What’s Left To Say? Another Commons Debate on Dentistry
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- Published: Thursday, 11 May 2023 07:58
- Written by Peter Ingle
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Given the time they spend discussing dentistry, perhaps any MP’s losing their seats at the election could be fast tracked onto the register as experts by experience?
Once again parliament has been debating dentistry, or to be precise “Reforms to NHS dentistry” and there were some familiar faces. The debate had cross party sponsorship from Judith Cummins (Lab. Bradford S) and Peter Aldous (Con. Waveney) both of whom have shown considerable interest in NHS dentistry.
Waveney, in Suffolk, is a known dental desert that may benefit from the controversial Community Interest Company scheme which the CDO is involved in. In Bradford South, despite a more urban character 98% of practices were closed to new NHS patients, according to the MP.
Judith Cummins started the debate by referencing her concerns about NHS dentistry, expressed over the last eight years, observing that, “The words of my campaigning over the past eight years now serve as a compendium of forecasting doom.” She recalled her repeated efforts to draw the Government’s attention to the numbers of dentists thinking of leaving the profession, or NHS work. The NHS dental crisis had been, “a devastating slow-motion car crash of the Government’s own making, yet year after year, Minister after Minister, they have assured me of their commitment to reform.” She recalled Maria Caulfield, informing her last year that work had started on contract reform. However, just one day ago at the Health Committee hearing, it had been apparent that the Government were once again starting with “an announcement of a plan to publish a new plan to improve access to NHS dentistry—a plan for a plan.”
Other MP’s gave examples of services being unavailable for their constituents, with particular concern about the plight of children. There was a call for proper data collection to give an understanding of how much time dentists spent on NHS work, rather than simply counting performer numbers.
Judith Cummins considered options to improve matters, including the introduction of a prevention-focused capitation-type system, where lump sums are provided to NHS dental teams to treat sections of the population. In 2017 she had developed a project in Bradford with the former Health Minister, Steve Brine who is now the Chair of the Health and Social Care Committee. Though a short term project it had spent over £250,000 of unused clawback over three years in Bradford South. The money went into local services and ensured that patients were able to access much needed extra NHS dental appointments.
Next, Steve Brine (Con. Winchester), revisited many of the points he had made the day before at the Health Committee hearing. He gave particular attention to the avoidable bottle necks in recruitment, a result of the GDC’s management of the process for registering international graduates. He also spoke of the absence of dental input into Integrated Care Boards.
Peter Aldous reminded the house that this was the third debate about NHS dentistry that he and Judith Cummins had secured. This told a “sad and sorry story.” Complaints about access to HNS dentistry had been the No 1 item in his inbox for two years, though the causes of the crisis went back more than 25. From Lowestoft, some people had needed to travel to Basildon for treatment. His formula to ease the crisis included keeping clawback money in dentistry, recruiting more dentists from overseas, and moving away from the “discredited 2006 UDA system.”
Dame Diana Johnson (Lab. Kingston upon Hull N) added the now familiar pitch for a dental school in her constituency, as a means of solving the workforce issue.
Other contributors painted a similar picture of constituents unable to access care, and there was a general call for more work on prevention. One speaker had been told by BUPA that half of the 85 practices set for disposal or closure, had vacancies that were open for over 6 months. They had needed over 150 extra dentists nationwide, to maintain their NHS services.
Hearing their comments it was apparent that both Labour and Conservative MP’s agreed on the severity of the problem, and many of the proposed solutions.
Next to speak was the Labour Shadow minister, Andrew Gwynne (Denton and Reddish), who if not reshuffled, could be speaking for the government well inside a NICE check-up interval. He covered the now familiar ground of an inability to get appointments, DIY dentistry, and children’s hospital admissions. He also said that for dentists, “the financial incentive in the past was to drill and fill, whether someone required that filling or not.” He later added: “We know that NHS dentistry has not worked for a very long time. Governments of all colours are responsible for where NHS dentistry is today.” He called on the minister to share his plans.
Minister, Neil O’Brien began by agreeing with one MP’s earlier comment saying it was, “time for real change, not patching, and I completely agree.” The Chair of the Select Committee, Steve Brine, had “made too many important points to list, but he made an important point about the need for greater transparency on data and delivery, and I completely agree.” He went on to name check most of the speakers and acknowledge their various comments and suggestions.
The minister than ran through the familiar list of “tweaks” including new UDA bands, the time limited 110% offer, efforts to speed up international graduate registrations, and of course, updated website information about availability. He claimed, “some positive effects”. There were “about 6.5% more dentists doing NHS work now than in 2010, and UDA delivery is going up.” He recognised the need to go further.
Rachel Maskel asked him for details about how improved data on dentist’s NHS activity would be obtained. The minister did not give a specific answer but did say: “We are trying to drive activity back up to at least pre-pandemic levels.” He believed that ICBs provided an opportunity for more transparency, and much more accountability. MP’s would be able to talk to their local ICB about what it was doing to improve delivery.
When asked when the desired changes would happen, the minister concluded by saying “We are working on the plan at pace. There is no date for its publication yet, but we are working on it at pace because we are conscious of the urgency.”
Judith Cummins concluded the debate saying, “We need fundamental NHS dental reform now, not a plan for a plan. Minister, the promise of reform and this plan must come with real action and a firm date of publication.”
Meanwhile in other parts of the NHS, it is not only dentists who are demanding contract reform.
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