Healthwatch & ICBs Asleep, Commons Committee Hears More

Healthwatch & ICBs Asleep, Commons Committee Hears More

As trailed by Guy Tuggle, the Parliamentary Health and Social Care Committee has now reconvened for a second round of oral evidence. This has come from a panel of guests selected to inform it about why MPs receive so many missives from angry patients unable to access NHS dentistry, and why so many dentists are walking away from NHS contracts. 

Or alternatively it has come about to answer calls for “something to be done” and buy some more time to avoid actually making significant changes. Guy’s preview rehearsed the likely content and predicted the expected answers, so how did the actual hearing compare?

Introducing the session Chair Steve Brine (Con. Winchester), made clear that the enquiry was not as a result of a media story, but was in response to MP’s “of all parties and none” having postbags that contain so many complaints about the lack of access to dental care.

Steve Brine, began with Jo York, Managing Director, Hampshire and Isle of Wight Integrated Care Board, who were early adopters of taking on dentistry into ICB’s. Jo York was “excited” about the opportunities that this would provide. She believed ICB’s brought with them a better understanding of the issues and influences in the area. She spoke of a more flexible approach, but always within the national contract. When asked by Steve Brine if amongst her ICB colleagues, when it came to dentistry, there were those wondering, “what on earth have we taken on here?” she could not conceal a smile.

Also invited to the first part of the session were, Chris McCann, Director of Communications, Campaigns and Impact at Healthwatch England and Sarah Fletcher CEO at Healthwatch Lincolnshire, a county which is a premier league dental desert. Healthwatch England, have been consistent in their highlighting of the access problem. The Committee had previously chosen the professional advocates of Healthwatch, who speak fluent ‘committee’ to give oral evidence, and rejected the commoners of the Toothless in England campaign.

When asked what difference ICB’s were making, Sarah Fletcher concluded that if anything things had got worse. Jo York, asked by Steve Brine what patients getting an “I’ve left the NHS letter” could expect (as many of his constituents were receiving) was unable to give a reassuring answer beyond “seeing what we can do” and hoping to bring up UDA rates in the most challenged areas. A dental bus service was also being considered, and of course there was NHS 111.

James Morris MP (Con. Halesowen and Rowley Regis) asked Jo York what an ICB could do to stop dentists handing back contracts. She spoke of possible reviews of UDA rates, and where staffing was an issue she leant heavily on salvation taking the shape of therapists, hygienists and the University of Portsmouth. Responding, he asked if the contract was really the key problem. Unsurprisingly, Jo York defended the potential of ICB’s to change things, but accepted that they had to work within the national contract.

Speaking for Healthwatch, Chris McCann asked for a reformed system where patients had a similar relationship with their dentist to the one they have with their GMP, and a known “point of access.” Sarah Fletcher added that there needed to be some prioritisation for particular groups, citing pregnant women, those with medical issues, those on a lower income, ex-military and travellers, and said out loud the words, “means tested.”

Asked by Steve Brine, Jo York admitted that she had no dental representation on her ICB board, but one of the GP’s that sat on it, had it in his portfolio. Steve Brine asked her how dentists might feel about that. In her convoluted answer she did not feel that this was a problem, but was developing relationships with the local LDC. Sarah Fletcher confirmed that in Lincolnshire too, dental registrants were not on the ICB board. Indeed, to the best of his knowledge Chris McCann was not aware of dentists on any ICB board.

Rachel Maskel MP (Lab. York Central) said that so far she had heard mainly about structure, but really wanted to know about outcomes. She asked what flexibility ICBs needed to reduce children’s GA’s. Jo York’s response fell back on DCP’s and working with local authorities. Rachel Maskel then asked about services for older people. Sarah Fletcher said that a service that could visit care homes was needed. Chris McCann was asked if UDA’s “could be flexed or traded” to help with priority groups. He responded that trading UDA’s would not fix things. There was a capacity problem, and it could not be solved piecemeal. In recent years, dental issues coming to HW had risen from 5% to 25% of feedback received.

Asked about the NHS patient charges increase by Taiwo Owatemi (Lab. Coventry NW) Sarah Fletcher agreed that this was a major deterrent. It would add to health inequalities. Chris McCann, when asked what changes he would like to see, responded again that it was about capacity. A fundamental dental health assessment of the population was needed and then appropriate resources allocated, rather than expecting a fixed budget to deal with all problems. There was some discussion about the public often not understanding how NHS dental care worked, for example the issue of “registration.” In the comments that followed Sarah Fletcher spoke of some of her staff having palpitations when they got an enquiry about NHS dentistry, as they knew there was nothing they could do to help.

Paul Bristow (Con. Peterborough) had the last question in the first part of proceedings. He asked Jo York what one thing she would change in the national contract, were she allowed. She replied that helping those who had not accessed care for a while, who often had high treatment needs, and emergencies, would help.

It was notable that MP’s had not pushed back when either the participants representing Healthwatch, or ICB’s, had to all intents recognised that a universal NHS dental service, available to all, might no longer be possible.

We will return in a follow up to the second part of the session which featured politicians talking to politicians, as the Committee’s members heard from Neil O’Brien MP, the Parliamentary Under Secretary of State for Primary Care and Public Health, Sara Hurley, Chief Dental Officer at NHS England and Dr Amanda Doyle, National Director for Primary Care and Community Services at NHSE.

Michael Goodchild
GPs representing Dentistry
"Asked by Steve Brine, Jo York admitted that she had no dental representation on her ICB board, but one of the GP’s that sat on it, had it in his portfolio."

And how often have we (or patients) heard "we don't do dental" from their GMP?


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