Dental appointment backlogs set to get even worse as MPs expose dire situation in Yorkshire

Health Minister Maria Caulfield told a Westminster Hall debate that Covid rules relating to dental practices over the past two years has led to major pressures on the system and accepted there were problems across the country with accessing appointments.

“The backlog that generated is something we are all seeing in our postbags right now,” she told MPs.

"Urgent appointments went back to pre-pandemic levels in December 2020, but with only 85 per cent of activity allowed the backlogs will only grow. We need to be honest about that; the impact is significant. I completely understand the pressures that that is putting on dentists."

Ms Caulfield admitted that issues with accessing dental treatment could not solely be blamed on the pandemic.

"There were problems before Covid and there are those same problems post-Covid, and we are absolutely focused on starting to tackle them," she said.

Her comments followed concerns being raised in the debate about the crisis state of dentistry in Yorkshire by cross-party MPs, with some patients unable to get appointments extracting their own teeth.

York Central MP Rachael Maskell said she had been "inundated" with correspondence from constituents seeking help to get dental appointments.

"It is getting harder, because dentists are disappearing, waiting lists are growing and oral health is deteriorating rapidly," she said.

"In York, it can take five years before people can see a dentist, and no practices are seeing new patients. Out of 39 practices, only one is accepting NHS patients on to a waiting list, but it already has 2,000 people on it."

Ms Maskell added: "In the midst of this crisis, many are receiving letters to say that their NHS dentist is going private, and they are therefore left without. One constituent said that they had spent their burial savings on tooth treatment, and another extracted his own tooth. This is a time of real crisis.

"Some of my constituents have found a dentist 40 miles or more away, and some say it is cheaper to travel abroad. Many have no dentist at all. The cost of living crisis is bearing down on York because of housing costs, meaning that people simply cannot afford to go private."

She said the situation is on course to get even worse, with over 40 per cent of dentists planning to leave the profession according to a recent survey. Ms Maskell said that at one practice in her constituency, three receptionists had left "because of the abuse they get from very frustrated members of the public".

The Labour MP called for the creation of a new National Dental Service.

"The system is so broken that we need to build it from scratch. The service must be free at the point of need and should never be dependent on people’s ability to pay," she said.

Bradford South MP Judith Cummins, who jointly led the debate with Conservative MP Peter Aldous, said that more than 40 million dental appointments had been lost since the start of the pandemic - equivalent to an entire year's worth disappearing.

"Even before Covid began, enough dentistry was commissioned for only half the adult population in England to see an NHS dentist just once every two years. With capacity now even more severely limited by Covid, access problems have reached an unprecedented scale in every community, with existing inequalities in access and outcomes widening even further."

Mr Aldous said that the East Yorkshire coastline is among the parts of England that are becoming "dental deserts".

"Figures published in March 2020, before the pandemic, show that 25 per cent of patients new to practices in England could not get an appointment. The situation has got worse: the most recent figures, from 2021, show that that number has increased to 44 per cent.

"Dentistry was locked down from March to June 2020 and the ongoing restrictions on dentists - fallow time between appointments - are still limiting the ability to see more patients."

He said: "The lack of access to NHS dentistry has a fivefold impact on patients. First, millions are missing appointments. Secondly, there has been a significant increase in DIY tooth extraction. Thirdly, the poor are hit hardest. Fourthly, mouth cancers are going undiagnosed. Finally, children are suffering."

Mr Aldous said the current target-driven contract for NHS dentists, which was introduced in 2006, has been "widely recognised as not fit for purpose" and is a "major driver of dentists leaving NHS dentistry".

Ms Cummins said she had received a briefing from Bupa who told her it has a growing number of loss-making sites among its 306 practices with an NHS contract.

"It points out that these NHS practices would not be sustainable if they were independent—they are kept afloat by Bupa’s private practices. To be clear, that is private healthcare subsidising the NHS," she said.

The MP added: "The BDA estimates that it would take £880 million per year just to restore NHS dental budgets back to 2010 levels. Chronic underfunding and the current contract are to blame for the long-standing problems with burnout, recruitment and retention in NHS dental services, with almost a thousand dentists leaving the NHS in England in the last financial year.

"Unless what the Government are seeking is the ultimate demise of NHS dentistry, we really need to see a change in the contract. NHS dentistry was in trouble before covid-19 and is now facing an emergency."

She said problems are particularly pronounced in Bradford and Yorkshire.

"In Bradford, almost 1,000 children under the age of 10 had to be admitted to hospital to have decayed teeth removed under a general anaesthetic in 2019-20," she said.

"Thousands of children in Bradford and across the country are waiting in pain, taking painkillers and potentially multiple rounds of avoidable antibiotics to control their infection while they await surgery. No figures for the size and length of waiting lists for hospital tooth extractions in children or vulnerable adults are currently collected, but I am told that people are routinely waiting as long as two to three years—that is two to three years in acute pain.

"Yorkshire and the Humber is currently the worst performing area in terms of child oral health, with more than one in seven children in the region suffering from decay by the time they are just three years old. That is more than double the rate in the east of England, where only one in 15 children are affected by that age."

Thirsk and Malton MP Kevin Hollinrake said dentistry problems was one of the issues he first raised when he became an MP in 2015 but the situation has "actually got a lot worse" since then.

"The reality is that it is impossible for most people in my constituency to get on an NHS waiting list. We must be honest with the public: either we open the gates so that more people can access treatment, or we tell them that dentistry is for some people and not for others," he said.

"This morning I checked across North Yorkshire - which is larger than my constituency - and there is simply no availability on NHS waiting lists. It has been like that for most of the seven years I have been in Parliament."

He highlighted two "unacceptable" cases from his constituency - one of an adult with special needs who has had to go private to get a tooth removed due to an abscess after problems developed because he couldn't get regular check-ups.

Mr Hollinrake said of the second case: "Even worse than that, a lady from Rillington wrote: 'My daughter has a toothache and needs to see a dentist… Our dentist ceased providing NHS services and there is nowhere else we can get into… They advised us to ring 111… and we were told a dentist would get back to us within 7 days. No one did. Tonight we rang again. We were on hold for 2 hours before we got through to the Yorkshire and Humber Dental Services, who told us they have no capacity to help'.”

He said it was vital to simplify the commissioning process for securing NHS dentistry after a 20-month wait in Helmsley to reopen their NHS dentists "despite the fact that we had someone who was willing to take the contract right from the start".

"I agree with others who suggest devolving this stuff back to local areas: we can look after it and commission the treatment, rather than having it all done centrally by super-regional managers," he said.

Responding to the contributions, Health Minister Ms Caulfield admitted there would be "some difficult steps to take to improve dental services across the board".

She said: "Since I came into post in September, dentistry has absolutely been a priority for me. I have been working night and day to try to make some short and long-term improvements, because I am live to all the concerns that have been raised."

Ms Caulfield said that the current dental contract "is the crux of the matter" and negotiations are beginning with the British Dental Association on changing the way it operates.

She said: "I say to any dentists watching the debate that I absolutely understand the problems that make delivering an NHS contract unbelievably difficult. The contract is the number one long-term issue that we have to deal with, and we are starting progress on that as soon as possible.

"The dental contract is the crux of the matter, and we are absolutely committed to reform. I met the BDA this week to start negotiations.

"We have started informal negotiations, and the formal negotiations will start in April. We all - the BDA, patients, MPs and the Department - know the urgency. It cannot be a long, protracted negotiation. However, we are working well with the BDA. We are keen to get negotiations under way and to reach a resolution as quickly as possible. We have to make the NHS a better and more attractive place to work, because dentists have other options."

Following the debate, the Association of Dental Groups called for "root and branch reforms" in the sector.

Neil Carmichael, Chair of the ADG said: “Last year the NHS lost a record 116 dentists in Yorkshire & the North East. Child patients now unable to access regular appointments across Yorkshire will be suffering the most.

“The solution is simple – we need more dentists. We welcome the announcement of additional funding but more must be done to attract people into the profession otherwise we are going to see more 'dental deserts' like those all along the Yorkshire coastal towns.”

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