Access to Dentistry: Somerset

11:00:00

I will call Anna Sabine to move the motion, and I will then call the Minister to respond. I remind other Members that they may make a speech only with prior permission from the Member in charge of the debate and the Minister—that is often forgotten. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates.

I beg to move, That this House has considered access to dentistry in Somerset. It is a pleasure to serve under your chairmanship, Mr Stuart. My grandfather might not have been a toolmaker, but he was dentist. He worked near Slough, and as a child I loved visits to the dentist because we got to play in the electric chair and dissolve bright pink mouthwash tablets in plastic cups, and we always got a Lambrusco and lemonade afterwards, which was of course entirely appropriate. That regularity of dental treatment means that, at 45, I am lucky enough to have no fillings at all, and I am not particularly scared of dentists. Many children growing up today in my constituency of Frome and East Somerset are not so lucky: one in five children in Somerset has tooth decay by the time they are five. Although we know that difficulty in accessing an NHS dentist is a nationwide challenge, data reveals that the south-west is particularly neglected. The most recent Office for National Statistics data shows that it has the worst access problems of all regions in England, with 99% of people without a dentist failing to secure the NHS treatment they needed in the last month. Furthermore, only 32% of adults in Somerset saw an NHS dentist in the two years to June 2024, which is much lower than the national average of 40%. The picture for children in Somerset is equally shocking: only 42% were seen by a dentist in the year to June 2024, well below the national average of 55%, and way below pre-covid averages.

My hon. Friend’s point about the south-west is absolutely right. Some 217 visits per 100,000 to accident and emergency are for dental-related issues, compared with 154 for the next highest region. So the south-west is a real outlier, and not in a good way. Does my hon. Friend think that that is having a detrimental effect on hospitals and A&E?

Yes, I absolutely agree, and I will talk later about how poor access to dentistry impacts other parts of the health sector. Yesterday, I was lucky enough to visit a local primary school in Frome, along with a friend who is a dentist. We started with an assembly about the many superpowers the mouth has, in which I was delighted to be given the leading role of saliva. Then we moved on to taking two reception classes through a supervised toothbrushing session. The school is part of the Government’s supervised toothbrushing scheme, an initiative I welcome. Sadly, of the 30 children in the room, 10 did not have consent for the toothbrushing—some because forms had not been returned, and some because there was a parental objection to the activity or to the use of fluoride. To ensure that they did not feel left out, my dentist friend played a game where they counted their teeth instead. She said that, based on what she could see from that game, that group of 10 children had 50 obviously decayed teeth, and one child had at least 10 teeth that would need to be removed under general anaesthetic. Those children were four and five years old. Although the scheme overall is to be welcomed, I hope consideration will be given to having an opt-out rather than an opt-in, to ensure that the children who most need the scheme are actually benefiting. Somerset used to be well above the national average on access to dentistry. As recently as 2018, 55% of adults were seen by an NHS dentist in a two-year period, compared with 50% nationally.

I commend the hon. Lady for securing the debate, and she is right to highlight the issue affecting children but also adults. Does she agree that the news that some pensioners are carrying out their own barbaric dentistry should send shockwaves about the affordability and accessibility of NHS dentistry? Does she also agree that there is a need for immediate intervention in each trust area, whether in Somerset, Scotland, Wales or Northern Ireland?

Yes, there are certainly some horror stories about tooth removal. It does beg the question as to why NHS dental services in Somerset and the wider south-west have deteriorated in the last seven years. It seems to me that that is symptomatic of a lack of investment in the region, in terms of not only health and social care but withdrawn levelling-up funding and diverted rural England prosperity funding.

My hon. Friend talks about the need for investment, and much of that will be in training new dentists. Does she therefore agree that it is baffling that a brand-new dental school at the University of East Anglia could be delayed by a full year because the Treasury refuses to release funding until a month after the deadline for UCAS course listings, and that another year’s delay is unacceptable for her constituents in Somerset and mine in North Norfolk?

That sounds very frustrating, particularly when, as we are seeing, there are so many crises in our dental services. A constituent emailed me in February to say that four weeks previously her husband, who is in his late forties, had had a massive stroke. He collapsed into the sink in the kitchen and hit his face on the taps, breaking his teeth. He was discharged from hospital on 14 February, but cannot speak, is partially paralysed, needs continuing care, rehabilitation and adjustment, and is suffering dental pain. He is not registered with an NHS dentist and cannot afford private dental care, so they called 111 and, after four calls, drove to an appointment where the dentist was given just 30 minutes to treat only one tooth, which he had to remove. My constituents will have to call 111 again to get treatment for the next tooth. The husband needs dentures, is on soft foods and is still in pain. As that case shows, and as my hon. Friend the Member for North Norfolk (Steff Aquarone) pointed out, a failure to invest now in dentistry not only causes more pain for the individual, but gets more expensive and adds to pressure on other areas of the NHS in the longer term.

A constituent in Mansfield, who works in a local NHS practice, wrote to me to suggest that dental therapists, hygienists and other professionals could be utilised a lot more effectively to deal with capacity. Does the hon. Member agree that to free up more appointments, such as those her constituent needs, and to ensure that people get better and more timely care overall, it would be better to utilise the skills of other people in the dental profession, in the south-west and throughout the UK?

Yes. That is one of the things I have talked about extensively—or rather I have been talked at extensively by my dentist friend about the way in which we manage staff and who does which bits of work in dentistry. It is really important that the Government engage with the British Dental Association about that to understand some of the complexity of how the contracts are working at the moment and what could be improved. If we do not deal with people’s dental pain, we get more pressure on the NHS in the long term: cancers go undiagnosed, and people are forced to use 111 or A&E. It cannot make sense that people have to use 111 to organise their dentistry if they do not have an NHS dentist. People are simply being pushed around the system instead of being treated and instead of illness being prevented. I absolutely understand and appreciate the financial situation the Government inherited from the Conservative Administration, but I am concerned that not enough is happening fast enough on dentistry.

The previous Government tried to tackle this problem by offering golden hellos to dentists in rural areas to encourage the uptake of NHS dentistry, but in reality that did not work. What we really need the new Government to do is to advance at pace with renegotiating the dental contract. Does my hon. Friend agree that if the new Government can get on with that rapidly, we might see an improvement in rural areas and, indeed, the whole UK?

I do agree. Golden hellos are all very well, but the challenge—as I hear from dentists in my constituency—is that once dentists leave NHS dentistry and go into the private sector, which more and more are doing, nothing will ever get them back again. That is a loss that we do not recover from.

It is a pleasure to serve under your chairmanship, Mr Stuart. I thank the hon. Member for Frome and East Somerset (Anna Sabine) for securing this important debate. Does she agree that Somerset benefits enormously from Bridgwater & Taunton College, where nurses and midwives are trained? Will she join me in asking the Minister whether dental hygienists, and in due course dental students from the University of Bristol Dental Hospital, might also train there and provide a service to the whole of Somerset?

I was not actually aware that we had those facilities there, and I am happy to know more about them. Yes, I would certainly join any call for more dentistry skills to be brought into the Somerset area. The Health Secretary made a point of meeting the British Dental Association on his first day in office, but the BDA tells me that there has been little follow-up. Could the Minister confirm whether the Government have now entered into formal negotiations to reform the dental contract? If they have not, when do they expect to do so? I am sure the Minister will rightly highlight in his reply the roll-out of the 700,000 extra urgent appointments.

The 700,000 new urgent dental appointments cover only a third of the need for urgent care, and are being funded by simply recycling underspends in an already stretched budget. Does my hon. Friend agree that what we actually need in Somerset is new money to invest in NHS dentistry, as promised at the election?

I totally agree. I was coming on to say something similar: the roll-out of the 700,000 extra urgent appointments is a positive start, but it covers less than a third of the need for urgent care appointments. The Government must put more money into dentistry so that people can get the help they need.

The area around Minehead, in my constituency, has the smallest number of dentists in the country. Does my hon. Friend agree that the fact that the area is both rural and coastal presents a unique set of problems because of deprivation and neglect, which means that the dental desert there is felt very acutely indeed?

I absolutely agree. Given the time limitations, I have not come on to discuss the challenges that places such as Somerset face due to their rurality, including the difficulties in getting to services, but my hon. Friend is absolutely right. The BDA’s asks and policy proposals are clear: the Government must invest in dental services and secure a long-term funding settlement for NHS dentistry that keeps pace with demand, and budgets allocated to NHS dentistry must be ringfenced. The BDA also agrees with the Liberal Democrats that NHS dental practices must be offered relief on the national insurance contributions rise announced in the most recent Budget. The Lib Dems believe that such relief should be extended to the wider health and social care sector, including GP surgeries, care homes, hospitals and pharmacies. Parents and families across Somerset are crying out for extra support with accessing affordable and reliable dentistry, and access to an NHS dentist should be guaranteed to everyone needing urgent and emergency care. To catch up with the national average, Somerset needs extra investment, and it needs it quickly.

I am grateful to my hon. Friend for drawing attention to the dental desert that is Somerset and to how keenly it is felt. Does she agree that many families have to choose between putting food on the table and paying to take their child to the dentist? We can expose the reality of the dental desert through more research, which I will be carrying out in Taunton and Wellington very soon.

We can absolutely carry out more research, and I urge Members to go and talk to their local school teachers. Yesterday, I found that teachers in Frome have a very clear understanding of why certain children are not going to the dentist. Sometimes that might be down to parental choice, and it is really important that we understand why that is happening as well as why there is not sufficient access to dentistry. To catch up with the national average, Somerset needs extra investment, and it needs it quickly. We need more NHS practices that are financially viable and exempt from the NICs rise, and we need more dentists who are remunerated and well treated in their work. We cannot let Somerset slip further and further away from the national average, which is already a low bar, and create more pain, misery and costs for generations to come.

11:13:00

It is a pleasure to serve under your chairship again this morning, Mr Stuart. I thank the hon. Member for Frome and East Somerset (Anna Sabine) for securing this important debate on access to dentistry in Somerset. We know that there are challenges in accessing NHS dentistry across the country, with some areas facing acute challenges. Put simply, too many people are struggling to find an NHS appointment. In the two years up to June 2024, just 31% of adults were seen by an NHS dentist in Somerset’s integrated care board, which covers the hon. Lady’s constituency, compared with 40% across England. In the year to June 2024, only 42% of children in Somerset ICB were seen by an NHS dentist, compared with 56% across England. The fact that the number of adults and children in Somerset ICB accessing an NHS dentist is even lower than the already struggling rate across England is concerning. Somerset is facing significant workforce pressures, and there are not enough NHS dentists available to do the job. As of March 2024, there were 334 vacancies in the south-west for full-time equivalent NHS general dentists. The 29% vacancy rate is the highest of any English region. It is a shocking fact that the No. 1 reason for children aged five to nine being admitted to hospital in our country is to have their teeth removed, with a primary diagnosis of tooth decay. It is a truly Dickensian state of affairs.

We have heard about the dental desert in Somerset. Stockton in my constituency has also been branded a dental desert. I welcome the 4,000 new appointments that the Government have granted for Stockton North and the surrounding area. However, given the urgency that he has described, particularly for children’s health, I ask the Minister whether the Government are taking any measures to accelerate the roll-out of those appointments.

We will absolutely ensure that integrated care boards are delivering to the target they have been set. If we see any evidence of slowing down or backsliding, we will certainly intervene to ensure that appointments are accelerated. I would also be more than happy to receive representations from my hon. Friend if he feels that performance in his ICB is not delivering. The state of NHS dentistry in Somerset, and the nation as a whole, is simply unacceptable and it has to change.

I welcome the action that the Government are taking to fix our dentistry crisis. In my constituency, only two dental practices accept adult patients, and vast swathes of the rural areas have no practice at all. Will the Minister set out how the Government’s plans will support my constituents to access the dental care that they need?

My hon. Friend puts her finger on the fundamental problem, which is that the NHS dental contract simply does not incentivise dentists to do NHS work. That is the fundamental reason why we are in this bizarre situation where demand for NHS dentistry is going through the roof, yet there is a consistent underspend in the NHS contract. It is a classic example of a false economy. The Conservatives thought they were being terribly clever by structuring a contract in a way they thought would deliver value for money, but in fact, it simply failed to incentivise dentists to do NHS work and they drifted more and more into purely private sector work. That is the very definition of a false economy.

I just draw the Minister back to my specific point about whether he can confirm that he is having discussions with the British Dental Association. The association agrees that the contract is wrong, and it wants to speak urgently to the Government about how it can be amended.

I am pleased to confirm that I am meeting the BDA in the coming days. The negotiations are moving forward. There is no perfect payment system, and there is a need to get the balance right between ensuring that we have a viable system that does not deliver underspends in the NHS contract, which is absurd, and that we deliver as much NHS dentistry as possible to the communities and people who need it. That is a complex process and it will take some time. The Government have taken intermediate measures, such as the 700,000 urgent appointments and supervised toothbrushing, which we will work on at pace over the course of the coming financial year while also working on a radical overhaul of the contract. By the time I came into government, the Nuffield Trust was describing the state of NHS dentistry as “at its most perilous point in its 75-year history.” As of March 2024, there are over 36,000 dentists registered with the General Dental Council in England, yet there are fewer than 11,000 full-time equivalent dentists working in the NHS.

I understand that at least 100 Ukrainian dentists in this country are unable to practise with the NHS because they are waiting to take examinations. Can the Minister do anything to expedite their ability to practise in this country?

I absolutely agree. Two big things need to happen. First, the General Dental Council needs to do more to get more exams in place for those very well-qualified dentists. Of course, they have to pass the British exam. We cannot have people practising in Britain who have not passed that exam, but the availability of the exam has been too limited and that needs to change. The other thing is provisional registration. Some work can be done to expedite the registration of an international dentist, but more needs to be done on that as well. I will meet the head of the General Dental Council shortly, and I will convey those messages to him. Recruitment and retention issues are not limited to dentists; there are difficulties across the whole dental team, including dental nurses, hygienists, therapists and technicians. In the past five years, there has been a 15% reduction in courses of dental treatment being delivered across England, and 28% of adults in England—a staggering 13 million people—have an unmet need for NHS dentistry. As a result, we hear too many stories about people who are unable to access the care they need, and some horrific accounts of DIY dentistry that nobody should have to resort to. Dentistry rightly receives a lot of attention because of its dismal state, and I am grateful to the National Audit Office and Public Accounts Committee for their interest in the previous Government’s dentistry recovery plan. It is evident that the plan did not go far enough.

The Minister talks about the previous Government’s dental recovery plan, and part of that was to impose a firmer ringfence on dentistry spending so that there was not an underspend that was reallocated elsewhere. The previous Government tasked NHS England with collecting monthly returns from ICBs to establish spending as against the allocation. Now that NHS England is being scrapped, will we still see that monitoring of ICBs to ensure that the spending matches the allocation?

I take the hon. Gentleman’s point about the ringfence, but in a way, ringfencing addresses the symptoms, rather than the cause, of the problem. The fundamental cause of the problem is the amateurish way in which the previous Government set up the NHS dentistry contract so that it does not incentivise dentists to do NHS work. That is what leads them to drift off. In a sense, we can do all the ringfencing we like, but if the workforce that we need is not incentivised to do the work that we need them to do, we are going to have that problem, because they vote with their feet. That is why the radical overhaul of the dentistry contract is the key point. However, I agree with the hon. Gentleman that once we have got a contract that works, we must ensure that every penny that is committed to NHS dentistry is spent on NHS dentistry, rather than the absurd situation that we have now, in which we constantly have underspends in the NHS dentistry contract while demand for NHS dentistry goes through the roof. It is a truly bizarre situation. I return to the subject of the dentistry recovery plan. The new patient premium, introduced by the previous Government, aimed to increase the number of new patients seen, but that has not happened. In reality, since the introduction of the previous Government’s plan, there has been a 3% reduction in the number of treatments delivered to new patients. It is clear to this Government that stronger action is needed, and we are prepared to act to stop the decay.

In Minehead, in my constituency, a dental surgery responded to the ICB in October and said that it would provide 12 NHS appointments a week for people who currently do not have a dentist. I have chased that ICB on five occasions, but we still do not have a result. That is 48 appointments a month that my constituents are missing out on. Would the Minister please agree to write a letter, on my constituents’ behalf, to the Somerset ICB?

We are very keen to ensure that targets are being met, and the ICB clearly needs to ensure that that is happening, so I would be happy to do that. Perhaps the hon. Lady could write to me so that we can get all the facts on the table, then we can take action accordingly. We will make the difficult decisions necessary to restore NHS dentistry to ensure that patients can access the care that they need, at the best value for taxpayers. Since coming into office, we have focused on implementing new initiatives and stopping the things that are not working. From today, 1 April 2025, the public will see 700,000 additional urgent dental appointments being delivered every year, as we promised in our manifesto. The urgent appointments will be available to NHS patients who are experiencing painful oral health issues, such as infections, abscesses, or cracked or broken teeth. Somerset integrated care board has been asked to deliver 13,498 of those appointments. That is 13,498 more chances for the hon. Lady’s constituents to get the urgent dental support that they need, every single year. Across the south-west region, there will be 106,776 extra appointments—that is more chances for patients in urgent need of care. However, to have a truly effective dental system, we cannot focus just on those who are already in pain; we must have a system that prioritises prevention. A cornerstone of the Government’s mission to prevent ill health is supporting children to live healthier lives. We want to ease the strain on the NHS and create the healthiest generation of children ever. As colleagues will be aware, too many children are growing up with tooth decay, which is largely preventable. That is why we have invested £11.4 million to roll out a national supervised toothbrushing programme for three to five-year-olds that will reach up to 600,000 children a year in the most deprived areas of England. The latest data shows that the rate of tooth decay for five-year-olds in Somerset is 20.2%, which is lower than the 22.4% for England but still far too high. We are taking a targeted approach to support those in the most deprived areas, which is why we have been able to allocate £50,000 of funding to Somerset to support around 2,000 three to five-year-olds. Our additional funding will help to secure and expand supervised toothbrushing based on local needs. This is extra resourcing to support targeted work by the local authority and its partners. I am determined that we will reduce inequalities faced by children living in the most deprived areas, helping them to brush their teeth daily in the nurseries and schools that they attend. Alongside this, we have launched an innovative partnership with Colgate-Palmolive, which is donating more than 23 million toothbrushes and toothpastes over the next five years. This is of incredible value for the taxpayer, and a fantastic example of how business and Government can work in partnership for the public good. A strong dentistry system needs a strong workforce. We recognise the incredible work that dentists and dental professionals do, and we know that the current NHS dentistry contract is not fit for purpose. We need to build an NHS system that works for patients and their dentists. A central part of our 10-year plan will be workforce, and we will ensure that we train and provide the staff, technology and infrastructure that the NHS needs to care for patients across our communities. We will publish a refreshed long-term workforce plan to deliver the transformed health service that we will build over the next decade, and to treat patients on time again. We know that some areas face challenges in recruiting and retaining the dental workforce they need. The golden hello scheme offers 240 dentists a £20,000 joining bonus to work in underserved areas of the country for three years. The recruitment process is well under way, with posts being filled by dentists in these areas as we speak.

I ask the Minister to reply to my suggestion that students from the University of Bristol Dental Hospital do some part of their training in Somerset, where they can benefit the population.

I thank the hon. Member for that intervention. It is an excellent idea, and it is something that we have seen in other parts of the country. If he would care to write to me about that, I would be more than happy to take that issue up. In the south-west, the golden hello scheme has already led to seven new dentists on the ground delivering NHS dentistry to patients, and a further six have been recruited and are waiting to start their roles. With 64 live adverts across the region, we are confident that the numbers will grow. And, for the first time in more than a decade, we have increased payments for practices training a foundation dentist. We will not stand idly by while the fundamental reforms to the contract are developed. Where we identify opportunities, we will make improvements to the current system when those can increase access and incentivise the workforce to deliver more NHS care. I am pleased that work to improve access has also been taking place at the local level, and that Somerset ICB is opening three new practices in Wellington, Crewkerne and Chard. Those services will provide much-needed additional capacity in Somerset. The ICB is committed to delivering additional urgent dental appointments and increasing access for residents facing the greatest health inequalities—although I do recognise what the hon. Member for Tiverton and Minehead (Rachel Gilmour) said about the concerns that she raised. Fixing our broken dentistry system will not be easy, but I want to reaffirm our commitment to making bold changes and tough decisions to stop the decay and to rebuild the foundations of NHS dentistry. This is an immense challenge—there are no quick fixes and no easy answers—but people in Somerset and across the country deserve better access to dental care, and we are determined to make that a reality. We are committed to rebuilding a system that puts patients first, ensuring that no one is left without the dental care that they need. Question put and agreed to.

11:29:00