NHS Dentistry: South-west

[Martin Vickers in the Chair]

14:30:00

I beg to move, That this House has considered NHS dentistry in the South West. It is a pleasure to serve under your chairship, Mr Vickers. I am grateful to the Chairman of Ways and Means to have been granted a debate on NHS dentistry in the south-west of England, which has particular problems. I know that the new Minister will have encountered enough problems with NHS dentistry as it is, but the south-west is a special case. To illustrate: if we were to go back to 2015, 51% of adults in the south-west could see a dentist. That was also the case across England at the time, with 51% of patients who wished to see an NHS dentist having access to one. By 2024, however, that figure has declined sharply. Now, the current average across England is 40%, and in the south-west it is just 34%.

I thank my hon. Friend for securing this important debate. In Somerset, the percentage of adults who have seen a dentist has dropped by 20% over the past decade. Does my hon. Friend agree with me that we should guarantee access to an NHS dentist for everyone needing urgent and emergency care?

That is exactly what is needed for urgent and emergency care. My hon. Friend draws attention to Somerset; the situation is bleak in Devon too. In Devon in 2015, 55% of adults were able to see a dentist, but that has since dropped to just 37% today. I have had so much correspondence from my constituents on this subject, and the decline, as I see it, is a direct result of 14 years of Conservative neglect of our health services and of NHS dentistry in particular. I find it really troubling that the situation is affecting people in some of the most vulnerable categories, such as older people and children, Children in Devon are missing out on crucial dental check-ups. Once upon a time, they used to have check-ups twice a year; now, it is not possible for children to be registered for NHS dentistry in many dental practices. It is therefore no surprise that tooth decay is now the leading cause of hospital admissions for five to nine-year-olds in the country. I talked to one primary school and was told that pupils are going to hospital in Bristol to have their teeth removed—often between four and 10 teeth at a time. The number of NHS dentists in Devon has dropped from 549 to 497, so the reality is that NHS dentistry is simply no longer available for all.

I entirely accept the points that have been made about Devon and Somerset. In Camborne, Redruth and Hayle, we have some of the most deprived areas in the country. I have met people who have chosen to access dental care privately at the expense of heating their homes or eating food. This is where we are today: we are in a dental emergency across the south-west, and in Cornwall, the situation is now critical. Does the hon. Gentleman agree that we cannot wait any longer for emergency dental care across the south-west?

The hon. Gentleman is right. We want to move NHS treatment back into primary care and away from the most critical acute care, yet it seems to me that primary care services are moving in the other direction.

Royal United hospitals in Bath saw nearly 260 people last year with serious dental issues such as abscesses, largely because those people could not get a preventive care appointment from a dentist in their community, forcing them to go to A&E. Does my hon. Friend agree that a lack of NHS dentistry drives up costs because people go to A&E when it should only be there for emergency cases?

I agree that emergency care should not suddenly become the routine. It is there for the most critical cases, but we have not seen that, given the drying up of NHS dentistry provision in our towns and villages.

Does my hon. Friend not agree that part of the problem is that we are only talking about emergencies? The Secretary of State, in his first week in the job, talked about working hard to look at preventive medicine. That should apply to dentistry as well. Does my hon. Friend not agree that we need to look at a serious timeline for reviewing the dental contract? We cannot only talk about emergencies all the time.

My hon. Friend makes an excellent point. Prevention is clearly cheaper than dealing with the problems down the line. There is no better example than offering check-ups for children’s dentistry.

I find it absolutely shocking—I am sure my hon. Friend will agree—that the recommendations of a report published 15 years ago by the previous Health and Social Care Committee have still not been implemented.

The hon. Member for Tiverton and Minehead has clearly done her homework. It is quite staggering that recommendations from that long ago are still not implemented.

Lord Darzi said in his review of the NHS that “urgent action is needed to develop a contract that balances activity and prevention, is attractive to dentists and rewards those dentists who practise in less served areas” such as mine in South Devon, where not a single dentist is taking on NHS patients any more. Would my hon. Friend agree that we urgently need a timeline for this work to be done?

Yes, I think so. My hon. Friend is right to point to some of the recommendations in the Darzi report. I was encouraged to see reference to neighbourhood hubs, where perhaps we can have delivery of primary care, such as NHS dentistry, nearer to the constituents we represent.

I thank the hon. Gentleman for securing this debate. Does the hon. Member not agree that the story in the south-west is being replicated across all of the United Kingdom of Great Britain and Northern Ireland? He may not be aware of a survey of almost 300 dentists in Northern Ireland that found that almost nine in 10 intend to reduce or end their health service commitments in the coming year. That could be the end of NHS dentistry. Is he experiencing the same thing in the south-west? If he is, Government must really grasp this issue, and, as the hon. Member for South Devon (Caroline Voaden) said , get it done.

I am glad that the hon. Member for Strangford made that point, because I did not know about the situation in Northern Ireland. It sounds like some regions of the UK are not getting the attention that they require when it comes to NHS dentistry. I want to share the story of two of my constituents, Mike and Shirley. I have received correspondence from them and many other residents, such as Martin Loveridge, who has had a similar experience. Mike and Shirley are hard-working people. Mike is almost 75 and retired after more than 50 years in horticultural work. Shirley, aged nearly 70, is still taking on part-time cleaning work to make ends meet. In 2023, their dentist in Sidmouth finally went private, driven away by the broken dental contract that we have heard described. The impact of that shift has been devastating. Shirley developed a dental abscess. Anyone who has had a dental abscess will know what excruciating pain it can involve. Years ago, Shirley suffered from a similar infection, which led to sepsis. This time, instead of receiving urgent care from the NHS, Shirley faced the following choice: either wait in pain or go private. Plainly, this incident is a stand-out case, given that it was crucial that she received NHS treatment for sepsis, but typically, it would cost them £1,200 in dental fees—a sum that is simply unaffordable for people in Mike and Shirley’s position. Mike has not seen a dentist since May 2022 because he simply cannot afford it. Mike and Shirley tried to get NHS dentistry—they went to NHS England, Healthwatch Devon and the complaints department of the Devon NHS—and they had people admitting to them the dire state of the system, but they were offered no real solution. They spent hours on “Find a dentist”, an NHS website just for that purpose, but they were referred to a clinic that was 80 miles away, an impossible journey for them.

I thank my hon. Friend for securing this important debate. Cheltenham, similarly, is a dental desert. My residents often find themselves referred out of our region and into the midlands for treatment, to places as far away as Malvern, if they are not lucky enough to get somewhere in the constituency of the hon. Member for Gloucester (Alex McIntyre). Does my hon. Friend agree that that is simply wrong and unacceptable? Will he join me in thanking community campaigners in Gloucestershire, including Councillor Paul Hodgkinson, the health lead for the Lib Dems on Gloucestershire county council, who are trying to fight this at the local level?

My hon. Friend is right to draw attention to community campaigners, but frankly it should not require grassroots organisations to self-organise and mobilise; as representatives and as Government, we should be able to provide that in this, the sixth richest economy in the world.

I thank the hon. Member for arranging this debate and for his forbearance on the incredible number of interventions. Does he agree that to solve this problem once and for all, and not just deal with the emergency situations that have been mentioned, the Government need to move towards a model similar to that for GPs, in which dentists are reimbursed for their work and rewarded for caring for patients and taking a more preventive approach?

Dentists need to be rewarded under an NHS dental contract that recognises that not everyone has the same ability to pay. Frankly, if a little money were invested early in preventive measures, some of our constituents would not cost the system nearly so much later. At a Westminster roundtable on dentistry last year, it was made plain that the issue was about not so much a shortage of dentists, but a need to attract private practising dentists to NHS work. Many dentists, even those who would ideally prefer to work within the NHS, avoid NHS work or leave it, because the current system is not fit for purpose. On Remembrance Sunday, I was talking to a couple near the war memorial in Sidmouth. They were both veterans. Between them, they had served for 62 years, and they were unable to get NHS dental appointments. They felt that they had dedicated their lives to public service and this was how the state was rewarding them.

I thank my hon. Friend for securing this important debate. I am sure that the issues in the south-west are similar to, and as challenging as, those in Wokingham in Berkshire. Commons Library data states that only 32.6% of children in Wokingham have seen a dentist in the past two years, compared with a 40.3% figure for the whole of England. Both figures show the Conservative party legacy of rotten teeth, fillings and agony. Arborfield and Swallowfield in my constituency are without dedicated dentists. That simply is not good enough. Does he agree that NHS primary care needs to be properly funded?

I am appalled to hear about those examples from my hon. Friend. The really disappointing thing is that some of the expense of secondary care could be avoided with a little more investment upstream in primary care. There is a clear disparity between the work that dentists do in the NHS and in private practice. There is so much more emphasis in private practice on preventive care. We need to see that same level of preventive work happening in the NHS. At an Adjournment debate last week in the main Chamber, it struck me that although many of us were there seeking to draw attention to NHS dentistry, not a single Conservative MP attended. I thank the Minister in the new Government for showing more commitment to NHS dentistry than the last administration, yet we have further to go. The Government prioritised the NHS in the Budget, allocating it an additional £25.7 billion. However, we needed more reference to dentistry in the Budget. The Labour party’s manifesto talked about a dental rescue plan that would provide 700,000 more appointments and, most critically, focus on the retention of dentists in the NHS. We urgently need that. We urgently need a dental rescue package to bring dentists back to the NHS, particularly in the south-west, where we have a dental training school in Plymouth. We understand that dentists, once trained, often stay where they went to university, so we need more dentists to be attracted to the south-west and to stay once they are there.

It is important to look at the role of public health in local government as well. Better Health North Somerset has a great programme led by Catherine Wheatley that is all about promoting oral health, which the hon. Gentleman mentioned, in early years and for children and young people. One thing I have noticed is that what works and good practice is not often shared between integrated care boards across local areas. With the strength of feeling here, demonstrated by the amount of south-west MPs that have attended this debate, there is a real opportunity for us to collaborate and share what works. That would be really useful.

I agree. One way in which we can share best practice is by thinking about not only training places, but the recognition of qualifications. After the UK’s exit from the European Union, we saw a breakdown in the number of EU dentists wanting to stay or being attracted here. With fewer eastern European dentists, in the south-west of England, for example, we need to look again at dental qualifications and whether there are some dentist qualifications we might recognise that might make it more attractive to be a practising dentist in the UK. The rural south-west of England needs to be able to expect the same level of NHS dentistry provision that we see in urban areas across the country. Will the Minister commit to the reform of NHS dentistry so that constituents such as Mike and Shirley do not have to go into the red or forfeit heating their homes to get dental care that avoids them going to acute hospitals such as the Royal Devon and Exeter hospital at Exeter?

I remind Members that if they wish to speak, they should bob. If they could limit their contributions to an absolute maximum of four minutes, we will probably get everyone in. But it is going to be a squeeze, particularly if there are too many interventions.

14:48:00

My constituent Jonathon Carr-Brown recently went to his dentist for a routine check-up. Dr King seated him in the dentist’s chair, as he had done many times before, and felt his throat, as he had done many times before. Unlike those other times, Dr King found something: he found a lump. After that visit to Bournemouth dental centre and further investigations, a tumour was identified. I saw Jonathon at the weekend. He had just completed a course of chemotherapy, because his dentist had helped to spot cancer. He was doing well: he was a little tired following his treatment, but he was not too tired to talk passionately about the importance of dentistry within our wider healthcare and about how more lives could be saved with the right changes by our Labour Government. Jonathon’s story shows the potential of so many things, including co-location, the promise of innovation and the possibilities of integration. Imagine if Jonathon had been able to go up the corridor to get diagnosed even faster and receive the right kind of support even faster. Jonathon’s story shows the power of prevention. There are so many people in Bournemouth East who are struggling to get the routine appointments that could spot problems and fix them sooner. Of course we need more appointments and of course we need more workers, but we also need a rethink of who does what. In my constituency, as elsewhere, I know the potential for local hygienists and therapists to use the full scope of their practice, and indeed for Bournemouth to pilot a new model of therapy-led practices, with dentists covering only the work that sits outside scope. I would welcome investment in the training and development of an oral health team who could learn by doing, providing clinical and preventive services to people who need them. Right now, Health Sciences University in Boscombe could help to increase local people’s access to oral health care by training even more professionals for the future and getting support to people who need it, bringing down the waiting list while also training people up and particularly providing outreach in areas of deprivation. There are so many areas of policy that we could focus on. I would love to talk at length about the reform of the dental contract, but in the hope that colleagues will do so, I will focus instead on the importance of empowering people by giving them accurate and clear information about NHS dentistry. The NHS app and the nhs.uk website are managed by NHS Digital and the NHS Business Services Authority—I said “NHS” quite a lot there. It is the responsibility of NHS contractors to update for their specific provision. That means that there is no kind of oversight or meaningful guarantee of accuracy of information. In April, before the general election, my team rang around all the surgeries in Bournemouth that were offering spaces to new NHS patients. They discovered that many had not updated their details, sometimes for years. Since then, there have been a small number of updates, perhaps prompted by my team’s calls. However, most of the surgeries that were recently showing as not having updated their details were private. They were only offering private appointments and seemed baffled to be rung by somebody looking for NHS care. It is not just that time-poor people who are desperate for dental care might be accessing incorrect information. It struck me and my team that people could be ringing surgeries listed on NHS platforms for NHS care—they are not listed as private dental providers. When those people are unable to access NHS care, they may be so desperate for any kind of care that they will buy into private dental provision. When we checked it out with the NHS, it had no way of determining whether patients commit to private dental provision, or what service members of the public may be offered. We were told that although so many private surgeries were not listed as private on the website and digital platforms, the NHS could not comment on the advertising of private dental providers. In April, under the Conservative Government, we discovered that there were no new NHS places available in a dental surgery in Bournemouth. Things have improved slightly since then, but only slightly. We need to improve the accuracy of the information that we provide to our public by putting in place the right mechanisms. We need to strengthen our digital platforms to ensure that citizens can book appointments, get personalised notifications to book routine check-ups and compare waiting times and patient satisfaction scores. Lastly, we need a digital health record as a single source of truth about someone’s health. That information is fragmented across pharmacies, GP surgeries, dental practices, hospitals and people’s phones. How much better would it be to bring that information together so that someone’s medical record is in hand and complete when they are seen? That would allow them to be seen by the right person at the right time in the right setting. Our NHS was founded on the principle that health should not depend on wealth. However, people who can pay are paying. The use of private healthcare will continue to rocket, perhaps even through unintended encouragement on NHS platforms, unless we co-locate, innovate and integrate. A healthy population will unlock a stronger Britain. I look forward to supporting the Government in their efforts to change our NHS and our NHS dentistry, so that they can survive and serve our public.

14:53:00

I thank my hon. Friend the Member for Honiton and Sidmouth (Richard Foord) for securing the debate. As the MP for a rural constituency in Somerset, I do not need to repeat the well-known fact that the south-west is one of the worst dental deserts in England. As a mum, and as someone who received excellent dental care as a child because my grandad was a dentist, I particularly worry about the effects on children. With such a scarcity of NHS practices accepting new patients and with the rising cost of living, working families simply cannot afford to go private. More often than not, that means that parents have to unwillingly forfeit their children’s health. This is a topic that people care about up and down the country. The regular emails I receive about it from my Frome and East Somerset constituents normally describe the same regrettable situation: they cannot get a space, there is no room anywhere in the vicinity and they are forced to go to hospital. However, one recent casework email was particularly stark: it was from a retired man and his wife who have recently become kinship carers for their two grandchildren following the sudden death of their daughter. Although one child had “luckily” already started orthodontic treatment prior to their mum’s death, the grandparents cannot find a single NHS practice that will onboard the other child. They receive the state pension and one child benefit. Luck should never be a factor in the question of children’s health, let alone set two siblings apart. NHS dentistry should be there to level the playing field and give access to all, regardless of background or family set-up. I know from having met local dentists and national dentist groups that the growing consensus is that there are two reasons why there are so few spaces in NHS dental practice. One reason is budget; the other is the availability of NHS dentists, many of whom are leaving the NHS or leaving dentistry altogether because of low morale and stress. Recruitment is already difficult, but retainment is even more so. NHS dentistry has been chronically underfunded. The UK spends the smallest proportion of its health budget on dentistry of any European nation, and England spends almost half less per head than other parts of the UK. Just as working families in the south-west are struggling with the rising cost of living, high inflation, energy costs and the cost of everyday household items, so are NHS dental practices. The chronic underfunding has coincided with rising overheads. Most notably, the rise in employer’s national insurance contributions announced in the Budget will have a severe impact on NHS dental practices, which are already on their knees. That tax rise will significantly affect health and care services for patients. The Liberal Democrats fear that it will only make the crisis in our NHS and social care sector even worse. We have urged the Chancellor of the Exchequer to urgently rethink the rise in employer’s national insurance contributions, either by cancelling it for all employers or at the very least by exempting those employers that provide vital health and care services, including GP services, dentists, social care providers and pharmacies. Without that exemption, the health and care crisis will only worsen and regional disparity will widen. Children in the south-west region will depend on good fortune. Parents will feel helpless and will be forced to make sacrifices. It risks setting apart and setting back thousands of children.

14:56:00

I will not rehearse the numbers that Members have already given for the south-west, except to say that fewer than half the children in Cornwall have been seen by an NHS dentist in the past 12 months. That is down 13 percentage points from five years earlier. It is just getting worse and worse: people simply cannot get an NHS dentist now in the whole of Cornwall. It is impossible. We are fortunate in that we have a new Government. We are looking at 700,000 new urgent appointments. Everybody recognises that the dental contract needs reforming, and there is a commitment to reform the contract. Obviously that will take time, so in the meantime we may need to look at what can be done locally. In Cornwall, the commissioning of dentistry has been passed down to the integrated care board, which has done some quite innovative things. A surgery in Lostwithiel that was just about to hand back its contract went into bespoke negotiations so that the under-18s, the elderly and vulnerable people could retain their NHS dentist. There is the option, within the contract, for local ICBs to do more, to go into bespoke negotiations and maybe to salvage some things while we are waiting for the large renegotiation of the dental contract. There are other things that I ask my hon. Friend the Minister to consider; I am sure he has done so. Could he say more about health hubs, about having more bespoke contracts and about how much power ICBs have to enter into those contracts? Will he look at things such as emergency dental vans, which I understand are a sticking plaster, but which have been used in some places?

14:58:00

It is a pleasure to serve under your chairmanship, Mr Vickers. It is interesting that the hon. Member for Truro and Falmouth (Jayne Kirkham) mentions dental vans: we were due to have one in Dorset, but I heard from my local NHS dentist in Corfe Mullen that they were seriously concerned about the prospect. They were worried that if they took it out to their rural community, there would be mayhem and frustration on the part of people who had not seen a dentist in so long. They were actually in fear for their staff, so they decided not to take the dental van. They also noted that it was 2.4 times more expensive than operating a practice, so they decided that they would invest the practice’s extra money in an additional graduate dentist. I met her a few weeks ago: her name is also Vicky. I am really excited about the work she could do, particularly in children’s health, but the decision to increase national insurance without exempting dentists means that the equivalent of half her salary will now go on additional national insurance for the staff within the practice. That is jeopardising the opportunity for practices like Corfe Mullen dental surgery to take on such staff. It is interesting that dental care was available on the NHS from its inception. The original advert for the NHS stated that it would provide “all medical, dental and nursing care” for everyone— “rich or poor, man, woman or child”. I am sure Beveridge and Bevan would turn in their graves if they thought that adults were pulling out their own teeth and children were being hospitalised for tooth extraction. It has already been said that fewer than a third of adults in the south-west are receiving dental care. When we describe it as a desert, we are not talking about our wonderful beaches. It is genuinely a dental desert. I find it hard because NHS Dorset has told us that it had a £9 million underspend in the last year, yet people are spending hours on the phone, begging for help. I am pleased that our ICB has approved an increase in the price of the unit of dental activity, but why is that being delayed until next year, and why are we not going further? Why is it that our hospital can find the money to go to a private hospital and sort out all the knee replacements, but our dentists cannot be brought online to deal with urgent cases? I ask the Minister to instruct ICBs across the south-west and beyond to ringfence the underspend in dental budgets, so that it cannot be used to plug the gap elsewhere in the service while people are struggling. Katie in Bearwood told me that she will lose her front tooth if she does not get help soon. She wakes up every day with blood on her pillow and all over her teeth. The pain is so unbearable that it has her in tears, and she has lost two stone in weight as she can barely eat. She cannot get a referral to hospital without paying to see a private dentist. She is ashamed to go out in public. She said that she will have to pay £1,000 in private costs before she can be seen, but nobody will give her a loan. Zoe in Wimborne told me it has been nine years since she has seen a dentist, and that she is close to using the old-fashioned method of string and a door. It is absolutely ridiculous. It cannot be allowed to carry on. I cannot not talk about the children in our area. It is wonderful that the Government are bringing in supervised toothbrushing, but what is the point if children then cannot see a dentist? I was mortified in 2022 when I took a foster child who had come to live with me to my dentist, because I had assumed that, as with GP practices, looked-after children would automatically be added to a family’s NHS practice. How wrong I was. We did not realise, so we insisted on telling the dentist that they had to see this child. He was 11 years old and he had seven teeth gone already. He needed those teeth replacing for his future and for his smile. If we cannot do it for the adults, we must at the very least do it for our children, especially our looked-after children.

15:03:00

I am here to speak on behalf of Exeter residents about the parlous state of NHS dentistry in our city after 14 years of the Tory Government, who allowed NHS dentistry to fall into complete disrepair. We have heard that the south-west is one of the most notorious dental deserts, but most troubling is the proportion of children who get to see a dentist. In Devon, it has dropped by a fifth, from about 61% of children in 2016 to 47% in 2024, well below the English average of 55%. The reality is truly shocking. Across the country, tooth decay is now the No. 1 reason why children are admitted to hospital, and more than 40,000 children in 2021-22 had teeth removed at hospitals across the UK. That is the case in Exeter too. The Royal Devon University Healthcare NHS foundation trust states in its annual accounts that tooth decay is still the most common reason for hospital admission in children aged between six and 10 years old. According to the oral health survey of five-year-old children, more than a fifth of children in Exeter—22%—have tooth decay by the time they are five. I talked to one of my local primary schools in preparation for this debate, to get the views of its staff. They said that they know of multiple children who have had teeth removed due to a lack of dentistry and then had to miss school. Some children have joined reception with all of their teeth brown or blackened stumps. Children are missing school due to being in agony from toothache and having no dentist, and many families—and indeed teachers—are unable to find an NHS dentist that will take them on. It is truly shocking, and, as with many things, our primary schools do what they can to pick up the slack. This primary school already teaches children how to brush their teeth, and they do so each day in reception. Exeter’s NHS dentist crisis is not just having a detrimental impact on people’s teeth and health; it is having a detrimental impact on children’s education and on our economy. It is also having a detrimental impact on our local A&E department, which is already stretched to capacity. Tooth decay forced 740 patients to attend the emergency department between April 2022 and March 2023, according to NHS Digital data. Comparing NHS regions, those in the south-west and south-east were least likely to have an NHS dentist and most likely to have a private one. Given that the cost of simply being accepted on to a private dentistry register can be upwards of £70 a month for a small family, before treatments are added in, this is clearly a cost of living issue for many. As referenced already, the NHS dental budget across the south-west is underspent by more than £86 million in the financial year 2023-24. That is not due to any lack of demand, of course, but largely due to dental practices being unable to work under the current NHS contract, which simply does not cover the cost of treatment. We are asking dentists to deliver NHS services at a loss, which is clearly unsustainable. Instead of seeking to provide flexibility in the dental contract, as I know some integrated care systems do across the country, Devon ICB simply reallocates that dental funding elsewhere in the budget, despite the fact that it is supposed to be ringfenced. That is causing us further issues in Devon, as the BDA informs me that dentists are leaving the NHS in droves. In Devon, we saw a 9% drop in the number of NHS dentists last year alone. My residents welcome the Labour Government’s pledge to provide an extra 700,000 urgent dentists’ appointments and to reform the NHS dental contract, as part of a package of measures to rescue NHS dentistry. I know the Department is working at pace to roll out those extra, urgent dental appointments, and to pave the way for a new reformed dental contract. I met the chair of the BDA recently to talk about Exeter specifically; he stressed that NHS dentists, who are stung by the many broken promises from the previous Government, need the Labour Government to deliver meaningful change, including a clear timeline for negotiations. I know the Government treat NHS dentistry extremely seriously—the Health Secretary made the BDA the first organisation he met after the election—and I was pleased to hear the Prime Minister say recently at Prime Minister’s questions that he would work as quickly as possible to end the current crisis. Given what I know and what we have heard today, for my constituents in Exeter that change cannot come soon enough.

15:07:00

It is a pleasure to serve under your chairmanship, Mr Vickers. I congratulate the hon. Member for Honiton and Sidmouth (Richard Foord) on securing this vital debate about NHS dentistry in the south-west. My constituents know the issues with access to NHS dentists only too well. Since 2020, the number of dentists in the county has fallen from 549 to 497. That means that each remaining dentist must see almost 300 additional patients a year. It is clear that we have a significant shortage of dentists in Devon. Only 34.7% of adults in the county have seen a dentist in the past year, compared with 55% 10 years ago. As we also heard from the hon. Member for Exeter (Steve Race), very few children are seeing dentists: 46.6% of children in Devon in the past year, compared with 61% in 2016. For those who live in or around Ivybridge in my constituency, there are currently only two dental practices within a 10-mile radius accepting new patients. That only gets worse for the more rural and coastal communities, and the statistics are not good for the communities within the Plymouth boundary. I am aware that an anomaly in Devon is that there is actually a waiting list for NHS dentists. At one recent meeting with local senior health officials, it was pointed out that Devon’s waiting list is unusual, perhaps even unique. We have 60,000 people on that list, believing they are entitled to an NHS dentist, when, as was discussed at the same meeting and I was led to believe on the day, the existing NHS contract was designed to serve only 55% of the adult population. The assumption was that others would access dental care privately. I am not making a judgment about whether that is right or wrong; I am just stating the fact that most people do not understand that. The dental system was set up to be more like that for opticians than GPs at the time. The issues we currently face in Devon have in many ways gone beyond those points’ being particularly relevant, but it is worth reflecting how important it is to be honest with people, as we make changes, to ensure they understand what the impact of those changes might be for them. Before I reach the main point I wish to make today, I will briefly mention two challenges we face in Devon: how we train dentists and how NHS contracts are awarded. Devon is fortunate to have an outstanding dental school at the University of Plymouth. When it opened, many believed it would provide the city and the region beyond with a ready supply of new dentists to help us tackle our dental shortage. The school, however, is so successful that it is incredibly difficult to secure a place to study there, which has an impact on local people’s being able to study at home and perhaps stay after graduation. Equally, I have been informed by an expert on dental training that the way we train dentists makes it very difficult for people to stay where they have studied. Currently, the system almost forces the non-local dentists—the ones that might be coming down from the midlands —to go back to where they came from, rather than staying in the south-west if they want to. I urge the Minister to look into what more can be done to ensure that students can more easily stay where they have studied; at the moment, even if a dental student falls in love with Devon, it is very difficult for them to stay and help us to solve our problems. Secondly, I am concerned about the lack of flexibility in the awarding of new NHS contracts at a time when we are in desperate need of more dentists. I was contacted about a year ago by a dentist seeking to open a practice in my constituency, who was told by the ICB that the window for applications had closed. That may have been the case but, given that we are in such dire need of dentists, perhaps an exception could have been made. That leads me, finally, to my main point. In the last 12 months, 876 people attended the emergency department at Derriford hospital for a dental reason. Of those, 18% were under the age of 20 and 82% were over 20. That is an average of 2.4 people per day having to resort to using the emergency department to access dental care. Of these patients, 77 were then admitted for treatment. That is why we need to see the stalled review into funding for Derriford hospital’s urgent and emergency care facility, because it is part of the bigger picture of how we provide dental care across the south-west. If we free up emergency, we have more capacity to look after the region more fully.

15:12:00

It is an honour to serve under your chairmanship, Mr Vickers. I extend my congratulations to the hon. Member for Honiton and Sidmouth (Richard Foord) on securing this important debate on NHS dentistry in the south-west. NHS dentistry stands at a critical crossroads, facing the most challenging period in its history. A recent report from the Nuffield Trust described the threat to NHS dentistry as “existential”. Under the previous Conservative Government, NHS dentistry was put under immense strain, with only enough dentists to serve half the population and a severe shortage of investment. The Tories left Britain with one of the smallest dentistry budgets across Europe. At the start of the year, a staggering 13 million people were unable to access NHS dental care, which is more than three times as many as before the pandemic. Tragically, 7% of adults have resorted to the most desperate of measures: performing DIY dentistry, including pulling out their own teeth. In the south-west, and particularly in my Gloucester constituency, the situation is deeply concerning. The region is one of the worst dental deserts in the country, as we have heard today, with just over a third of adults in the south-west having seen an NHS dentist in the last two years. In some cases, people are waiting up to four years for an appointment. The effects on children are particularly shocking. In the south-west, only one in two children was seen by an NHS dentist in the last year—well below the national average. That is a disgrace. We see an increasing number of children suffering from tooth decay, to the point that the most common reason for hospital admissions among children aged five to nine is to have their teeth removed due to rot. In my constituency of Gloucester, two in five constituents are facing significant delays in accessing dental treatment, with many unable to see an NHS dentist at all. I heard some of these challenges first hand on a visit to the Bupa surgery on Painswick Road in my constituency. Sadly, Gloucester falls below the national and south-west averages for children and adults seen by a dentist, and has one of the lowest numbers of dentists in England. Families across Gloucester are suffering. Plans are afoot to change that, and I have had positive early discussions with the ICB and the University of Gloucestershire about their plans to establish a new dental hub at the university’s new campus in the city centre, which is very exciting for my city. I am also aware that we need long-term change and investment from the Government to ensure that we meet the current challenges in NHS dentistry and reverse the worrying finding that 60% of NHS dentists in England have considered leaving the profession. That is why I am proud to support the Government’s plan to fix NHS dentistry to deal with the immediate crisis. The Government have committed to providing 700,000 additional urgent dental appointments to tackle the backlog and to provide immediate relief to those suffering in my constituency. I look forward to the Minister’s update on that in his closing remarks. I know that the Labour Government are committed to providing the necessary investment and reform to ensure that our dental services are fit for the future, but these measures are desperately needed in Gloucester and across the south-west.

15:15:00

It is a pleasure to serve under your chairmanship, Mr Vickers. I congratulate my hon. Friend the Member for Honiton and Sidmouth (Richard Foord) on leading a genuinely important debate. I also congratulate my hon. Friends the Members for Glastonbury and Somerton (Sarah Dyke), for Frome and East Somerset (Anna Sabine), for Bath (Wera Hobhouse), for Tiverton and Minehead (Rachel Gilmour), for South Devon (Caroline Voaden), for Chippenham (Sarah Gibson), for Wokingham (Clive Jones) and for Mid Dorset and North Poole (Vikki Slade)—to mention but a few. I also thank Government Members for their contributions to this important debate. Nearly three years ago, in 2022, long before I was a Member of Parliament, I launched a survey of dental provision for the NHS in my Taunton and Wellington constituency. It showed that fewer than half of people there had access to an NHS dentist. Nearly three years on things have, incredibly, got worse. There are 64,000 children in the county who did not see a dentist last year. That puts Somerset in the worst-hit 5% of local authorities in the country. As has been mentioned, access to NHS dentists in Somerset has fallen from more than half of people back in 2015 to less than a third—32%—this year. Over half the constituents who contacted me did have an NHS dentist but were then told it was going private, so they lost it. That decline has been consistent. My constituents are having to travel out of county and, as I said in the Chamber a couple of weeks ago, one of my constituents, a stage 3 cancer sufferer, is having to use her savings to pay for dental treatment that she is entitled to for free on the national health service. Taunton and Wellington has many of the same problems as other areas of the country, in particular the terrible state of the dental contract, which is at the root of much of this issue. I have met the BDA chair, as have Government Members, and it definitely wants a timescale for the negotiation of the new dental contract. I hope the Minister will give a clear timetable for the negotiations so that we can have a new contract, which is what is needed to unblock this situation. If we are to train and equip the profession for the future, which we need to do, we have to end the uncertainty that is exacerbating the drain from the profession and the retention crisis we have seen over the past few years. It is vital that that uncertainty comes to an end. Uncertainty hits in other ways as well. For example, we all want more housing built—certainly, those on the Liberal Democrat Benches do, and I know that Government Members do too—and we want new housing developments to be infrastructure-led, with GP surgeries and dental surgeries. Developers could contribute to those surgeries, but what would be the point in building them if they are to lie empty, unstaffed by the dentists we need? Will the Minister consider whether ICBs can be required to support the finding of dentists to staff those facilities, when they are provided? I put on the record the fact there was a huge £11 million underspend in Somerset last year. Children, pregnant women and cancer sufferers are all being denied free treatment and £11 million is sitting in the coffers—it is a scandal. I hope the Minister will consider ensuring that that money is ringfenced year on year, so that it is ultimately spent on the patients who need treatment. I urge the Minister both to give a timetable for the negotiation of the new contract and to safeguard the underspends so that the money can be used to help patients in Taunton and Wellington, in Somerset and in the south-west as a whole.

15:19:00

Thank you, Mr Vickers, for chairing this essential debate about dentistry in the south-west. My mailbox is full of people complaining about the lack of NHS dentistry, and we have heard all the horror stories. As a GP, I see people staggering into my surgery holding their face. I know no more about teeth than anyone else here, but we GPs have to try to treat them with painkillers and antibiotics, because there is nothing else available. We must change that. Let me quickly talk through the dental contract; I then have a couple of positive stories, which will perhaps stimulate the Minister in respect of what could lie ahead. As has been said, the current dental contract nationally has an £86 million underspend, which is absolute madness, but it is because the contract is incredibly restricted and restrictive. The funding for units of dental activity is very poor.

The £86 million underspend relates to the south-west in particular.

Yes, but that is even more shocking, is it not? There are also disincentives in the contract for dentists to take on new NHS patients. When we look into it, there are all sorts of other things. For example, a dentist cannot provide urgent NHS dentistry unless they have used up their quota of UDAs, which are issued to dentists at the start of the year. The whole system is crazy, which is why there has been such a massive saving. As we have heard, dentists are leaving the profession, and it is clear that we are not training enough. I accept what the hon. Member for South West Devon (Rebecca Smith) said about how dentists are trained and where they are likely to end up working, because that is incredibly important. As to solutions, we must have prevention. Dentistry is exceptional because dental treatment is preventive in its own right, so as soon as NHS dentistry is stripped away, there are immediately problems. We also have to make sure that young people’s diet is better. Dentist Cerri Mellish and I have developed a project in our area. Cerri sees young pre-school children who are under five. She has a quick look in their gobs and if there are signs of decay, they are whipped out and the children are given treatment. If there are any other signs of problems, she can give them fluoride enamel. These types of innovative solutions are really important. One thing that happened with the pandemic was that NHS dentists stopped registering new patients. The pandemic started in 2020, so almost all pre-school children are likely not to be registered with a dentist, which is a real disaster. We should remember that two thirds of general anaesthetics used for children are used for dental reasons, and a general anaesthetic is not without risk.

I congratulate the hon. Member for Honiton and Sidmouth (Richard Foord) on securing this important debate. I apologise for being an interloper from the west midlands, but it such an important debate that I want to add some thoughts. My hon. Friend has hit on an important point. As the father of a toddler, I struggle every day to ensure that he brushes his teeth. The gap in the number of registrations since covid is creating a generation of children who are not used to going to the dentist. We have to reverse that trend; otherwise, we will have huge problems as a society, having to treat teenagers and adults with severe dental problems who have never been to the dentist.

That is absolutely true. Simple things such as dental brushing schemes, which we introduced in the Stroud area before the election, are essential. Those sorts of things are often laughed at, but they are probably the most important thing we do as a Government. One other quick win relates to urgent care. The Gloucestershire ICB, particularly in the Stroud area, was able to pay more for the units of dental activity and allowed all NHS dentists to do urgent care. In that way, some of the £86 million that the hon. Member for Honiton and Sidmouth (Richard Foord) talked about was spent. We were able to quadruple the number of urgent appointments. We can do that kind of work on a smaller scale, but I suggest that we need to do things step-wise. We must get the prevention in place and start doing urgent dental care, and when we have enough money we can do more. It is all very well talking about fantastic NHS dentistry, but we need the funding for it and we need the taxes to pay for it. As a Government, we are responsible for that. In the long term, we need to look to universal NHS dentistry in this country.

15:24:00

I thank you, Mr Vickers, for ably chairing the debate, and my hon. Friend the Member for Honiton and Sidmouth (Richard Foord) for securing it. I represent Torbay, which is sadly a dental desert. We have more than 2,200 people on our waiting list, desperate to receive support from a dentist. I fear that is just a shadow of the reality of the need there, because people think that it is a forlorn hope to be able to register for a dentist. More than half the adults of Torbay have not seen a dentist in the past two years. More than a third of children have not seen a dentist in the past year. This is a cocktail of severe dangers for the health of communities across the United Kingdom. I have spoken to a number of residents since being elected, and I want to share a couple of examples of how the situation is impacting on real people. One of them told me that she was halfway through treatment to resolve challenges in her mouth when her dentist withdrew, leaving her with a job half done. She still suffers with pain and is upset about her dentistry needs. Another resident, Kirstie, tells me that she suffers with a condition that means she is highly likely to develop mouth cancer. She is meant to receive three-monthly checks yet, as she has no NHS dentist and cannot afford a private practice dentist, she is having to go without. That is resulting in severe depression and her having to medicate for those depression issues. That is not where the United Kingdom should be. Coastal and rural communities face real challenges in dentistry. When we look at the national picture, urban areas tend to be rich in dentists; our far-flung areas are much more challenged. I am delighted that we are looking at about 700,000 new emergency appointments, but how many of those will happen in Torbay? On the renegotiation of the dentists’ contract, how will we be able to take account of rurality and coastal issues as part of the mix?

15:27:00

I thank my hon. Friend the Member for Honiton and Sidmouth (Richard Foord) for securing the debate. Last year, a staggering 58% of children in south Gloucestershire were not seen by an NHS dentist, despite the NHS recommending that under-18s see a dentist at least once a year. When we talk to dentists, however, that is not surprising. As we emerged from the pandemic, one local dentist stopped NHS work for all, including children. When I spoke to those at the practice, they were clear that the contract was at fault, but they also explained that they would have liked to continue NHS dentistry for children but NHS England in the south-west was not supportive. The last Conservative Government failed to fix the broken contract, and the new Government have yet to show that they grasp the scale of the challenge. We are calling for an emergency rescue plan, including the use of the underspends that have been referred to today to boost the number of appointments. I will mention a couple of examples from my inbox. The first I alluded to recently in the Adjournment debate on rural NHS dentistry led by my hon. Friend the Member for Chippenham (Sarah Gibson). A constituent who had to retire from his job due to health and mobility issues is entitled to free NHS dentistry, yet he was unable to find treatment anywhere near where he lives. Facing a dental emergency, he ended up having to seek private treatment, because of the pain he was in. He struggled to afford it, but felt he had no choice. Later, my constituent experienced another painful dental issue. This time, when he contacted the NHS, he was told that there was provision but, because he was now registered, it was unavailable to him; it was available only to unregistered patients. As a result, he had to pay £95 for a small temporary filling at a private practice. He was then told he was not entitled to be enrolled as an NHS patient, as he was registered as a private patient with the practice. I hope the Minister will agree to look into that situation to ensure that everyone can get the care they need. Another issue I will draw attention to is people missing appointments. A constituent of mine got in touch to complain that, although he is one of the lucky ones in the area who is still able to access dental treatment on the NHS, he was shocked to see a sign saying that 39 people had missed their appointment last month. Staff confirmed that that was the number of people who missed appointments at the practice with no warning or formal cancellation—and that is just one practice. They also said that number was actually quite low, and that it was regularly much higher. Because those missed appointments were no-shows, not cancellations, the slots could not be offered to other people desperately in need. That resulted in the equivalent of more than eight days of lost work. That brings us back to the question of the contract and how we can make sure that dentists are rewarded for their time, because it adds to the problem of them not being remunerated in a way that enables them to continue NHS work. It is also a question of making the best use of limited resources. I welcome the Minister’s thoughts on how to ensure that happens. Over 12 million people were unable to access NHS dental care last year. That is more than one in four adults in England, and three times as many people as before the pandemic. I echo the comments made by my hon. Friend the Member for Torbay (Steve Darling) about the challenges, particularly in rural areas, and look forward to hearing the Minister’s comments on that. We have been warning about the issues for years, yet there has been little decisive action to address the crisis. The British Dental Association has been pushing hard to get the Government to ditch the current failed dental contract and instead move to a more prevention-focused, patient-centred system that rewards dentists for improving the overall health of the communities they serve. In short, I welcome the warm words from the Government on dentistry, but we need more than words; we need action. I urge this Government not to kick the can down the road as the previous Government did.

15:31:00

It is a pleasure to serve under your chairmanship, Mr Vickers. I thank my hon. Friend the Member for Honiton and Sidmouth (Richard Foord) for securing this debate. The strength of the contributions by south-west Members from all parts of the House show how important this issue is for everyone in the region. I thank my hon. Friend for making the debate about the south-west. I grew up in Gloucestershire, and my dentistry as a child began in Tewkesbury. The comment by the hon. Member for Stroud (Dr Opher) that dental treatment is preventive in its own right was helpful. Indeed, thanks to the insistence of my mother, Christine, on my going to the dentist twice a year, I never got a filling until I was into my 40s. I thank her for that. While I welcome the Government’s injection of funds into the NHS as a whole, we must be clear that dentistry should not be forgotten. That is why I, along with many of my Liberal Democrat colleagues, have today written to the Chancellor of the Exchequer to ask her to reconsider the proposed increases in employer national insurance contributions in the case of various healthcare providers, including the dentistry sector and those providing NHS dentistry. Commenting on that letter, the British Dental Association said that the changes, should they go ahead, will inevitably punish patients. Before coming to this debate, I had meetings with the National Care Forum and the children’s hospice charity Together for Short Lives. In all those forums, grave concerns have been raised about the impact of the increase in employer national insurance contributions on the work that providers do, and the potential cuts to the number of people they employ and the services they offer. I ask the Minister to urge his team in the Department of Health and Social Care to reconsider and to press the Treasury to rethink the increase, or at least look at finding some form of dispensation. As hon. Members have said, tooth decay is the most common reason for hospital admission in children between the ages of six and 10. Thanks to a freedom of information request commissioned by the Liberal Democrats, we know that over 100,000 children have been admitted to hospital with rotting teeth since 2018. That is shameful, yet also entirely preventable. That is what makes it so tragic. Our failures stretch across the full breadth of age groups. Last year, a poll commissioned by the Liberal Democrats revealed that a shocking one in five people who fail to get an NHS appointment turn to DIY dentistry. Indeed, during the general election, I knocked on the door of somebody who told me that he had pulled his own teeth out. It is simply Victorian that that has happened to dentistry in our country in 2024. The Darzi review found that “only about 30 and 40 per cent of NHS dental practices are accepting new child and adult registrations respectively.” To me, and I think to everyone here, the fact that our dentistry system is in a position where people feel the need to pull out their own teeth is appalling. The south-west is feeling the full force of the crisis, having lost more than 100 dentists last year alone. However, the issue is not limited to the south-west. Only one of the 13 dentists in my constituency of Mid Sussex is accepting children as NHS patients, and none is accepting adults. Using data from the House of Commons Library, it is estimated that 44% of children in West Sussex did not see a dentist in the year to March 2024. My Liberal Democrat colleagues and I are calling for three things and we have a plan to make them happen. First, we need guaranteed access to an NHS dentist for everyone who needs urgent and emergency care. Secondly, we need guaranteed access to free NHS check-ups for those already eligible: children, new mothers, those who are pregnant and those on low incomes. Thirdly, we need guaranteed appointments for all those who need a dental check before commencing surgery, chemotherapy or a transplant. The first thing that we can do to achieve those vital baselines in dental care is to deliver a dental rescue package, including investing in extra dental appointments, fixing the broken NHS dental contract and using flexible commissioning to meet patient needs. Secondly, we need to ensure that a proper workforce plan for health and social care, including projections for dentists and dental staff, is written into law. Thirdly, we would reverse the previous Government’s cuts to public health grants to support preventive dental healthcare. We must tackle the root causes of the oral health catastrophe in the south-west by focusing on investment in prevention. In doing so, we can put an end to the suffering of so many children and adults, take away the need for DIY dentistry and provide some much-needed respite for the NHS system as a whole.

15:37:00

It is a pleasure to serve under your chairmanship, Mr Vickers. I congratulate the hon. Member for Honiton and Sidmouth (Richard Foord) on securing a debate on this important subject, starting at the significant time of two-thirty—I thought that was particularly skilled of him. [Laughter.] I thought you would like that one, Mr Vickers. Nobody should have painful teeth and nobody should have difficulty accessing an NHS dentist. Lincolnshire, which is home to my constituency, suffers similar challenges with access to NHS dentistry; indeed, I led an Adjournment debate on the topic in October 2021. It has been pointed out that the number of dentists is not the issue; in fact, we have more dentists per capita than we did 10 years ago. Rather, dentists are either in the wrong place—concentrated in urban rather than rural and coastal areas—or they do not perform NHS work, for a variety of reasons. That leads to the underspend that has been described. There has been some progress, with 500 more practices accepting NHS patients as a result of the dental recovery plan, and 6 million more dental treatment processes completed in 2023 than in 2021-22. One thing that helped with that was the patient premium for new patients, who are more likely than repeat patients to have a problem with their teeth that requires treatment. They are also more expensive for dentists to treat, so the current contract disincentivises the seeing of new patients. The patient premium is funded until April 2025. Will the Minister say whether he plans to continue it beyond that date? Another help has been the golden hello of up to £20,000 for dentists working in underserved areas, including the south-west, the midlands and East Anglia. Will the Minister say whether that scheme will continue? A number of hon. Members have mentioned a long-term workforce plan. There are already additional dental training places in the south-west, but, as my hon. Friend the Member for South West Devon (Rebecca Smith) pointed out, there can be challenges in the way the training is organised, which means that people do not stay in the local area—although more do stay than if they had been trained elsewhere. Will the Minister look in detail at the problems my hon. Friend raised? Ultimately, we have more dentists than ever before, but private dentistry is much more lucrative than NHS dentistry, and the NHS contract is complicated, offers disincentives and needs reform. The previous Government began reforming the 2006 contract by increasing the UDA rate to £28 as a minimum. The Labour party had a manifesto promise to negotiate with the BDA. Will the Minister confirm if negotiations have started and, if they have not, when he expects them to start?

I have just been rereading the 2010 Conservative manifesto—a delightful read. On page 47, it promises full dental contract reform. I then looked at comments by Conservative Ministers in 2024, when they promised to “consider” dental contract reform. Can the hon. Lady explain why no meaningful reform happened over those 14 years of Conservative government?

It is unfair to say that there was no meaningful reform. There was reform, but it has not been enough to ensure that everyone gets a dental appointment, and we need further negotiation and reform. We can relitigate the election, but the Labour party won a majority for this term and it needs to use it to do what it promised. One of those things is reforming the contract, and that is why I am asking the Minister to tell us whether he has entered negotiations to do so. One thing the Government have done—this was brought up by the hon. Members for Mid Dorset and North Poole (Vikki Slade) and for Mid Sussex (Alison Bennett)—is increase national insurance contributions and lower the thresholds at which they are paid, which presents a challenge for dentists across the country. I know the BDA has written to the Chancellor to ask for an exemption, and I wonder whether the Minister can comment on that. I have tabled a number of written questions, and the answers I have received have been less than satisfactory; they are really not proper answers at all. The Government do not seem to have worked out how much they intend to mitigate the increase in national insurance contributions, for whom they might do so, or how much it might cost. That is clearly a great worry. The Health Service Journal published a leaked letter suggesting that the cost of the 700,000 extra appointments —and presumably, in many cases, the national insurance contributions—will have to be found within the current budget. The Department of Health and Social Care has suggested that the letter was never sent and therefore may be inaccurate. Will the Minister put on the record the reality of the situation? Will the funding be expected to come from the current budget, or will there be extra money—and, if so, how much? The Minister has said himself that water fluoridation is safe and effective and reduces tooth decay, so will he be adding fluoride to our water? He said in answer to a parliamentary question that he would do so “in due course”. Will he tell us what that means and how quickly he expects to do it? The Government have talked the talk on prevention; now they need to take action. The previous Government conducted a consultation on whether newly qualified dentists could be tied into working for the NHS for a period of time. What is the Government’s assessment of that consultation, and what do they intend to do about the issue? Supervised toothbrushing is an interesting plan, but what about children of other ages? What is being done to encourage parents to take responsibility for ensuring that their children’s teeth are cleaned? Armed forces families move around the country a huge amount, and our forces do an excellent job keeping us safe. The Conservative Government brought in the armed forces covenant to protect our armed forces and their families. What plans does the Minister have to ensure that families can access NHS dental care as they move around the country, and that they do not have to wait for a place only to not get one, and then move again and have the same problem? I think it was the hon. Member for Honiton and Sidmouth who brought up international dentists. An international dentist with equivalent qualifications can work in the UK privately, but they need to go through an additional process to work for the NHS and be on the performers list, which is unnecessarily complicated. What will the Minister do to ensure that, if a dentist is able to practise privately in the UK, they can also practise on the NHS—or does he think that is not the right thing to do? Other Members have mentioned fluoride varnish. Does the Minister have a plan to ensure that young children have access to that treatment? Finally, the Secretary of State for Wales has said that Labour will “take inspiration from Wales”. Given that dental activity is at 58% of pre-pandemic levels in Wales, compared with 85% in England, and that 93% of practices in Wales—a greater proportion than in the rest of the UK—are not taking on new adult NHS patients, will the Minister reassure us that that is definitely not the case?

15:44:00

It is a real pleasure to serve under your chairship, Mr Vickers. I congratulate the hon. Member for Honiton and Sidmouth (Richard Foord) on securing this very important debate on NHS dentistry in the south-west. My right hon. Friend the Secretary of State has said that this Government will be honest about the problems facing the NHS and equally serious about tackling them. The truth is that we are very far from where we want and need to be. Lord Darzi’s report laid bare the true extent of the challenges facing our health service, including NHS dentistry. Even he, with his years of experience, was shocked by what he discovered. I pay tribute to all the hon. Members from across the House—too many to name in the short time available to me—for helping to highlight and elucidate their concerns. In many ways, those reflected what Lord Darzi set out, but we have also heard today some heartbreaking examples of the experiences our constituents are having. Colleagues across the House have brought those to life today. Lord Darzi’s report is vital because it gives us the frank assessment we needed to face the challenges honestly. Lord Darzi is clear that rescuing NHS dentistry will not happen overnight, but we will not wait to make improvements to the current system, to increase access and to incentivise the workforce to deliver more NHS care. We inherited a broken NHS dentistry system. It is truly shameful and nothing short of Dickensian that the most frequent reason for children of between five and nine years old to be admitted to hospital is to have their rotten teeth removed. That is, frankly, disgraceful. Those are the sort of challenges that we need to face. Some 13 million people in England have an unmet need for NHS dentistry. That is 28% of our country. It is absurd that people cannot access NHS dentistry when each year the budget is underspent—in recent years, that has been to the tune of hundreds of millions of pounds-worth of care going undelivered. That is why we need to reform the dentistry contract. In NHS Devon integrated care board, which includes the constituency of the hon. Member for Honiton and Sidmouth, 34% of adults were seen by an NHS dentist in the 24 months to March 2024, compared with an average of 40% in England. In 2023-24, there were 40 dentists per 100,000 of the population, whereas the national average, across all integrated care boards, was 50 in the same year. We acknowledge that there are areas of the country that are experiencing recruitment and retention issues—including many rural areas, where the challenges in accessing NHS dentistry are exacerbated. As Lord Darzi said, we have enough dentists and dental care professionals at an aggregated national level; the problem is that not enough of them are doing NHS work in the right parts of the country, where they are most needed. The mountain that we have to climb is daunting, but this Government are not daunted and we are working at pace. Take for example the golden hello scheme, which will see up to 240 dentists receiving payments of £20,000 to work in those areas that need them most for three years. ICBs have already started to advertise those posts through that scheme. Nationally, there have been 624 expressions of interest and 292 of those have since been approved. Thirty-eight posts are now being advertised with the incentive payment included. Or take our rescue plan, which will help to get NHS dentistry back on its feet by providing 700,000 additional urgent appointments as rapidly as possible. We know that rescuing NHS dentistry means acknowledging that we need more dentists doing NHS work and we know from survey data that morale among NHS dentists is low. We must turn that around. This Government will do all we can to make NHS dentistry an attractive proposition. Strengthening the workforce is key to our ambitions, but for years the NHS has been facing chronic workforce shortages and we have to be honest that bringing in the staff we need will take time. We are committed to reforming the dentistry contract to make NHS work more attractive, boost retention and deliver a shift to prevention. There are no perfect payment models, and careful consideration needs to be given to any potential changes to the complex dental system, so that we deliver genuine improvements for patients and the profession. We are continuing to work with the British Dental Association and other representatives of the dental sector to deliver our shared ambition to improve access to treatment for NHS dental patients. The Secretary of State met with the BDA on his first day in office, and I engage with it regularly, including at a meeting earlier this month. I share the BDA’s desire for a timeline for negotiations, but we have had to wait for the Budget and the ensuing discussions with the Treasury to initiate and conclude those discussions.

Is the Minister able to say when the timeline for those negotiations will be available?

As the hon. Gentleman will understand, we are in a sequence: we have the Budget, then the complex negotiations around the spending review. We cannot engage in meaningful, formal discussions and negotiations until we are clear on what exactly the financial envelope is. We are working at pace on that. However, we have been meeting informally to sketch it out, so I would say that the scope of the negotiations is agreed. The formal negotiations will really start only once we have the detailed budget in place. We will listen to the sector and learn from the best practice to improve our workforce and deliver more care. For example, the integrated care boards in the south-west are applying their delegated powers to increase the availability of NHS dentistry across the region through other targeted recruitment and retention activities. That includes work on a regional level to attract new applicants through increased access to postgraduate bursaries, exploring the potential for apprenticeships and supporting international dental graduates. There are two dental schools in the south-west: Bristol Dental School, and Peninsula Dental School in Plymouth. I recently had the pleasure of visiting Bristol Dental School and seeing the excellent work that they are doing there, training the next generation of dental professionals, supporting NHS provision by treating local patients, and reaching underserved populations through outreach programmes. I also know that Peninsula Dental School, which first took on students in 2007, is doing the same for Plymouth and its surrounding areas. I would also like to pay tribute to Patricia Miller of NHS Dorset, Lesley Haig of the Health Sciences University and council leader Millie Earl for working so constructively with my hon. Friend the Member for Bournemouth East (Tom Hayes) on improving oral health in his constituency. A number of hon. Members have rightly highlighted the importance of prevention, and we are working around the clock to end the appalling tooth decay that is blighting our children. We will work with local authorities and the NHS to introduce supervised toothbrushing for three to five-year-olds in our most deprived communities, getting them into healthy habits for life and protecting their teeth from decay. We will set out plans in due course, but it is clear that to maximise our return on investment, we need to be targeting those plans at children in the most disadvantaged communities. In addition to that scheme, the measures that we are taking to reduce sugar consumption will also have a positive effect on improving children’s oral health. Separate from the national schemes, I was pleased to note that NHS Devon integrated care board has committed £900,000 per annum for three years to support further cohorts of children for supervised toothbrushing, fluoride varnish and Open Wide Step Inside, with a new fluoride varnish scheme due to go live in September 2025. Open Wide Step Inside is a local scheme in which a dental outreach team, run by the Peninsula Dental Social Enterprise, goes into schools to deliver 45-minute oral health education lessons across Devon and Cornwall. It is a truly commendable scheme. The steps we take in NHS dentistry will feed into the wider work we are doing to fix our broken NHS. We have committed to three strategic shifts: from hospital to community, from sickness to prevention and from analogue to digital. Our 10-year plan will set out how we deliver those shifts to ensure that the NHS is fit for the future.

The Minister has iterated the problem, and he has spoken warm words about listening, talking and working with people. However, he has said little that is concrete, except about things that were happening already, either locally or as a result of the previous Government. With a minute left to answer all the questions he has been asked, can he commit to answering in writing those he does not have time to answer in the remaining minutes?

The first thing I will say is that I am not going to take any lectures from any Conservative Member about the state of our dental system. What brass neck we see from that party, both in the Chamber and in this place—lecturing us, given the disgraceful state of our NHS and the fact that the biggest cause of five to nine-year-olds going to hospital is to have their rotten teeth removed! I will not be taking any lectures on that from the Conservative party. Of course, I am more than happy to answer the hon. Lady’s detailed questions, many of which I feel I have already answered in my preceding comments. I will not take any more interventions from her because I need to finish shortly. Our 10-year plan will set out how we deliver these shifts to ensure the NHS is fit for the future. To develop the plan, we must have a meaningful conversation with the public and those who work in the health system. We are going to conduct a range of engagement activities, bringing in views from the public, the health and care workforce, national and local stakeholders, system leaders and parliamentarians. I urge hon. Members from across the House to please get involved in this consultation—the largest in the history of the NHS—at change.nhs.uk. I urge them to make their voices heard in their constituencies, through the deliberative events.

I have been on to the survey, and it is incredibly limited. It would be helpful if there were a way for the public to be encouraged to introduce more freeform responses.

I am slightly surprised to hear that. The presentation I received on the portal showed there was a clear channel through to having a more discursive engagement with the platform. I will take that feedback away and, through officials, will come back to the hon. Lady on that point. I thank the hon. Member for Honiton and Sidmouth once again for bringing the issue of dentistry in the south-west to this debate. On 4 July, we inherited a profoundly challenging fiscal position, but I can assure him that we remain committed to tackling the immediate crisis facing NHS dentistry, and that we are taking steps to make delivery more efficient through long-term reform. To recap, we are committed to providing 700,000 more urgent dental appointments, delivering the golden hello scheme to recruit more dentists in areas of greatest need, bringing in preventive measures to improve our children’s oral health and negotiating long-term contract reforms to make NHS dentistry more attractive. Those steps will help tackle the place-based disparities commonly seen in dentistry, and ensure that everyone who needs to access NHS dentistry can get it, including in the south-west. Our NHS dentistry is broken after 14 years of Tory neglect and incompetence, but it is not beaten. In 1945, it fell to Clement Attlee’s Labour Government to create a health system for the 20th century. Now, 79 years later, it falls to this Government to clear up the mess we have inherited, to get NHS dentistry back on its feet and to build an NHS dentistry service fit for the 21st century. That is what we shall do.

15:58:00

I acknowledge what the Minister said about the Conservative Government’s legacy for NHS dentistry, which is apparent for us all to see. The Health Service Journal revealed last month that in Devon and Cornwall, the wait for an NHS dental appointment for a new patient is 1,441 days—almost four years. Many of my constituents cannot wait that long. I hope the Minister has heard not only the examples of pain and suffering set out today but some of the prescriptions proposed by the Liberal Democrat spokesperson and other MPs from across the west country. Question put and agreed to. Resolved, That this House has considered NHS dentistry in the South West.