Agenda item

An opportunity for the Committee to discuss the situation regarding the lack of availability of NHS Dentists within the North Devon area.

Please see link to the meeting held at Devon County Council on 21^st September 2023:

Health and Adult Care Scrutiny Committee - Thursday 21 September 2023, 10:30am - Devon County Council Webcasting (public-i.tv)

The Committee considered the report of the Devon County Council Health and Adult Services Committee held on 21^st September 2023 together with a minute extract of the meeting.

The Vice Chair advised that the aim of the meeting was to invite a panel of experts to discuss the ongoing problems for the residents of North Devon in securing NHS dental care and that invitations had been sent to representatives that they wished to discuss their concerns with and that of the four invitations sent out, one was declined and the other three were not acknowledged.

He added that there were local residents together with representatives from Save our Hospitals who were keen to attend to meet with the experts. However, without a panel to ask questions of this had not been possible.

Following some research, he raised the following points:

·       At the present time, every child in the UK is entitled to free NHS dentistry. However, there were not enough dentists to treat them.

·       People entitled to benefits together with pregnant women and recent mothers also had the right to the unobtainable service.

·       These rights were guaranteed until you try to exercise them.

·       The number of active NHS dentists in UK at its lowest in a decade despite a growing population.

·       According to figures released by the British Dental Association (BDA) in early 2023 23,577 dentists carried out NHS work in 2022/23 financial year, which was down by more than 1100 on the pre-pandemic level and lowest level since 2012/13.

·       Overall 80% of practices in the UK no longer take on child NHS patients and about 90% were refusing new adult patients.

·       The latest figures from the NHS Devon indicated that 6287 people were currently on NHS waiting lists in North Devon and Torridge, 1183 of which are children.

·       Corresponding figures for Devon are 98,378 and 20,096.

·       Obtained a link to the NHS Devon website, listed all NHS dental practices. Was unable to find one practice that would take a new NHS dentist.

·       The current situation was that fewer than 4 in 10 adults in Devon visited a NHS dentist in a year, and only half Devon’s children.

·       There were fewer dentists with long, and growing, waiting lists for those few practices still accepting NHS patients.

·       When a dentist provides treatment to patients on the NHS they lose money, because state funding does not cover their costs.

·       The situation would continue to get worse because funding for NHS dental services had been cut in real terms by 4% year. Dental inflation driven by the rising costs of laboratory bills, energy, wages together with materials, was about 11% a year.

·       The payment system imposed by the government meant that dentists received the same payment from the NHS for a patient who required 10 fillings as for a patient who required one.

·       Treating a patient earns three Units of Dental Activity (UDA) points, regardless of the length and expense of the procedure.

·       Every practice had to meet an annual UDA target. So there was no incentive to practise preventive dentistry, and every incentive to exclude the patients with the greatest needs.

·       The NHS allocated dental funding to areas, like Devon, on the assumption that about one in six people won’t need any care and about one in three were treated privately.

·       There was funding provision for half the population, and the money per person wasn’t enough to pay for their treatment.

He gave an example given to him by a practicing dentist in North Devon:

“I agreed to see the early 20s age son of one of my NHS registered families. He hadn't been for a few years but I agreed to see him on the NHS because his parents have been patients for years and he was my patient as a child. He needs something like 2 teeth out and many fillings to get him dentally fit. His treatment will take 3 or 4 hours of surgery time plus filling materials etc. Had I seen him on a private basis, his treatment would have brought around £1,500 into the practice to cover wages/materials/overheads. The NHS will pay the practice £150 for the same treatment! It will actually be costing the business and me personally money to do the treatment for him. Whilst it's nice to do a nice thing for people occasionally, you can't keep a business afloat like that!”

·       If a practice were to expand their NHS provision they could only do so if there was space within the local budget. There rarely was since no new money was being added to the pot, instead the pot has been shrinking. For some years many of the available NHS contracts were hoovered up by corporate groups who offered to do the contracts for a smaller amount of money than an individually owned practice could.

·       This was also a large part of the reason that there was no orthodontist in North Devon. A large group were successful in obtaining the contract from the existing established local practice by offering to deliver the service at a more cost effective rate.

·       They had achieved such cost savings by not employing a full time orthodontist at the practice and opting to utilise the skills of therapists undertaking the day to day work and employing a "supervising" orthodontist to travel down to North Devon from a location outside of the North Devon area.

·       The arrangement subsequently broke down when the orthodontist decided that he no longer wished to undertake the commute and the company had been unsuccessful in recruiting a replacement.

·       The situation had been further compounded owing to the low value of the contract in that it wasn’t cost effective to employ an orthodontist to a full time position and move to the area.

·       There were two orthodontists that lived in North Devon. However, neither were prepared to work for the larger company as they had held the original contract within North Devon for a number of years. The impact of this meant that as it currently stood there was no provision to adjust and monitor the braces of children within the North Devon area.

·       In a post on X, formerly Twitter, the British Dental Association (BDA) said: “Oral cancer claims more lives than car accidents. But NHS dentistry was still waiting on a promised recovery plan.”

·       More than 3,000 people in England died from mouth cancer in 2021, compared with 2,075 in 2011, according to figures by Oral Health Foundation (ORF) first reported by the BBC, representing an increase of 46%. The ORF, Toothless in England (TIE), a group that campaigns for free dentistry, and the BDA said the rise was a direct result of cuts to NHS dentistry.

·       There were instances of some of the Ukrainian refugees currently living in the North Devon area who would return to their home country for dental treatment because they cannot find it in North Devon. So, they would rather fly into a war zone to seek treatment than wait for dental care in the sixth largest economy in the world.

·       The quality of the dental care provided had also dropped. The number of complaints received by the health services ombudsman had increased by 66% in five years.

·       From 1,193 in 2017/18 to 1,982 in 2022/23. Over the same period the proportion of complaints upheld by the ombudsman had increased from 42% to 78%. The figure of 78% was “significantly more” than for any other area of NHS care, such as GPs, hospitals and mental health care where the overall average was 60%.

The Committee discussed and raised the following points:

·       Acknowledged the depressing situation that northern Devon was currently facing.

·       Raised concerns about the process that was followed to procure the orthodontist contract and questioned whether due diligence was taken in awarding the contract to the larger company who had failed to deliver on their promise.

·       Requested a more detailed response related to how the orthodontic contract was procured and whether or not the lack of an orthodontic provision in the North Devon area was being addressed.

·       Expressed their disappointment that no one had attended the Committee to meet with the Members and listen to their concerns.

·       Also noted their disappointment that the MP had not attended the Committee.

·       Were advised that the MP had written a number of letters to the Department of Health over the last 12 months. However, there was uncertainty as to whether or not this was publicly available. The Member agreed to speak with the MP’s agent to ascertain if the letters were within the public domain.

The Director of Resources and Deputy Chief Executive advised that with regards to the procurement of new NHS dental contracts for Units of Dental Activities (UDAs) a report considered by Devon County Council in September 2023 outlined those procurements within phase one that had been awarded. However, there were 4,500 UDAs in the EX39 (Bideford area) and 3,000 UDAs in the EX32 (Barnstaple area) that contracts had not been awarded following phase one of the procurement exercise. He was unaware if any further progress had been made on those procurements and the Committee should look for an update on this procurement position.

RESOLVED, that Standing Orders be suspended to allow a Member of the public to virtually address the meeting.

The Member of the public addressed the Committee and encouraged Members to lobby government to change the NHS contracts to support dentists and encourage them back into the NHS and address the major funding impact upon healthcare services.

RESOLVED, that Standing Orders be reinstated to allow the remaining business to be transacted.

RESOLVED:

a)    That the Committee write to the MP and congratulate her on her position in the Private Members Ballot and request that she consider using dentistry as the main thrust of her private members bill;

b)    That the Committee offers its full support to the MP and request that she provide an update to the members on the steps that she had taken to address the lack of NHS dentistry provision for the North Devon area so far;

c)    That a request be made to the NHS to provide an update on the planned procurement of new contracts for the Units of Dental Activity (UDAs) in the Northern Devon area as EX39 and EX32 postcodes were originally planned in phase one procurement; and

d)    That a Notice of Motion be raised at Full Council on 17^th January 2024 to request the support of both the Leader and Full Council in requesting that the MP take on dentistry as part of her Private Members Bill.