New Clause 67 - Review of the capacity of the dental laboratory sector

Health and Care Bill – in a Public Bill Committee at 10:00 am on 2nd November 2021.

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“The Secretary of State must within six months of the passage of this Act publish a report assessing the capacity of the dental laboratory sector in the UK to meet the needs of patients.”—

This new clause would require the Secretary of State to review the capacity of the UK’s dental laboratory sector.

Brought up, and read the First time.

Photo of Alex Norris Alex Norris Shadow Minister (Health and Social Care)

I beg to move, That the clause be read a Second time.

Photo of Steve McCabe Steve McCabe Labour, Birmingham, Selly Oak

With this it will be convenient to discuss new clause 68—Access to NHS dentistry—

“The Secretary of State must within one year of the passage of this Act publish a statement setting out what measures the Government is taking to ensure universal access to NHS dentistry.”

This new clause would require the Secretary of State to publish a statement of what measures it is taking to ensure universal access to NHS dentistry.

Photo of Alex Norris Alex Norris Shadow Minister (Health and Social Care)

The two new clauses refer to two linked but distinct sectors of the heath service—dental laboratories and dentistry. In each case, we are seeking for the Secretary of State to publish a report about the health of these important sectors.

On new clause 67, the dental laboratory industry manufactures dental appliances to assist in the provision of oral care, such as crowns, bridges and dentures. The British dental laboratory industry plays an important part in the wider oral health landscape, and it is vital for patients, dentists and other registered dental care professionals. This is an unheralded industry, but it touches all our constituencies, and enables our constituents to live without pain. It also provides skilled work in an economy that has too little of it. It is based in communities all over the country, not concentrated in big cities or in London and the south-east. In many ways, it is a towns industry in a country that desperately needs more towns industries.

However, the industry is struggling. It was struggling prior to the pandemic, but it has particularly struggled during it. In the early stages and indeed even today, dentists have rightly—we supported this—been paid full contract for reduced output to reflect the challenging circumstances in which they are operating, but there has never been an obligation to pay this forward to their suppliers. Whereas we might normally expect dental labs to account for 6% to 7% of a dentist’s outgoing, as output has fallen so has that outgoing, so the sector has suffered, but dental labs have needed to stay open to meet need, so they have not been able to completely avail themselves of support.

The messaging around dentistry at a local and national level has also had knock-on impacts for dental laboratories trying to make insurance claims for business disruption, because there has been a misunderstanding, shall we say, about whether they are operating, and how they are operating or not operating.

The Dental Laboratories Association is a professional body that covers about 80% of dental laboratories in the UK. Last June, it warned of financial ruin for dental laboratories. In recent conversations that I have had with its representatives, they said that demand has increased, but it is not back to its usual levels, particularly regarding NHS services, and the previous impact is still being felt heavily, such that the industry remains in dire straits.

We will lose this sector, or big chunks of it. We will lose British jobs. I know, because I have had conversations with Ministers and the Government on this, that the Government are relaxed about this issue, because they think there will be ample supply from the continent or from China, and in those places, this industry is growing. That is a real mistake, because we would lose control over our understanding of the quality, and particularly the employment and the supply chain. Personally, I think this is an area where we should be once again prioritising buying British, at a time when that seems to be off the Government’s radar, which is really sad.

The new clause is a pretty modest ask in that context. It says that the Secretary of State should enter this space, should have an understanding of what is going on, and should in some way account for it, before we lose this very important industry.

I turn to new clause 68. NHS dentistry also faces significant challenges. Dentistry is now the No.1 issue raised with Healthwatch, which in the context of 35 million lost NHS dental appointments is probably not surprising. However, there are continued access issues, which of course will deepen health inequalities. I would argue that the impact of the pandemic means that these access problems are now on an unprecedented scale in all our communities. Some patients requiring specialist services under sedation are now facing waits for treatment for as long as four years, which is leading us to these horror stories of patients performing DIY dentistry on themselves, or travelling for hours to access the help that they need.

Ahead of last week’s Budget, the British Dental Association warned of a “last-chance saloon” for NHS dentistry, stressing that Government spending on NHS dental services has fallen by a third in real terms over the last decade. Sir Robert Francis QC, the chair of Healthwatch England, who gave evidence to the Committee, joined the BDA in urging the Treasury to commit adequate funding to ensure the recovery and long-term sustainability of our dental services, highlighting that it would take an additional £879 million just to restore resourcing back to 2010 levels. That, of course, was the theme of the Budget, was it not—pretending that the last decade had not happened? Yet in this area there was no new funding, and we have not heard a commitment that a single penny of the billions pledged for the recovery of NHS services will go to dentistry.

Photo of Justin Madders Justin Madders Shadow Minister (Health and Social Care) 10:15 am, 2nd November 2021

As my fellow shadow Minister quite rightly points out, this is a huge issue for most constituency MPs. I am not surprised to hear what he said about this being the No.1 complaint to Healthwatch, because behind GP access, dental access is now a huge issue. Before the pandemic, dental services in the Cheshire area were contracted to attend to 55% of the local population’s dental health needs. Clearly, that is insufficient, but the challenges of the pandemic have only made matters worse. I encourage my hon. Friend to continue to raise this very important issue.

Photo of Alex Norris Alex Norris Shadow Minister (Health and Social Care)

I am grateful for that intervention. It is sobering to hear that 55% was what we started with; we know that it will be less than that now. That rather picks away at the idea of a universal healthcare service.

To finish where I was going with my previous point, if I am wrong about where recovery funding for the NHS is going, and there is to be investment in dentistry, I hope that the Minister will correct me. I would be delighted if that was the case, because the BDA is warning—again, this is something that we will have picked up on in our constituencies—that morale among NHS dentists is at an all-time low. Almost 1,000 dentists in England have stopped providing NHS services in the last financial year. There was the failed contract—I know there is enthusiasm for contract reform in the Department and we will support the Department on that, but we are running out of time to have anything ready for April. In fact, we are probably already too late in that regard. The shambles of the negotiations before Christmas last year that led to the breakdown and the imposition of targets really whittled away at good will and caused a lot of upset.

Almost half of NHS dentists are saying that, unless things change, they intend to hand back their contracts or reduce their NHS commitment. This exodus of dentists from the NHS will have a disastrous and lasting impact on our ability to access NHS dentistry. If 55% is the summit of our ambition, goodness me, where will we go from there? The British Dental Association talks about the last-chance saloon; it is not hyperbole to say that we will not have NHS dentistry in the medium term if we do not have a course change.

More and more people are being pushed into the private sector. That creates market forces that mean that it is almost a self-fulfilling prophecy that dentists—both new ones entering the profession and those who have come to the end of their tether with their NHS contract—go into the private sector. We are seeing significant growth in that space as people living in pain seek drastic action. We will see more pushed on to dental insurance if people do not want to be worried about their finances. That is what privatisation looks like. We will not have NHS dentistry in the medium term unless we do something about this issue—that is the wrong way forward.

New clause 68 makes a very modest ask; it asks the Secretary of State to do what any Secretary of State should want to do: commit to universal access to NHS dentistry and say how it will practically be achieved. At the moment, we have a yawning gap. In that lack of leadership, we will see the drip, drip, drip of the loss of NHS dentistry, until we no longer have it.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care), Shadow SNP Spokesperson (Europe)

I rise to support new clause 68, which is linked to new clause 67. We are aware of the impact of the pandemic, particularly on dentistry. Using a drill on someone’s teeth generates aerosols in their mouth, and that would vastly increase the risk of spreading covid to the dental staff, or to any patient who entered the space soon afterwards. Despite that impact, there has not been significant funding from the UK Government for the dental industry in England to fund the establishment of ventilation and air purification systems. The Scottish Government have committed £5 million specifically for this. As the hon. Member for Nottingham North highlighted, the pandemic impact comes on top of an underlying issue, the core of which is the 2006 dental contract in England and Wales, which breaks provision down into units of dental activity. It does not reward preventive dentistry. It does not reward any practice for taking on someone who already has dental issues, because it will not be properly funded for that.

Out of that comes the failure to focus on child dental health and making sure that this generation of young children grow up with good dental health. Scotland set up Childsmile in 2007, and Wales set up Designed to Smile in 2011. There is plenty of data from both of these programmes to show that providing free dental treatment to children—along with supported tooth brushing at school, fluoride coating and so on—can decrease caries found in children in primary school and at the beginning of secondary school.

Poor dental health has a big impact on general health and self-confidence, yet we hear repeated reports of families and children struggling to access an NHS practice. In the last five years, NHS practice numbers in England have dropped by over 1,250. BDA surveys suggest that almost half of remaining NHS practices are planning to reduce their NHS commitment over the next 12 to 24 months. There was a promise that the contract would be changed by next April, and 100 practices have been trialling a new method of contract. According to the BDA, it has been warned of a return to using units of dental activity from next April. This would be an enormous missed opportunity to improve NHS dental access for everyone, and particularly to take the further step of ensuring that every child in England does not just have access to a dental practice, but is involved, as they grow up, in a programme promoting good dental health.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

As ever, I am grateful to hon. Members for highlighting issues relating to new clauses 67 and 68 for debate.

I reassure the Committee that the Government continually assess the capacity of the dental laboratory sector in the UK. It is an important issue, as was highlighted by the shadow Minister, and one we already take seriously. However, it is not necessary to include a specific report requirement, especially as that could focus activity away from addressing the recovery of activity in the sector.

As colleagues will know, and as the hon. Member for Nottingham North set out clearly, dentistry has been significantly impacted throughout the pandemic due to the specific risks associated with aerosol-generating procedures, as the hon. Member for Central Ayrshire set out. The steps we have had to take during the pandemic to ensure the safety of dental patients and staff has led to a reduction in the number of NHS patients who can be seen, although activity continues to grow quarter on quarter. This reduction in NHS dental activity, including for band 3 treatments such as crowns, bridges and dentures, has had a knock-on effect on the laboratory sector. The Government recognise this, and we are already taking steps to secure the capacity of the sector.

First, throughout the pandemic, dental laboratories, where eligible, have been able to access a range of financial support that Her Majesty’s Treasury has made available to private-sector businesses and individuals affected financially by covid-19. Dental laboratories that satisfied the eligibility criteria were able to access financial support through the coronavirus business interruption loan scheme and bounce back loans. In addition, up to September 2021, technicians and lab workers had been able to access the coronavirus job retention scheme, known colloquially as the furlough scheme. The recovery loan scheme, now open until 30 June 2022, supports access to finance for UK businesses as they recover from the pandemic.

During the pandemic, we carefully considered the impact on the sector, including on dental laboratories and their important role, partly through work led by the chief dental officer. We continue to work closely with all relevant parts of the sector. I am happy to confirm that officials from the Department, together with the chief dental officer and others, will be happy to again meet representatives from the dental laboratory sector to better understand their concerns on capacity, what they are seeing in terms of the recovery of their business and trade, and what further action may be needed as we work to recover from the pandemic and safely increase levels of dental activity, for patients, the profession and the industry surrounding it.

Secondly, we are committed to building and maintaining a robust dental workforce and appreciate the important role played by laboratory technicians as part of that. In September, Health Education England released their “Advancing Dental Care” review, which provides recommendations on the reform of education and training for dental care professionals, including dental technicians.

Although this is not directly in my portfolio of responsibilities, I have asked officials to work closely with HEE on the recommendations and actions of this report, including, where it falls into my area of work more broadly, how apprenticeship places for clinical dental technicians are developed, based on an assessment of the role they could play in the delivery of NHS care. The Government are therefore already taking action to help secure the capacity of the dental laboratory sector and ensure it continues to meet the needs of patients in this country.

I turn to new clause 68. It would require the Secretary of State to publish a statement on measures taken to ensure universal access to NHS dentistry. In addition to the actions I have highlighted, I assure the Committee that this Government are taking action to ensure access to NHS dentistry and, again, I do not consider it necessary to include a requirement to make a statement on this issue on the face of the Bill.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

I will give way to the hon. Lady—not least so that I can have a glass of water.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care), Shadow SNP Spokesperson (Europe)

That is not the least of my reasons for intervening. Rather than just stating that the Government are taking action, does the Minister plan to explain what action they will be taking?

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care)

The hon. Lady is psychic, because I was just turning to that.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care) 10:30 am, 2nd November 2021

I am very touched by her medical concern for my welfare.

In light of the reduction in activity within dentistry due to the pandemic, dental practices have been asked to deliver as much care as possible, with their first priorities being urgent care, care for vulnerable groups and for children, and then delayed planned care. I put on the record my gratitude to the profession for its hard work and efforts during this time, and I am pleased to note that the levels of urgent care being delivered have now returned to pre-pandemic levels, because of the over 700 urgent care centres established in practices to improve access for people during the pandemic. Throughout the pandemic, we have worked closely with NHS England and NHS Improvement to consider the level of NHS dentistry that can be delivered safely. Activity thresholds for full renumeration are based on data showing what is achievable while maintaining compliance with infection prevention and control measures.

The pandemic has reinforced the fact that transformation in NHS dentistry is essential. As has been alluded to, NHSEI is leading ongoing work on reforming the current dental system, working with a wide range of stakeholders and system partners. We acknowledge that, even before the pandemic and the imposition of limitations that it necessitated, access to NHS dentistry was sometimes a challenge in some areas and for some people. Putting that right will require action to both reform contractual arrangements and ensure that there are trained and qualified dental teams providing NHS services throughout the country.

Since the announcement in March that NHSEI is leading on the next stage of dental system reform, it has continued to work closely with system partners and stakeholders, including the British Dental Association in particular. The NHSEI dental system reform will deliver against a number of fundamental aims, including delivering improved health outcomes, an increased focus on preventive dental work, affordability for patients, and recognising that changes need to be supported by the profession. Making the NHS dental contract more attractive to the profession is a key part of helping with vital recruitment and retention. I know that will be particularly welcome to hon. Members from rural and coastal areas, as it has been highlighted that there is a particular challenge in some of those communities.

A key objective of this work is to improve patient access to NHS care, with a specific focus on addressing inequalities. We will set out our proposals in that area next year, in addition to the provisions in this Bill that will allow the Secretary of State to expand water fluoridation schemes. In addition, Health Education England’s “Advancing Dental Care” programme will, over the next four years, deliver its blueprint for change to reform education and training, develop skills, enable modernised flexible working, and widen access and participation among the workforce.

Together, we believe these measures will address the key challenges that impede the delivery of NHS dentistry, and improve patient access to NHS care. The Government will carry on with this essential work, and will continue co-operating with HEE and external stakeholders on this important issue. For that reason, I ask—possibly in vain—that the hon. Member for Nottingham North considers withdrawing the new clause.

Photo of Alex Norris Alex Norris Shadow Minister (Health and Social Care)

I am grateful to colleagues for their contributions. I am particularly glad that the hon. Member for Central Ayrshire brought up units of dental activity, which are a Treasury way of understanding activity, not a public health way of understanding oral health. Although they are effective for setting balanced budgets on an annual basis, they are really bad for saving money—in fact, they have cost money. There is broad consensus that UDAs are long out of date, and that after 15 years, it is time to move away from them.

Dealing with new clause 68 first, I was glad to hear the Minister at least suggest that this is an active process, because it was the first sign I have seen that the move away was not just a conceptual one. On that basis, I will not press the new clause to a Division, because we will not prejudge that process. However, I gently say that we really need to get on with this, because lots of dentists are waiting on the outcome of that process before making their judgment as to whether or not NHS dentistry is in their future. I was also glad to hear the Minister acknowledge that the system was not good enough before the pandemic. In response, I would say that removing a third of the real-terms funding was perhaps a significant reason why it was not very good anymore, and in future the answer may lie in tackling that point.

Turning to new clause 67, I was of course glad to hear the Minister say that this issue is being taken seriously. However, I was not clear on what “taken seriously” means beyond the existing support there is for businesses generally, not least because dentists have operated in this half space of still being open but not having the fullest demand on their order books, which has often meant that they have fallen between stools. However, I think the offer of that meeting is better than the new clause and, on that basis, I will pursue the route of that kind offer. I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.