PARLIAMENTARY DEBATE
NHS Dentistry: Rural Areas - 5 November 2024 (Commons/Commons Chamber)

I am grateful to have secured this evening’s Adjournment debate on access to NHS dentistry in rural areas.

In my first few months as the Member of Parliament for Chippenham, there has been one issue that has been raised with me almost every day: the decision by Hathaway dental practice in Chippenham to close its doors to NHS patients on 1 November. Today, I wish to put on the record why dentists like Hathaway are ceasing to offer NHS dental care, and why that is particularly devastating in rural communities such as the one I represent.

Since being elected, I have corresponded with hundreds of my constituents about the state of NHS dentistry in Wiltshire. I have met patients, one of the directors of Hathaway dental practice, representatives of our integrated care board, Denplan and the British Dental Association—anyone that could help me understand what was happening, why it was happening, and how we might save NHS dental care in Wiltshire from disappearing altogether.

Only a week into this Parliament, I was able to raise the issue with the Secretary of State for Health and Social Care during a briefing on preventive healthcare. Today, I hope to make the case to Ministers—yet again—that NHS dental care is in crisis. The failure to fix NHS dentistry is proving catastrophic in rural communities up and down the UK and is, unfortunately, not a problem unique to the south-west. I thought it might be helpful for colleagues if I took the time to relay some of the facts.

I thank my hon. Friend for giving way. At a time when tooth decay is the most common reason for hospital admission in children aged between six and 10, and when my constituents in rural areas such as Swallowfield and Hurst struggle to access dentists, does she agree that the Conservative party has fundamentally failed the country on dentistry?

I agree that dentistry has been failed over the past 14 years.

According to the House of Commons Library, 51,000 children have not seen a dentist in Wiltshire in the past year.

My constituent in Ilton is now in debt because they had to take their son, who is eligible for free NHS dentistry, to a private dentist, as they could not find an NHS dentist in the whole of Somerset. Sadly, that comes as no surprise, given that four in 10 children in Somerset have not been able to see a dentist this past year. Does my hon. Friend agree that dentists need to be encouraged back into the NHS by reforming the broken NHS dental contract?

I do agree with my hon. Friend, and I will mention that point later in my speech. It is no surprise to me that children in her constituency are having similar problems to children in my constituency.

According to NHS England, only 33% of adults under the NHS Bath and North East Somerset, Swindon and Wiltshire integrated care board have seen a dentist in the past two years. According to a freedom of information request by the British Dental Association, my local ICB’s projected dentistry underspend equates to £4.6 million.

When Hathaway closed its door to NHS patients last Friday, this was a major blow to my constituents.

Some of my constituents in Melksham and Devizes, who until recently have had an NHS dentist in Chippenham, now find that the service has been stripped away from them. They now have to pay a monthly fee, which totals up to more than £150 a year at a minimum. Does my hon. Friend agree that that and the state of children’s dentistry are becoming a source of national shame? Urgent funding is needed now to revive vital services and to ensure that the oral health of the nation’s children and adults is protected.

I agree with my hon. Friend; that speaks to the fact that we are being left with a dental desert, with no sign of relief.

I commend the hon. Lady for securing this important debate. She mentioned that dental deserts can be a problem up and down the country. That is certainly the case in my constituency of North Northumberland. I welcome the Government’s dental rescue plan and the commitment to an additional 700,000 appointments per year. However, my situation is like hers: constituents in hundreds of square kilometres of my constituency tell me that they simply cannot access NHS dentistry. It is a real shame that no Conservative Members are here to hear this. Does the hon. Lady agree that rural residents should expect the same provision of NHS dentistry as those in urban areas?

I do agree with the hon. Member. The real issue for rural areas is, again, access to public transport. Dental provision might be relatively close in theory, but public transport does not allow people to get to the dentist. The issue of rurality is important and needs to be addressed.

Analysis conducted by the Rural Services Network shows that someone living in a rural area is less likely to be able to access an NHS dentist than those living in an urban area, with 10% fewer dental practices taking on new adult NHS patients in rural areas. The analysis also shows that in rural areas, there are 16% fewer dental practices with an NHS contract per 100,000 people. That again points to the fact that rural areas are definitely in a worse situation than urban ones.

I commend the hon. Lady for bringing this issue forward; the number of people in the Chamber indicates the interest in it right across the United Kingdom of Great Britain and Northern Ireland. Does she agree that dentistry is on the brink and that the additional national insurance contributions are going to push even more dentists into refusing NHS contracts and taking private patients only? Should not the Government immediately instigate an increase in prices in rural areas, to save the few dentists left who are braving rural isolation and the increased costs of operation?

I agree with the hon. Member. The disparity is clear. As he mentioned, rural areas are being hardest hit by our broken NHS dental contract system.

Unfortunately, there does not seem to be much hope on the horizon. Denplan tells me that 90% of dentists plan to reduce their NHS commitment in the next two years and that the UK has the lowest dentist-to-population ratio in the whole of Europe. Although all dentists are dedicated to improving the nation’s health, access to NHS dental services remains a persistent challenge under the current system, particularly in rural areas.

In lieu of the dental contract being renegotiated, could something not be done by the local integrated care boards that commission dentistry to make special provision for local contracts when dentists are considering giving up contracts in the short term? That could be done now, in lieu of that renegotiation.

I agree. Hold on. [Interruption.] Sorry.

Will my hon. Friend give way?

Yes—thank you, Richard.

My hon. Friend is making an excellent speech. She has mentioned ICB commissioning. I wrote to the Minister to ask whether there were set criteria for knowing where a patient is on the waiting list, and I understand that that is entirely in the gift of individual practices. Does my hon. Friend think that it ought to be for ICBs, or for NHS Devon in my case, to determine where people are on the waiting list for NHS dental care?

Let me give the hon. Lady a moment to gather her thoughts before she resumes her speech. It is best not to refer to a Member by their first name. She has a solid 30 minutes—although the Minister has to respond within those 30 minutes—so she can take her time.

Thank you, Madam Deputy Speaker.

I remind the House that the Conservative Government had the last decade to reform the dental contract but failed to do so. I therefore implore the new Government to act now with two simple actions. First, they should introduce a timeline for reforming the NHS dental contracts system. The Secretary of State for Health and Social Care said that that was their intention, but I feel that there is an element of urgency about this—especially for rural areas—that has not been addressed. Secondly, I would like it to be a mandatory requirement for ICBs to appoint dentists to their boards. There is a strong feeling among dentists that ICB boards of directors do not understand the issues they face.

Does the hon. Member think it indicative of the state of politics today that, although Members from both sides of the House are here, not a single one of the culprits—those responsible for the shameful state of dentistry across the UK, not least in my constituency—is here to listen to her very important speech?

I agree with the hon. Gentleman. It is disappointing that those who have failed to address this issue over many years still do not seem to see it as important. Although the dental contract was introduced under a Labour Government, it was clear that, after a length of time, there was an obvious moment when it should have been reformed but was not. That is disappointing and noticeable.

To reinforce the points made by the hon. Members for Truro and Falmouth (Jayne Kirkham) and for Camborne and Redruth (Perran Moon), and by my hon. Friend, this is not purely down to money. Indeed, there is an underspend in the dentistry contracts of many ICBs, and not just in Cornwall. Fundamentally, we know that it is the nature of the contract itself that means we end up in situations such as that in Cornwall, where children can expect never to see an NHS dentist until adulthood.

I agree with my hon. Friend. As I have mentioned, the ICB that represents my constituency has quite a significant underspend in its dental budget. That is quite often because dental practices do not wish to take up the contract as they find that the payments system, and its use of units of dental activity, fails to support them in a way that allows them to make a living. As we said earlier, small businesses are struggling across the country. They find that they are subsidising their NHS dentistry with private dentistry, to the point that it is no longer sustainable.

Another issue that is prevalent in most rural areas, and certainly in the south-west, is recruitment. While NHS dentistry does not pay, it is extremely difficult for dental practices to find dentists who will take on NHS contracts. Many of the dentists who took on NHS contracts have left—some were European citizens—or are simply no longer prepared to spend that many hours in a dental surgery and have decided either to retire or to take on easier work elsewhere. This ongoing problem will continue unless the dental contract is reformed quickly.

Does my hon. Friend agree that it is wrong that patients who have been forced to seek private care in an emergency are then refused NHS registration, because they are considered to already be registered as private patients? Should this not be addressed in any revised contract?

My hon. Friend makes an interesting point that I was not aware of. From discussing this matter with dentists, it was my understanding that these days, nobody is actually registered with a dentist; they are merely allowed to come regularly, and if they do not, they are taken off that dentist’s lists. My understanding was that it is quite difficult to register, so that is an interesting point that I hope the Minister will note.

A particular concern to dental practices, and a point that Denplan made very clear to me, is that once a dental practitioner has handed in their NHS provider number, even if the dental contract is improved, they are unlikely to come back to the NHS because of the complications involved in getting that provider number reinstated. That is why we need the Government to act now, before more dentists leave the NHS. Another issue for dental practices is that when qualified dentists come over from the EU, their qualifications are valid, but they have to spend an extra year training before they are allowed to register as NHS practitioners. That is slowing down any chance of increasing our intake from our European partners.

I am very grateful to the hon. Lady for securing this debate, and particularly for highlighting the added impact that the loss of dentists has in rural areas, where, if people lose their dentist, there is often no other dentist nearby. In my constituency, people frequently say that they struggle to find any dentist taking new NHS patients. She is right to highlight that the dental contract is the root cause of the issue, and to press for a clear timescale. Does she agree that by the end of this calendar year, the Government should have set out a timescale for starting crucial negotiations on the contract?

I agree that a timeline for reforming the dental contract is vital; that is what I am asking for. If we lose this opportunity and our NHS dentists leave the system, we will be in an increasingly difficult place. Across Wiltshire, for those not already registered with an NHS dentist, it is absolutely impossible to get one. There is not a single practice taking on NHS patients right across the unitary authority of Wiltshire, despite its size.

The number of dentists is obviously extremely important, but that is just part of what goes into the equation. In rural constituencies such as mine, access to healthcare services is heavily dependent on frequent, reliable services—in particular, bus services. Does the hon. Lady agree that if people are to access dental services, we need to ensure that those reliable, frequent public services are back in place?

As I am sure the hon. Member will remember, I have already mentioned the serious issue of public transport in rural areas on several occasions. I could not agree with him more.

I thank the House once again for allowing me to make the case for improved NHS dental care, and I implore the Minister and his colleagues to do the right thing by my constituents and those of the Members who have intervened, in order to support dental care, specifically in rural areas.

I start by thanking the hon. Member for Chippenham (Sarah Gibson) for securing this important debate. As my right hon. Friend the Secretary of State has said, we will be honest about the problems and challenges facing our health and care system, and we will be serious about tackling them.

In my constituency, there has been an 11% decline in the number of adults who have seen an NHS dentist in just the last few years—it has been precipitous. There is a specific problem, however, with adults in care homes. I spoke to a local dentist, and she explained that the standard insurance for dentists no longer covers them visiting and performing services in care homes in the community. Can the Minister look into that, and does he agree that it is a huge problem that when vulnerable people cannot come to a dental practice, dentists cannot go to them?

My hon. Friend points to a specific problem set against the backdrop of the general challenge that we face in dentistry, thanks to the legacy of 14 years of Tory incompetence and negligence. We will of course look into it, and if she would care to write to me, I would be happy to look into the issue.

The hon. Member for Chippenham is right to raise the problem of NHS dentistry in rural areas—a problem that will, sadly, be familiar to Members across the House. The truth is that we are very far from where we need to be. Lord Darzi’s review laid bare the true extent of the challenges facing our health service, including NHS dentistry, and even he, with all his years of experience, was shocked by what he discovered. His report was vital, because it gave us the frank assessment we need to face the problems honestly and properly. It will take lasting reform and a long-term health plan to save our NHS. Rescuing NHS dentistry will not happen overnight, but we will not wait to make improvements to the system, increase access and incentivise the workforce to deliver more NHS care.

The Government have committed to three seismic shifts: from hospital to community, from analogue to digital and from sickness to prevention. Our 10-year plan will set out how we will deliver those shifts to give the country an NHS that is fit for the future.

Order. Interventions should be short, and the Minister must respond to the Member whose debate it is.

We are working at pace, and I will say more about that shortly. I share my hon. Friend’s reflections on the complete absence of the Conservatives. They made a complete mess of our public services, called an election and ran for the hills.

On 4 July, we inherited a broken NHS dentistry system. It is a national scandal that tooth decay is the leading cause of hospital admission for five to nine-year-olds in our country. It is truly shameful and nothing short of Dickensian. In the area served by the NHS Bath and North East Somerset, Swindon and Wiltshire integrated care board, which includes the constituency of the hon. Member for Chippenham, 33% of adults were seen by an NHS dentist in the 24 months up to March 2024. That compares to a 40% average across England. In 2023-24, there were 44 dentists per 100,000 of the population there, whereas the national average was 50.

When we look at the problem in the round, it is not so much that we do not have enough dentists, but that not enough of them are doing NHS work, and they are not in the parts of the country that need them most. That challenge is compounded by the fact that some areas of the country are experiencing recruitment and retention issues, including many rural areas, where the challenges in accessing NHS dentistry are exacerbated. That of course includes Chippenham, where Hathaway dental practice has recently had a request granted to reduce its NHS activity, as the hon. Lady pointed out. I understand, thanks to a freedom of information request by the British Dental Association, that the practice had a £4.2 million underspend on its NHS contract. That is precisely the problem that hon. Members have pointed out. There is a quantum of funding, but the way in which it is structured makes private sector dentistry far more attractive than NHS dentistry. That is the root cause of the problem; we are alive to that issue.

Overall, it is clear that we have a mountain to climb. It is a daunting challenge, but we are not daunted, and we are working at pace. The golden hello scheme, for example, will see up to 240 dentists receive payment of £20,000 to work for three years in one of the areas that needs them the most. Integrated care boards have already begun to advertise posts, as we have accelerated that process. In the ICB area of the hon. Member for Chippenham, there have been seven expressions of interest, five of which have been approved. Providers can now include incentive payments when they advertise vacant positions.

Alongside that, we will deliver a rescue plan that gets NHS dentistry back on its feet. That will start with providing 700,000 additional urgent appointments as rapidly as possible, as set out in our manifesto. Strengthening the workforce is key to our ambitions, but for years the NHS has faced chronic workforce shortages, so we have to be honest about the fact that bringing in the staff we need will take time.

Will the Minister give way?

I have very little time left.

We are committed to reforming the dentistry contract to make NHS work more attractive, boost retention, and deliver a shift to prevention. This Government will always make sure that our health and care system has the staff it needs, so that it is there for all of us when we need it.

We are already working at pace with the British Dental Association and the dental sector to improve and reform the dental contract. The Secretary of State met the BDA on his first day in office, and I have met it a couple of times, including yesterday. We will listen to the sector and learn from the best practice out there. For example, I know that the ICB of the hon. Member for Chippenham has applied its delegated powers to increase the availability of NHS dentistry across the south-west 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. In addition, a consultation for a tie-in to NHS dentistry for graduate dentists closed on 18 July, and we are now considering the responses. The Government position on this proposal will be set out in due course.

We are also working round the clock to end the appalling tooth decay that is a blight on our children, as I have mentioned. We are working with local authorities and the NHS to introduce supervised tooth brushing for three to five-year-olds in the most deprived communities across the country, getting them into healthy habits for life and protecting their teeth from decay. We will set out plans for that in due course, but it is clear that to maximise return on investment, tooth-brushing programmes must be targeted at children in the most disadvantaged communities. In addition to our supervised tooth-brushing scheme, the measures we are taking to reduce sugar consumption will have a positive effect on children’s oral health. We also know that water fluoridation is a safe and effective measure to reduce tooth decay. It currently covers 6 million people in England, and a decision on expanding that will be made in due course.

We find ourselves in an extremely challenging fiscal position, but we remain committed to tackling the immediate crisis, and to fixing NHS dentistry in the long term with dental contract reform. We are committed to: providing 700,000 more urgent dental appointments; the golden hello scheme to recruit more dentists in areas of greatest need; continuing to work with the sector to help find solutions to improve access to NHS dentistry; tackling the disparities that are commonly seen in dentistry; rolling out supervised tooth-brushing for three to five-year-olds in our most deprived communities; making sure everyone who needs a dentist can get one, irrespective of whether they live in a city or in a rural area; and doing the job on long-term dental contract reform, which will take some time. We will clear up the mess we have inherited, we will get NHS dentistry back on its feet, and we will build an NHS dentistry service that is fit for the future.

Question put and agreed to.