NHS: Dentistry Services — House of Lords, 2019-07-25
Topic: Health
Michael John Storey (Liberal Democrats, Centre to centre-left): My Lords, I thank the noble Baroness, Lady Gardner, for initiating this debate. I remember a similar debate in the Moses Room about two years ago. I knew nothing about dentists or dentistry, but I was on the subs bench and had to speak on the topic. I learned so much from that debate and I hope that that learning experience continues. I am conscious of the fact that I am among people who have given a lifetime to the profession. I also thank those organisations that sent some stunning briefings; particularly our own House of Lords Library and the Royal College of Paediatrics and Child Health The title of the debate concerns the availability of NHS dentistry. If you live in Barrow-in-Furness, it is a 90-mile round trip to see the dentist. It is the same in Whitehaven, Windermere, Bodmin and King’s Lynn. Morecambe is not exactly in a remote part of the country—I declare an interest in that my wife, like Thora Hird, is from Morecambe—yet it is a 61-mile round trip to see a dentist. It is the same in Plymouth. Tim Farron, the MP for Westmorland and Lonsdale, in a debate in the Commons in July this year, said that the situation "has reached breaking point". For those who have to travel, it is not just the cost of going to the dentist, it is the cost in travel. Will the Minister, in replying, address those difficulties It seems to me that whether we are the fifth- or sixth-wealthiest country in the world, it is surely not acceptable that 31% to 41% of five year-olds across the UK have tooth decay. It is particularly unacceptable that those young people are concentrated in the most deprived communities of our country. Of course, we all know that tooth decay is the most common single reason that children aged between five and nine are admitted to hospital. Not only could we do something to sort out decay in children’s teeth—we will come to that in a moment and we will all have contributions to make—we could do something about waiting lists and waiting times in our hospitals. Just imagine the time we could free up if we did something about this, because tooth decay is entirely preventable NHS dentists struggle to see even 55% of the population in a one-year period. Lack of access to emergency dentistry is often seen as contributing to overcrowding in hospital accident and emergency departments. The British Dental Association claims that 380,000 patients a year with dental problems are approaching their general practitioner—what? We know that in England dentists are now paid in units of dental activity—UDAs; I learned about this last time, and I spoke to one of my colleagues. Typical values for these units are £20 to £35. They are paid at one unit for a band 1 course of treatment, three units for a band 2 course of treatment, and 12 units for a band 3 course of treatment. For many treatments, the rate of pay is below the cost of providing the treatment to a modern standard and, as a result, many dentists will refer patients for any unprofitable services. I raise this, and I hope the Minister can give more details, because I do not quite understand it I asked Adam, my dentist, "How do you ensure that more young people are treated by an NHS dentist?". He replied, "Ah, Mike, the problem is UDAs". Each practice is given so many UDAs to treat children, and when they are used up, they cannot treat any more children. The problem is that in affluent areas, dentists will have UDAs left, which will go back to the Treasury, but in deprived areas, the UDAs might finish after six, eight or nine months. Why can we not transfer the surplus UDAs from the affluent areas to those areas? I do not understand that, and I would be grateful if the Minister could explain it, making it simple for me—keep it simple for a simple person—so can I understand how we can use UDAs effectively to treat young people’s teeth Poor oral health can profoundly affect an infant or child’s health and well-being. A quarter of adults do not think that it matters if their child develops cavities in their baby teeth, and admit to a lack of knowledge about oral health. There is a common misconception that baby teeth do not matter. However, they are essential for speech, the structure of the space, and for holding space for adult teeth to grow into. Decay can lead to not only infection and discomfort but potential damage to the teeth below. It is therefore essential that parents take their children to the dentist as soon as possible and understand about tooth decay and good dental practices. That is why I regret the closure of Sure Start centres and the reduction in the number of children’s centres. Those were ideal places for parents to learn about the importance of not just dental care but baby teeth, and how parents should be encouraged to look after the child’s baby teeth for the very reasons I have given In recent years, although the number of children being seen by NHS dentists in England has increased, as we know, the number of adults has seen a falling- off. This decrease has partly been attributed to labour shortages in the NHS and dental practices, and dentists scaling down their commitment to the NHS or leaving entirely. On the question of fluoridisation, as we know, fluoride is a mineral that prevents tooth decay and can be added to drinking water, salt or milk as a means to promote oral health. The excellent briefing from the House of Lords Library, which I do not need to repeat, explains how and where that is happening. However, I remember how, as a young head teacher, my progressive local authority—which was in fact Labour-controlled; should I say that?—introduced what was called dental milk, which had the correct amount of fluoride in it. That was a deprived community, with some of the worst dental problems in the region, and parents could choose between the dental milk in a green carton, or ordinary milk in a white carton. Guess what—99% of parents chose the dental milk, and the visiting hygienist said, "Mr Storey, your children’s teeth are improving year by year" I regret that for all sorts of reasons—perhaps a fear of fluoridisation—dental milk is not as prevalent in our schools as it used to be. Could the Minister reflect on that issue and say what government might do about it? A study in Scotland—never mind my school in Knowsley—where a similar scheme was in place found that decay rates fell by 48% among five and 10 year-olds who were drinking dental milk. I know that there are legal problems, and so on, but it seems that we are silly not to have developed that opportunity Healthwatch produced a fascinating briefing. It states that one theme that has consistently cropped up is that of dentists lacking knowledge or training to be able to treat individuals with learning disabilities, autism or special needs. I had not thought about that, but I should have thought that part of a dentist’s training should be in treating people who are autistic or have a particular special need, or that there were, as there are in America, child-friendly practices and practices which can cope with people with special needs We can eradicate tooth decay. It is very simple to improve dental health. It need not be expensive. Most parents can afford to buy a toothbrush and toothpaste. Schools should be willing, particularly in the early years, to work with parents and children to develop good oral hygiene. I remember when the hygienist visited every school up and down the country every year to check the pupils’ teeth. No doubt the Minister will tell us about particular programmes that are operating. That is great, but we want it right across the country, not limited programmes. Why can we not go back to a system where the equivalent of the school nurse, the hygienist or the dentist comes into school and checks young people’s teeth to see what the damage is or what needs to be done and then works with the parents to ensure that children get the treatment they deserve I am not going to talk about sugar in food and drinks—I am sure that other noble Lords will raise that. Children should receive their first check-up as their first teeth come through, recorded on their personal child’s health record. Together, we can eliminate tooth decay from our country.