UK - House of Lords

Lord Colwyn Conservative  8:21 pm, 3rd June 2015

My Lords, I must declare my interest as a now fully retired dental surgeon. Single-minded as my focus on dentistry has been, and may be, it is no mere quirk or niche focus, but rather a genuine concern for an area of health that deserves much more attention over the course of this Parliament.

The election campaign demonstrated the importance of all health issues. The parties tried to outbid each other on spending, but where does dentistry sit in that health debate? When it comes to issues the public care about, oral health is conspicuously absent. I was flattered to be included in meetings with my noble friend Lord Howe and with the Secretary of State to consider likely health issues for the manifesto, but it was telling that, of all the major parties, only the Greens and Plaid Cymru mentioned dentistry in their manifestos. It was conspicuously absent from the manifestos of my party and that of the Opposition Labour Party’s policy platform.

This is in spite of some worrying figures. In the 2013 Children’s Dental Health Survey, nearly a third of five year-olds and nearly half of eight year-olds had obvious decay experience in their primary teeth. Under a Government led by a one-nation vision, we must feel deep concern about oral health inequality that sees a fifth of five year-olds eligible for school meals with severe or extensive tooth decay, compared with 11% of those from more privileged backgrounds.

Dentistry is too readily seen in aesthetic terms and so perhaps more easily dismissed, but at its core is a commitment to good health that has holistic benefits for individuals’ overall health, including mental health. More than a third of 12 year-olds and more than a quarter of 15 year-olds reported being embarrassed to smile or laugh due to the condition of their teeth.

The 2010 Conservative manifesto promised to,

“introduce a new dentistry contract that will focus on achieving good dental health, not simply the number of treatments achieved”.

Beyond a few pilot schemes, the dental profession is still waiting for any conclusions. A contract that ends perverse incentives to undergo more costly interventions and instead rewards improving oral health can only be to the benefit of patients and dentists. I sincerely hope that we can finally implement the promise from 2010.

Worldwide scientific evidence, including three systematic reviews of studies comparing children from fluoridated and non-fluoridated communities, indicates that water fluoridation reduces the amount of tooth decay experienced by children and increases the proportion of children who do not experience tooth decay at all. A fourth systematic review found that adults who have lived mainly in fluoridated areas have lower tooth decay rates than those who have lived mainly in non-fluoridated ones. Water fluoridation has made a significant contribution to oral health improvements in communities where it has been introduced. Fluoride has the greatest efficacy in preventing caries, so it was with disappointment that I noted Southampton’s recent rejection of water fluoridation. Hull is currently undergoing a consultation to fluoridate its water supply to deal with an epidemic of poor oral health. More than 43% of children aged five in Hull have fillings and tooth decay; fluoride would play a vital role in combating that. Last year, Birmingham celebrated 50 years of waterfluoridation—a great success that saw the number of children with tooth decay halve in six years. Other cities could learn from that example.

Many dentists will also hope that this Parliament will have a rethink as to how the profession is regulated. The dental profession has expressed grave concerns with its regulator, but also a willingness to move to a better model for all. It is therefore disappointing that the gracious Speech made no reference to the Law Commission’s recommendations for health regulation—something health regulators and unions are all keen to scrutinise with a move to implementation.

The gracious Speech called for integration of health services, as well as devolution across the UK and within England. It is essential that dentistry is factored into integrated healthcare and “devo-Manc” style devolution of health budgets and priorities. More than 25,000 children were admitted to hospital in 2013-14 because of tooth decay—the single largest

reason for admission across all the National Health Service, and up from 22,500 three years previously. This cost about £30 million. It is clear that dentistry cannot be considered in isolation: the interplay between oral health and general health, dentistry budgets and other NHS budgets, must feature in any discussion on healthcare provision over the next five years.

Dentists are not by nature the most militant of professionals, but there are worries among many that the trade union reforms set out in the gracious Speech will impact on them. Many have called for the introduction of electronic balloting, so that should unlikely industrial action ever take place it could be done with a legitimate turnout, meeting the threshold being suggested by the Government and proving that these reforms are about legitimacy, not diminishing the right to withdraw labour.

In conclusion, I thank my noble friend Lord Howe and his team for their long and important contribution to dental politics, and more recently myhonourable friend Dr Daniel Poulter for his time at the Department of Health. I also welcome my right honourable friend Alistair Burt as the new Minister of State for Care and Support, with responsibility for dentistry. There are many challenges ahead and real opportunities for dentistry in the UK. With a Conservative majority Government, we should show what we can do to end inequalities and improve oral health for all.

They never give up pushing fluoridation on a reluctant informed public.