Date: 2023-04-27
Neil O'Brien: I thank my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins) for securing this important and timely debate as we work  on our dental plan and the NHS workforce plan. We have had some excellent and useful contributions, and all the ideas that have been put forward are extremely timely. The hon. Lady said it is time for real change, not patching, and I completely agree. The Chair of the Select Committee, my hon. Friend the Member for Winchester (Steve Brine), made too many important points to list, but he made an important point about the need for greater transparency on data and delivery, and I completely agree. The hon. Member for Washington and Sunderland West (Mrs Hodgson) listed some of the problems that are firing our ambition to fundamentally change the system. My hon. Friend the Member for Waveney made a series of important points, and I am grateful for his contribution not only today and in previous debates but outside the Chamber. He has many thoughtful observations to make about ringfencing, changing the UDA system, fluoridation and so on, and all those ideas are flowing into our work. The right hon. Member for Kingston upon Hull North (Dame Diana Johnson) was the first in this debate, but not the last, to emphasise the importance of where dentists do their training and foundation training to getting more dentists into under-served places, which we are looking at. My hon. Friend the Member for Hartlepool (Jill Mortimer), like my hon. Friend the Member for Waveney, talked about the perverse effect of the contract bands. That was brought home to me by the conversation she engineered for me with some of her local dentists. I found that conversation incredibly useful. Their passion for NHS work and dentistry shone forth, and it brought home the central role of local commissioners in making the choices of the kind she raised in this debate. The hon. Member for City of Durham (Mary Kelly Foy) talked about the importance of prevention, not just treatment, and we are thinking about that. My hon. Friend the Member for Broxtowe (Darren Henry) raised the important issues for Sacha and Joan, and I am happy to meet him and his local ICB to talk about how we can address those cases. The hon. Member for Bootle (Peter Dowd) asked whether we have gone far enough. No, we have not, hence the need for a dental plan. My hon. Friend the Member for Milton Keynes North (Ben Everitt) emphasised the need for housing plans to take better account of the need for primary care facilities and dentists, which we have discussed outside the Chamber. Some places do it well, but that does not happen everywhere, including in his local authority. The hon. Member for York Central (Rachael Maskell), as always, made interesting comments about prevention among young people, which we are certainly looking at. My hon. Friend the Member for Barrow and Furness (Simon Fell) was the first person to mention that the overseas registration exam is much too long-winded, and that it takes people much too long at the moment. The legislation to enable that to change came into force last month, and we now need the GDC to move quickly to address the backlog and those problems. It is always a pleasure to hear the hon. Member for Strangford (Jim Shannon) speak in a debate to bring a UK-wide perspective, and he asked a straight question about how we are engaging with the profession. We are generating these ideas by talking directly to dentists.  My right hon. Friend the Member for Tatton (Esther McVey) said that dentists had told her that the 2006 contract had never worked, and I have certainly heard that from many dentists. I am happy to meet my hon. Friend the Member for Bolsover (Mark Fletcher) and his ICB to discuss the recommissioning of services. He raised the issue of Bupa, and I agree that having a three-way meeting would be useful. My hon. Friend the Member for Don Valley (Nick Fletcher) got to the nub of the issue when he talked about basic incentives. When I visited my hon. Friend the Member for North Devon (Selaine Saxby), I was once again reminded of the particular challenges of coastal communities, and that is especially true in dentistry. We have talked about this before and are thinking about how to get dentists to go places that are historically under-served. My hon. Friend the Member for Broadland (Jerome Mayhew) raised the same point, as well as a deep question about the historical allocation of funding in dentistry. We are certainly looking at that. I reassure him that we are also looking at the whole issue of centres for dental development, and the proposals emerging in his area are extremely interesting. Last but not least, my hon. Friend the Member for Keighley (Robbie Moore) mentioned our new requirement for dentists to keep their records on the NHS website up to date. We are keen to drive that forward and to ensure that records are accurate for exactly the reasons that he mentioned. Dentistry was hit much harder than most other health services because of its fundamental nature: dentists are looking down people's throats and creating a lot of aerosols, so of course during the covid pandemic the sector was particularly hard hit. We allocated PS1.7 billion of funding to carry NHS dentists through the pandemic, which enabled many to survive, but dentistry was clearly hard hit, and it is a hugely important part of the NHS, as many Members have said. The package of changes that we brought in last July were an important first step--only a first step--in addressing the challenges facing the sector. We have started to reform the contract, with the first significant changes since 2006, to make NHS dentistry more attractive. We have created more UDA bands to better reflect the fair cost of work and to incentivise NHS work. We introduced for the first time a minimum UDA value to help sustain practices where values are lower, and to address unfair and unjustified inequalities in UDA rates, which are now based on quite historical data. We have enabled and allowed dentists to deliver 110% of their UDAs for the first time to encourage more activity and to allow those who want to deliver more NHS dentistry to do so. We have also made it a requirement for the first time for dentists to keep their availability up to date on the NHS website. We have also made it easier--a number of hon. Members have made this point today--for dentists to come to the UK. The legislation came into force last month to enable the GDC to increase the capacity of the overseas registration exam. As of 1 April, people will no longer have to pay the charges that they used to pay. The Chair of the Select Committee stressed how important it was for the GDC to respond to those increased flexibilities and to work at pace to get through  the backlog, and we are actively in discussions with it about how best to do that. Plans are advancing for centres for dental development, as a couple of different hon. Members have mentioned, not just in Suffolk or Norfolk, but further afield, such as in Cumbria. We are watching those plans closely and working with local partners to see what is possible. Hon. Members raised the matter of prevention. We have already started the process of expanding fluoridation across the entirety of the north-east, which would--subject to consultation--encompass about 1.6 million more people. We will be launching that consultation this year in order to provide the benefits of fluoridation to a large new area for the first time since the 1960s. All these changes are starting to have some positive effects. In the year to March, about a fifth more patients were seen compared to a year earlier. In total there are about 6.5% more dentists doing NHS work now than in 2010, and UDA delivery is going up from that huge hit it took in the covid pandemic, but of course we must go further; I am the first person to say that. I can see that some of the reforms are working. The proportion of dentists making the new band 2b claims is increasing and it is great to see that practices are prioritising those with higher needs. But this is absolutely just the start and I know that we must go further.