Debate contribution: Dental Services: Fermanagh and South Tyrone

Debate contribution by Mr Mike Nesbitt on 25 February 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

25 February 2025

Type

Debate contribution (made as a minister)

Business

Adjournment

Heading

Dental Services: Fermanagh and South Tyrone

Assembly identifier

Official Report component 4815565

Read the official Assembly record

Text

Thank you very much, Mr Deputy Speaker. I begin by thanking Deborah Erskine for bringing the debate to the Chamber this afternoon. It is an important debate that reflects a serious problem, one of many serious problems in health and social care delivery. It is a timely debate, certainly for me, because, on 18 February, I met the British Dental Association to tease out some of the issues. I will make some prepared remarks, but I have to put down a warning. In the short number of months that I have been in this position, I have engaged in quite a number of debates in the Chamber, but this is the one where the irony klaxon has sounded most loudly and most often. I warn Members that I will return to that at the end of my remarks. First, I acknowledge the challenges facing many patients, particularly those who are not registered, in accessing dental care when they need it. Access to health service dentistry across Northern Ireland has reduced significantly over the last five years, and one of the underlying reasons for that is that general dentist practitioners spend less time treating health service patients and more time meeting the strong demand for private work, which, as independent contractors, they are entitled to do. I am also aware that some areas of the country have historically lower registration and treatment rates, and that is particularly true of Fermanagh and Tyrone. That is at least partly due to geography. Areas with a low population density tend to have a lower density of practices. It is important to remember that general dentist practitioners are independent contractors, so, as such, they are not required to register new health service patients, nor does the Department have a role in deciding the location of new practices. That is a business decision made by the practice owners. One area where my Department has some limited control is in regard to dental foundation training. Recent changes to that scheme have resulted in increased applications from general dentist practitioners wishing to become educational supervisors for newly graduated dentists who are completing their training year. That increase has allowed the Northern Ireland Medical and Dental Training Agency, NIMDTA, to improve the geographical distribution of dental foundation training places across Northern Ireland, and, as a result, there are seven fully funded health service training placements in the west of the Province in this financial year compared with just one in 2023-24. Recruitment of educational supervisors for 2025-26 is ongoing. It is anticipated that the geographical spread will continue positively. Access to health service dentistry remains a priority focus for me, and my Department has specifically targeted investment this year at improving access for priority groups across the Province. There is an investment package of £9·2 million, and that has supported general dental services (GDS) in this financial year, including £1 million for newly registered child patients through the re-establishment of the enhanced child examination scheme. That provides children aged nought to 10 who have not been registered with a dentist with an examination, individualised oral health advice and age-specific fluoride application to teeth to assist with preventing dental decay. There is £4·3 million that has funded a 30% enhancement, and that is to fees paid to dentists for health service fillings, extractions and root canal treatment to support public access to priority treatments.

Finally, there was £3·9 million for the treatment of high-priority unregistered patients through a dental access scheme. I will give way at the end, if there is time. Officials continue to monitor the performance of those initiatives. The indications are that they have had a positive impact. As I mentioned, I met the British Dental Association last week and discussed the issues facing the industry. Officials held a follow-up meeting today to continue the engagement. The BDA is clear that the current system is unsustainable, so my Department is developing options to increase investment in the service next year but is doing so in the context of a Budget that is entirely inadequate to meet the needs of Health and Social Care services.

I have said before that my Department faces a funding deficit of approximately £400 million in the next financial year. That places massive constraints on my scope to take the action that we would all like to see taken to sustain and develop services across the entire Department of Health.

Although those additional investment interventions are necessary to stabilise general dental services in the short term, I am clear that GDS, in common with other services, will require a sustained effort to ensure sustainability over the longer term. My Department is therefore committed to taking forward work on the long-term future of dental services to ensure that patients can continue to access care when they need it and that the service is sustainable. As an important first step, I have approved the commissioning of a general dental services cost-of-service review that will be completed in the 2025-26 financial year. The review will, in turn, provide a robust evidence base for informing how the service will develop over the coming years. I have said many times that my vision for Health and Social Care is to see more care delivered through primary and community care and to move towards a more preventative model of healthcare that will be better for patients and more sustainable in the longer term. GDS play an important role in improving the general health of the population and reducing pressure on other areas of the health service. Improving oral health is an important element of the future sustainability of dental services and is central to the delivery of improved outcomes for patients. For that reason, I was pleased that oral health was included in the pathfinder programme for my Live Better initiative in the north-west. I look forward to the lessons learned from that initiative informing our longer-term priorities. As for an out-of-hours service, there are currently three emergency dental centres providing emergency dental care at weekends and on bank holidays to registered and unregistered patients. The centres are located in Belfast, Armagh and Ballymena. When they were originally established in the 1990s, it was agreed with local dentists in the west that they would provide emergency cover through local, practice-based rotas covering weekends and public holidays. In 2019, the western local dental committee (LDC) approached the legacy Health and Social Care Board (HSCB) to advise it that it was no longer prepared to operate the local rotas and requested that the HSCB commission an emergency dental centre similar to that in other areas. Although the pandemic impacted on progress on that work, an out-of-hours working group was established in 2021 to review the future of dental out-of-hours and emergency care provision across Northern Ireland. The strategic planning and performance group (SPPG) is working through the actions emanating from the working group's findings, including engagement with the western LDC and the Western Trust on future arrangements for the west. Funding those actions, however, will be a significant challenge in the current financial climate. Mr McGrath talked about the oral health strategy. I am aware that it dates back to 2007, but many of its recommendations and much of its evidence base are still valid. Developing a new strategy would carry a significant resource cost, including having a dedicated dental public health expert or expert group, owing to the complex and extended nature of developing a new strategy and the prerequisite oral health needs assessments. For example, one oral health strategy target was to improve the then 39% of five-year-old children who were decay-free to at least 50% within 10 years. In 2013, the data indicated that we had achieved 60%, and the 2018-19 data indicated that around 70% of our five-year-old children were decay-free. That represents great progress, but I am aware that more needs to be done. I promised to return to the irony klaxon. Mrs Erskine challenged me by asking what steps I would take to introduce financial support and incentives for dentists. The first step will be to continue to try to persuade her that she made a big mistake in voting for the 2024-25 Budget. Áine Murphy made the point that a lot of dentists were no longer providing NHS dental treatment because it is no longer economically viable for them to do so: I agree. What is the solution? We need to find more money. Where do we find more money? We find more money in the Budget, but you voted for a Budget that, you were warned, was not adequate to meet the health and social care needs of our population. The other point and the other irony klaxon is about health inequalities. I ask Members this: which Health Minister in recent years has put more of a focus on tackling health inequalities than I have? When it comes to moving into areas of deprivation to tackle the issues and disparities, particularly those in healthy life expectancy, who has done more to put a focus on that than I have?

1,516 words. Text as published by the Northern Ireland Assembly.

Assessment

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Assessed 21 October 2026 at 12:02 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

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