PARLIAMENTARY DEBATE
Dental Healthcare: East Anglia - 11 December 2024 (Commons/Westminster Hall)
Debate Detail
That this House has considered dental healthcare provision in East Anglia.
It is lovely to see you in the Chair, Mr Dowd. I am grateful to colleagues from East Anglia for supporting this debate and, I hope, making some interventions. I am also grateful to the Minister for Care for coming yet again to Westminster Hall, because this is not the first time that we have had a debate on dentistry in the east of England, and in East Anglia in particular. The reason for those numerous debates is the significant problem of access to NHS dentists in particular, but also to private dentists.
Peter Aldous, who I am sorry to say lost his seat at the recent election, was a doughty campaigner on the issue. I pay tribute to him for the numerous debates he brought forward. Most recently, in September, the hon. Member for Norwich South (Clive Lewis), who is not here today, held a debate on the topic. Time is short, so I will not focus on the need as much as I normally would, but the Minister has been here before and knows very well how significant the need is for increased access to NHS dentistry in East Anglia.
I will give highlights, however, because the Secretary of State for Health and Social Care has described Norfolk not only as a dental desert, but as the “Sahara of dental deserts”. The Minister—the noble Baroness, Lady Merron—confirmed in the other place on 25 November that the Norfolk and Waveney area has
“the worst ratio of NHS dentists to patients in England”.—[Official Report, House of Lords, 25 November 2024; Vol. 841, c. 479.]
In my last debate in this forum, I was shocked to report that in Norfolk and Waveney the ratio of dentists per 100,000 population was 39, when the national average was 52. Now I have to update those figures, because the Secretary of State has recently confirmed that the figure of 39 has dropped to 36 per 100,000 of population, while the national average has increased to 53. It is getting worse, not better.
The data from this month is even more concerning. The British Dental Association confirms that there are 3,194 NHS dentists in the east of England, which are the statistics we previously used. BDA’s further analysis last month reveals that that equates to just 1,096 full-time equivalent dentists in NHS roles. If those figures are run through the population, there are 17 full-time equivalent NHS dentists per 100,000 population in the east of England. Those are truly shocking figures.
The issue can be sliced and diced in another way. The amount of money that the Government spend on people’s mouths in the east of England makes for sobering reading. The national average is £66 per mouth spent on dental treatment by the NHS. In the east of England, that figure is just £39. What is it? Is it that our fillings and dental work are cheaper in the east of England, or are we doing less? It is not due to less demand; we have the greatest demand. We had more than 1,000 people presenting in the past year at NHS A&E with significant dental problems. I believe I am right in saying that dental concerns are the single biggest reason why primary school children present at hospitals.
The big question is why the east of England is in this position. The wrong analysis of how we got here will lead to our imposing the wrong solution. Some people say, “Well, it’s because Norfolk is a remote, rural area with lots of coastline, and that brings problems. If you’re a newly qualified dentist, it’s probably a rather unfashionable place to go to make your new career if you’re not from that neck of the woods. It has a more elderly demographic, which may put off young dentists. It’s not where they want to go to set up their new home.”
Yet compare Norfolk with similar counties, such as Devon. I often use Devon as an example because it shares many characteristics with Norfolk: a slightly older population, a large rural coastline and a pretty similar population size. Look at the number of dentists in Devon: they have 49.6 per 100,000 people, which is far more than we have in the east of England. What is the difference? The answer is obvious. Since 2005, Devon has had a dental training school at Plymouth, which was the last one to be set up. The east of England made a bid for that contract and lost out to the Peninsula bid, and we can see the consequences of that in the teeth of Norfolk residents.
If someone wants to train as a dentist in Norfolk, Suffolk or elsewhere in East Anglia, the nearest place they can go to train is either Birmingham or London. That means that our home-grown talent has to go off somewhere else, several hours away, to train and qualify. The usual things happen: they develop their professional relationships in that region; they meet someone, fall in love and settle down; they put down roots in the community and they stay there and do not come back. The exact opposite is the case for people not from our region who qualify elsewhere. What is the incentive for them to come and set up home in a part of the world that they do not know and that is perhaps not attractive to newly qualified people in their mid-20s?
We also know that about 40% of graduates tend to stay where they train. We have that data from the University of East Anglia and its medical school, because each year it surveys graduates to see where they get their first job and each year about 40% of them take a job locally. This is the really important question for the Minister: do he and his Department accept that analysis? If they do not accept it, what is his explanation for the dearth of NHS dentists and even private dentists in East Anglia?
We can all talk about how we got here, and I can defend lots of very good things that the previous Administration did, but did we get everything right? No, we did not. What I am more interested in is how we can encourage the Government and work with them across the parties to solve the problem in the very near future.
I hope we have got to a reasonable analysis of why we are in this position. If it is substantially because of a lack of dental training facilities in the east of England, an obvious solution, although not the sole solution, would be a school of oral health at the University of East Anglia. The Minister knows that the UEA is ready to go. He knows that there is a building under construction and that a large amount of funding has been applied for, some of which has been already agreed. He knows that the UEA is making an application for registration with the General Dental Council and that it will be completed within the next six weeks at the latest.
That brings us to the crucial next step, which is the Office for Students. I recognise that the Minister is important and impotent at the same time. He is important because as the dental Minister he sets direction and gives impetus to change, but I accept that in some sense he is impotent because the Office for Students is an arm’s-length independent body. I hope he will take these requests in the light of my acknowledgment of his constraints, but it would be helpful for the UEA and the residents of our area to have his confirmation on the following three points.
First, can the Minister confirm whether additional dental training places will be made available by the Office for Students in 2025? It is a political decision how much funding the Government are prepared to put into the overall number of dental training places in the country in 2025. What is the pot that the Office for Students has to work with? Can he confirm that the number will be increased to take account of increased need?
Secondly, if that is the case, will there be a regional allocation within that global figure specifically for the east of England, given that the need is not national? There are regional variations, and in the east of England it is worst of all. There is precedent for that approach: recently, medical training places had a regional allocation, although I accept that historically it has not happened with dental places. It is an important point and would be of huge encouragement to our residents.
Thirdly, can the Minister give some indication of the timetable on which he and the Office for Students will work to process the 2025 allocations?
The other problem, which is slightly more recent in origin, is the imposition of national insurance contributions on dental practice. The British Dental Association has outlined that the recent Budget could have a devastating impact on struggling NHS practices. A local practice in Norfolk says that
“the recent changes to employers’ NI and raising of the living wage will lead to bankruptcy and breakdowns. We have been trying to keep our 100% NHS dental practice open under very difficult circumstances, being unable to fill our vacancy for a full-time dentist. This post has been empty since April 2023 and we can no longer go on with only one dentist and pay the bills.”
I recognise that it is above the Minister’s pay grade, but I do hope that in his advocacy to His Majesty’s Treasury he will ensure that it is fully aware of the negative impact of the NI increases on dentistry, as well as on GP practices, and that that will be taken into account in future decisions.
The debate follows hot on the heels of a debate on 3 September that my hon. Friend the Member for Norwich South (Clive Lewis) led on healthcare provision in the east of England. We know that huge swathes of the region are dental deserts. These areas are facing great pressures from challenges in the recruitment and retention of dentists, leaving patients struggling to access the NHS dental treatments that they need. As has been pointed out, it is a scandal—frankly, it is Dickensian—that the No. 1 reason for children aged five to nine to be admitted to hospital in our country in 2024 is to have rotten teeth removed.
Norfolk and Waveney integrated care board had 31.5 dentists per 100,000 of the population in 2023-24, which is the lowest number in England. That is why I have met with colleagues from the east of England, including the hon. Member for Broadland and Fakenham, to discuss the specific challenges in the region and to discuss the University of East Anglia’s plans to open a dental school. The UEA’s proposal to begin training dental students is very welcome news. As I said to all the colleagues I met recently, and to the hon. Gentleman at oral questions last month, the Government strongly encourage the UEA to continue its progress towards establishing a dental school by submitting its bid to the General Dental Council as rapidly as possible.
The independent Office for Students is another key player. It has statutory responsibility for allocating funded training places to dental schools. As the hon. Gentleman has pointed out, the OfS is independent from the Government. I cannot make specific commitments about allocating additional training places for future years, because to do so would be to cut across the independence of the OfS. The OfS makes decisions based on its own assessments, following guidance issued by Government. What I can say to the hon. Gentleman is that our guidance is influential, but I cannot guarantee its outcome.
The guidance for the 2026 academic year will be published in due course. Provided that the UEA meets those requirements, it would absolutely be considered for Government-funded dental training places. That would certainly help to retain local dentists in East Anglia. As a Member for a rural constituency, I absolutely understand how important that is to the hon. Gentleman and to the many other hon. Members present who represent his part of the country.
We also need a clear-headed diagnosis of where we are. It is beyond doubt that NHS dentistry was left in an appalling state of disrepair by the previous Government. As the Prime Minister said last week, the precious contract between the state and the British people has been broken. He rightly said that our public services are
“in crisis, unable to perform their basic functions”
and that they are
“unable to provide the timely care and dignity that Britain relies on”.
Almost five years on from the beginning of the pandemic, NHS dentistry has still not recovered to pre-pandemic levels. Only 40% of adults were seen by an NHS dentist in the 24 months to June this year, down from almost 50% before the pandemic. Although 34 million courses of dental treatment were delivered in England in 2023-24, that is down from almost 40 million courses five years ago. As I say, it is disgraceful that having rotten teeth removed is the single most common cause of hospital admissions for children aged five to nine, causing them untold pain and suffering and affecting their ability to sleep, speak and socialise.
On the subject of the general state of dentistry, I thank the National Audit Office for its recent investigation of the previous Government’s dental recovery plan. Its report lays out in black and white something that was already apparent to millions of people across the length and breadth of our country: the dental recovery plan that we inherited did not go far enough. We are reflecting on every line of the NAO report as part of our efforts to rebuild dentistry, get it back on its feet and make it fit to serve people of all ages. We have launched the largest ever national conversation to inform our 10-year plan to reform the NHS, and our workforce will play a central role, because they are key to unlocking improvements across our communities.
The golden hello scheme offers dentists £20,000 to work in underserved areas of the country for three years. The recruitment process is well under way, with posts being filled by dentists in those areas as we speak. As of 7 November, 64 posts had been advertised. Our manifesto pledged 700,000 more urgent dental appointments, and we are working to ensure that patients can start to access them as soon as possible. They will be targeted at the areas that need them most.
Strengthening the workforce is key to our ambitions, but for years dentistry has faced chronic workforce shortages. We have to be honest that bringing in the staff we need will take time. To rebuild dentistry in the long term and increase access to NHS dental care, we will reform the dental contract with a shift to focusing on prevention and the retention of NHS dentists. There are no perfect payment systems, and careful consideration needs to be given to any potential changes to the complex dental system, so that we deliver a system that is better for patients and the profession.
We need to ensure that the process to register a dentist in the UK is as efficient and fast as possible, while retaining robust safeguards for patient protection. The Department regularly engages with the General Dental Council to understand what it is doing to improve the waiting times for the overseas registration exam. Earlier this year, the Department ran a consultation on introducing a further piece of legislation to give the GDC powers to provisionally register overseas qualified dentists, which will help to address some of the workforce challenges.
In summary, this is an immense challenge. There are no quick fixes or easy answers, but we will choose change, not because it is easy but because it is what we have to do. We have to do the hard yards, and I look forward to working with the hon. Member for Broadland and Fakenham and other colleagues to deliver what is needed.
Question put and agreed to.
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