Conservative, Totnes 2:20, 9 January 2024

It is a pleasure to speak in the debate and to raise the issues that so many people face across the south-west and south Devon, many of whom are in immense pain. I will start by responding to some of the remarks made earlier in the debate. It is acceptable to make the point that the NHS contract from 2006 does not work and has not worked. It is acceptable to say that we tried to make it work, and we hit an enormous roadblock in the form of the pandemic, which has shown the system to be wanting. None of those are controversial statements to make.

Labour should not be outraged when we ask for their plans. Time and again, Labour Members go in front of the cameras and say they have a plan for this and that and everything we might possibly imagine, so we therefore should be able to ask them, given that this is their debate. They can laugh, as they are doing now, or smile about this, but it is a serious and legitimate question. If they are a Government in waiting, they should come up with proposals for a short-term solution to this issue.

The shadow Health Secretary, Wes Streeting, decided to tell me that he and the Labour party have been talking about this issue since 2010. Indeed, he said it was in their manifestos in 2010 and 2015. I cannot find any record of it being in their manifestos. In fact, it is hard to actually see when the shadow Health Secretary even cared about this issue before his appointment, but I will leave that to others to make clear in the course of the debate.

My right hon. Friend the Secretary of State made perfectly clear the challenges we face. She made the point clearly that there have been some improvements, but no Conservative Member is complacent. We are all aware of this, because we speak to our constituents and look at our email inboxes. We are aware of the size of the trouble and problems being faced. It should be welcome that we are now pushing taxpayer-funded dentists who have been in training to work within the NHS at the end of their training. It should be welcome that there are 40% more dental training places and that we are looking at ways in which we can bring dentists from abroad, as well as creating training places right across the country. I welcome the report and comments by the Chair of the Health and Social Care Committee, my hon. Friend Steve Brine.

All of that boils down to what we think the priorities of NHS dentistry should be. Simply put, having spoken to many dentists in my constituency, the priorities boil down to three areas: prevention, education and pain relief. [Interruption.] I do not think many people are looking to disagree on that point, but if Preet Kaur Gill wants to disagree with me, she can. The point is that the pandemic has blown two of those priorities off course. The focus for the short term must be how we address pain relief. That is the issue we face today, and children and those of an older age are suffering from it across the country.

What are the short-term actions that we can take today? They have been mentioned by many Conservative Members. We can look at dental access centres and mobile units that can move across the country. We might think those are fantasy, but they are already in practice in some places in the country. Indeed, they have been raised by a number of dentists in my area of south Devon, who suggest that they are not just feasible but incredibly possible with the underspend that has not been utilised. We must unlock the money that has not been spent through NHS contracts. I am sure my hon. Friend Selaine Saxby will correct me if I am wrong, but I understand that some £50 million of underspend on NHS dentist contracts could be made available to help those on waiting lists.

As a number of Labour Members have said, we must allow dental therapists to play a larger role in helping treat people within the process and address their needs. As I have said, we must focus on pain relief as the priority. Reform of UDAs has to happen as quickly as possible. The time and geographical disparity means the system has been found wanting, and it is clear right across the country—whether in urban, rural or coastal community settings—that there are huge disparities in remuneration for a UDA. Rather than standing here and speaking about parliamentary candidates, it is probably more appropriate to think about the solutions that we can find to help those who are suffering so much.

I will give examples of what is going on in Devon. We have 17,000 more UDAs, which is welcome. We have a dental care stabilisation system. We have 406 extra appointments per week, which can be found through contacting 111. We have one of the finest dental training schools in the form of the Peninsula Dental School, located just outside Plymouth. It is working to help address the need and to support the Government in helping areas across the country. It is looking to help ensure that its trainees remain within the area after their training, to make the NHS as flexible as possible to the needs of those who need to use it.

We must have reform. Many of us on the Conservative Back Benches agree that we must have the reforms that have been promised before, because they are the hook that we can hang our hat on, and they will be the solution. If the Minister could look at the short-term solutions I have proposed and give a response, that would be welcome not just in my part of the country, but all across the country.

Photo of Mike Amesbury Mike Amesbury Shadow Minister (Levelling Up, Housing, Communities and Local Government) 2:26, 9 January 2024

Surely in this day and age everybody should have the right to receive dental treatment when they need it. That was the fundamental principle of the national health service that we, the Labour party, founded all those glorious years ago. Unfortunately, as Labour Members know—it has been well documented throughout the debate so far—the principle behind national health service dentistry has been severely undermined and eroded in each one of the 14 years of this Tory Government. Today, quite astoundingly, I think the Secretary of State mentioned that at some stage, shortly, they will publish a long-term plan. Fourteen years on, they will publish some kind of long-term plan shortly, with no date. That is the state of chaos that this country is governed by at the moment. Meanwhile, 12 million people cannot get the dental treatment they need and deserve.

We all know a bit too well that 90% of dental practices in England are closed to NHS routine patients. That is essentially creating dental deserts all across the country, including, of course, in my constituency. It is something I see all too often in the Halton and the Cheshire West and Chester parts of my constituency. I see only too clearly how bleak and extreme the dentistry desert landscape has become.

I was recently contacted by my constituent Allan from Northwich, who had been registered with the local dentist for over 10 years. After a visit to a private hygienist, he was advised to book a dental check-up. When he tried to do so, he was told that he had been de-registered as an NHS patient because he had not had a check-up in over two years. That happened during the pandemic, and he was one of many people who could not have a check-up in that period. Again, that has been documented in the debate. He was told that the dentist was not taking any new NHS patients due to a lack of capacity, yet he could be offered a fully private paid check-up in just a few weeks’ time. Of course, if people do not have the money in their pocket and do not have the ability to pay, that is not possible, and that is the case for far too many of our constituents up and down the country. Why should Allan, and millions like him, not be able to get access to the NHS dental services they need if they cannot afford private care—unlike some in this country, and even some Members on the rather sparse Government Benches that I see at the moment?

Across Britain, too many people face the stark choice of having to pay for expensive payment plans in the private sector or going without dental treatment. The cases of people resorting to DIY treatment have been well documented, as has the additional strain on our NHS hospital services when people go for emergency dental treatment. The problem extends to all parts of my community. In a recent meeting with the joint headteachers of Leftwich Community Primary School, they raised the desperate attempts they have made to try to get NHS dental appointments for some of their primary schoolchildren. Of course that is not the teachers’ bread-and-butter issue, but they are going the extra mile to help some of the children most in need in my constituency—and again to no avail.

What have the Government done to ensure increased access to dentists across England, including in my patch in Cheshire and Merseyside? The short answer is not a lot, and the situation is getting worse. I and other Members of Parliament who represent Cheshire and Merseyside constituencies recently met the chief executive and chair of the integrated care board, who told us that they have been informed by the Department of Health and Social Care that the underspend that they had inherited to spend on local dentistry, which amounted to some £10 million, must now be de-ringfenced and used for what they classed “inflationary cost pressures”, not for NHS dentistry. That has come from the Department itself. I would be interested to hear a response from the Minister on that, because it is incredible that NHS England previously said that that money was ringfenced, yet now we have evidence from the integrated care board of direction from the Department of Health and Social Care saying, “No, you will spend it on other things.”

With my neighbouring MPs across Cheshire and Merseyside, we made strong representations to the chair and chief executive of the integrated care board, but, as outlined by my good colleague the shadow Secretary of State, this is happening up and down the country. It is happening everywhere, almost by design: running down NHS dentistry, making it a thing of the past so that the default position is private dentistry.

Photo of Fiona Bruce Fiona Bruce Conservative, Congleton 2:33, 9 January 2024

One of the most important steps the Government can take to improve access to NHS dental care is to boost our workforce and train more dentists and dental professionals, in line with the Government’s NHS long-term workforce plan, which has a clear reference to dental training as a priority. I will focus in particular on the importance of training dental professionals, who support dentists in many important ways. The workforce plan recognises that we must ensure that the skills of our whole dental workforce are utilised, by supporting dental hygienists, dental therapists, dental nurses and others to provide additional care, freeing up more time for dentists and increasing overall dental care and provision. I will focus on the importance of that and what the Government are doing to prioritise it.

I digress briefly by saying that in my own professional background as a solicitor—I refer to my entry in the Register of Members’ Financial Interests—I know how vital it is that our support staff are there to help the qualified solicitors do our job. We could not work without them and without their expertise, often honed over many years and in particular specialised areas. The same applies to the dental profession.

I applaud and commend all those who work in the profession and support dentists. I welcome the Secretary of State’s statement that we must empower them to take on even more responsibility—not because it is a burden, but because I can see how those working in professional environments find their work increasingly fulfilling the more responsibility they are trained to take on. I support her statement that we should do that and ensure that those staff are qualified, competent and indemnified.

Turning to the NHS long-term workforce plan in particular, while it is commendable that dentistry training places have a target and the Government are working to expand places by 24% by 2028-29, I particularly applaud the focus on increasing training places for dental therapy and hygiene professionals by 28% in the same period, adding hundreds more professionals to our dental workforce. That work is not just looking to the future, but is happening now: in the past year, NHS England has made an investment in postgraduate dental specialty training, focused on areas currently underserviced by existing provision, which will improve access to specialist dental services.

As the plan states:

“We recognise the important contribution to dental care that the wider dental workforce makes, including dental nurses. While training of dental nurses is largely the responsibility of dental practices, we will work with dental practices and other stakeholders to support the wider dental workforce to meet NHS service delivery plans for dentistry.”

It is heartening to note that

“the Plan aims to deliver 15% of dental activity through dental therapists and dental hygienists, as opposed to the current estimate of 5%.”

That has to be a positive target to work to. In addition, the plan focuses on the

“national Return to Therapy programme…being developed to enable dental therapists working as hygienists to fulfil their full scope of practice”, and states that

“NHS England is reforming contractual arrangements to encourage more dentists back into NHS practice and to make it easier for therapists and hygienists to provide NHS care”.

I will move on to the consultation that the Government held on making better use of the whole dental workforce, supporting dental hygienists and therapists to provide additional care to patients. I know the Secretary of State has said that the Government will shortly set out the outcome of the consultation. I urge them to do so and to take particular note of any contributions to that consultation from dental hygienists, therapists or nurses. They have so much to offer through their work at the coalface on the challenges that we all recognise in ensuring that everyone can see a dentist quickly and receive the treatment they need to keep themselves healthy and well. Dental care is an essential part of the NHS and should continue to be so for the future.

Photo of Paulette Hamilton Paulette Hamilton Labour, Birmingham, Erdington 2:38, 9 January 2024

I sit on the Health and Social Care Committee and was shocked at what I heard during the inquiry, but it lined up with what residents in my constituency are facing. There are more than 100,000 people living in my constituency and only seven dental surgeries, at least three of which are not accepting any new adult patients. That issue is not unique to Erdington. Across the west midlands, 73% of dentists are not accepting any new adult patients.

A constituent contacted me after her dentist’s practice closed down, as she had spent four hours trawling through websites and ringing practices, and she was not getting anywhere. She cannot afford private dental care, and her son has a serious health condition that means he requires regular dental check-ups. She explained that to every practice she could, but without success. Another constituent’s daughter was referred for braces in 2021. Two years later, after being referred to three separate orthodontists, she was told that there is a waiting list of more than 1,500 children, and it continues to rise. The response that I received from NHS England advised my constituents to call 111 for any urgent care services, and said that it is

“working to address the challenges facing the service right now.”

The list of challenges is long. The record of the Conservative Government means that NHS dentistry has completely collapsed. Over the past two years, 6 million adults tried and failed to get an appointment, and 4.4 million did not even try because they knew that there was no hope. Rotting teeth is the No. 1 reason that children aged six to 10 are admitted to hospital. Despite that, seven in 10 UK dentists are not accepting any new child patients. Shamefully, one in 10 people in the UK have attempted their own dental work out of pure desperation. That is how my constituents are experiencing the shocking record of the Conservative Government: getting them to properly fund our NHS is quite literally like pulling teeth.

In April last year, Ministers promised a dental recovery plan. In December, the Secretary of State promised in the Government’s response to the Health and Social Care Committee’s report—I was there—that the plan would be “published shortly,” so where is it?

Unlike the Government, Labour does have a plan that would help people in our communities to access the NHS dentistry that they so desperately need. Labour would fund NHS practices to provide 700,000 more urgent appointments. Our plan would create incentives for new dentists to work in the dental deserts that the Tories have created. And, rather than offering sticking-plaster solutions, we would reform the dental contract to rebuild the service in the long term.

It is becoming more and more obvious, everywhere we look in Britain, that nothing works, and our NHS dentistry is no exception. My constituents, and people across the UK, cannot go on without basic healthcare while we watch our NHS crumble around us. Only the Labour party has a plan for NHS dentistry. Like a decaying tooth, it is time for this Government’s extraction.

Photo of Peter Gibson Peter Gibson Conservative, Darlington 2:43, 9 January 2024

I wish to put on the record at the outset my thanks to my hon. Friend Neil O’Brien for his work on dentistry. I also thank the Under-Secretary of State for Health and Social Care, my right hon. Friend Dame Andrea Leadsom, for her early engagement with colleagues on this topic just days into her new role.

My constituency office has received enquiries from almost 200 residents who have been unable to access NHS dentistry services, despite the fact that there are many dentists in our town. The current NHS contract for dentistry stems from Labour’s reforms of 2006, and has increasingly shown itself to be lacking. The regime of payments based on units of dental activity has been unfair to dentists from the start, and, due to insufficient commissioning in areas of greatest need, it has been unfair to patients too.

Last year, a practice based at Firthmoor community centre in Darlington handed back its NHS contract as it was unable to be economically viable while being paid a mere £23.50 for a UDA. After struggling to recruit a new dentist, the owner of the practice, who also operates in other parts of the north-east and is paid almost £40 for a UDA in leafy parts of Newcastle, took the very sad but entirely understandable decision to close their Darlington branch. No business can recruit and employ staff when the money coming in does not cover the operating costs, never mind make a profit. NHS England, which did the commissioning prior to April 2023, offered to increase the UDA rate to nearly £30, but frankly, that was too little, too late.

When the North East and North Cumbria integrated care board took over responsibility for dentistry in April last year, I was filled with fresh hope that a resolution for the situation in Darlington would be found. I was assured that emergency provision would be expanded and additional commissioning would be provided at a higher UDA to further expand provision in Darlington. Imagine my dismay and disappointment when, in late November, I learned that little, if anything, had been done—literally nothing. There then followed numerous meetings, conversations and communications as I became increasingly angry that I had effectively been misled and my constituents were still being under-provided for. I am grateful to Wes Streeting for kindly highlighting my work on this topic as a constituency MP, in contrast to his time prior to his current role, when he mentioned dentistry not once.

Our ICBs do not even have to have a dentist on their boards. It has become clear to me that only by our lobbying, pushing and raising this in the media will our ICBs actually turn their attention away from their own internal bureaucracy and focus on the job of providing the services that they have an obligation to commission. I welcome that the Government will bring forward a dental recovery plan, which really cannot come soon enough. In the meantime, I urge the Minister to give our ICBs a boot up the backside and get them to pull their finger out. When things are as bad as they are, their underspend on dentistry is utterly shocking.

While I am on my feet, I have a few suggestions for the Minister. I have shared them directly with her before, but it would be good to get them on the record. We need more dental training. Will she consider the addition of a dental school to Teesside University, alongside its excellent dental technician training facilities? I welcome that we will oblige our new dentists, whose training comes at massive public cost, to spend a period of time providing public services before they go fully private. Dentists should be required to publish their fees and charges for NHS, private and insurance-backed work, so that patients can make clear and informed choices. We also need to see greater provision of mobile dentists visiting schools, particularly in areas of higher deprivation.

We need to see much more progress on this issue. We need to go further and faster, and I am quite sure that my right hon. Friend the Minister is the right person to do just that.

Photo of Tim Farron Tim Farron Liberal Democrat Spokesperson (Environment, Food and Rural Affairs), Liberal Democrat Lords Spokesperson (Communities and Local Government) 2:47, 9 January 2024

I need hardly say that dentistry is not the only part of the national health service that the Conservative Government have allowed to fall into crisis while shamelessly seeking to shift the blame on to others. However, it is welcome that we have the chance to focus today on dentistry and on the millions of people in this country, including many thousands in Westmorland, who are being so badly let down.

For communities in Westmorland and Lonsdale, the heart of this crisis is a basic difficulty in securing an NHS appointment. Many people in our area know that they cannot afford to have their teeth or their children’s teeth checked. They feel a crushing financial burden, and a burden of guilt, because they cannot access an NHS dentist for themselves or their family, and they know that they cannot afford to go private.

This crisis has very real, very personal, very expensive and very painful consequences for people in our communities in Cumbria and nationwide. Healthwatch found that one in 10 people in England had resorted to paying for private dental care because they could not find an NHS dentist. However, most people I speak to cannot afford to go private, so what do those families do? Well, YouGov found that one in 10 adults had tried some form of DIY dentistry, the difficulty of accessing a dentist forcing them to resort to medieval practices. This country—proud of our prosperity and proud of our NHS—is in the shameful situation of its people’s teeth and, most shamefully of all, its children’s teeth, getting worse.

In 2022, the BDA found that one in four five-year-olds in my community in Cumbria had tooth decay, and that tooth decay was the No. 1 reason for hospital admissions among young people. Regular dental appointments are vital for preventing tooth decay, and even more so for children, whose teeth tend to decay more quickly. However, fewer and fewer children are able to access those appointments because of the negligence of this Government. In Cumbria, the proportion of children seen by a dentist in the NHS each year went from 64% in 2018 to just 50% last year, a drop of 14% in five years. Half of our children in our communities—from Grasmere to Grange, Appleby to Ambleside, Kendal to Kirkby Stephen and Windermere to Warcop—do not have access to an NHS dentist. That is a disgrace.

I have heard at first hand from my constituents about the shocking scale of the difficulty of getting access to appointments for children. One attendance officer at one of our primary schools wrote to me earlier last year after she found that families in her school were going abroad for dental appointments. She said:

“Tim, I felt compelled to email you to tell you… We have a high number of children who are regularly missing out on education due to being unable to register with a local NHS dentist. A large number of our children have Polish, Romanian, Latvian and Ukrainian parents and therefore will find it easier to travel back to their parents’ original home country rather than wait for a local NHS dentist who is accepting patients.”

Wow! Let us be clear: she is saying that some children in Cumbria find it easier to get dental treatment travelling to a war zone than to access the NHS dental care that their parents have already paid for through their taxes.

For adults in Cumbria, the picture is also awful. The number of adults seen by a dentist in the past two years is also down by 14%, to only 36.5%. Almost two thirds of adults in our communities in Cumbria cannot access the NHS dentists that—as I said—they have already paid for through their taxes. This is not only a crisis, but a colossal act of fraud and an injustice. People who work hard, pay their way, and rightly expect the Government to be competent enough to provide the services they have paid for are being let down, taken for a ride, and forced into either intense and painful physical suffering or paying again to get the treatment they were entitled to receive from the state. This is more than just a health issue; it is a moral issue, a fairness issue and a justice issue. A quick search of the NHS website shows that the nearest dental practice to Kendal that is taking on NHS patients is in Accrington, an 80-mile round trip, and that the nearest NHS practice to Kirkby Stephen is in Newton Aycliffe in County Durham, a round trip of two hours.

Let us remember that, as others have said, we are also facing a cancer care crisis in the UK, and part of the problem is a failure to diagnose cancers early so that they can be treated and cured. Dentists play a crucial role in identifying oral cancers, but if two thirds of Cumbria’s adults are not seeing an NHS dentist, we can be certain that cancers will be missed. They will therefore be untreatable and people will die unnecessarily. Core to our identity as Liberal Democrats is our belief that everyone in the UK should be able to access a dental health check-up on the NHS, with an emphasis on preventative oral health. We would reform the dental contract to ensure that those things take place, and fund it properly.

I am so often told by our local NHS ICB that, when all is said and done, the Government give them the money for only about half the people in our area to have access to an NHS dentist. Outrageously, that means that the only time they will contract a new NHS provider is when a previous provider has shut its doors, such as when the Avondale practice in Grange went private, leaving 5,000 people in limbo. People with a family of four faced a yearly fee of £1,000 just to stay on that practice’s books. I have proactively gone out to persuade private dentists to accept NHS work, and although I know it is only a sticking plaster, I reckon I could find more. However, the ICB will not take those dentists on because this Government will not let them. The dentistry crisis is an outrage—an injustice meted out to people and families across our area. It seems to us in Westmorland that the best way we will defeat that injustice is to defeat the Government who are responsible for it.

Photo of Selaine Saxby Selaine Saxby Conservative, North Devon 2:53, 9 January 2024

I rise for the 15th time during my time in this place to raise my concerns about the state of dentistry in my constituency. On being elected, the first letter I wrote was about dentistry, and although I fully accept the Government’s position that things have got worse following the pandemic, they were pretty bad in North Devon before. When I moved to Devon six and a half years ago, it took me two years to find an NHS dentist, and then I had to travel 45 minutes to get there.

One of my concerns about the statistics used is that they compare dentists per 100,000 of population. As a very sparsely populated rural location, we might not look like as much of a dental desert as some other places, but at present the nearest dentist taking NHS patients is over 100 miles away. A constituent contacted me before Christmas to say

“with regards to the extremely limited dental care in North Devon. My partner, who suffers from mental health issues which limits him from performing daily tasks and travelling, was in need of dental treatment this weekend. However, after being on hold for almost an hour I was told that there were no appointments in the whole of North Devon and the nearest appointment was in Exeter. Travelling that distance is just not possible for someone who has mental health issues, and due to the nature of his illnesses, he cannot drive and I don’t either at present.”

Exeter, which is the nearest city to my constituency, is over 50 miles away for most North Devon residents. Even private practices in North Devon are unable to take on the volume of patients in some parts of my constituency. I have parents writing weekly to ask what to do when their appointments are cancelled because dentists are handing back their NHS contracts. And because residents in North Devon are unable to get check-ups, by the time they are seen they have extensive dental needs costing hundreds, if not thousands, of pounds. Calling us a dental desert is no help at all. Given the structure of dentistry, dentists are not going to want to deal with the oral backlog each unseen mouth potentially holds.

I welcome the new dentistry Minister to her role, and thank her for her immediate engagement on this issue. I very much hope that her experience will ensure that the Government’s plan to further recover and reform NHS dentistry is expedited because, frankly, the good people of North Devon have waited long enough to see a dentist.

Photo of Richard Foord Richard Foord Liberal Democrat Spokesperson (Defence)

I am grateful to the hon. Member for giving way, and I recognise what she is describing in North Devon. A 75-year-old and his wife who live in Tiverton told me that they were contacted by their dentist, who said that they were not seeing NHS patients any more. They called a further 20 dental practices and were told by several receptionists that no NHS appointments were available in Devon at all. Does she recognise the experience of my constituents?

Photo of Selaine Saxby Selaine Saxby Conservative, North Devon

I thank the hon. Gentleman for his intervention. While I recognise some of those concerns, I will come on to the response that the Minister has given to my petition in this place.

The waiting list for dentistry is reportedly over 100,000 in Devon, and there are reports of children having all their teeth extracted. While that is horrific, we need to encourage children and adults alike to practise good dental hygiene, as schools and nurseries have more than enough to do to educate their children without also brushing their pupils’ teeth every day. When I visit schools in my constituency, they raise concerns about why dental hygienists with plaque-disclosing tablets no longer visit schools at least to highlight where poor brushing at home might be an issue. When I visited the Marines based in my constituency, they raised the issue of dentistry. On every social media post I put out, whatever topic it is on, someone raises dentists. Can the Minister please confirm when we will see a catch-up plan, since the last one apparently got stuck at the Treasury? As I have said before, I understand that money does not grow on trees, but neither do teeth.

I have presented a petition in this place about dentistry in North Devon, and I thank the Minister for her response, which details some improvements such as the Access Dental helpline in Devon. However, we know that even the post-covid schemes to help dentistry catch up did not reach places that needed it most, with the majority of the funds not actually being spent on dentistry. I have listened to my ICB’s plans for catching up, but I am not sure that anything I have heard fully reflects the issues around rurality and dentistry. Delivering most healthcare solutions in a rural environment is different from delivering them in an urban one: in rural constituencies, the closure of one dentist can leave patients travelling an additional 50 miles. As I have explained, popping to Exeter for treatment is not an option for many, and far too many of our health treatments involve that 120-mile round trip. We need the dentists to come to us, not us to the dentists, please.

I warmly welcome the steps that this Government are taking to train more dentists, but as even the Prime Minister conceded when he spoke to local press on his recent trip to the North Devon District Hospital, those steps will not help in the short term. The Opposition clearly have no plan in this area, and they have very little grasp of what rural life is like, given that most Opposition Members represent urban seats. I was delighted to hear the Secretary of State commit to fairness in rural and coastal areas, but I ask the Minister to see whether it is possible to get some dentists on to buses and into rural areas, and especially into our schools. Over 50% of children in North Devon have never seen a dentist. Dentists come to see our fishermen; why can we not similarly arrange for them to see our servicemen’s families, our schoolchildren, and those who simply cannot travel to an NHS dentist or afford to see one locally?

I do fear that the magnitude of the issue is not well understood by those living in London. People who call an NHS dentist in London will likely be seen almost immediately, and probably quicker than someone back home would have their phone call answered. Ideally, we would have regular dentist check-ups prior to getting toothache, but as even the bard said,

“there was never yet philosopher that could endure the toothache patiently”.

My patience and that of my constituents is running thin with the ongoing delay in hearing that the dentist will “see you now”.

Photo of Emma Hardy Emma Hardy Shadow Minister (Flooding, Oceans and Coastal Communities) 3:00, 9 January 2024

In a landscape where health conditions have become a barrier to opportunity, dental health has unfortunately joined this growing list. The state of NHS dentistry after 13 years of Conservative Government is nothing short of a national tragedy. However, I rise not just to address this dire state of affairs, but to give hope that there is a path towards real solutions and lasting change—a path that can only be available under a future Labour Government.

The national surveys by the NHS Business Services Authority and the British Dental Association evidence the stark reality of our dental health crisis. Children in parts of England endure waits of up to 18 months for dental procedures and our dental workforce has fallen to the lowest levels since 2013, with morale at an all-time low. In Hull and the east riding, the situation is even more alarming, with over half of adults in Hull not having attended a dentist’s for two or more years, which is double the number in 2015.

My Facebook post asking people to share their experiences got nearly 300 comments, mostly on the same issues: the limited access to dentistry for children and adults; long waiting periods for critical interventions, such as tooth extractions, leading to prolonged pain and suffering for those in need; the inadequate availability of emergency care that forced individuals, as has been heard in this debate, to resort to DIY dentistry and unnecessary visits to A&E; and the impact on children’s health, with alarming waiting times for crucial procedures under general anaesthetic.

Angie told tell me about problems with special educational needs dentists. She said that they

“have had to start outsourcing to other dentists in and around Hull who are willing to work with those with SEN. Still waiting on an appointment for my son to be seen by the dentist we chose over 6 months and he’s supposed to be seen every 6 months”.

Sarah told me:

“I needed a dentist during 2021 due to having chemotherapy…so I go to my local NHS dentist which I had been with for years!...they had struck us off with no notice…so I ended up ringing over 40 dentists with no response other than a waiting list. 2 years later after treatment I went private, in debt of over 2,000 pounds and having lost 1 tooth. I’m lucky to being back to OK health.”

Stephen told me:

“Yeah our dentist closed at East Hull...and it’s taken me 2 years to try and get my kids a dentist. I actually called 37 dental surgeries and even had to try York, Leeds, Scarborough, Lincoln. My Polish dentist could not resit the English dental exam after we came out of the EU in time due to Covid delays so she went back to Poland. Such a shame, she was an amazing dentist... She was fully qualified but there was an exam you had to resit…it was all delayed at the time so I think we lost quite a lot because of that.”

Despite getting moulded for a new veneer for a tooth, he had

“to superglue an Amazon £9 tooth on my front tooth for over a year”.

Locally, people are trying to make a difference, and I pay tribute to Chris Groombridge and the Teeth Team charity, which goes out talking to children—nursery age and primary age children—about oral health and hygiene. However, we need to train more dentists, and we need to do more to keep the dentists we already have. I really welcome the reform of the dental contract.

On dentist training, I presented a petition calling for a Hull York dental school based on the Hull York Medical School that the Labour Government set up in 2003. Unfortunately, the Government rejected that idea. However, there have been positive conversations with the integrated care board about a centre for dental development being set up in Hull, so some dentists could be trained in the city, albeit not in the dental school that we would like to see. If that does happen, and I do hope it does, we will still be waiting five years for dentists to be trained. The emergency is here and now.

That is why I so wholeheartedly support Labour’s plan to get 700,000 more urgent appointments annually, reforming the dental contract to keep the NHS dentists we have, introducing supervised toothbrushing as a strong preventative measure, and funding improvements. The plan will cost money of course, but it will be funded, as we have explained, by abolishing the non-dom tax status, because people in Kingston upon Hull West and Hessle need healthcare more than the ultra-wealthy need a tax break.

Under the Conservatives, NHS dentistry faces a slow demise, with dentists leaving vast areas as dental deserts. Unlike the Tories, the Labour party believes in accessible healthcare for all. We pledge immediate action for those in urgent need and long-term reforms to restore NHS dentistry for everyone. The motion I am voting for today is not merely a formality; it is a reflection of the urgency and gravity of the situation. This Government’s legacy is one of stagnant growth, soaring prices and a crumbling public service. It is a legacy of failure, and it is time for the positive change that only a future Labour Government can bring.

Photo of Mary Foy Mary Foy Labour, City of Durham 3:05, 9 January 2024

It was music to my ears when my hon. Friend Wes Streeting announced that a Labour Government will introduce 700,000 extra appointments each year, get more dentists into the communities such as mine that need them the most and ensure that everybody who needs an NHS dentist can get one, because I am fed up with the state of NHS dentistry. I am fed up that my constituents cannot get an appointment, fed up that people in Durham have resorted to DIY dentistry and fed up that Tory Governments have sat on their hands for over 13 years.

To be clear, NHS dentists are not to blame for the crisis. We know they are trying their best. It is Ministers on the Benches opposite who are to blame, and they cannot say they have not been told. I have raised this important issue for the last two years and other Members have done so for so much longer. Last May, I raised, as a point of order, that the Prime Minister may have made several inaccurate statements regarding the number of NHS dentists. For instance, in Prime Minister’s questions on 3 May, he stated that

“there are more than 500 more dentists working in the NHS this year than last year.”—[Official Report, 3 May 2023;
Vol. 732, c. 111.]

However, a freedom of information request obtained by the British Dental Association threw the Prime Minister’s comments into doubt. According to the FOI response, the number of dentists is in fact down by 695 compared with the previous year, and there were fewer dentists undertaking NHS work than before the pandemic, bringing the workforce down to levels not seen since 2012-13. Unsurprisingly, the Government did not correct the record, and that says it all.

Everyone knows that NHS dentistry is in crisis—our constituents tell us regularly—but the Government continue with their “It’s all fine” attempt at message discipline. Why do they not just accept that vast areas of our country are now described as dental deserts and do something about it? I hoped that the Chancellor would have offered something—just anything—for NHS dentistry in the autumn statement, but dentistry was not mentioned in the Chancellor’s speech or the policy report. Not a penny was put forward, even though the Government announced a recovery plan in April last year. That recovery plan, as we have heard, still has not been published. Even worse, perhaps, was the sinister announcement, confirmed in the answer to a written question I tabled in November, that the Government would withdraw free dental care for the long-term sick.

Last year, I led an Adjournment debate on one such dental desert—my constituency, City of Durham—and I want to repeat what my constituents shared with me so that Ministers know what people are going through. One constituent told me that they had moved to Durham four and a half years ago, but could not find an NHS dentist. They were told that, after a kidney transplant, it was vital they had regular dental check-ups to monitor their health, but then they broke their tooth and could not afford to fix it. Another constituent told me she had to borrow money to afford a private appointment; after becoming pregnant, the exemption she got from dental charges was worthless because there were no appointments available. A young girl from my constituency tripped over and shattered her teeth, and her family could not find a dentist to help her. It was only after I reported the case on social media that a local dentist kindly offered their assistance. Another was unable to find an NHS dental appointment, so out of frustration decided to go private. Following that, they were diagnosed with oral cancer.

Why is this happening? A visit to a dental practice in my constituency provided some answers. The practice had just one dentist working two days a week seeing NHS patients and it had 10,000 patients on its books. In the north-east, almost 97% of surgeries are not accepting new adult patients. It does not take a genius to work out why my constituents cannot see a dentist.

The situation nationally is diabolical. Rotten teeth is the No. 1 reason why children aged between six and 10 are admitted to hospital, with an average of 169 children undergoing tooth extractions every working day. It is clear that a preventive approach to healthcare has eroded in Britain. Fundamentally, this is because of austerity. For over 13 years, the Government have hollowed out our welfare state.

Photo of Peter Gibson Peter Gibson Conservative, Darlington

The hon. Lady and I share the same integrated care board. If this is to do with austerity, why has she not engaged with our local ICB to ask it about the underspend and the provision in her constituency?

Photo of Mary Foy Mary Foy Labour, City of Durham

I do speak to the ICB whenever I need to and it has told me, as I am about to say, that our welfare state, of which the NHS is a part, has been hollowed out. The system is wrong. Austerity has caused these problems: it is not the pandemic; it happened many years before then.

Supporters of austerity often say they do not want to burden future generations with debt, but austerity and preventive healthcare are incompatible; we cannot have both. The healthcare problems this Government have caused our constituents—issues that could have been prevented with funding and investment—will now be more expensive to resolve down the line. Conservative Members have saddled future generations with poorer health, poorer opportunities and ultimately a poorer country, and it is time for them to go.

Photo of Grahame Morris Grahame Morris Labour, Easington 3:12, 9 January 2024

It is an honour to follow my good friend my hon. Friend Mary Kelly Foy. I also raise an issue related to the integrated care board, which may be of interest.

I am sure you are far too young, Madam Deputy Speaker, to remember the school dentistry service but some of us of more senior years will recall the annual visits from the school dentist. Each year, the dentist and dental nurse would attend school assembly, class after class would line up, and every child would have their teeth inspected. At home time, anyone requiring further treatment would receive the dreaded letter asking parents to make a follow-up appointment. This was a simple, efficient, and productive process. The system allowed thousands of children to receive annual dental check-ups. The day was also an opportunity for children to be educated on the importance of dental hygiene—Selaine Saxby mentioned the special tablets that highlighted plaque on teeth—and how to avoid the dreaded follow-up letter the following year.

I recently asked the integrated care board about reintroducing this scheme, but despite the NHS North East and North Cumbria integrated care board taking over responsibility for commissioning dental services, it passed the buck on this question to the local authority, stating in its reply:

“Commissioning responsibility for dental public health falls under the remit of Public Health, which is hosted by the Local Authority. As such, the ICB is unable to comment on the school dental screening programme and this would need to be raised directly with Durham County Council.”

This silo mentality is a disgrace. I will mention some statistics on opportunity cost in a moment. Although annual school screening would not necessarily be popular with the children, it would ensure they are all seen by a dentist, and it would free up space in dental practices.

Currently, our children are paying the price. Data from NHS Digital shows that 44% of children have not received an annual check-up with an NHS dentist. I looked on the NHS “Find a dentist” website today and there is not a single dentist accepting children aged 17 or under in my Easington constituency. Ministers should be ashamed that after they have been in power for 14 years, NHS dentistry is catastrophically failing our children.

I say to my constituents watching this debate that there are dentists accepting children in neighbouring constituencies—in Wheatley Hill, Easington Lane and Houghton-le-Spring. However, those dependent on public transport will find accessing these services almost impossible due to the appalling state and unreliability of our bus services. That is another story and another catastrophic failure of Tory neglect and mismanagement.

The situation for adult patients in Easington is also dire. There are no dental practices accepting adult patients within a 10-mile radius of my constituency. Within a 15-mile radius, there are only three. Again, that is completely inaccessible for those who are dependent on our unreliable and infrequent local bus services.

The Prime Minister says he is proud of his record on dentistry and has boasted that there are now more NHS dentists across the UK, but he must inhabit a parallel universe. In the real world, data shows that there were 24,151 dentists performing NHS work in 2022-23—more than 500 down on pre-pandemic levels. Moreover, as colleagues have pointed out, the headcount does not show the level of NHS treatment, because a dentist working in the private sector and doing a single NHS check-up in a year counts just the same as a full-time NHS dentist.

There are some scary statistics. One in 10 people have attempted their own dental work, with Healthwatch, the patients’ voice, reporting patients pulling their own teeth out with pliers. That might seem ridiculous but my mother is 87 and very frail, and she did this out of desperation. It is appalling. Here is another terrible statistic—every day is a school day, Minister: tooth decay is the most common reason for hospital admission for children aged between six and 10. Oral cancer is one of the fastest rising types of cancer and kills more people than car accidents in the United Kingdom. Limited access to dental services means that fewer oral cancer cases will be detected early, which will lower the survival rate and further widen health inequalities.

It is time for the Government to get control of this problem and to deliver for the British public, who are being let down time and again by the dysfunction at the heart of the Conservative party.

Photo of Janet Daby Janet Daby Shadow Minister (Youth Justice) 3:18, 9 January 2024

It is clear that under this Government our NHS dentistry is in crisis. Across Lewisham East a number of dental surgeries are no longer accepting new adult patients. Recent Healthwatch polling shows that one in 10 people in England are paying for private dental treatment because they cannot find an NHS dentist, yet many others cannot afford to do this and instead are suffering. The Government promised to publish their dental recovery plan by the summer of 2023; it is now 2024 and the Government still do not have a plan.

I will focus my remarks on a specific issue facing dental patients, as well as practitioners, that is making this crisis even worse. A constituent of mine contacted me about her father who was driven to suicide after more than a decade of seeking compensation for dental work that left him in severe agony. Despite being awarded a record compensation sum, he never received a penny. The dentist who carried out the surgery was registered with the General Dental Council, which requires all dentists, both NHS and private, to have professional indemnity to be a member. However, it turned out that the dentist did not have full cover. Instead, she was covered only via her membership of the Dental Defence Union. Such organisations are not insurance companies but offer professional indemnity on a discretionary basis against the risk of dental neglect claims and professional conduct proceedings. That means that successful compensation claims by patients are not guaranteed to be paid out. The General Dental Council currently accepts that as appropriate, but in my view it is not, and neither is it in my constituent’s view, especially when it led to such a horrific experience for her late father.

The Paterson inquiry recommended that the Government should, as a matter of urgency, reform the current regulation of indemnity products for healthcare professionals. In 2018, the Government launched a consultation on indemnity cover for healthcare professionals including dentists, but little progress has come from it, despite the majority of stakeholders arguing against discretionary indemnity. I have written to the Secretary of State highlighting calls for the Government to outlaw discretionary indemnity options for what is considered appropriate cover for practising dentists, but I am yet to see a response. Therefore, I would welcome it if the Minister met me and my constituent to discuss this matter and the response to the consultation.

I am sure we all know that the Horizon scandal was a terrifying injustice, but in its own way the situation I am speaking about is also a scandal. Through no fault of their own, people are being denied huge amounts of compensation that they are legally entitled to. There is nothing in place to stop what is happening to my constituent’s father happening to many more people— I hope that it does not, but that is the reality. The Government have a duty to address safeguarding for patients and dentists. To exacerbate the problem, most patients and professionals do not know that their discretionary indemnity arrangement could still leave them out of pocket. When will the Government bring about change, or are they just incapable?

Photo of Lloyd Russell-Moyle Lloyd Russell-Moyle Labour/Co-operative, Brighton, Kemptown 3:22, 9 January 2024

In my constituency, 11 dentists have updated their data. Seven are not accepting adults and nine are not accepting anyone, but the reality is that if I phoned around, I would find that none of them on that list are accepting people.

The situation is so bad in Sussex that the ICB has taken matters into its own hands, ignoring the NHS portal, which it says does not work, and producing a list every month of dentists that will do drop-ins. For the whole of Sussex, we have two in Hastings—hopefully soon to be Labour, with our fantastic candidate Helena there—two in Hove and one in Brighton Pavilion. There are none in Worthing—Worthing West and East Worthing and Shoreham are hopefully soon to get Labour MPs —or in Crawley, Bexhill and Battle, Lewes, Eastbourne, Mid Sussex or Chichester, all of which are marginal constituencies in the next election. I would have thought the Government would be more on it to ensure that constituencies that they are about to lose have dentists that patients can see, but they are not.

The ICB says that it cannot find dentists to volunteer—that is what they do. All the ICB can do is beg and plead with dentists to voluntarily take extra patients, because the contracts do not work. Also, many dentists say that they cannot update the online system because other dentists do not update it, so if they do, they are flooded and all their places get taken. So dentists do not update the system properly. When asked why they do not, they also say that the system does not provide enough granularity. They can say whether they accept children and adults—yes or no—but they cannot say whether they take local people or prioritise other requirements.

Dentists prefer to operate a system in which patients have to ring around. That is no good for my constituent Carolynn Bain, who rang around all the lists in Worthing and Eastbourne, and in the end had to go to London for her dental treatment. She was told that dentists do not want to update the system because they are afraid of the effect. When I have asked the CCB—sorry, the ICB; they change the names of these darned things so often that no one can remember—it says that that inhibits the information to constituents. We need a system, like we have for doctors, of proper planning in catchment areas. We need the ICB to be able to say, “This is the population in this area. This is what is needed.” Just like with doctors, patients should be able to choose dentists out of area or dentists they have a connection with, perhaps because they work in an area but do not live there. There needs to be proper planning, and there is none at the moment. That is why Labour’s plans for more urgent appointments and better and more NHS training are welcome.

I hope the Government will also look at dental schools. At the moment there is no dental school in Sussex, Hampshire, Surrey or Kent—none in the south-east. There are London dental schools. That makes a huge difference to the ability to train and recruit dentists, because many will end up staying in the area in which they have trained. I urge the Minister to look at establishing a new dental school in the south-east—we would love to have it in Brighton, but Hastings is also a good option. Our Hastings candidate will be pushing very hard for that. After the closure of the University of Brighton in Hastings, there is a need for a new university or medical school there, and that would be very welcome.

We have heard a lot of pledges from the Government to increase the number of dental hygienists, but this is a huge smokescreen. Under the NHS, patients can only access a dental hygienist if they have been referred by a dentist. If they go private, they can pay to go directly. Actually, we should encourage people to go to directly to dental hygienists once a year, and once a year to a dentist. There is no need for a six-monthly check-up with a dentist if a patient also goes to a hygienist. But at the moment, patients cannot go to a hygienist unless they are referred as a tier 2 form of treatment, so they cannot do it on the initial check-up. That needs to change to make dental hygienists relevant; otherwise, the Government are talking about recruiting into the private sector a load of dental hygienists no NHS patient will be able to see.

The same goes for the list system. It is absolute madness that if a patient has not seen a dentist for six months or a year, they can be thrown off the dentist’s list. That would never happen with a doctor. We need to change the funding model so that dentists are encouraged to keep patients on their list if they have not seen them. They should get a bonus for seeing them, and some reward for preventive treatment. That preventive treatment might not always involve seeing a patient, but may involve educational resources or sending them to a hygienist, with the hygienist reporting that no further action is needed.

All those things could be done. The start of an education and preventive approach should be in our schools. That is why Labour is pledging to take action. That is why this country has been so let down by the Government.

Photo of Simon Lightwood Simon Lightwood Shadow Minister (Transport) 3:28, 9 January 2024

I am grateful for the opportunity to speak in today’s debate on such an important topic. Last year, I launched my “Save Wakefield’s Smiles” campaign to highlight the horrifying state of dentistry access across my constituency. I have had an avalanche of constituents contact me to share their heartbreaking experiences of trying to get an appointment in Wakefield.

With permission, I will briefly share two of those testimonials with the House. Anne is a 71-year-old pensioner entitled to free dental treatment, and she has been trying to get a dentist appointment for five years. She told me that she feels let down by this country. She says that she has worked all her life since she was 15 and paid into the system for her entire career, and now has to decide whether to heat her home or get her teeth seen to.

Steve says he has been waiting two years for an NHS dentist because he cannot afford the estimated £5,000 it would cost to fix his teeth privately. He says that the anguish he has experienced while waiting has severely impacted his mental health. Steve told me:

“I barely leave the house. I am too scared to change job because I worry no one wants to hire someone in desperate need of healthcare.”

Like Anne, Steve feels frustrated. He says that he does not think it is too much to ask to receive the care he pays his contributions towards.

Those are a handful of cases from my constituency, but I know that up and down the country, the story is the same. Nine out of 10 clinics in England do not have the capacity to take on new patients. Millions of our constituents simply cannot get an appointment, and this Tory Government have failed every single one of them. Perhaps most shockingly of all, one in 10 of our constituents now feel that they have no choice but to resort to their own DIY dentistry. What kind of country have we become? What sort of grim Dickensian dystopia have this shambolic Tory Government presided over, where people are pulling out their own teeth with pliers over a sink?

Colleagues will recall, I hope, my first ever question in Prime Minister’s questions last year. I pressed the Prime Minister on the national dental emergency. I looked him in the eye and told him how 25% of five-year-olds in Wakefield already have visible tooth decay. I told him how less than half of Wakefield’s children managed to get an NHS dentist appointment in 2022, and I told him how a constituent of mine had desperately telephoned every single dentist in Wakefield to find an appointment while his daughter cried in pain from her teeth, black with decay.

From the Prime Minister’s reply and follow-up letter to my question, you would honestly think he was living on a different planet. He boasted of the funding he is putting into NHS dentistry, boasted of the number of NHS dentists and boasted that he had made reforms to the NHS dental contract. In fact, the British Dental Association has stated that the Prime Minister’s boastful claims may have been inaccurate. I fear he may have inadvertently misled the House as a result. Indeed, the British Dental Association has been clear that it believes the Prime Minister “offered a grotesque misinterpretation” of his work to address the crisis. The Prime Minister may have promised a dentistry recovery plan last year, but months later nothing has been published and he has nothing to show for it.

The Prime Minister may have admitted last week that he is running scared of a May election, but we on the Opposition Benches could not be more ready to take our dentistry rescue plan to the British people. Labour will address the immediate crisis head-on by providing 700,000 more urgent dental appointments and recruiting new dentists to the areas most in need. To treat the long-term challenges, Labour will reform the dentistry contract, which is no longer fit for purpose in its current form. With a vital focus on prevention, Labour will introduce supervised toothbrushing in primary schools.

Unlike Government Members, who had a soft spot for announcing economy-crashing, uncosted policies under the previous Prime Minister, Labour has a dentistry rescue plan that would be fully funded by abolishing the non-dom tax status. We have an incredible, ambitious plan ready to go from day one of a desperately needed Labour Government. The Prime Minister may be scared of an election, but when I speak to my constituents and hear how badly we need to fix our public services, I know where I stand—bring it on.

Photo of Angela Eagle Angela Eagle Labour, Wallasey 3:33, 9 January 2024

It is a pleasure to follow my hon. Friend Simon Lightwood, who made a superb speech. I have childhood memories of much older relatives who grew up before the NHS was created having no teeth left at all—they had had them all extracted because it was cheaper. I never thought that might start to happen again, but I fear that in some cases we are getting far too close to it with the current situation in our dental service. As many hon. and right hon. Members have pointed out in today’s debate, this is not only serious for oral health but has other health connotations. New medical insights link oral hygiene with heart and lung health. If we neglect oral hygiene to the extent that we are—we have heard about that in the debate—that will have huge implications for the health of future generations.

As Labour’s motion sets out, NHS dentistry is in crisis and is approaching breaking point, if it has not already passed it. The people of the UK are paying the price, and the poorest are paying a much heavier price. The Nuffield Trust says that NHS dentistry

“is at its most perilous point in its 75-year history.”

In Wallasey, my constituents are living with the reality of that day to day. As we have heard, a seven-year-old is more likely to be hospitalised for rotting teeth than for any other medical issue. That is an astonishing statistic. Many people—including my constituents—are growing up in places where they simply cannot get access to dental care. In Wallasey, only two dental surgeries will take a child as a new patient, and not a single one is taking any new adult patients on to its books.

In Wallasey, we have seen people kicked off existing lists without notice. That happened often during the pandemic, with the excuse that they had not visited the dentist in two years—they could not, as the dentists were closed because of the pandemic—and they cannot get access to another provider. There are care homes in my constituency where there is no access to dental treatment for those living in them. I have had email after email from constituents writing to me in despair, disbelief and often pain, all unable to get an appointment. NHS workers, an expectant mother, a retired firefighter, concerned parents and disabled people with declining health are all unable to see a dentist because of the terrible 14 years of Tory neglect.

Last summer, Sarah wrote to me when she was at her wits’ end. She had moved into my constituency from Liverpool a few years ago with her partner, pleased to be closer to family as they prepared to welcome a baby. Despite their home being close to four different dentists, Sarah was unable to register with any surgery. Each one was not accepting new patients. None even had a waiting list that she could join. She has now lost one molar and broken three. She has tried and failed to get an emergency appointment numerous times, and she has had to call 111 in desperation. She is in constant pain and still has no access. Her little boy, who is now four years old, has never seen a dentist, despite his parents’ best efforts.

Dentists, too, are outraged. Last year, Annette, a local dentist who has a superb surgery and has worked for the NHS her whole life, wrote to me in total despair. Her surgery has being working overtime to see NHS patients and to try to meet the unmet need—it has even overperformed on its targets to get the NHS to care for local people who desperately need it. She was doing that, but it got to the stage where her surgery was not being paid for NHS work due to errors and unexplained hold-ups in money. Just before Christmas, she said:

“At the end of next year I will have been a dentist for 50 years, always working on the NHS. I don’t think I have ever known it in such a bad state, nor for the Government to have so little care of its state.”

She is over-worked, under-compensated, exhausted and unable to keep up with demand, and she is not being paid for the work that she is doing. It is a terrible state of affairs.

We see a picture of underspent ICB dental budgets and massive unmet need. It is obvious that those things demonstrate a system that simply is not working. The Government know about this as well as we do and announced last April that there was going to be a plan, but we still have not seen one. If they care, where is their sense of urgency? They cannot say that our plan to put NHS dentistry in working order will not work when they will not bring forward their own plan. They must get on with it now. My Wallasey constituents are in pain, and I expect it to be alleviated.

Photo of Sarah Edwards Sarah Edwards Labour, Tamworth 3:39, 9 January 2024

Most of us get two sets of teeth in our lifetime. We learn with our milk teeth how to take care of them, and then, as adults, we must take care of the teeth that should see us through to the end of our days. Often overlooked, sadly, is that it is getting harder and harder to take care of our teeth. In my constituency, seven dental surgeries responded to a survey and revealed that five were not accepting any new adult patients. In 2022, the Local Government Association found that Tamworth was one of the most difficult places in the country to register for a dentist, with a striking ratio of 0.065 dentists per 1,000 people. Tamworth is growing. Many new houses are being built in the constituency, and it is consistently raised with me that there are no services to match the growth in population. That refers not only to schools and GP surgeries, but to NHS dentistry. Tamworth’s population has grown by nearly 3% between 2011 and 2021.

We also know that tooth decay is now the most common reason that children aged between the ages of six and 10 are admitted to hospital. It is therefore no surprise that the Health and Social Care Committee report in 2023 branded the current contract “not fit for purpose” and described the state of the service as

“unacceptable in the 21st century”.

The current contract prioritises Government aims over patient care. The Government also did not fundamentally reform the contract when advised to by the Health and Social Care Committee, so patients are left with inadequate provision and a lottery in access to care. Last year, over 12 million people were unable to access dental care. That is more than one in four adults in England and three times as many as before the pandemic. In times of crisis, more and more people are picking up the pliers and turning to do-it-yourself dentistry, with a poll from YouGov indicating that one in 10 adults attempted some form of the dangerous practice last year.

Free healthcare at the point of access is a cornerstone of this country pioneered by a Labour Government, yet recent Healthwatch polling shows that one in 10 people in England paid for private dental treatment in the last 12 months because they could not find an NHS dentist. This is having adverse effects on the detection of oral cancer. I campaigned against the privatisation of cancer care services in Staffordshire and I am dismayed that one of the detection and diagnosis avenues is becoming privatised by stealth. Millions who cannot afford to go down that route are left without the help they need. I share concerns raised by my colleagues that the Government are rolling out a pilot in Cornwall in which only children and the most vulnerable patients will be eligible for NHS treatment.

The Government have been ignoring all the symptoms of decay, and now NHS dentistry is in need of a root canal. It is not enough to wait for the tooth fairy to fix these problems. I support my Labour colleagues in calling for urgent reform. Like a cavity, we must repair the damage caused by this Government. We need Labour’s plan to create 700,000 more appointments a year. We need targeted recruitment schemes to fill the voids of decay left by a lack of strategy. We need reform to the dental contract. It is time to rescue NHS dentistry from this crisis, and get patients seen on time and smiling again.

Photo of Alistair Strathern Alistair Strathern Labour, Mid Bedfordshire 3:43, 9 January 2024

As a man with a great fondness and enthusiasm for Irn-Bru and a habit of throwing my body on the line on the football pitch to make up for a lack of skill, it is fair to say that over the years I have had to rely quite a few times on fantastic NHS dental care. But, like for far too many of my constituents, those positive past experiences of NHS dentistry are exactly that—a thing of the past.

We have all heard today stories of constituents who have struggled to access dentist care when they needed it and struggled to pay for private care in the absence of NHS provision in their area. Whether they have been struck off as a patient over time or their NHS practice has gone completely private, our constituents are repeatedly paying the price for the continued failure to stop the rot in dentist provision. Just in the last week, I have had constituents contacting me to express their frustration and challenge in accessing routine dental appointments, with NHS dentists telling them they can only have emergency care. People are forced to wait for things to get worse just so they can afford to be seen. Another told me about the incredible cost they are now having to pay to drive to see an NHS dentist, having been pushed further and further afield as more and more practices near them have withdrawn eligibility. This should not be acceptable, but shamefully it is far too common. Last year nearly 800 people across Bedfordshire were admitted to accident and emergency units for tooth-related reasons. In the year before, 165 children in central Bedfordshire presented at hospitals requiring a tooth extraction: 165 young people had to go to hospital to receive treatment for conditions that should have been picked up months earlier. Across the country, nearly 5 million people were told when they last inquired that no appointment was available, either because the practice was not taking more patients or because it was fully booked.

Sadly, under the present Government this situation has become endemic, and what is so heartbreaking is that it is not a new issue. For some time, Members on both sides of the House have been sounding the alarm bell, but rather than working with professionals to bring about the changes that are needed, the Government have ignored them and just tweaked around the edges. The effect has been the continued decay of dental provision throughout the country. We are nearly a year on from the promise of a dental recovery plan which is yet to be published, but our NHS dentists need immediate support to alleviate the pressures they are facing and the pain their patients are suffering.

Shamefully, as we have already heard today, integrated care boards throughout the country—including mine—are struggling to make use of the money available to them because of the challenges posed by the current funding and contract structure for bringing dentists into the NHS fold. That cannot be acceptable to anyone in the Chamber who recognises the existence of a crisis that requires emergency action to put it right, and certainly requires a plan that involves a fixed date rather than some unspecified point in the future.

We need a Government who will finally prioritise this issue, take the necessary action to ensure that dentists are available to those who need them, and return the service to a better footing for all our constituents. We need incentives for new dentists to work in areas where there is the greatest need, we need 700,000 more urgent appointments for patients requiring, for instance, fillings and root canal treatment, and yes—we need supervised toothbrushing in schools for three to five-year-olds to target the root of some of these challenges. If Conservative Members have a problem with that, I dread to think what they will make of some of the things that are already happening in schools which are now teaching cooking, physical education and hygiene. All those subjects play an important part in our school system. When we are facing such a clear issue as the current state of dental care for young people, it is shocking to think that we could sit on our hands and not do our bit to try and support them.

As well as all that, we need the fundamental reform of the NHS dentists’ contract that will put the service back on to a good footing. Together, Labour Members have a plan to put dentistry back on track, but I hope all Members will agree that my constituents have already had to wait long enough just to have an MP who wants to do this job. As the Government drag out and drag out the date of the next general election, my constituents should not be having to wait for an election to see national change on this issue. Please, let us stop pushing that strategy further and further away. Let us stop turning to infighting and being obsessed with who our next leader will be, and agree together today to put something right. Labour has a plan to get NHS dentistry back on track, and I hope that Members in all parts of the House will back it today.

Photo of Ashley Dalton Ashley Dalton Shadow Minister (Equalities Office) 3:48, 9 January 2024

I am grateful for the opportunity to speak in this debate, because inability to gain access to an NHS dentist is an issue plaguing my constituents.

In 2024 Tory Britain, the opening of additional NHS dentistry practices is national news, with reports of people queuing on high streets just for the chance to be seen by a dentist. This is a Britain where a call to an NHS dentist to inquire about registering as a new patient is met with laughter down the phone. That is not hyperbole or hearsay: it is what I heard when I tried to register my 88-year-old mother and myself with a new NHS dentist. My dad does not need one: he had his teeth taken out for his 21st birthday, because—my hon. Friend Dame Angela Eagle made this point—it was cheaper and easier. It is shocking that we seem to be back in that situation today. In 2024, it is easier to get your hands on Taylor Swift tickets than to get an NHS dental appointment.

For the benefit of Selaine Saxby, who is no longer in her place, my constituency is a rural one, and it is a beauty. However, for many of my constituents, living in a rural constituency makes accessing vital services nothing short of stress-inducing. The presence of the new Labour Members, my hon. Friends the Members for Selby and Ainsty (Keir Mather) and for Mid Bedfordshire (Alistair Strathern), would point to the idea that people in rural communities do believe that Labour has got a grip on what rural communities need; and our colleagues the candidate in Hexham, Joe Morris, and the candidate in Carlisle, Julie Minns, are also telling me that their local people, and hopefully future constituents, believe that Labour has a grip on what is needed in rural communities.

When services are not available in Burscough, in my constituency, it is not as simple as phoning the next practice down the road, or the one just over from that. It means travelling to Skelmersdale, to Southport, to Liverpool. One of my constituents has contacted every practice in our constituency and beyond, from Ormskirk to Blackpool, and is unable to register anywhere as an NHS patient—and Blackpool is 50 miles away, a four-hour round trip by public transport. Another parent in my constituency has been unable to register either of their children, both of whom have additional needs, with an NHS practice.

Another recent arrival to Skem cannot register any of his family members as an NHS patient. I took up his case with the ICB—I am sure that Peter Gibson, who is still in his place, would approve. The ICB told me the shocking truth that Government funding of NHS dentistry is only sufficient to enable around 50% of the population to access routine dental care. So where is the funding for the other half? What are the other 50% of our constituents meant to do?

Photo of Peter Gibson Peter Gibson Conservative, Darlington

The hon. Lady is obviously in a different ICB area from mine and I am not privy to the detail in respect of her ICB’s underspend, but it would be wonderful to know whether her ICB does in fact have an underspend.

Photo of Ashley Dalton Ashley Dalton Shadow Minister (Equalities Office)

I thank the hon. Gentleman for leading up conveniently to my next point. The issue is that the ICB is actually bringing back more money than ever before from our dentists, and the local NHS dentist in Burscough is telling me that that is because they cannot recruit dentists or hygienists or other dental professionals in order to meet their target. They would love to do it; they cannot. The hon. Member for Darlington also talked about choice, but it is no choice when the only choice is private or nowt—and that is what my constituents are looking at.

If only the problem stopped at dentistry. The inability to access a dentist and regular check-ups leads to people having to visit their GP for knock-on health issues, or they are in so much pain that they are forced to end up at an already stretched A&E. Under this Government, the state of NHS dentistry services has ended up as dismal. A member of the public who contacted Healthwatch Lancashire recently, reported that they were in so much pain that they were feeling suicidal.

The public know that they cannot trust the Tories with NHS dentistry, and the alternative with Labour is clear. Prevention is by far the most effective way to improve patient outcomes across the NHS, and there is no better way to prevent than to educate. We have heard that a Labour Government will introduce supervised toothbrushing in schools for three to five-year-olds, giving children the best chance to avoid tooth decay altogether; 700,000 more urgent appointments for the most serious treatments such as fillings and root canals; and will incentivise dentists to work in areas where they are needed most. That is music to the ears of residents in rural areas such as mine. Even better than that, it is all paid for, by ensuring that the people who make Britain their home pay their taxes here, abolishing the non-dom tax status once and for all.

Toothache is nothing compared with the hurt of another five years of this Government’s inaction on dentistry. It is time they called a general election to make way for a Government with a plan to fix our nation’s teeth.

Photo of Nigel Evans Nigel Evans Deputy Speaker (Second Deputy Chairman of Ways and Means), Chair, Restoration and Renewal Programme Board Committee, Chair, Restoration and Renewal Programme Board Committee

I am afraid that I have to reduce the time limit to five minutes for the last four speakers, so that we get the Division as close to half-past 4 as possible.

Photo of Sarah Dyke Sarah Dyke Liberal Democrat, Somerton and Frome 3:54, 9 January 2024

The British Dental Association recently said that NHS dentistry is facing access problems “on an unprecedented scale”. Those of us who live in rural areas such as Somerton and Frome will recognise the cavity of dental provision across rural Somerset. There simply are not enough dentists, as there is only one dentist delivering NHS services for every 1,773 people.

I have been in touch with dental surgeries across my constituency and none could provide, nor could they tell me of any NHS dentists in the area who are taking on new adult patients. Dentists cannot signpost patients to an alternative service because they simply do not exist, causing residents anxiety and frustration.

This Conservative Government have recognised that our NHS dental services are rotting, but they do not know how to fix them. They are the ones who have underfunded our services and failed to reform NHS dental contracts. The Government pledged to create an NHS dentistry recovery plan back in April 2023, but it has not yet been published. And while they delay and allow problems to fester, my constituents in Somerton and Frome are suffering in dental agony.

A constituent got in touch with me recently. They are 60 years old, and they work hard in their community. However, they have not been able to see a dentist for years. They told me that they feel hopeless. They are in constant pain and no longer have the confidence to smile, to socialise, to work or even to go shopping. They are left isolated by this lack of provision and, unfortunately, it is becoming way too common, especially in rural areas. The shortage of dentists is a major issue that limits access to oral healthcare, especially for elderly residents who are at higher risk of dental decay and social isolation. There are specific challenges to rural dentistry provision, recruitment and retention. These need to be recognised because gaps in provision lead to gaps in teeth.

This issue is prevalent in South Cambridgeshire, where there is a 100% refusal rate for new NHS dental patients. The lack of dental provision in rural areas is exacerbated by the fact that the east of England is one of the few regions of the country with no dental school to train new dentists.

I specifically want to see policies that address the lack of dentists in rural areas. Our communities are spread across a large geographical area, and if the one remaining dental surgery in a town such as Somerton or Castle Cary in my constituency cannot take on new patients, residents are faced with major obstacles to accessing a dentist. I want to see mobile dentistry hubs established to cater for rural communities that do not have dental provision.

The Liberal Democrats are clear that we require reform to NHS dental service contracts to provide an incentive for dentists to continue to provide these services, and to ensure they are able to take on new patients. A more holistic approach to dental services is needed, one that emphasises preventive care and that understands that dental health is intrinsically linked to general health.

It is possible to improve access to dental health in rural communities and to bridge the gap to dental care, but we must provide dentists with the respect and funding they need and deserve.

Photo of Keir Mather Keir Mather Labour, Selby and Ainsty 3:59, 9 January 2024

Before I begin my remarks, let me just say how disheartened I am to see the Government Benches deserted in this crucial debate on the state of NHS dentistry; nowhere could the picture of the dereliction of duty that the Government have shown to our NHS dentistry be made clearer. However, it is a pleasure to join so many Labour colleagues to speak in favour of the Leader of the Opposition’s motion on dentistry, a part of our healthcare system that is in rapid decline and that has been left to rot by the absent leadership of those on the Conservative Benches—they were there until very recently.

The number of active NHS dentists in England is at its lowest in a decade. In my maiden speech, I mentioned that one of my constituents, too, had resorted to pulling out one of her daughter’s teeth because dental provision is so poor in my constituency. Another constituent, a veteran, has been left without a dentist because armed forces personnel are removed from their home dentist upon joining up and cannot find a practice that will let them register when they return. How do the Government find it acceptable that people who take the bold and brave decision to serve our country are left abandoned by an NHS dental system that is supposed to be there for them?

It has been documented that our country is now plagued with dental deserts. According to a report published last year by the Association of Dental Groups, only a third of adults and less than half of English children have access to an NHS dentist. Some 90% of dental practices no longer accept NHS patients, leaving 4 million people without access to NHS dental care. In Selby and Ainsty, we have been left with just nine dental practices offering NHS services; we have just nine for a vast rural constituency that stretches from Doncaster in the south to Harrogate in the north, and suffers fundamentally with issues such as a lack of public transport in our rural areas—it is simply not good enough.

We did not get into this situation overnight; we have had 13 years—almost 14 now—of mismanagement by the Conservative party, which has shown a complete dereliction of its duty to protect the health of the British people. The Government’s chronic underfunding of dental practices, with funding cut by a third in the past decade, has meant that patients are being failed on an unprecedented scale. The Government and the Minister have been quick to blame the dental contract, as well as the covid-19 pandemic, for the crisis that dentistry faces, but the Government have had 13 years to revise that contract, stabilise dentistry and make it fit for the future. Instead, they have chosen to rest on their laurels and have pursued muddled plans, allowing dentistry to crumble.

The crisis in our dental system can be traced back to one fundamental cause: challenges to our workforce. Over the past decade, there has been a complete failure to forward plan about the workforce needs of our dentistry system in the future. We must be aware that any hope of recovery must be catalysed and underpinned by a comprehensive workforce plan that sets the NHS and dentistry up for a long-term, stable and productive future that serves the citizens of our country. That brings me on to Labour’s plan to revive NHS dentistry. It was Labour’s plan 75 years ago that brought NHS dentistry into existence and it will be Labour’s plan that will save NHS dentistry from the perilous position that the Conservative party has created. Our plan will give patients the care they need and deserve. Our plan will fund 700,000 more urgent appointments, for things such as fillings and root canals. We will incentivise new dentists to work in areas with the greatest need, tackling those dental deserts that are now so rife across our country. We will implement supervised toothbrushing in schools, so we can directly tackle these issues at source, and in the long run we will reform the dental contract so that we can rebuild the service and that NHS dentistry is truly there for all who need it. This powerful and comprehensive plan will give dentistry the staff, equipment and modern technology it needs to get patients seen on time, and help thousands of people across my constituency who are in such desperate need of the dental care that, fundamentally, they deserve as British citizens.

Photo of Alex Sobel Alex Sobel Labour/Co-operative, Leeds North West 4:03, 9 January 2024

Access to dental care in West Yorkshire is a problem that cannot be ignored. Dental care is a fundamental right and its absence has far-reaching consequences for the health of our whole community. Currently, no dentists are accepting new NHS patients in the whole of Leeds, with waiting lists lasting years. Only recently, a dentist in my constituency, in the rural market town of Otley, withdrew from the NHS scheme citing a “chronic lack of investment”; Manor Square has been a reliable provider of NHS dentistry to the local community for many years—intergenerational communities and families have been receiving NHS care at that practice for many decades—but now they cannot receive it there.

The practice’s withdrawal from the scheme has affected 15,000 patients and raises serious questions about the future availability of affordable dental care in the whole area. One constituent was paying around £45 for two annual check-ups at the practice, with their children receiving free dental care. Under the practice’s new private dental plan, the cost will be £640, which is clearly unaffordable for many families in Otley. Such costs are set against rising costs for families across the board.

The decision appears to be yet another symptom of the chronic underfunding and neglect faced by the NHS. Oral health is an integral part of our overall wellbeing and neglecting it can lead to serious health issues down the line. The withdrawal of NHS dental care not only affects individuals, but has a broader impact on the health infrastructure of our communities. The consequences are felt not just by those who currently need dental services, but by all of us who value a robust and comprehensive healthcare system.

We need an urgent reform of dental care. We need to recognise its critical role in maintaining overall health. Our communities deserve access to quality and affordable dental services. The Government have no clear plan, but Labour does. Labour plans to provide 700,000 additional appointments and education on basic life skills in areas where children’s dental health is most affected, through supervised toothbrushing, and to reform the dental contract, which the Government have failed to do over the last 14 years. As many colleagues have said, there are major issues facing the workforce as many NHS dentists have left to practise privately, or have left the UK for countries where dentistry is more highly valued than it is by our Government.

To conclude, the lack of dental care in West Yorkshire is a serious concern that demands immediate attention. It is not just a matter of oral health but a reflection of broader challenges across the NHS. That is why we should support the motion.

Photo of Nigel Evans Nigel Evans Deputy Speaker (Second Deputy Chairman of Ways and Means), Chair, Restoration and Renewal Programme Board Committee, Chair, Restoration and Renewal Programme Board Committee

Members who have taken part in the debate should make their way to the Chamber now, as the wind-ups will begin after Mr Western finishes his speech.

Photo of Andrew Western Andrew Western Opposition Whip (Commons) 4:07, 9 January 2024

After 14 long years of Conservative Government, our country is going backwards. Nothing demonstrates that better than the dire condition of NHS dentistry. What kind of country has this Government allowed us to become when people are forced to pull out their own teeth with pliers, because locating a dentist taking new patients is almost impossible? Talk about going backwards: the Conservatives are dragging us back to Victorian times.

The lack of access to NHS dentistry is one of the most common issues raised with me by constituents in Stretford and Urmston. The most recent data available shows that only 4% of dental practices in my local authority area of Trafford are accepting new adult patients on the NHS. Moreover, the current NHS “find a dentist” website is badly out of date. Despite claims to the contrary, a search using a postcode from Old Trafford in my constituency reveals that none of the top five results is accepting new patients. My constituents tell me they waste time they do not have calling around surgeries because of the results they have been given, only to be disappointed.

For the lucky few who can find a dentist, the wait times for treatment are simply unacceptable. As of September last year, there were almost 2,000 patients waiting for oral surgery in my local authority area of Trafford, with the majority waiting far longer than the NHS 18-week target for treatment. Behind these numbers are people enduring months of pain, distress and misery. In many cases, their ability to work or learn is affected. They cannot sleep. They cannot enjoy the basics of life, like food and drink, and do not feel confident enough to go out with friends and family socially. That is the impact. That is the devastation that this crisis is causing up and down the country.

Although no one doubts the challenges that the pandemic has caused NHS dentistry, the truth is that a lack of funding and a failure to reform in the preceding decade left NHS dentistry uniquely exposed to the impact of the virus. Between 2010-11 and 2021-22, total funding for dental services in England fell by 8%, leaving budgets that have been unable to keep up with inflation or population growth. Although today many Conservative Members have been quick to complain about the dental contract, their party has been somewhat slower to do anything about it, taking 12 years to make what have widely been acknowledged as minor tweaks—tweaks that were criticised at the time by the BDA, which said that their implementation would make “little meaningful difference”.

The Prime Minister pledged to restore NHS dentistry during his leadership campaign, but, over a year later, we know that a pledge from this Prime Minister is the kiss of death for whatever service he is highlighting. Lo and behold, his dental recovery plan, which was promised last April, is still nowhere to be seen. In contrast, Labour has a plan and it will not take us 14 years to deliver it. We will take immediate action to provide: 700,000 more urgent appointments; new incentives for new dentists to work in areas with the greatest need; supervised toothbrushing in schools for three to five-year-olds; and reform of the dental contract to rebuild the service in the long run. That is the type of ambition needed to address the scale of this enormous crisis, and it is an ambition that will have the funding it needs to become reality.

Politics is about choices. We on the Labour Benches choose NHS dentistry, ending the misery, the wait and the pain for so many, over tax breaks for the super-rich. There should be no contest. I urge all Members, including those on the Conservative Benches, to support the substantive motion.

Photo of Preet Kaur Gill Preet Kaur Gill Shadow Minister (Primary Care and Public Health) 4:12, 9 January 2024

I start by expressing my thanks to Members across the House for their many powerful contributions this afternoon. They include my hon. Friends the Members for Stockport (Navendu Mishra), for Weaver Vale (Mike Amesbury), for Wakefield (Simon Lightwood), for Birmingham, Erdington (Mrs Hamilton), for City of Durham (Mary Kelly Foy), for Easington (Grahame Morris), for Leeds North West (Alex Sobel), for Selby and Ainsty (Keir Mather), for West Lancashire (Ashley Dalton), for Tamworth (Sarah Edwards), for Mid Bedfordshire (Alistair Strathern), and for Lewisham East (Janet Daby). They all spoke forcefully about the struggles of their constituents to find an NHS dentist. That is far too common, as we have heard today. Recently I was contacted by a constituent whose daughter was told she would have to wait four years for an appointment to get braces. She is 13 now and will be 18 by the time that she is seen. That is not acceptable.

Let me also thank my hon. Friends the Members for Bradford South (Judith Cummins), for Sheffield, Brightside and Hillsborough (Gill Furniss), for Brighton, Kemptown (Lloyd Russell-Moyle), for Stretford and Urmston (Andrew Western), and for Kingston upon Hull West and Hessle (Emma Hardy) for raising the issue of DIY dentistry. Recent polling has found that around one in 10 adults has attempted some form of DIY dentistry. No one should be forced to pull out their own teeth with pliers. That is Victorian healthcare in Britain in 2024. The British Dental Association survey found that more than half of dentists in England have reduced their NHS commitment in the past few years, and almost half are considering either a change of career, early retirement or turning fully private. I hope that this is a wake-up call for Ministers. All of this paints a bleak picture, Mr Deputy Speaker. The Nuffield Trust described it as a “widespread crisis”, bringing NHS dentistry to its “most perilous point” in its 75-year history. That is why we are debating this motion today. Without urgent action, we are looking at the end of NHS dentistry as we know it.

Seventeen months ago, while he was losing a leadership election to Elizabeth Truss, the Prime Minister pledged to “restore” NHS dentistry. I thought the Prime Minister might have learned his lesson about five-point pledge cards by now, but I remind the House what he promised: ringfenced funding; frontline retention; strengthened prevention; and contract reform. Yet hardly any of that has been delivered. There are fewer NHS dentists now than when he took charge, and they are doing less NHS work. There has been no national roll-out of a supervised toothbrushing scheme to promote healthy habits among children, despite cavities being the top reason they are admitted to hospital. As the Health and Social Care Committee has said, changes to the dental contract

“constitute tweaks rather than anything close to ‘reform’.”

The recovery plan, promised last April, is nowhere to be seen. The Government’s one big idea so far has been to tweak the dental activity contract to allow practices to deliver 10% more NHS work but, having listened to today’s debate, I do not think that a fraction of practices upping their workload by 10% will actually cut it—talk about toothless—and it certainly will not without the money to fund it. We have heard some laboured explanations from the Secretary of State about how local dentistry budgets can be ringfenced, yet simultaneously ICBs have been told that they can raid those same budgets to balance their bottom lines.

Let me raise a specific example. Last week, it was reported that one integrated care board in the west midlands has instructed practices that they will no longer receive funding to deliver the extra 10% of NHS work that was promised. Labour’s candidate in Newcastle-under-Lyme, Adam Jogee, told me that people were already struggling to access basic dentistry as many dentists are not accepting new patients. ICBs are supposed to improve access locally, better integrate services and address inequalities. For one practice in Birmingham, the decision means that from next month the money for it to see NHS patients will run out for the rest of the financial year. The U-turn means that dentists who want to do more NHS work simply cannot. That is bonkers!

It is not just happening in the west midlands: throughout the country there are more examples of care boards cutting back funding for dentistry. Eight out of 10 practices are not taking on new NHS patients, and people are pulling out not just their hair but their own teeth, because they cannot get an appointment. One local dentist in Birmingham said:

“The system is on the verge of collapse—and the only stakeholder that will eventually lose out is the patient.”

That is not restoring NHS dentistry; that is another broken promise. Does the Minister know how many other ICBs are withdrawing funding? Have the Government even made an assessment of the U-turn’s impact on thousands of people who cannot get an appointment with an NHS dentist? Do they know how much scheduled dental activity will be lost under the revised financial plans of ICBs?

As we have heard today, the consequences for patients are shocking, particularly for children and the most vulnerable. Tooth decay is the No. 1 reason for hospital admissions among children aged six to 10. Tens of thousands of children are left in pain for months, if not years, waiting for procedures. They face difficulties learning, eating and sleeping. It is particularly grim when we consider that children from the most deprived areas are three times more likely to have hospital extractions than their peers.

How can the Government hope to level up opportunity for every child in Britain when some are in too much pain even to concentrate at school? Sixty thousand school days were lost to this problem last year. That is why our plan includes rolling out a national supervised toothbrushing scheme that targets the most deprived 20% of children, embedding good habits. It is recognition that prevention is better than cure. It will cost £9 million per year, which is dwarfed by the estimated £51 million that it cost for child tooth extractions in hospital in the latest year. Labour actually understands good economics—that dealing with issues early saves cases worsening and ending up in secondary care, which puts pressure on hospitals and costs the taxpayer far more.

While the Government have been rolling back their ambitions, Labour will ramp ours up. Our motion proposes giving dental practices extra money to run urgent care programmes to give people access to timely acute care, which they simply cannot get right now. We will fund an extra 700,000 urgent appointments a year from revenues generated by abolishing the non-doms tax status. Not only is that costed, but it is deliverable and doable, because dental practices have the capacity to deliver; the issue is that they do not have a Government with a plan that gives them the certainty they need. Our constituents need dental appointments far more than the wealthy need tax breaks.

I am grateful to colleagues who have raised the issue of the dental activity contract. They are right that it is no longer fit for purpose, and I think that Ministers know that—despite having pledged to reform it 14 years ago, which they have clearly failed to do. Do they share my concern that without wider reform to tackle retention issues in NHS dentistry, recruitment alone will be like trying to fill a leaky bucket?

In the meantime, NHS dentistry is dying a slow death. I was shocked to read about a pilot scheme in Cornwall in which only children and the most vulnerable are being seen on the NHS. At one practice, 4,500 patients were kicked off the books and told either to go private or to find another dentist. This is what we can expect under five more years of the Conservatives: dentistry for the few and everyone else left to sink or swim. We in the Labour party will never accept that.

NHS dentistry is an issue that crosses party lines and is as desperate in many Conservative constituencies as it is in Labour ones. We have good data on dentistry practices self-reporting whether they can take on new NHS patients. In Milton Keynes North, 12 out of 12 practices are not accepting any new adult patients, and in Bassetlaw, 10 out of 10 surgeries are not accepting new adult patients and seven in 10 are not accepting anyone at all. In Louth and Horncastle, the Health Secretary’s own constituency, not a single practice is accepting new adult patients. That is a big constituency; imagine how far someone living on the coast would have to travel to get an appointment. I heard it is about 21 miles to the nearest dentist. Is her message to constituents just to get on their bike? Or will she back our proposal today for a targeted recruitment scheme to train up new dentists in left-behind areas?

The crisis in NHS dentistry is urgent and cannot be ignored any longer. The Government need to drop the spin and accept the facts. In the short term, services need to be put on a sustainable footing, and in the long term we need deeper reform to ensure that everyone who needs an appointment can get one. I urge Members across the House to do right by their constituents today and vote for Labour’s motion to rescue NHS dentistry from further decay.

Photo of Andrea Leadsom Andrea Leadsom The Parliamentary Under-Secretary for Health and Social Care 4:21, 9 January 2024

I welcome the chance to come to the House to hear from colleagues about the challenges of dentistry and access to dentistry, as well as some of their constructive ideas for our recovery plan, so that all our constituents can get the healthcare they deserve at a time when systems continue to be under huge pressure since the covid pandemic. The Opposition were rather determined to debate dentistry today; I am a bit suspicious that that is because they are trying to pre-guess what the Government’s dentistry recovery plan will contain, but I am as desperate as they are that we get on with it and I can assure all colleagues across the House that I am working flat-out on that.

When the Prime Minister asked me to take on this job in November, I leapt at the chance to improve our whole nation’s health and especially—as colleagues throughout the House will know—to prevent future ill health in babies and children. It is the chance to change the future health of every baby and child that is the big opportunity here, and I am proud of some of the measures we have already introduced to support supervised toothbrushing through the start for life programme and in local authorities.

The Opposition’s motion talks about supervised toothbrushing for three to five-year-olds. I do not know whether they do not know this, but we have teeth from before we are born. If children do not get your supervised toothbrushing until they are three at a minimum, their teeth are about four-and-a-half years old. It is much more important to have that supervised toothbrushing in the family hub, education for parents and supervised toothbrushing in nurseries. Let us say that that is something we can all agree on: children certainly have their teeth long before they are three, so I think our plan will be significantly better.

As my right hon. Friend the Secretary of State said in her opening remarks, recovering and reforming NHS dentistry is a top priority for the Government. That is why one of the first things I did as a new Minister was to host a roundtable with key figures from the dental sector, including the chief dental officer Jason Wong and dentists from right throughout the country, to hear about the challenges they face. I have also met colleagues from throughout the House to hear about the specific challenges in their constituencies. I have heard them loud and clear, and every bit of feedback is informing our dentistry recovery plan.

I want to set out some of the recovery that is already under way—not enough by any means, but good progress, and not the failure that Labour wants to portray it as. It is a good recovery from a disastrous situation during covid. In 2022-23, 6.1 million more courses of treatment have been delivered than in 2021-22, and seven out of 10 patients have had a good overall experience of dental services, according to surveys. More than 18 million adults were seen by an NHS dentist in the 24 months to June 2023, which was an increase of 10% on the previous year. Some 6.4 million children were seen by an NHS dentist in the 12 months up to 30 June, which was an increase of 800,000 compared with the previous year. Nearly 1,400 more NHS dentists were available in 2022-23 than in 2010-11.

Of course, in our long-term workforce plan we announced a 40% increase to dentistry training places—that is incredibly important. I pay tribute to all our NHS staff, who continue to work tirelessly to deliver vital dental care to those who need it the most. Dental staff deserve our support, which is why we are working flat out on both short and long-term solutions for the recovery and reform of NHS dentistry.

Colleagues raised a number of points that I will seek to answer in turn, although I apologise that cannot deal with them all. Gill Furniss and a number of other Opposition Members raised the issue of tooth decay in children. I totally agree with her that good oral hygiene right from the very beginning, even before milk teeth come through, is absolutely crucial. She also praised community dental services, and I share her gratitude to those who go out into care homes, hospitals and community centres to help people with urgent care needs.

My hon. Friend Steve Brine, who chairs the Health and Social Care Committee, made a number of incredibly helpful points. He asked specifically whether we plan NHS access for all. We certainly intend it for all who need it. He asked how we will realise it. He said that we need to get NHS dentists back on side through our reforms, and asked about the dental workforce. He is absolutely right to raise those issues, all of which will be dealt with in our recovery plan.

My hon. Friend Derek Thomas is a huge campaigner for his area’s needs. He and I have already met on a number of occasions to talk about dentistry. He is right to highlight that some areas are struggling more than others because of under-delivery on NHS contracts on the one hand and insufficient NHS contracts on the other. I am prioritising measures to tackle both.

Navendu Mishra talked about the UDA rate, which he said was just too low. I have a lot of sympathy for that argument, but equally, he will appreciate that the ’22 reforms ensured that dentists would be paid more for complex treatments.

My hon. Friend Anthony Mangnall rightly challenged Labour. This is a Labour Opposition day, but Labour has no real plan. Labour Members talk about lots more appointments but do not say how they will deliver them. They talk about raising the money from non-doms but they have spent that money many times over. They plan to supervise toothbrushing for three-year-olds, but that is too little, too late.

Mike Amesbury raised the issue of access to dentists. He was right to do so because that is a key challenge for everybody throughout the country. There is no clear pattern of deprivation going hand in hand with poor access to dentistry; if anything, the worst access to dentistry is in coastal areas. We are looking carefully at that to improve access right across the country.

Lloyd Russell-Moyle pointed out that his ICB is supporting and promoting drop-ins where there is availability for patients. That is exactly what ICBs should be doing and is brilliant news. I appreciate his points about the difficulty that dentists find in updating the NHS website. If he wants to take that up with me separately, I will be happy to look into it on his behalf. Likewise, Janet Daby raised an important case about dental insurance. If she writes to me, I will be happy to take it up on her behalf.

My hon. Friend Fiona Bruce talked in particular about the workforce plan and training, which are so important. We will look at many ways of increasing access, both by enabling dental therapists and hygienists to work to the extent of their licence and by getting far more overseas-registered dentists and improving their throughput so that they can start working, particularly in the least well-served areas.

My hon. Friend Peter Gibson highlighted the problem with NHS dentists returning their contracts in order to work privately, and he is right that we need to work on that. He shared great thoughts about a dental school at Teesside University, about the importance of graduate dentists working in the NHS and, of course, about the importance of mobile dentistry, all of which are crucial ideas.

My hon. Friend Selaine Saxby talked about long distances and the problem of getting dentists into more rural areas. She also raised the fact that toothbrushing and prevention are crucial. There have been some great contributions from Members right across the House, for which I am very grateful.

Dentistry has been one of the most challenging subjects in my portfolio as a new Minister, and I am determined to address it. As my right hon. Friend the Secretary of State outlined, we are investing £3 billion a year in dentistry, and we need to ensure that every penny is spent properly and delivers the best results. However, the honest truth is that to recover from covid, during which hardly anyone saw a dentist, whether private or NHS, money will not be the silver bullet—a quick funding fix cannot solve all of the backlog and deliver on our ambition that everyone who needs an NHS dentist should be able to access one. As such, we are working on both short-term recovery and long-term system reform, supported by the profession. We will be fixing some of the fundamental flaws in patient access and health inequalities that have been highlighted and exacerbated by the pandemic, many of which have been raised in the Chamber today. We have made good progress on dentistry, particularly through the 2022 reforms, and can be proud of the improvements achieved to date. Again, I sincerely thank all dental staff for their hard work and commitment to recovery.

Finally, having been on the receiving end of “in due course” for many years myself, colleagues will realise that I am chomping at the bit to reveal more about our dentistry recovery plan. I need to ask them all to be patient just a little while longer, but I will change the line about when to expect it from “shortly” to “very shortly”.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.

Division number 34 Opposition Day: NHS Dentistry

Aye: 190 MPs

No: 296 MPs

Aye: A-Z by last name


No: A-Z by last name


The House divided: Ayes 191, Noes 299.

Question accordingly negatived.

Question put forthwith (Standing Order No. 31(2)), That the proposed words be there added.

Question agreed to. The Deputy Speaker declared the main Question, as amended, to be agreed to (Standing Order No. 31(2)).


That this House recognises the impact of a once-in-a-generation pandemic on NHS dental services, with 7 million fewer patients seen in England across 2020 and 2021; notes these challenges were reflected in both Scotland and Wales; acknowledges the steps already taken to recover services in England including the introduction of a minimum rate and increased payments for complex dental activity to better reward dentists for their work; welcomes the publication of the Long Term Workforce Plan which committed to expanding dental training places by 40 per cent; and supports the upcoming publication of the Government’s plan to further recover and reform NHS dentistry and promote good oral health throughout life.