Neil Carmichael: Levelling up must include improving access to NHS dentistry

22 Nov

Neil Carmichael is the former Conservative MP for Stroud 2010–2017 and the Executive Chair of the Association of Dental Groups, the trade association representing dental groups whose members are delivering NHS and private dentistry across the UK.

Every MP from across the political divide will have heard the growing crisis in access to NHS dentistry from their constituents this year. As Government grapples with the meaning of “levelling up” it is clear that equitable access to NHS dentistry has long been left behind.

In response to the tax rises to clear the NHS backlog in September a voter from Blyth, speaking to LBC stated, “it still won’t help get me an appointment or see a dentist.” These are the real world voter expectations that have to be met in the next two years as the stories of “DIY dentistry” mount.

The findings of Public Health England’s report Inequalities in oral health in England published this year are stark – for example, relative inequalities in the prevalence of dental decay in five-year-old children have increased from 2008 to 2019. These inequalities will only now be deepening as the impact of the pandemic becomes clearer – latest figures show around nine million children in England have missed dental treatment in the 12 months to March 2021.

The report also confirms a North/South divide exists running through the former “Red Wall” (together with pockets of deprivation in London and coastal communities in the South). It is at its worst in rural and coastal communities, as highlighted by MPs from Lincolnshire, Norfolk, Cumbria and Yorkshire in recent parliamentary debates. The challenge for a Government so committed to “levelling up” is clear.

There is no one simple explanation for this divide. Over the last 10 years, government net spend on NHS dentistry has been flat with no increase with inflation, which in real terms represents a cut. However, current NHS spending can be used more wisely. It is widely accepted, all the way to ministerial level that the current NHS dental contract of UDA activity is broken and the time has clearly come for more local flexible commissioning for hard to reach groups such as children and care homes.

But the immediate crisis is in the workforce – 951 dentists across the whole of England chose to cease NHS activity last year, many due to burnout and the NHS contract. Recruitment is no longer a “local” problem. We agree with Jeremy Hunt who argues for proper long term workforce planning by the NHS and incentives for dental teams to raise outcomes where need is highest. Put simply, “we need more dentists.”

MPs in Lincolnshire, the Isle of Wight and Yorkshire have called for new dental schools. But training a dentist takes over five years. To date, recruitment challenges have been met through overseas professionals coming to work in UK dentistry. This will remain part of the solution in dentistry and healthcare as a whole. A Global Britain should attract the best clinicians from the rest of the world. However, the registration process administered by the General Dental Council for overseas dentists to work here has been suspended for two years due to the pandemic, choking off recruitment. It urgently needs reforming and restarting.

Finally, nearly a decade has been lost whilst responsibility for water fluoridation stagnated at local authority level. Now the Government is following the example of New Zealand and taking powers directly to roll out fluoridation this can change. The British Society of Paediatric Dentistry estimate that water fluoridation could reduce tooth extractions in children by as much as two thirds in the most deprived areas.

Lack of access to NHS dentistry is a real and visible example for communities that sense they are “left behind” and addressing this must be part of “levelling up” health. Failing to do so will see dentistry become the next workforce crisis in the headlines. Doing so will begin to narrow the gap of inequality and “put the mouth in the body” across the whole country.

Paul Bristow: Ministers must make it easier for the NHS to recruit dentists from overseas

9 Oct

Paul Bristow is the MP for Peterborough and a member of the Commons’ Health and Social Care Select Committee.

As we prepare to leave the European Union on January 31, the UK is forging new bilateral relationships and turning towards our long time Commonwealth allies. As we do so, we will gain the flexibility to solve many of our national challenges, both big and small, as a part of the global community. One such challenge is improving access to dentistry.

Across Britain, NHS dentist numbers are falling. My own constituency is no exception, with Peterborough seeing a decline of 2.5 per cent in NHS dentists from 2018/19 to 2019/20. In other areas the latest figures show dentist numbers dropping more dramatically, and it is local people who are paying the price. A recent report found that Plymouth had 14,000 patients, including 3,000 children, on a growing waiting list for dental care.

Covid-19 has made it even harder for many people to get access to the dentist, with the Association of Dental Groups finding that less patients are being seen and some of the most vulnerable groups are being hit hardest.

But even before the pandemic struck, many parts of the country were already seeing rising oral health problems due to the shortage of dentists. Last year new cases of mouth cancer increased by ten per cent in the UK and hospitals in England carried out an average 177 operations a day on children and teenagers last year to remove rotting teeth, costing the NHS more than £40m.

To ensure that people can get the treatment they need, we need to attract and train more people here in the UK to become dentists. But this is not a short-term fix. Currently training takes five years to complete and Covid has further complicated matters for dental students. With Covid-19 exacerbating the existing crisis in access to dentistry, we need to act immediately.

Brexit presents an opportunity to turn the situation around now by attracting outstanding clinicians from around the world. As we build relationships with potential trading partners outside of Europe, we should look at making it easier for overseas professionals to enter UK dentistry.

For example, India is one of a number of Commonwealth countries with outstanding dental schools. The country trains more than 30,000 dentists per year. This had led to an over-supply of skilled dentists in India and significant demand for British qualifications. Once the UK has left the European Union, we could assess and mutually recognise those schools that meet our standards. If just ten per cent of the dentists trained every year in India were recruited to work in NHS dentistry in the UK, the current severe problem of access would be dramatically reduced.

At present, there are too many obstacles standing in the way of skilled dentists who wish to come here from overseas. On average, over the last year, it has taken 199 days to recruit an EU dentist into the NHS, despite current mutual recognition. For candidates who qualify in the Rest of the World, the system is deeply complex and can take considerably longer.

Now is time for the system to be simplified and hurdles removed. In the summer, the Government announced a new health and social care visa to attract the best overseas professionals to work for the NHS. Over the next few months we could build on this by making it easier for skilled dentists and dental therapists from overseas with an offer of a contract to start work for the Health Service in the UK. The General Dental Council is also being urged to look at how to reform the Overseas Registration Exam and recognise the qualifications of dental schools meeting UK standards in territories outside of the European Economic Area.

Making it easier for the NHS to recruit skilled clinicians from overseas in this way will improve patient access to vital NHS dentistry, particularly in more deprived parts of the country where oral health outcomes are being hardest hit. It will also help us take advantage of the UK’s decision to leave the European Union by creating closer relationships with Commonwealth countries. It would be good for global Britain and good for communities across the UK, from Plymouth to Peterborough.

Dean Russell: As a volunteer in my local hospital, I saw at first hand the damage done by NHS fearmongering

1 Sep

Dean Russell is the MP for Watford and a member of the Health & Social Care Select Committee.

Concurrent with Matt Hancock’s recent announcement about the creation of the National Institute of Public Health (NIPH) came the usual reactionary political cries that this means the NHS is under threat of privatisation.

The sad truth is that whilst politicians are repeating old myths like a broken record, they once again fail to look at the actual record of the NHS under the Conservatives since its inception in 1948; in doing so, they are causing genuine distress to those who are most vulnerable.

I understand that old habits die hard when it comes to political fearmongering; however, in the efforts to win votes through these repeated false claims, they are only hurting the very people they claim to protect – health and social care workers.

The problem with these entrenched and unfounded claims around NHS privatisation is that politicians make it difficult to be open about where issues exist within these large institutions, which, in turn, means that front line staff are the worst hit.

Just this week, I was fortunate to spend a day with St John Ambulance and meet hospital staff who they had been volunteering alongside during the crisis. They all made the point that that pre-Covid the levels of red tape and bureaucracy needed to enable St John Ambulance to help volunteer on wards would have been too immense ever to see it happen.

The nature of the Covid crisis enabled the NHS to be allowed to utilise the assets that an organisation like St John Ambulance teams can provide. This additional workforce during such an unprecedented crisis has provided invaluable support to NHS staff. I am confident if any Conservative politician had tried to suggest this last year, they would have been lambasted for attempting to undermine NHS staff or for putting the UK on a “slippery slope” towards privatisation.

Since March, I have volunteered with my local hospital – something I feel incredibly fortunate to have been able to do as it enabled me to support the frontline in action.

What struck me at the height of the crisis was how impacted NHS staff were by some sections of the media and those who engaged in baseless NHS political point-scoring. When the news was reporting the country was running out of PPE, despite the fact my local hospital had stock, I could hear the concern in the voices of some staff that they thought they were about to run out imminently.

Like the rest of the country, NHS staff, too, are watching the news day after day. When they hear a constant flow of the absolute worst-case scenarios presented as the norm, it understandably affects their anxiety levels.

Whilst the NHS has been presented with challenges it had never faced before, the unhealthy obsession with scaremongering poses a threat to NHS employees mental health and the morale of the nation.

Our NHS is the most prized possession in the Government’s arsenal, and it has become a proud cultural symbol for Britain. The uncorroborated and alarmist claims by part of the media and fed by some politicians deny honest and nuanced debate about the issues facing the NHS and social care both during Covid and looking long-term.

One of the many reasons I am proud to be a new MP as part of the 2019 intake is because of our Party’s renewed focus on health social care. During Labour’s time running the NHS, use of Public Finance Initiatives (PFI) increased to the point that even The Guardian described its crippling effects on hospital budgets.

It was Hancock who wrote £13.4 billion off hospital debts, much of which had accumulated due to PFI contracts. It was formerly Chancellor Phillip Hammond who ended the use of PFI and PF2 contracts. It was the last Labour government who privatised Hinchingbrooke Hospital, which the Conservatives then took back into public ownership in 2015.

More recently, the opposition has found itself at odds with the CMO and BMA over attempts to change testing policies through an amendment in Parliament. Even during the early history of the NHS, it was Labour who introduced prescription charges along with charges for spectacles and dentistry.

As a member of the Health and Social Care (HSC) select committee, I don’t shy away from being critical myself. I am aware of the need for transformation in many areas. It has been clear to me that the parity of esteem between physical and mental health, for example, needs addressing much more robustly. As does the parity between NHS and social care workers.

The good news is I believe the decision-makers for these areas have heard this call loud and clear from the very top and are focussing on solutions.

The announcement by Hancock mid-August regarding the creation of the NIHP was an important step that sadly once again had to battle against the noise of opposition repeating the old “privatisation” rhetoric.

For anyone who listened carefully, they would have heard this critical line at the end of the speech. The Secretary of State said, “It (NIHP) will work hand in glove with the NHS, and it will use the most modern, cutting-edge digital and data analytics tools at its core.” Such remarks are not about privatisation, but about a new era of agile government supported by highly capable health agencies.

The easing of unnecessarily bureaucratic systems, the harnessing of technological capabilities, the rise of telemedicine and enhancing the powers of frontline staff should now become the new norm for healthcare.

We have also seen a robust partnership with AstraZeneca and others with the vaccine development, the use of private healthcare facilities for public purpose and the building of the Nightingale Hospitals’ at a record pace. The Government will enable the NHS to spend £10 billion over the next four years on private hospitals to tackle waiting lists.

Not one aspect of this has been a drive towards privatisation, but a more collaborative way of working that aims to benefit patients and staff.

I am not arguing that the Government shouldn’t be put under intense scrutiny by the opposition – in fact – I welcome it. We must end this knee-jerk media scaremongering that only puts fear into the most vulnerable and those working on the frontline.

What we need is a visionary approach to healthcare for this century if we want to seek ways improving patient outcomes and being the best possible employer for Health & Social Care staff. 65 per cent of the NHS’s history has been under a Conservative government, and privatisation simply has not happened under our watch.