hazylavender/hi huggingface dataset:
Date: 2023-04-27
Peter Aldous: I thank the Backbench Business Committee for granting this debate. It is the third in a trilogy that the hon. Member for Bradford South (Judith Cummins) and I have secured, and that in itself tells a sad and sorry story. Complaints about access to NHS dentistry have been the No. 1 item in my inbox for getting on for two years and, while there is a particular challenge in Suffolk and Norfolk, I am conscious that this is very much a national crisis. The fundamental causes of the collapse of NHS dentistry go back over 25 years, with a gradual withdrawal of funding by successive Governments and the poorly thought-through 2006 NHS contract. Covid was the final straw that brought the edifice crashing down. The challenge now in front of us is to put NHS dentistry on a secured long-term footing, but in a way that enables our constituents, many of whom are in acute agony, to see a dentist straight away.
Date: 2023-04-27
Jill Mortimer: I, too, thank everyone involved in securing this important debate, including the hon. Member for Bradford South (Judith Cummins), who so eloquently laid out the terrible state of NHS dental services in this country today and the desperate need for reform of that terrible Labour 2006 contract, which, in effect, destroyed NHS dental services in the UK. That is why I welcome the general direction of the Government's plans for NHS dental reform, as outlined in the statement on 19 July last year. It is a good start, but we must do more. We must take this opportunity to not only put NHS dentistry back on track after disruptions during covid, but ensure we create a long-term sustainable plan to enable good NHS dentistry for all who want it. I wholeheartedly agreed with the Under-Secretary  of State for Health and Social Care, my hon. Friend  the Member for Lewes (Maria Caulfield), when she  said that "the contract is the nub of the problem; it is currently a perverse disincentive for dentists to take on NHS work."--[Official Report, 14 June 2022; Vol. 135.] That contract is the primary structural issue in NHS dentistry at the moment and has been since 2006. I have spoken to a dentist who owns 17 NHS practices across England, including two in my constituency. They are struggling financially to keep those practices going, but are totally committed to providing NHS dental services to my constituents and so push on despite the difficult environment.
Date: 2023-04-27
Jill Mortimer: No, I want to make progress. That dentist's many problems include the unfair way UDA rates are calculated, which ironically disadvantages areas such as Hartlepool, which have severe health deprivation. That has knock-on effects on their ability to employ staff at competitive rates and leads to a reliance on expensive locum dentists, further stretching the viability of the business. Dentists find a way to make their practices work with access contracts, but the lack of certainty they face because of the difference in competences between different integrated care boards adds further issues. For example, under one ICB's access contract they were provided with clarity for a two-year period, but under our ICB they were still waiting to hear at the end of the month whether a contract would be renewed four days later. Not only did the survival of the practice and the jobs of 30 staff depend on that contract, but the dental care of 20,000 patients also depended on it. Thankfully it was renewed, but it is unacceptable that the ICB provided them with no indication of whether the contract would be renewed so close to its end. No business can run like that. For areas such as mine that have a desperate need of NHS dental services, we should be fully valuing and supporting good dentists like that to ensure the survival of their essential services. I urge the Minister to consider radical reform of the way in which NHS dental service contracts are remunerated, so that established NHS dentists continue to offer NHS services to new patients. I would also like to see changes to stop newly qualified dentists being tempted into private work. It costs the taxpayer a significant amount of money to train a dentist, but they are not then required to work in the NHS. It is only fair on working people who have subsidised these professionals to train in their chosen career to expect a degree of payback. I would therefore welcome the Minister looking into the possibility of a staggered mandatory amount of NHS work per year for the first few years after qualification. Good dental care starts with good preventive care, and I want to see a day when everyone who wants it can access NHS dental services for all routine procedures and check-ups, not just emergencies, without the difficulties that my constituents are currently facing.
Date: 2023-04-27
Mary Foy: Across Durham and the whole country, dentistry is in crisis. It is a system in need of urgent reconstruction, not tinkering. To be clear, the problem has not been caused by NHS workers or dentists. It has been caused by the Conservative Government, who have ignored the concept of prevention rather than cure. Dentists have told me that the key  issue is the chronic underfunding of NHS dentistry. Let us not forget that it has been subject to cuts unparalleled elsewhere in the NHS. There is a real recruitment and retention crisis in the workforce, but the situation cannot be improved by simply recruiting more dentists. The fact is that NHS dentists are made to work in a fundamentally flawed system that does not have prevention at its heart. I fear that if NHS dentistry continues down this road, England may have an entirely private dental provision, and the facts speak to that. In August last year, the BBC showed that eight in 10 NHS practices were not taking on children as patients, nine in 10 practices were not accepting adult patients, and a third of council areas were not taking on adult NHS patients. How can we have a preventive approach if my constituents cannot get to see a dentist? In addition, tooth decay is the most common reason for A&E hospital admissions in young children. That is a disgrace. Nothing could reflect the current crisis more than DIY dentistry. People are fitting their own fillings and extracting their own teeth without anaesthetic or professional training. This week alone, I have been contacted by eight constituents who have performed DIY dentistry. The situation is compounded by the cost of living crisis, which is blighting the lives of ordinary people. If someone needs to choose between eating and heating, they will probably not want to fork out for an expensive root canal; they will probably choose to have an extraction instead or do it themselves. This is a stark example of health inequalities. I have some questions for the Minister. When will the Government adopt a preventive approach to health and social care, particularly to dentistry? When will the Government provide NHS dentistry with the funding it desperately needs? Has the Department had meetings recently with the Treasury to discuss funding? When will the Government work with the British Dental Association to reform the current dental contract, to stop the exodus of staff from the NHS? In 1948, Labour recognised that it was vital to integrate dentistry within the NHS and that oral health is not an optional luxury but integral to our national health and key to the NHS. How we tackle it must therefore be a priority, not an afterthought. Only a Labour Government can save dentistry from the rot and decay that has set in under the Tories' watch.
Date: 2023-04-27
Darren Henry: Like many colleagues, I have received a large volume of communications from constituents in Broxtowe regarding the ongoing problems with securing an NHS dentist appointment. Polling conducted by YouGov on behalf of the British Dental Association has shown that one in four adults in England have already delayed or avoided much-needed care due to cost. I am aware that improving access to NHS dentistry is one of the Government's key priorities for our health service. It is evident that waiting times have been affected by the infection control measures required during the pandemic. Despite these pressures, dental services in many parts of England have been slowly recovering, which is good to see. However, much more must be done to reduce waiting times and ensure that appointments are available. As my hon. Friend the Member for Winchester (Steve Brine) said, we need more gums on seats. The BBC recently contacted every NHS dental practice in England and found that 91% were not able to accept new adult patients and 80% were not able to accept new child patients. This is not acceptable. Oral health inequality is rising, and we must act now to ensure that we focus on retaining current dentists, recruiting new ones and ensuring that adequate funding is in place. My constituent Sacha told me about the difficulty she has had. Not being able to book a dentist appointment has caused her great stress and anxiety. She will potentially lose her teeth if a dentist is not found. Sacha has gum disease and is supposed to see a dentist four times a year. She faces great pain and does not have the option of visiting a private dentist. I have heard many cases like hers, and a private dentist is often not an option. People should not have to turn to private dentists. Sacha is currently waiting for a response from NHS England. Another constituent, Joan from Toton, recently shared her difficulties with me. She rang multiple practices in her area but was told there are no NHS dentists available. Joan is 70 this year and should not be unable to get basic dental care. It is essential that we fix this problem by ensuring that new NHS dentists are entering the workforce and that we retain the ones we currently have. The Government have rightly been holding talks since 2021-22 with the British Dental Association and other stakeholders on reforming dental contracts. Through these talks, a number of steps have been and are being taken, including improving financial incentives for dental practices, supporting new practices to take on patients and supporting people with dental costs, but more must be done. The Department of Health and Social Care has stated that it will publish a plan for dentistry in the coming months. I welcome that announcement and look forward to receiving the plan. In the meantime, I implore the Minister to do all he can for those, such as Sacha and Joan, who face not being able to access dental treatment.
Date: 2023-04-27
Peter Dowd: I thank my hon. Friend the Member for Bradford South (Judith Cummins) and the hon. Member for Waveney (Peter Aldous) for securing this debate, and I thank other hon. and right hon. Member for their persistence in pursuing this matter and ensuring it remains a priority. It is worth repeating that this debate is about the progress on reforming NHS dentistry. The two colleagues I mentioned made the case for this debate: "Underfunding and the current NHS dental contract are to blame for long-standing problems with burnout, recruitment and retention in NHS dental services. Morale amongst NHS dentists is at an all-time low and we are facing an exodus of dentists from the NHS. Reform of the dysfunctional NHS dental contract is a matter of urgency--a reformed service won't work if there is no workforce left by the time it's finally introduced." To solve the problem, it is crucial to accept that there actually is a problem, and it is important to recognise the extent of that problem. The first question I want to ask the Minister is whether he accepts that there is a problem with access to NHS dental services.
Date: 2023-04-27
Nicholas Fletcher: I will try to keep my contribution short, as many points have been covered already by hon. Members on both sides. The simple problem is that the dentists do not feel that they can function on their current contract, so asking them to do 110% of their contract when they do not want to do the initial 100% of their contract is not a way forward. We need to look at the UDA contract to make it more financially viable, because at the moment dentists are taking on private work to subsidise their NHS work. The UDA contract is a problem across the board. If there were one or two dentists across doing it, we could say, "Well, maybe that's their business plan.", but it is not. It is happening across the board, and we need to look at the contract. We also have a problem with dentists coming through. We need more dental places. As colleagues have mentioned, we ought, maybe, to look at a bursary for dentists who commit to stay in the NHS for at least five or 10 years, so that we have the dentists within the system to cope with the demand that is out there. I am not 100% certain about taking dentists in from abroad. I always think when we pull the lever of immigration it goes against the grain of a Conservative Brexit MP such as myself, but there is also the fact that we are taking skilled people from other countries. If that is what we need to do to cover the backlog, then fair  enough; I can understand a certain amount, but I always believe in training our own people and training them well, and I think that is what we should do. Finally, I thank the dentists in my constituency. John Gatus is a fantastic chap and he has explained a lot about what we are dealing with now. I know the Minister is a good Minister. I know he has listened to everything that has been said in this debate and I know he wants to get this sorted out, but I ask him and everyone in this House to remember what it is like to have toothache. We all need to remember that. Let us all cast our minds back to those 24 hours when we could get no sleep and we were in pain. It is dreadful, and an awful lot of my constituents are in that position now--or, what is worse, seeing their children go through it. We need to jump on this problem and we need to jump on it now. I am hopeful that the Minister will deal with this today.
Date: 2023-04-27
Neil O'Brien: The hon. Lady is right; in dentistry, not only do we have headcount measures showing that six and a bit per cent. more dentists are doing NHS work, but we can see the amount they are delivering and we can see those UDA rates starting to go back up again. Of course, we want them to go up further, and I am keen to start publishing more data so that there is greater transparency about what is being delivered where. There are further changes we must make. We are trying to drive activity back up to at least pre-pandemic levels and to address the fundamental shortfalls that were there even before the pandemic. When I speak to dentists, they have a keen sense of whether the payments they are offered under the 2006 contract make work profitable or unprofitable. Often, for some of those bands, they feel that they are not being fairly remunerated for the cost of the work they are doing. We need to make sure that they do feel fairly remunerated so that they are more attracted to doing NHS work. We could go further in addressing some of those historical, and potentially now unjustified, variations in UDA rates. In particular, the move to ICBs and away from regional commissioning provides an opportunity for not just more transparency, but much more accountability. Instead of a remote regional body, hon. Members will be able to talk to their local ICB about what it is doing to drive up delivery. When we arm Members of this House with greater transparency and greater data, they will be able to have those conversations about what we are doing collectively to drive up the levels of delivery.
Date: 2023-04-27
Sharon Hodgson: I am listening intently to what the Minister is saying. When I go back to speak to my local dentists, what do I tell them about the "when"? He is saying all the things that we would like to do and the Government would like to do. We want to see all that happen, but when will this contract that has needed changing since 2010--[Hon. Members: "2006!"] We had it in our manifesto to update it in 2010. We had said  we would update it in 2010. The Government have had 13 years to fix this, so when is it going to happen?
Date: 2023-04-27
Neil O'Brien: I have mentioned some things that are already changing--some of the first reforms to the contract since 2006 that we have started to bring in. We are working on the plan at pace. There is no date for its publication yet, but we are working on it at pace because we are conscious of the urgency. I thank the hon. Member for Bradford South and my hon. Friend the Member for Waveney for securing this important debate. I hope they have been assured that we have started to reform dentistry, that we are seized of the importance of the issue, and that we recognise that we can and must go further to further strengthen NHS dentistry.
Date: 2023-04-27
Judith Cummins: Thank you, Mr Deputy Speaker. I thank all 19 Members for their contributions and interventions, for which both I and the hon. Member for Waveney (Peter Aldous) are immensely grateful. Although the contributions are too numerous to mention, I will highlight the one from the hon. Member for Winchester (Steve Brine), the Chair of the Select Committee, which encapsulated many of the common themes. He spoke on a wide range of issues, including the lack of access to NHS dentistry and the problems, not only in his constituency, but right across the country, of the retention of NHS dentists and the lack of transparent data. He also talked about the need to have dentists represented on ICBs. Many Members raised those common issues of access, including my hon. Friend the Member for Bootle (Peter Dowd), who spoke of a lack of funding. He posed two crucial questions: does the Minister accept that there is a problem?; and, if so, what progress has he made in resolving it? My hon. Friend then concluded that the situation has worsened since last year. Clearly, the need for full-scale reform has been recognised right across the House today, as we all know that change is needed. The fact that 90% of NHS dentists are no longer accepting new adult patients reflects the severity of this crisis. We have reached the point where the patching of our services is no longer possible and many of our constituents are simply suffering with the inadequacies of the current system. We need fundamental NHS dental reform now, not a plan for a plan. Minister, the promise of reform and this plan must come with real action and a firm date of publication. Question put and agreed to. Resolved, That this House has considered progress on reforms to NHS dentistry.
Date: 2023-04-27
Nigel Evans: We were going to come to the debate on reducing plastic pollution in the oceans. I said that it would be repositioned, but that is clearly not the right word, because it will still be here. "Rescheduled" is what I was grasping for, and I have now finally found the word. We hope that it will be rescheduled in the not-too-distant future, because it is a very important debate, and it was right not to truncate it in the way that was going to happen.
Date: 2023-04-27
Jim Shannon: I congratulate the hon. Gentleman on securing the debate. I recognise that he is coming to a critical point. This is about the suppression not just of human rights, but of freedom of religious belief. They walk hand in hand: if someone's human rights are taken away, so is their opportunity to worship their God in the way that they wish to. Does he agree that, when it comes to the Act that he refers to, human rights and the freedom of religious belief will be under immense pressure?