Dentistry: Access for Cancer Patients

Antimicrobial Resistance – in Westminster Hall am 4:54 pm ar 17 Ebrill 2024.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Photo of Andrew Western Andrew Western Opposition Whip (Commons) 4:54, 17 Ebrill 2024

I beg to move,

That this House
has considered access to dentistry for cancer patients.

As always, it is a pleasure to serve under your chairmanship, Mr Dowd. I want to start this debate, which I am delighted to have secured, by paying tribute to my constituent Michele Solak-Edwards, who is here to listen to the proceedings. Her phenomenal campaigning on these issues is the reason that we are all here.

Back in 2016, after a routine health assessment, Michele found out that she had triple negative breast cancer—a devastating diagnosis, followed by nine months of gruelling chemotherapy. Among the many, many challenges that Michele faced in that time was a deterioration in her dental health. That is a common yet rarely discussed side effect of chemotherapy and radiotherapy.

Unlike other physical side effects of cancer treatment, which may be medicated with the free prescriptions that cancer patients are entitled to, any side effects requiring dental treatment must be paid for. As we all know, the costs of dental treatment, even if someone is lucky enough to be registered with an NHS dentist, can be overwhelming. For Michele, the significant costs of her dental treatment had to be paid for at a time when, like many other cancer patients, she was unable to work because of her condition.

When Michele was going through one of the most difficult experiences a person can face, she found that accessing affordable dentistry was yet another obstacle for her and others in her position to overcome. So like all great campaigners, she took action to make a difference. She set up an online petition calling for better access to dentistry for cancer patients and for dental care to be free for cancer patients for five years from diagnosis, or until the end of life, if the diagnosis is terminal. This is crucial, given that dental issues do not always become apparent straight away at the outset of cancer treatment, and the issues caused can take a number of years, in some cases, to present themselves.

Within weeks, Michele had more than 130,000 signatures on the petition, with support from dentists, surgeons and oncologists. The petition now has the backing of almost 200,000 people, many of whom are cancer survivors. It is a privilege to be able to highlight its importance to the Minister today. Why is it important? Primarily, because there is an indisputable link between cancer and dental health issues. As the National Cancer Institute said, chemotherapy and radiotherapy can cause dental side effects, with both therapies altering the balance of bacteria in the mouth, leading to ulcers, tooth decay and potentially serious infection.

The link between cancer and dental health does not end there, because existing dental problems can worsen during cancer treatment, which can then impact the effectiveness of treatment or lead to it being delayed. That is why it is widely recommended, including by the British Dental Association, that a dental health assessment should take place after a cancer diagnosis and before the start of treatment.

While the link between cancer and dental health is clear, the pathway from a cancer diagnosis to dental health treatment is often blocked. The biggest issue is the crisis in accessing affordable dentistry. This challenge is not unique to cancer patients, with one in four of Britain’s adult population unable to see an NHS dentist in 2022. In my and Michele’s local authority area of Trafford, only 4% of dental practices are accepting new adult patients on the NHS, and that is by no means a low number, based on current availability. What this means for most people is the choice of going private or going without. When the costs of private dentistry are so high, that is not really a choice at all for many, especially for those on lower incomes.

Even if someone is lucky enough to access NHS treatment, costs can still be sky high, with the price of dental charges increasing by 45% over the past decade. I am not attempting to be party political, but I am suggesting that there is a link between being a cancer patient and being on a lower income because, as I mentioned, many do need to give up work. Macmillan Cancer Support estimates that a cancer diagnosis leads to a person being around £570 a month worse off, with 33% of patients having to give up work because of their condition. Cancer patients are more likely to be priced out of the dental treatment they need, and in cases where dental treatment is required before cancer treatment can begin or continue, that can have potentially life-changing consequences. Every day lost risks lives.

Let us look at some specific examples, such as the case of one of Michele’s campaign supporters, Kelly. Kelly is waiting to start bisphosphonate treatment, which is needed to strengthen bones that are at risk of breaking due to cancer. To start that vital treatment, she must undergo important dental work, which is proving impossible as she cannot see a dentist. The fact that a person’s cancer treatment can be delayed, impacting their life quality or even survival chances because they cannot access dental care is clearly unacceptable.

I know that the Minister understands the crisis in accessing dentistry and I am aware of the Government’s recently published dental recovery plan, which aims to address that. However, the British Dental Association has said that the plan fails to embrace the fundamental reform that patients and dentists so desperately need, with no new money provided and inadequate measures to tackle the workforce retention crisis. If we are ever to achieve the goals of Michele’s campaign, we must get that right, because the speedy provision of dental care for cancer patients would be significantly undermined if, in practice, many cancer patients were still unable to see an NHS dentist due to an unaddressed workforce crisis.

While addressing the crisis in NHS dentistry and the affordability of dental care is not something that can be achieved overnight, there are more immediate things that could be done to improve the pathway from cancer diagnosis to dental treatment. Currently, there is no guarantee that cancer patients will be informed by their doctor that they should seek a dental check-up before undergoing cancer treatment. That is despite guidance from the NHS Specialist Pharmacy Service, the Royal College of Surgeons, the BDA and the British Society of Special Care Dentistry stating the importance of patients being dentally fit before starting cancer treatment.

Michele’s campaign therefore calls on the NHS to provide information to all newly diagnosed cancer patients, telling them of the need to seek dental assistance prior to their cancer treatments commencing. That does happen in many places, but we want to see it enshrined in law. That information could be provided by GPs and would include a list of dental practices in each area that could treat the cancer patient on the NHS.

I would also like to share the experience of Hayley from Reading. Hayley is another supporter of Michele’s campaign, and her stories sum up the issues that I have tried to raise today. When she was 21, Hayley had chemotherapy and radiotherapy for non-Hodgkin lymphoma. The radiotherapy caused severe dental issues. Now aged 44, Hayley has breast cancer and has had to remortgage her house to spend £11,000 on removing the remaining six teeth in her lower jaw and replacing them with implants. At no stage has Hayley been able to access NHS dentistry. Experiences such as that are why this campaign is so important. No one wants a situation where cancer patients are losing out on the healthcare they need because they cannot afford or access it.

We must act on this underappreciated crisis. I therefore encourage the Minister to address in her response the asks of Michele’s campaign, including not only the long-term aim of free dental care for cancer patients, but, in the short to medium term, the possibility of prioritising cancer patients for NHS dentistry and ensuring that there is clear guidance on the need for cancer patients to receive dental care provided at the first point of contact with their GP or cancer team. I am particularly interested to know what consideration the Minister could give to joining cancer and dentistry services together for cancer patients, offering out-patient appointments for sufferers in hospital alongside their other treatment. That would seem a practical way of ensuring that people can access the care that they need.

I also invite the Minister to meet Michele and myself—as the shadow Minister, my hon. Friend Preet Kaur Gill, kindly did earlier today, and I know Michele was appreciative of that—so that we could discuss these issues in greater detail. She will appreciate that I have not been able to cover all aspects of this important issue. Likewise, I accept that there is an escalator of asks here, some with financial implications. Michele has a mine of further information on the subject, and I know that she would be keen to talk the Minister through some of her ideas for funding these changes.

Ultimately, we must all work together on improving access to dentistry for cancer patients. As I said, I do not consider this to be party political, but it is something that we must get right. It is the least we can do for people who are already facing one of life’s toughest challenges.

Photo of Richard Foord Richard Foord Liberal Democrat Spokesperson (Defence) 5:05, 17 Ebrill 2024

It is an honour to serve under your chairship, Mr Dowd. Since being elected to represent Tiverton and Honiton almost two years ago, one of the issues that has appeared most regularly in my inbox and mailbag is access to NHS dentistry. It is common across the country for someone to have difficulty accessing new NHS dentists if they are not already registered, but that is particularly difficult in some parts of the country, including in Devon, which is often regarded by many as a so-called “dental desert”.

In recent months, we have heard the Government suggest that a way to address the difficult shortages of dentists is to try to attract qualified dentists into an area regarded as a dental desert. For example, we have seen the proposal to pay one-off incentives to qualified dentists to move into a dental desert such as Devon, but the truth is that this is still very difficult. I appreciate that the new proposal has not come in yet, but given that it is a one-off incentive, there is still no long-term incentive for dentists to move into dental deserts. That is difficult for many of my constituents, but it is more deeply worrying for those who are living with cancer. This is not a hypothetical scenario; it is the experience for people in rural communities such as Devon where finding a new dentist is impossible.

I will recount a real-life story from one of my constituents who was caught in just that scenario. Robin Whatling lives in Tiverton and is aged just 55. He is struggling with advanced cancer. Because of the treatment and medication that he is on, his bones and teeth are weaker than they would otherwise be, which means that regular check-ups are more important for him.

Robin’s wife, Sharon, contacted me last December and told me how, after booking a check-up, he received an abrupt phone call just a few days before it was due to happen. He was informed that the practice was no longer treating NHS patients and that if he wanted to go ahead with his appointment, he would need to go private. That is clearly a massive issue for a couple like Robin and Sharon. Due to Robin’s vulnerable state, Sharon has had to go part-time to become his carer. That means that she is not able to work the hours that she used to, which would have possibly afforded her more money to pay for private healthcare treatment.

Instead, the couple pursued the idea of finding an NHS dentist. They were held on the phone for three hours before being cut off. In the end it all became too much, and Rob ended up removing one of the teeth that was causing him pain by himself at home. I do not need to tell the House that that is a shocking, appalling situation to have to contend with while suffering advanced cancer.

Despite years of working hard and paying into the system, this couple are now left adrift with no support or access to dental care. In some of the correspondence that Members receive, we have constituents who rage at us with anger, but this couple approached me with great modesty and humility. They absolutely were not seeking to score any sort of political point. They just wanted to let me know, in a very factual way, the experience of a rural couple contending with cancer and trying to find NHS dentistry on the state.

The British Dental Association has laid bare the facts. Oral cancer is one of the fastest-growing types of cancer and it is killing more people than car accidents every day. Dentists can play a key role in diagnosis and referral, and if oral cancer is diagnosed early, survival rates can be as high as 90% compared with just 50% if diagnosis takes place at a later date.

Let us say it as it is: NHS dentistry is in crisis. It is another example of the Government continuing to let people down and stand by as our vital services crumble. The NHS dental budget has been cut in real terms by £1 billion while the Conservatives have been in power. That is a shocking legacy of neglect. My constituents were not party political about this, but I am going to be: this Government have presided over the crumbling and decay of NHS dentistry, and have paid lip service to proposals to do bits and pieces that do not amount to contract reform. So I urge the Minister, for the sake of Rob, Sharon and everyone who is trapped in a situation like this, to take on board the urgency of the issue of NHS dental care for cancer patients and those who might become cancer patients.

Photo of Paulette Hamilton Paulette Hamilton Llafur, Birmingham, Erdington 5:11, 17 Ebrill 2024

It is a pleasure to serve under your chairmanship, Mr Dowd. I thank my hon. Friend Andrew Western for securing this important debate.

As someone who has lost family members and friends to cancer, I frequently come to this place to try to shine a light on the huge problems in our health service, which disproportionately impact people with cancer and their families. Dentistry is no exception. Like many colleagues, I have been contacted by constituents, in Erdington, Kingstanding and Castle Vale, because they are unable to find an NHS dentist. There are more than 100,000 people living in my constituency, but only seven dental surgeries, and at least three of those are not accepting any new adult patients. A constituent without a dentist contacted me and said: “I am desperate for an NHS dental repair. I now have an abscess in my jaw. Please help me”. That case is one of many. The response I received from NHS England advised my constituents to call 111 for any urgent care services and said that it is

“working to address the challenges facing the service right now”.

The challenges in our dental system are exacerbated for people in our communities living with cancer. The Less Survivable Cancers Taskforce states that 90,000 people in the UK are diagnosed with one of the less survivable cancers every year, which is an average of nearly 250 every day. People with less survivable cancers are twice as likely as people with a more survivable cancer not to be diagnosed until symptoms are severe enough for them to go to hospital. I personally know that that is far too long. Some 80% of people with pancreatic cancer are diagnosed at stages 3 and 4.

People with cancer need fast and effective dental services in a system that recognises the difficulties they will face during their treatment. Dentists also play a huge part in detecting, diagnosing and managing oral cancers, which kill more than 3,000 people a year in the UK. Unlike the less survivable cancers, oral cancers have a survival rate of 90% when diagnosed early, as Richard Foord said, so it is crucial that dentistry can be accessed quickly and treatment is free for those people.

Both those issues come down to one main problem: money. Over the past decade, dental charges have increased by 45%, and last year YouGov found that nearly a quarter of respondents to its survey in England about dentistry delayed or went without dental treatment because they just could not afford it.

There are hidden costs in cancer care, such as increasing energy bills and the cost of frequent travel to and from hospital, and the burden of rising dental costs is too great for people with cancer. Although I think that it is a great idea to introduce free dental treatment for all cancer patients, we need to think bigger. We must reform the NHS and make it fit for the future.

There are two huge problems facing our health service—a crisis in both cancer care and NHS dentistry—with waiting lists for both at record highs. As a nurse, it breaks my heart to say that the NHS has never been in a worse state. The last Labour Government delivered the shortest waiting times and the highest level of patient satisfaction in history, because we invested properly in our NHS. It is high time that we did so again.

Photo of Yasmin Qureshi Yasmin Qureshi Llafur, Bolton South East 5:16, 17 Ebrill 2024

It is a pleasure, Mr Dowd, to serve under your chairmanship.

First, I thank my hon. Friend Andrew Western for securing this very timely debate, and I also thank Michele for the wonderful campaign that she has been running on this issue. I declare an interest, as I am the chair of the all-party parliamentary group on dentistry and oral health. Hopefully, that will remind the Minister that is a cross-party issue and that many of her party colleagues are concerned about it.

Dentistry is in crisis across the country, whether in Devon, Somerset or in constituencies such as mine—Bolton South East. My hon. Friend the Member for Stretford and Urmston has detailed the importance of free dental treatment for all cancer patients. I listened to my hon. Friend Mrs Hamilton, who has just spoken, about the details of the effects of this crisis on cancer patients, which she knows because of her experience of being a nurse. I also listened to what Richard Foord said about his dealings with a constituent who had a cancer issue and who then had to take out his own teeth, which really is not acceptable in 21st-century Britain. I strongly support an exemption for people who are suffering from cancer and who therefore should be able to receive all the treatment that they need.

In fact, I was contacted by a constituent who had breast cancer. She told me how confused—indeed, how overwhelmed—she had felt. The last thing on her mind was dental health. However, a dental check-up should be essential for cancer patients; indeed, it should happen before anyone starts chemotherapy. Imagine the complications in treatment for someone with a suppressed immune system who is recovering from an infection. There are countless horror stories out there about the expensive dental work required by many cancer patients and they simply cannot afford it, especially given the cost of living crisis and the rising cost of bills.

I urge the Minister to get things done so that free dentistry is made available. The reality, however, is that even if the Minister made such a commitment today, as I am urging her to do, many people will not be able to access the service due to the ongoing crisis in NHS dentistry. For example, pregnant women and new mothers theoretically enjoy free NHS dentistry, but official data shows that over the last three years 1.2 million of them missed out on this entitlement because they were not able to access an NHS dentist.

It is crucial for all patients that this crisis is addressed urgently. The Minister will be aware that in 2021 about 2,000 dentists quit the NHS. In 2022, a BBC survey found that nine out of 10 of the dental practices still offering NHS services were not accepting any new adult patients, and eight in 10 were not taking on any more children, even though children are supposed to be a special category. Many of them have been left without access to basic healthcare, resulting in “dental deserts” across England. The problem is getting worse because many dentists are leaving the profession. For those who have stayed, morale has reached rock bottom.

What are the Government doing about this? They have been in power for 14 years. Recently, they introduced a so-called dental recovery plan, which many dentists have said is not even worthy of the title, because it will not stop the exodus from the workforce or offer hope to the millions who are struggling to access care. If the whole point of this plan was to stop dentistry becoming an issue, I am afraid the Government have failed. This is a crisis that will remain a burning issue in our communities across the country until we get real change. Constituents like mine in Bolton South East can see that NHS dentistry has been abandoned and left to rot by this Government. The system is not working. Many constituents write to me about trying to access NHS dentistry, and I have personally made phone calls trying to get them an appointment. It has been impossible to get an appointment until my office writes and persuades them to accept someone.

When the NHS dental recovery plan was introduced, the Health and Social Care Secretary assured the House of Commons that the plan was backed by £200 million in new funding. She very clearly said:

“There is £200 million on top of the £3 billion that we already spend on NHS dentistry in England.”—[Official Report, 7 February 2024;
Vol. 745, c. 264.]

She reiterated that the £200 million was additional money. I was therefore very surprised to hear the Minister who is here today explain to the Health and Social Care Committee that the plan to deal with crises in NHS dentistry was not in fact backed by any additional investment. She stated that it was

“all coming out of the £3 billion that is currently” being “underspent”.

I hope the Minister understands that these two statements contradict each other. On 20 March, I made a point of order in the Commons Chamber in which I raised this matter with the Deputy Speaker. I asked the Minister to return to the House to correct the record. So far, she has not done so; I hope she will do it today.

Saving dentistry is not rocket science. We need an NHS contract that is actually fit for purpose, with funding that means practices can be sustainable. We need real reform now.

Photo of Kirsty Blackman Kirsty Blackman Shadow SNP Spokesperson (Cabinet Office) 5:23, 17 Ebrill 2024

Thank you for chairing this debate today, Mr Dowd. I thank Andrew Western for bringing the debate to the Chamber, and I thank all Members who have spoken. It is really good to have their constituents’ input and thoughts on the issues they face. I especially thank Michele for the campaign she has been running, which is the reason why this debate is taking place today. It is incredibly important that these issues are aired, and I look forward to hearing from the Minister what the Government are planning to do to improve the situation. It clearly cannot continue.

I want to talk a little about some of the things that we are doing in Scotland. Honestly, this sounds like the conversation I remember having 20 years ago in Scotland about being unable to get an NHS dentist. When I moved house in 2016 in Aberdeen, I had the choice of two different NHS dentists to go to. Everybody was like, “There’s no problem getting an NHS dentist now,” because of everything that has been put in place in Scotland to ensure that we can have those NHS dentists. More than 95% of the population in Scotland is registered with an NHS dentist and therefore able to get free dental check-ups.

Part of the increase in the amount of NHS dentists was the result of the creation of a new dental school in Aberdeen, specifically because we recognised the fact that Aberdeen was struggling with dentists. We created a new dental school there, which has had a significant impact on the numbers of dentists in Scotland. We also have various measures to ensure that dentists move to areas that are struggling to get any, as Richard Foord mentioned. A £37,000 golden hello package is available for trainee dentists who are willing to move to areas that desperately need dentists. That is over the course of a three-year period of practice, so it is not like they get it all on one day—they have to be there for the three years to get the £37,000. There has also been a change in the amount of money that dentists get for the treatments they provide, to ensure that they are properly compensated, that they are able to do the treatments and that it is affordable for them to continue as an NHS dentist, rather than feeling obliged to go private.

Lastly, Brexit has had a significant impact on the NHS dental workforce and how it works. We are struggling with the loss of dentists because of Brexit. My husband was talking about his most recent dentists being Greek, Polish and Romanian, but the change in the relationship with the EU means that the situation is more difficult. People are less likely to want to stay in the UK as a dentist when they could stay in the country of their birth, closer to their homes, with people they feel might actually want them, rather than people who have voted for Brexit. The negative change there is causing a problem.

Specifically on cancer patients and the cancer strategy, in Scotland we have a 10-year strategy for cancer and it is a national priority for the Scottish Government. Everything done for cancer support is about having a person-centred outcome. A person-centred approach to support ensures personalisation, so that everyone gets a variety of the supports that they need, rather than a variety of the supports that exist or that happen to be—“You have this type of cancer so we will give you this.” Instead, it is very much a person-centred approach.

People undergoing cancer treatment could be eligible for free dental treatment and check-ups in a variety of ways. Some people on universal credit who meet income thresholds can get free treatment. For anyone who is an in-patient and treated by dentists in hospitals—which we have—that treatment is, again, free. A low-income health scheme is in place as well. Given the much wider availability of NHS dentists in Scotland, people are able to access such services and are much more likely to get free treatment, because of the increase in the numbers.

I did not want to talk for too long. This is not a concern that affects a significant number of my constituents, because they have access to dental services at this incredibly worrying time. They are able to get appointments, so it is one less thing for them to worry about when their lives are a complete and total rollercoaster. The Minister must ensure that we do everything we can for people who have had a cancer diagnosis and are going through treatment. Their lives have potentially changed dramatically overnight, and a lack of accessible and affordable dentistry services is one more thing that they do not need to be worrying about right now. They need to concentrate on getting through their treatment, on the support they are receiving, on ensuring that they can get well as quickly as possible, and on following doctors’ instructions and guidance. People do not need to be worrying about dentistry.

The Minister must do everything possible to ensure that personalised treatment is provided and that an increase in access to NHS dentists is in place. If there is not to be a widespread increase in access to NHS dentists across England in the near future, is there anything the Minister can do in the meantime to prioritise the treatment of cancer patients? They need to be able to access appropriate dental treatments that they can afford as soon as possible, until the NHS in England is in a position to offer dentistry services at a reasonable level and people can actually access treatments.

Photo of Preet Kaur Gill Preet Kaur Gill Shadow Minister (Primary Care and Public Health) 5:29, 17 Ebrill 2024

It is a pleasure to serve under your chairship, Mr Dowd.

I thank my hon. Friend Andrew Western for securing the debate and for speaking so powerfully about how the dentistry access crisis affects cancer patients and survivors such as his constituent, Michele. I had the pleasure of meeting Michele with my hon. Friend earlier today, and it was eye-opening to hear the stories about what cancer patients and survivors face. I am delighted that Michele is here today. I thank her for all her campaigning and the support that she provides for those suffering pretty much what she had to go through.

I am afraid the state of NHS dentistry under this Government is Dickensian. Most of us might think that our teeth would be the least of our worries if we were diagnosed with cancer, and as we have heard, oral health is incredibly important. Many cancer patients, who previously had few or no dental issues, can experience the loss or crumbling of teeth, together with a host of other dental problems during or after treatment. Poor dental hygiene can lead to infections, which can interfere with a patient’s chemotherapy. Radiotherapy can cause acute complications for teeth and gums through tissue damage. In rare cases, extractions afterwards can result in bone necrosis, whereby the jawbone essentially dies.

It is therefore crucial that timely access to dentistry, including any required treatment and preventive advice, is provided before, during and after cancer therapy to maximise positive outcomes. The last thing that any cancer patient needs is to find that they cannot access a dentist when they need one. However, as the Minister knows, the current crisis in access to dentistry is shocking. After more than a decade of neglect, patients are desperately queueing round the block to see a dentist. Eight in 10 practices are not taking on new adult NHS patients and, as we have heard, one in 10 people have tried DIY dentistry. Some of the most vulnerable people in society, who need to get seen, are missing out.

I want to share with the Minister some of the stories that were shared with me before the debate. Michaela from Alresford said:

“I lost all my root canals and my teeth just started falling to bits on chemotherapy. I wasn’t able to see an NHS dentist and I couldn’t afford private. I’m awaiting treatment again for cancer (for the second time) and urgently need my teeth sorted before I have chemotherapy again, but I can’t get in to see a dentist.”

Carole from Shropshire said:

“I was with an NHS dentist but missed a check-up while going through chemo—was very ill. So got knocked off. I had problems when taking ibandronic tablets for bones, had to go for emergency treatment. NHS dentist in Shrewsbury 17 miles from home. This was two years ago—still not been able to register. Tried surrounding towns. I know I am not on my own. There are hundreds in the same situation as me.”

What does the Minister have to say to Carole and Michaela? Has the Department made any estimate of the impact of the access crisis on cancer patients and survivors?

As we heard today, according to research by Macmillan Cancer Support, four in five cancer patients are hit with an average cost of £570 a month as a result of their illness. If patients face oral health complications because of their treatment and they cannot be seen on the NHS, most will simply go without. A two-tier system, whereby those who can afford to go private and the rest go without, is obscene. How are the Government working to minimise the financial cost of cancer for patients and survivors? Those costs can knock back their health.

It was disappointing to hear from Michele that when she was diagnosed with breast cancer her doctor did not tell her about the impact her treatment could have on her oral health. I know the Minister accepts that such advice should be routine. The Department of Health and Social Care guidance for delivering better oral health states that cancer patients should receive appropriate care to manage and stabilise their oral health before treatment, but it appears that not all cancer patients are getting that support. I urge the Minister to address the matter and raise it when possible.

In my team, a parent of one of my staffers was diagnosed with throat cancer in 2020, but did not get his orthodontist appointment to have four teeth removed until a year after his treatment. Will the Minister comment on the fact that the latest estimates show that in February 2024 more than 325,000 patients were waiting for oral surgery in England? That is up by nearly 200,000 since 2015, almost a decade ago, which was the last time the NHS target was met. How many cancer patients’ treatments are delayed as a result?

There is also the dire issue of cancer diagnoses themselves. Oral cancer is now one of the fastest-growing types of cancer in the United Kingdom, with mortality rates up by 46% on a decade ago. It now kills more than 3,000 a year in the United Kingdom. But if diagnosed early, oral cancers have a survival rate of roughly 90%, compared with 50% if diagnosis is delayed. Given that dentists are often the first to spot the early signs of the disease, will the Minister say whether she has made any assessment of the contribution of the dentistry crisis to the appalling mortality figures?

As my hon. Friend Yasmin Qureshi said, the Health Secretary claimed in the Commons in February:

“There is £200 million on top of the £3 billion that we already spend on NHS dentistry in England.”—[Official Report, 7 February 2024;
Vol. 745, c. 264.]

But that is not true. Notwithstanding the fact that £1 billion of that is covered by patient charges, not central Government, the Health Secretary also subsequently admitted that the money will come from existing budgets. So really it is only £200 million as part of the money that she might spend on NHS dentistry if the £400 million yearly underspend persists.

The Health Secretary also claimed:

“The Opposition’s ambitions reach only as far as 700,000 more appointments. Our plan will provide more than three times that number of appointments across the country—that is 2.5 million”.—[Official Report, 7 February 2024;
Vol. 745, c. 255.]

But that is not true either, is it? It is not true because the Government’s scheme will run for only one year, while Labour’s plan would deliver both in the here and now and into the future. Perhaps the Health Secretary might correct the record on that, too.

My hon. Friend the Member for Stretford and Urmston shared his thoughts on how joining up services in hospital for cancer patients could address access to dentistry for very high-risk patients. NHS dentistry is dying a slow death under this Government, and the people who rely on NHS care cannot wait another five years for a Tory Government to decide that, this time, they really mean it and they will reform NHS dentistry for good. Labour’s fully funded plans would provide 700,000 more urgent appointments a year, supervised tooth-brushing schemes in areas of deprivation, and a targeted recruitment scheme in left-behind areas, all paid for by cracking down on tax dodgers. We would get on with the reform to the NHS dental contract that this Government have put off for 14 years. Cancer patients, new mothers, those in rural communities and millions of others are being failed every year that we let the decay in NHS dentistry continue.

Photo of Andrea Leadsom Andrea Leadsom The Parliamentary Under-Secretary for Health and Social Care 5:37, 17 Ebrill 2024

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate Andrew Western on securing this really important debate on behalf of Michele and all the other petitioners. I would of course be delighted to meet Michele to hear her views, and I particularly take note of her call for all cancer patients to be advised of the potential impact of cancer treatment on their oral health. That is a really solid and actionable thing that I undertake to take away today. I look forward to meeting Michele and the hon. Gentleman in due course.

I wish to take this chance to pay tribute to the Mouth Cancer Foundation, the Oral Health Foundation and Dentaid, to name just a few of the excellent charities that provide support and advice to so many.

I thank all Members who have spoken in what has been an excellent debate. I say to Richard Foord that I fully appreciate the challenges in Devon. He will no doubt welcome the fact that a mobile dental van, which will be quite a boost for very underserved and geographically distant areas, will be forthcoming for Devon in the near future. In addition, one of the real problems in Devon—this is not the hon. Gentleman’s fault at all—is that in his area on average only around 57% of commissioned units of dental activity are actually undertaken by dentists. I am sure he might like to talk to his local integrated care board about that, if I can help in any way, I would be delighted to.

As I will come on to talk about, our dental recovery plan attempts to incentivise further NHS dentists to really ramp up delivery. In fact, we have already seen hundreds of thousands of new dental treatments just since 1 March, when the plan went live. Unfortunately, the data is not publishable as yet, but I feel really optimistic. I totally understand what Members say about it being not good enough—I totally get that—but we are seeing rapid improvements and I encourage the hon. Gentleman to talk to his local ICB.

Photo of Richard Foord Richard Foord Liberal Democrat Spokesperson (Defence)

On the Minister’s point about only 57% of the units of dental activity being taken up in Devon, is that not a workforce issue?

Photo of Andrea Leadsom Andrea Leadsom The Parliamentary Under-Secretary for Health and Social Care

No. How it works is that the ICB commissions dentists to provide NHS dentistry, and the NHS contractor undertakes to fulfil a number of units of dental activity. If they do not do that, for whatever reason, at the end of the financial year the ICB claws back the money they gave the NHS dentist to fulfil that contract. I am not judging anything; I am merely giving the hon. Gentleman information that I hope is helpful to him.

Photo of Yasmin Qureshi Yasmin Qureshi Llafur, Bolton South East

On that point, it is very much an issue of being able to survive: many dentists say they return the units because if they took on all the NHS appointments, they would not be able to survive financially.

Photo of Andrea Leadsom Andrea Leadsom The Parliamentary Under-Secretary for Health and Social Care

I hear what the hon. Lady says. My own assessment is slightly different, but I obviously respect her view.

Mrs Hamilton and I have worked together for many years on all matters to do with early years intervention. She made a really good point about less survivable cancers, but I would highlight to her the 160 diagnostic centres that are being opened, which will help with early detection. She also made some good points about the importance of good oral health assessments, and she is right to raise that. One thing I would point out to all hon. Members, which was astonishing to me when I came into this role in November, is that since 1948, when the NHS started, only between 40% and 50% of adults in England have ever received NHS dentistry. It is not like Scotland, where Kirsty Blackman said the number is 90%—is that the right number?

Photo of Andrea Leadsom Andrea Leadsom The Parliamentary Under-Secretary for Health and Social Care

Yes, 95% of people in Scotland receive NHS dentistry. In England, it is extremely different, and it always has been under Governments of all parties. I would just put that to hon. Members as a piece of information that it is really important to know.

To Yasmin Qureshi, I would highlight SMILE4LIFE, which is a big part of the dental recovery plan. The shadow spokesman, Preet Kaur Gill, also raised the SMILE4LIFE. It focuses on the earliest years, including getting pregnant mums to have their teeth checked, and on good oral health in babies and toddlers, so that by the time they go to school they are used to brushing their teeth twice a day. Good oral health is absolutely critical. In answer to the point raised by both the hon. Member for Bolton South East and the shadow spokesperson, I should say that the Secretary of State and I both made very clear and full responses to the Health and Social Care Committee on the issue of where funding for the dental recovery plan has come from.

Moving on to the things that I actually intended to say, I am absolutely aware that almost everyone in our country has been personally affected by cancer, whether themselves or through a friend or relative, and that includes members of my own family, so I really do understand the issue. Last year, just over 340,000 new cancer patients were diagnosed in England—almost 1,000 every single day or one every 90 seconds. We know that receiving a diagnosis can be terrifying, and we should never lose sight of what those patients and their families are going through. I am really glad that the petition has been brought forward to highlight the terrible disease of oral cancer and the impact on the oral health of those with other cancers.

Before I turn to cancer, I want to quickly outline the steps we have taken to improve access to dentistry across the country since publishing our recovery plan on 7 February. As colleagues will know, access has simply not recovered fast enough since the covid lockdowns, and the issue was my top priority on appointment to this role in November. I am really proud that the plan is creating around 2.5 million additional NHS appointments. We are supporting dentists through a new patient premium to take on patients who have not seen a dentist for two years. We are increasing the minimum value of a unit of dental activity to £28. We are helping patients to find a dentist through a new marketing campaign. We are bringing dental care to our more isolated communities through mobile dental plans and by encouraging dentists to work in underserved areas through golden hellos for 240 dentists. As I have mentioned, the SMILE4LIFE initiative is designed to get in early and help families to understand the importance of good oral hygiene.

Not only that, but we are also making progress to increase the workforce and, in fact, there were 1,352 more dentists doing NHS work in 2022-23 than in 2010-11. It is not the case that dentists are disappearing from the NHS; there are 1,350 more. As announced in the long-term workforce plan, we are going to increase dentistry training places by 40%, so that there are over 1,100 places by 2031-32. We are also increasing training places for dental therapists and hygienists to more than 500 a year by 2031-32. Importantly, we are exploring whether the prospects for a tie-in could ensure that dentists spend a greater proportion of their time delivering NHS dental care, rather than receiving that very expensive training and then perhaps going off to do private dentistry, which means fewer people have access to NHS dentists. It is great to see that, since we published the plan on 7 February, and it went live on 1 March, hundreds more dental practices are already opening their doors to new patients. I look forward to giving the House a full update on the recovery plan shortly, when I will be able to talk to colleagues about the significant increase in the number of patients able to access an NHS dentist.

In the hon. Member for Stretford and Urmston’s own integrated care board in Greater Manchester, there is the second highest number of dentists doing NHS work in England. That is almost 71 dentists per 100,000, against a national average of 53.5. I understand that the ICB there is supporting a local initiative called the dental quality access scheme to improve access to NHS dentistry, which requires practices to commit to seeing new NHS patients and, importantly, to providing urgent care access. The practices have been asked to prioritise vulnerable patients and patients with serious conditions, including cancer. That is a fantastic scheme by the ICB, and I encourage other ICBs listening to this debate to follow suit. The scheme brought over 200,000 extra appointments for patients in the last financial year, which I am sure the hon. Member is delighted about.

Turning to the hon. Member’s specific points on charges, the Government responded to a petition on 9 November that requested

“Free Dental Treatment for All Cancer Patients”.

Our reply pointed out that, in 2022-23, 47% of all courses of treatment for NHS dental patients were delivered free of charge, and those who do pay for dentistry are providing an important contribution to NHS budgets. I am sure the hon. Member will know that dentistry charges have been in place almost since the foundation of the NHS 75 years ago. Also, as I have already pointed out, under Governments of every party only about 40% to 50% of adults have ever received NHS dental care.

Despite inflation and other spending pressures, we froze charges between December 2020 and April 2023 to help all our constituents with cost of living pressures, and since then we have raised the charges only proportionately. The hon. Member is right to say that cancer patients face additional financial burdens, and that is why the Government are committed to supporting every patient who faces financial hardship with full or partial exemptions from dental patient charges, which are available through the NHS low income scheme. As the hon. Member for Aberdeen North pointed out in the case of Scotland, those also apply to people being treated in hospitals, and that will not change.

I am sure that the hon. Member for Stretford and Urmston will appreciate that, at a time when NHS budgets are under extreme pressure, it is not feasible to offer free dental care to every patient regardless of their means. We are instead focusing our efforts on continuing to ensure that the most vulnerable are supported to access NHS dentistry, including patients with cancer. In 2021, there were just over 9,100 oral cancers, which was equal to around 3% of all cancers. It is clear that cancer must be caught at the earliest opportunity to give people the best possible chance for recovery. Dentistry plays a crucial role because dentists check for signs of oral cancer in every routine check-up, and it is a contractual requirement for dentists to prioritise patients at a higher risk of oral cancer for more frequent recalls.

Turning to the hon. Gentleman’s specific point about prioritising dental appointments for cancer patients, I am aware of instances where patients have faced unacceptable delays to the start of their treatment because of a lack of dentistry appointments. I agree with all hon. Members that such delays are just unacceptable, and we are committed to making sure that everyone who needs a dentist should get one. That is why, along with the raft of measures we are introducing to improve access to NHS dentistry across the country, we are also publishing new guidance to make it crystal clear to every integrated care board that they have a responsibility to commission additional specific services in their local area when they identify problems such as cancer patients being unable to access timely treatment.

As soon as we published our dentistry recovery plan on 7 February, I turned my attention to seeking out the expertise and knowledge of dentists and their representative bodies to understand their perspectives on the need for dental contract reform. I am specifically looking now at what reforms would improve access to dentistry and encourage greater capacity, as well as how at we can consult the dental profession and prepare for further announcements later this year. I can assure hon. Members that, in every decision, I will keep pushing for every patient in our country to have access to the dental care they need, while protecting our cast-iron guarantee to support those most in need with full or partial exemptions from dental patient charges for those on low incomes.

Photo of Andrew Western Andrew Western Opposition Whip (Commons) 5:51, 17 Ebrill 2024

I thank everybody who has contributed to the debate. We have a considerable amount of expertise in the room—in particular, my hon. Friend Yasmin Qureshi is the chair of the all-party parliamentary group and my hon. Friend Mrs Hamilton is a former nurse and national lead for the Local Government Association on all things relating to health.

I am grateful to colleagues who have contributed to the debate in various ways and focused more generally on the considerable issues facing those seeking to access dentistry. I want to drill down more specifically on the issue of access for cancer patients, and I appreciate the Minister’s offer of a meeting, which will hopefully move us forward. I also welcome her commitment to looking at how we can deal with the information side of this. However, with respect—she would expect me to say this—that is perhaps the easiest of the issues to tackle. I gently say to her that at no point did I ask for all patients to have free dental treatment, but just for cancer patients to have dental treatment because their experience has not come about as a result of not looking after their teeth, but as a direct result of other treatments. [Interruption.]

I am cognisant of the Chair’s clearing of his throat, and I will raise some of the other issues that I was hoping to discuss today in the meeting with the Minister. As I say, I am grateful to her and the shadow Minister for meeting me and Michele earlier, and to everyone who has contributed.

Question put and agreed to.


That this House
has considered access to dentistry for cancer patients.

Sitting adjourned.