Debate contribution: NHS Dentistry: North Belfast
Debate contribution by Mr Mike Nesbitt on .
- MLA
- Mr Mike Nesbitt
- Party at the time
- Ulster Unionist Party
- Date
- 14 April 2026
- Type
- Debate contribution (made as a minister)
- Business
- Adjournment
- Heading
- NHS Dentistry: North Belfast
- Assembly identifier
- Official Report component 5482977
Read the official Assembly record
Text
Thank you, Deputy Speaker. I thank Phillip Brett for raising the issue and thank the Members who contributed. The debate highlights the very real and ongoing issues being experienced in Mr Brett's constituency. However, access to health service dentistry is a challenge across the entire region, not just North Belfast, so I will address concerns in the wider regional context. I have made it clear that improving access and sustaining health service dentistry is a key area of focus for me. Access has reduced significantly over the past number of years, and in my update to the Health Committee earlier this year, I noted that official statistics now evidence that the percentage of our population currently registered with a health service dentist has fallen below 50%.
That percentage does not include those who are registered with a private dentist or who are receiving dental treatment through trust-based services, but the figure is still very concerning.
Historically, some areas of the region have had lower registration and treatment rates, often reflecting geography or population size, and North Belfast faces a combination of wider workforce pressures and reduced health service provision that mirrors trends that are being seen across many of our urban areas. Members will be aware that general dental practitioners are self-employed, independent contractors and are therefore free to choose where they practice and the proportion of their time that they wish to dedicate to the health service. The number of practices and practitioners registered to provide health service care has not changed markedly in recent years. In North Belfast, there are 82 practitioners across 27 practices, and that is the fourth-highest number across all Assembly constituencies. That, Members may think, appears promising, but the registration rate in North Belfast has reduced by 27·9% in the past four years. It is clear that, although there are a sufficient number of dentists, the type of work that they are doing has changed. They are reducing the level of health service work that they are carrying out and increasing their private work. The pattern is the same right across Northern Ireland. The reason that is given for that is that the fees that are paid for health service treatment are insufficient to maintain practices' financial viability. In January, I met representatives of the British Dental Association, and they were unequivocal in saying to me that the current system is unsustainable and nearing collapse. They proposed a payment reform model to address the current instability and the continuing loss of dentists to private practice. They are looking for a reduced, or core service, model, but that is a reform that would require significant investment. At present, the current budget cannot meet that requirement, because no Budget has been agreed. Although I recognise the necessity of payment reform, the reality is that reform on that scale is dependent on funding decisions that have not yet been agreed. Reaching agreement on the Budget as soon as possible is essential if we are to progress meaningful reform of general dental services. Until then, I am afraid that difficult constraints will remain, and my focus will remain on stabilising the service and protecting access wherever possible. I have taken tangible steps to support and encourage the profession to continue providing health service dentistry in recent years. In 2025-26, I invested an additional £7 million in general dental services, and I have just agreed a further investment of £8 million for this financial year. That includes the continuation of a 30% enhancement to the fees for priority treatments, the continuation of the enhanced child examination scheme to encourage new child registrations, and £2 million of direct support for dental practitioners who continue to provide health service dental care. To answer Nuala McAllister's question, that is an increase on the £1·6 million that was provided in 2025-26. Moreover, the enhanced child examination scheme is demonstrating that children in the most deprived quintiles represent the biggest registration figure. The enhanced child examination scheme is helping 76,493 children up to 10 years of age who are registered. Children who, owing to medical conditions, are unable to access care in general dental practice may be referred to community dental services. Miss McAllister mentioned preschool children, and she may wish to note that there has been an expansion of the Happy Smiles programme to children in P1, P2 and P3 in the 20% most deprived areas in Northern Ireland. The recommendation is for a child to see a dentist by their first birthday, as soon as their first tooth appears. The dental access scheme also remains in place, providing access for unregistered patients with a pressing or urgent oral healthcare need. Separately, last year, I also allocated a recurrent £2·5 million to practitioners to offset the costs associated with increased employers' National Insurance contributions. Although I hope that those investment measures will be welcomed as meaningful and tangible steps in an extremely challenging financial context, I am also acutely aware that a financial envelope of £8 million is not enough to address the significant challenges facing general dental services. Sustaining and improving health service dentistry will require longer-term reform that is underpinned by additional investment if the service is to be placed on a stable and sustainable footing. My Department is facing a projected deficit of approximately £800 million — £800 million — in this financial year. Like last year, that is unprecedented and, frankly, unmanageable, and it will place a significant constraint on my ability to deliver immediate and meaningful reform. Members will be aware that, in December 2024, I commissioned a cost-of-service review. The Department has now received that report. I say gently to Mr Kingston that I have not received it yet, but the Department has. I would like to think that I will receive it in days rather than weeks. We have that draft report, and officials will undertake detailed analysis and present it to me. In the immediate term, my focus is on stabilisation, as I said, while longer-term reforms progress. Officials continue to target engagement with the dental profession through the BDA and the recently established GDS to form an advisory group whose aim is to better understand where access pressures are most acute and to direct resources accordingly. That includes improving our understanding of local access in areas such as North Belfast. I want to be clear with Members that I fully recognise the real difficulties faced by patients in North Belfast who are struggling to access health service dentistry. I also recognise that those pressures are being felt elsewhere and that general dental practitioners are operating in an increasingly challenging environment. In conclusion, I will make three points, if I may. The cost of service is extremely important, because the Department and the BDA are not on the same page when it comes to that critical area. Mr Brett quoted, I believe, that more than 70% of BDA respondents said that they were not appropriately rewarded. That in itself explains why the cost-of-service report is so important. Let us get on the same page as the BDA. We also need to explore something more than investing in the current regime. We need a new regime, but achieving that will be very challenging in the current financial constraints. The third point is to try to inject a little hope. I hope that the announcement of an £8 million investment, including the increase from £1·6 million to £2 million that Ms McAllister asked for clarification on, will do just that. I will finish with this note of caution, however. We need a Budget. Every Department needs a Budget, and preferably a multi-year Budget. We need a Budget, because we are well into the financial year already.
We have a draft Budget, and within that, there are many, many lines of budgetary commitments. Let me write to Mr Brett rather than try to recall hundreds of lines of budgetary commitments off the top of my head.
1,328 words. Text as published by the Northern Ireland Assembly.
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