MPs Wrestle With The NHS Dental Crisis
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- Published: Monday, 14 February 2022 07:36
- Written by Guy Tuggle
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“We would not accept people having to ring around A&E departments to see if there was any space for NHS patients, so I do not see why we should accept it for dentists” - Justin Madders, Ellesmere Port & Neston (LAB).
Monday’s debate at Westminster ‘That this House has considered access to NHS Dentistry’ was the culmination of a series of endeavours by MPs to address an issue that is accounting for much awkward reading in their daily inboxes, including from dental professionals encouraged to write in by the BDA’s Eddie Crouch.
“NHS dentistry has been the No. 1 issue in my inbox for the past nine to 10 months. This is a national crisis, though the problem in my constituency—in Lowestoft and Waveney—is acute” said mover of the motion Waveney MP, Peter Aldous (CON).
Over the ensuing three hours, MPs from all three parties muscled in to cite the problems of NHS dentistry in their constituencies and nationally. There was much consensus: too few dentists, a thoroughly broken contract, obstructive regulation and lack of funding. There were accounts, too numerous to detail, of patients unable to access emergency treatment, unable to register their families at a practice or having to travel excessive distances to see a dentist because local practices had closed or returned their NHS contract to pursue a private route.
Dental Deserts
“Access to NHS dentistry is a problem that has been brewing for a long time. The situation can be likened to a house built on shallow and poor foundations. The earthquake of covid has led to that house falling down. There are now parts of the country—particularly in, though not confined to, rural and coastal areas—that are dental deserts” said Peter Aldous who went on to quote Sir Robert Francis, Chair of Healthwatch England: “Every part of the country is facing a dental care crisis, with NHS dentistry at risk of vanishing into the void”.
Crisis with Five Consequences
To illustrate the consequences of the situation Mr Aldous stated “The lack of access to NHS dentistry has a fivefold impact on patients. First, millions are missing appointments. Secondly, there has been a significant increase in DIY tooth extraction. Thirdly, the poor are hit hardest. Fourthly, mouth cancers are going undiagnosed. Finally, children are suffering. This very serious situation has been confirmed by the “Great British Oral Health Report” carried out by mydentist”.
MPs acknowledged that a new contract was essential if the depleted workforce was to be retained, along with flexible commissioning and a speeding up of the process.
Bupa’s ‘loss making’ NHS surgeries
Labour’s Judith Cummins (Bradford South) highlighted the fact that even before covid the NHS only funded enough dentistry for half the population to see a dentist once every two years and slated the dental contract. “I received a briefing from Bupa, which tells me that across its 306 practices with an NHS contract in England it has a growing number of loss-making sites. It points out that these NHS practices would not be sustainable if they were independent—they are kept afloat by Bupa’s private practices. To be clear, that is private healthcare subsidising the NHS. The current dental contracts make dentists’ work highly stressful and do not allow them to provide the quality of care that they want to provide for their patients. According to the BDA’s surveys, that is the No. 1 reason why dentists are leaving the NHS or reducing the amount of work they do in it” said Cummins who added that the recent £50M blitz fund was of little appeal to an exhausted workforce” and in any case it was funded from the £169M of clawback from practices that had failed to meet their 2020-21 contract.
Father of the House Sir Peter Bottomley (CON Worthing West) cited the Toothless campaigners Mark Jones and Steve Marsling expressing the hope that the Minister had met them and spoke of a dentist in his constituency who spends 40 – 50% of his time with NHS patients but they only account for around 10% of his income.
Dentistry And ‘Levelling Up’
Conservative MP for the Essex constituency of Clacton, Giles Watling, stated that access to NHS dentistry was now the number one topic in his mailbag and many letter writers were complaining about having to fund private care for a service they had paid their taxes to receive. “I welcome the levelling-up agenda, but I do not believe we are being levelled up in an entirely fair manner. Areas such as Clacton are often considered to be rich and well-heeled because we fall into the wider eastern region—Essex is lovely and leafy and is an economic powerhouse—but the coastal areas have pockets of deprivation. I am not proud of it, but my constituency has the most deprived ward anywhere in Britain. Something has to be done about that. If we really want to level up public services, we must consider areas such as Clacton when it comes to dental care”.
Regulations & Recruitment
No debate on dentistry would be complete without an insightful contribution from Sir Paul Beresford, Conservative MP for Mole Valley and himself a dental practitioner. Beresford cited the burden of all the regulations imposed on the profession that had proved a tipping point for many to retire whilst the shortage of dentists was a crucial impediment. He argued for more overseas dentists to be recruited and expressed sympathy for the Minister. “We have to recognise that we will not have an instant or even a fast solution to the problems laid out today. Everybody has laid out problems, and a few people have come up with ideas. I am sorry for the Minister, because she is getting hammered for the problems, and she will not be able to provide a fast solution. It is not a case of money; it is a case of having the dentists to do the work” said Sir Paul.
As the debate progressed there was a recurrence of themes, suggesting that the MPs had been well briefed and understood well the challenges their constituents faced accessing NHS dental appointments. It really did sound like they understood how demoralised and undervalued the profession felt.
Parliamentary Under-Secretary for Health and Social Care Maria Caulfield replied.
The Minister thanked members for their contributions and acknowledged the scale of the problem. Joint working between the Department, the CDO, NHS England and the BDA had begun “because we are serious about reform” with reform of the contract the number one long term aim. “I have been working night and day to try to make some short and long-term improvements, because I am live to all the concerns that have been raised” she said.
- The Department was investigating ways of speeding up the procurement service so that contracts could be awarded swiftly, fluoridation was part of the Health and Care Bill and the upper tolerance threshold and activity had been increased from 104 to 110% to reward additional over-performance.
- Informal negotiations to reform the contract had begun this week with the BDA and formal ones would commence in April. It was hoped to announce some quick fixes over the coming year with a recognition that the NHS had to be made a better place to work as dentists had alternative choices and were voting with their feet.
- “On the recruitment, retention and training of dentists, Health Education England published its “Advancing Dental Care Review” in September. It is working through how we can train not just more dentists but the whole dental team, and on how we can upskill dental technicians and dental nurses. We will bring forward legislative changes to enable other members of the dental team to take on more roles. We are setting up centres of dental development in those areas of the country with the biggest shortages, which tend to be coastal and rural”.
- The Department was consulting the GDC regarding making it easier to recruit from overseas.
Whilst there were no new earth-shattering announcements, the debate revealed some encouraging mood music. MPs demonstrated that they ‘get it’ and are doubtless contemplating the political fallout the crisis could pose in marginal constituencies. From constituent’s letters to BDA and Healthwatch reports, it looks as if change may be on the way. What that change will be, and what the priorities of NHS dentistry will be, however, is still far from clear.
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