Debate contribution: Dental Care

Debate contribution by Mr Danny Donnelly on 27 May 2025.

MLA

Mr Danny Donnelly

Party at the time

Alliance Party

Date

27 May 2025

Type

Debate contribution

Business

Private Members' Business

Heading

Dental Care

Assembly identifier

Official Report component 4972209

Read the official Assembly record

Text

Thank you, Madam Principal Deputy Speaker. I thank everybody for their contributions today. It was very striking that the contributions from across the Chamber were very similar, so there seems to be unanimity on the experiences across Northern Ireland. I thank the DUP Members in particular for their amendment, which we will be supporting. Let us be honest: we are back here again with another day and another crisis. This time, it is dental care, but the pattern is painfully familiar. Services are collapsing, professionals are at breaking point, and the public are left wondering where it will end. Once again, we will hear the familiar lines of, "This is a priority", "You know my record" and "We are engaging". It is the kind of response that we have seen rolled out time and time again, almost as if it is ready and waiting for every crisis to be brought to the Chamber. If words alone could fill cavities, the people of Northern Ireland would have the healthiest teeth in Europe. The truth is that we have a Minister who can talk the talk, recite the stats, express sympathy and even promise reform, but sympathy does not get you a dental appointment. Strategy announcements do not pay the bills of dental practices that are going under. Good intentions do not bridge the funding gap that leaves NHS dental services financially unviable. Believe me, I do not underestimate how difficult the Minister's job is, and I am not pretending that reform is simple, but someone has to step up and drive that change. If the answer is, "There is not enough money", that is fine, but what is the plan? Do we keep pouring limited funds into a failing system and call it effort, or do we finally commit to meaningful, lasting reform that actually delivers for people who are depending on it? This is not abstract policy talk; it is about people across Northern Ireland — we have heard a lot about them today — trying to get on with their lives while dealing with pain that could and should have been treated. It is about missed school, missed work and avoidable complications. It is not just a dental issue any more; it is a system-wide failure that is hitting people where it hurts and reminding them that help is not guaranteed when they need it. The numbers are shocking. There are 192,780 fewer patients registered with a dentist as of January 2025. In 2024 alone, almost 41,000 NHS patients were removed from dental lists. Since the peak of quarter 1 in 2023-24, we have lost more than 177,000 people from the NHS dental rolls, which is a 13% drop in 18 months. For adult males, registrations were down by nearly 94,000. For women, it was nearly 99,000. Those are not just numbers; they are people and families. That causes pain and puts pressure on the health system, which is now absorbing that in other ways. It would be an omission if I did not highlight the fact that that decline in access to service has been going on for years, including those years when this place was prevented from working by one political party or another, thus preventing a Minister from being able to address the problem. There will be years of negative effects as a result of this growing lack of access. Dentists have been explaining to us for years why this is happening. The fees that they are paid no longer cover the costs of care, and they are subsidising the NHS out of their own pockets. More and more are having to transfer to private practice to make ends meet, and that is affecting patients. In fact, GDC data shows that Northern Ireland has seen the largest shift away from NHS dentistry of all the Celtic nations in the UK, and, of the 364 dental practices here, only 29, which is less than 10%, have signed up to the dental access scheme. That speaks volumes about confidence in that system. Here is the worst part: we know that prevention works. Every pound invested in dental care saves the system multiple pounds down the line in reduced pressure on the NHS, A&E departments and GPs and leads to fewer emergency admissions, fewer antibiotic prescriptions and fewer complications. This is not a moral obligation; it makes economic sense. What do we need? We need a new oral health strategy that is modern, resourced and honest. We need a cost-of-service review that is published and acted upon. We also need the Minister to show that he can do more than just say the right things but can do them, because, right now — you will have to excuse me if I am not convinced by the words — I do not think that the people of Northern Ireland are convinced. They are tired — tired of excuses, tired of crises without resolution and tired of those in power who say, "We feel your pain" while causing more. I will now go through some of the comments that Members made during the debate. My colleague Paula Bradshaw highlighted the fact that this is another example of the two-tier health system in Northern Ireland and that the inability to access health service dentistry is a glaring issue of inequality. Again, that is something that the Minister highlighted as a priority of his. Alan Robinson, in proposing the amendment, said that there were additions to the call to address regional inequalities, and we will support that, Alan. Alan very eloquently highlighted the difficulties that people have in accessing NHS dental care and said that a number of dentists have handed back their contracts. Philip McGuigan, Chair of the Health Committee, highlighted the fact that dental care is not a luxury but a necessity. He said that having the right to free dental care has no meaning when you cannot access it, and I thought that that was a very pertinent statement. Private healthcare is becoming more and more common across Northern Ireland, and nowhere is that more stark than in dentistry. Alan Chambers pointed out that he is very well aware that it has become more difficult for people to access NHS dentistry over the past few years. Colin McGrath said that dentists are losing money every time they deliver treatment, and he highlighted his own experience with tooth decay. I hope that that is resolved, Colin. Órlaithí Flynn said that this has come up time and again and that the BDA has been warning of this collapse for years. She gave an example of a constituent who had to take a private dental plan to remain a patient. Deborah Erskine highlighted the impact on constituents in rural areas and made a very strong point about people in those areas having to travel long distances to access treatment. She also highlighted the links to heart disease, diabetes and complications in pregnancy, which are very serious issues. Timothy Gaston gave an example of a mother having to register her child miles away. He also called for a fixed funding model and for a rebuild of the workforce. As usual, he mentioned immigrants, who have very little bearing on this debate. Gerry Carroll noted the spread of dental deserts and cited stats on the effects of inability to access timely dental care, including people carrying out their own dental work. That is a shocking thing for any of us to hear. He also called for NHS dentistry to be brought into public ownership.

Claire Sugden said that waiting for care is not just inconvenient but clinically dangerous and, again, highlighted the impacts on pregnant women of not having access to dental care. She also said that long delays in payment from BSO are impacting on dentists' cash flow, and, again, we have heard that previously. She stated that she has spoken to dentists, many of whom have low morale and are burned out. We are certainly hearing that as well.

Mike Nesbitt, in his response to the debate, mentioned that he met the BDA in February, which is welcome: it is good to hear that there are ongoing negotiations on the matter. He mentioned the recent investment announced in the budget but stated that investment is not a panacea. Investment is not a panacea, Minister, but it is required to sustain the services. The Minister suggested that dentists are deciding to treat more private patients than health service patients. That conflicts with what we are hearing, which is that dentists have no choice but to do that in order to keep their practices financially sustainable. The Minister announced, I think, that the GDS cost-of-service review will be completed within this financial year, which means by April next year, and that that will provide an evidence base for the funding of the service. I hope that it will be done as soon as possible. The Minister also said that moving towards a more preventable form of healthcare is his plan, but that is not where most people see the service as being at the moment. Diane Dodds, in her winding-up speech on the amendment, noted the escalating number of people, particularly children in areas of deprivation, who are being removed from dental lists, which is very worrying. I think that we can all agree that it is shocking that only 49% of people in the Fermanagh and Omagh District Council area are registered with a dentist. We were elected to lead. We need to start doing that for our constituents, for our health service and for the principle that, in our society, access to care, including timely dental care, should never be a privilege. I thank MLAs for their contributions today, and I hope that the Minister will take them on board.

1,637 words. Text as published by the Northern Ireland Assembly.

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