Debate contribution: NHS Dentistry

Debate contribution by Mr Mike Nesbitt on 28 April 2026.

MLA: Mr Mike Nesbitt
Party at the time: Ulster Unionist Party
Date: 28 April 2026
Type: Debate contribution (made as a minister)
Business: Private Members' Business
Heading: NHS Dentistry
Assembly identifier: Official Report component 5510166

Text

Thank you, Madam Principal Deputy Speaker. I thank the proposer of the motion, the proposer of the amendment and, indeed, all Members who contributed. I begin by fully acknowledging the strength of feeling not just in the Chamber but amongst the public regarding access to health service dentistry. The concerns are legitimate and widely shared. The figures highlighted in the motion are stark, as are the scale and pace of the decline in dental registrations in the health service here. Over the past two years, the proportion of individuals registered with a health service dentist has declined significantly, and the volume of treatment being provided is lower than it was before the COVID-19 pandemic. Those trends present real challenges not just for patients but for dental professionals and for the sustainability of the entire system. Against that backdrop, it is important to place the issues in context, to outline the factors that have contributed to the current position and to describe the work that is under way to address immediate pressures and the longer-term structural issues in general dental services (GDS). The decline in registrations and activity is the result not of a single failure or decision but, rather, a number of interrelated and cumulative pressures that have built up over time. Like many other healthcare services, dentistry was significantly impacted on by the pandemic, resulting in a backlog of unmet need, disrupted patterns of attendance and registration and, for some, an increased reliance on private care, further widening inequalities in access. I am particularly conscious of, and share Members' concerns about, registrations lapsing due to non-attendance. While that may be understandable in the context of the disruption caused by the pandemic, it can create significant additional barriers to individuals who are seeking urgent or preventative care, especially where access options were already limited. At the same time, dental practices have reported increases in operating costs, including staff costs, the cost of clinical supplies, energy prices and the ongoing costs associated with regulatory and contractual compliance. Members have raised concerns about the sustainability of the current general dental services payment model. The GDS contract has been in place largely unchanged since 1990 and was not designed for the cost-based workforce reality or patient demand that exist today, so I am determined to look at that in the remainder of the mandate. It has been widely acknowledged that rising operating costs have placed the payment model under unsustainable strain. The pressures have contributed to a contraction in health service dentistry across all trust areas in recent years at a faster pace than elsewhere in the United Kingdom. That has been compounded by workforce challenges, including difficulties with recruitment and retention, and by the increasing attractiveness of having a private practice as a mechanism for some providers to manage their rising costs. I commissioned the cost-of-service review precisely to provide a robust, evidence-based assessment of all those challenges. The purpose of the review is to ensure that decisions on dental payment reform are informed by a clear and accurate understanding of the costs that are involved in delivering health service dental care in Northern Ireland. I recognise the sense of urgency that Members have around the publication of the review report, given its importance to both the dental profession and the Assembly. I share that sense of urgency. My officials have received a copy of the draft report and have been actively scrutinising its contents, as one would imagine they would. They met with the author, Professor Ciaran O'Neill, on Friday past and sought clarification on a number of issues. I am told that certain areas of the report need a rewrite so that it is user-friendly and as clear as possible in its thoughts and conclusions. The report remains in draft form, subject to that further clarification and assurance, but I want to have the final version in a matter of weeks. I also fully recognise the fact that accurately estimating the cost per hour of delivering health service dental care is inherently complex. I expect to go into negotiations with dental representatives about the conclusions. Dental practices vary significantly in size and have different staffing models and patient mixes. Any robust cost assessment must take proper account of that complexity and diversity. Although the report remains in draft form, it is an important piece of work that will, I hope, ensure that any future reform is grounded in accurate and robust evidence. I do not wish to pre-empt any conclusions, but I stress again that it is an urgent matter for me and the Department. I have directed officials to continue to engage closely with the author and to work at pace to complete the necessary assurance and consideration processes. Furthermore, any changes to the payment system must be financially sustainable, deliver value for public money and support improved access and outcomes for patients. I recognise the call to develop an action plan for reform. As already detailed in my three-year plan for health and social care, that action plan will be in place by the end of the financial year and will provide a road map for the future of general dental services. Alongside the cost-of-service review, the work of the general dental services reform advisory group will play a key role in shaping the development of an action plan for reform. I also recognise and accept the importance of balancing the need for urgent stabilisation measures with longer-term reform. Members will be aware of the extremely challenging financial context in which we are operating. My Department faces a projected deficit of towards £800 million in this financial year — £800 million — but we are currently working without an agreed Budget. That places a very real and unavoidable constraint on my ability to do all the things that I want to do or to move at the pace at which I would like to move. Despite those constraints, and in the full knowledge that this cannot, on its own, resolve the underlying problems, I made the decision to prioritise an additional £8 million investment in health service dentistry this year. That investment will fund the continuation of the 30% enhancement to the fees associated with fillings, extractions and root canal treatment; the continuation of the enhanced child examination scheme; an increase to the activity support payment that was introduced last year from £1·6 million to £2 million; the commissioning of an emergency dental clinic in the Western Trust area; and an additional six dental foundation training places. I can say to Mrs Erskine that it is planned that the centre — the emergency unit — will be housed in her constituency of Fermanagh and South Tyrone.
I can also tell Members that, between June 2024 and March of this year, 76,493 children were registered with the enhanced child examination scheme. I am acutely aware that access to affordable dental care is not distributed evenly across communities. Barriers to access can disproportionately affect those on lower incomes, older people, individuals with disabilities and those who live in rural or socio-economically deprived areas. The point has been made about that health inequality. In terms of dental decay, the inequalities follow socio-economic gradients. That is a global issue and is not particular to us.
I recognise the need to improve access for not only registered patients but those who are currently unregistered, particularly where there is an urgent clinical need. Schemes such as emergency dental clinics and the dental access scheme are therefore essential components of the current response. In that context, it is vital that the limited resources available are targeted where they can have the greatest impact. That is why this investment also includes funding for the establishment of a new emergency dental clinic in the western area, where registration rates have historically been and remain lower than in other regions. The new clinic will provide additional access at weekends and public holidays for patients in need. In addition, the dental access scheme continues to provide weekday access for patients with a pressing or urgent oral health need. The sustainability of health service dentistry is inseparable from workforce issues. Recruitment and retention challenges are evident right across Northern Ireland and continue to affect dental services. To help address that, the funding package will also support six additional dental foundation training places this year, helping to retain newly qualified dentists, addressing workforce shortages and strengthening the sustainability of health service dentistry in the years to come. I am taking action now, within the limits of the resources available to me, to make targeted improvements. I am also putting in place the evidence and the framework required for the much-needed long-term reform, but I cannot pretend that those measures alone will reverse decades of structural pressure. I want to be clear with Members: the pace of reform is constrained not by any lack of willingness or ambition on my or my Department's behalf but by the absence of the financial envelope that is required to act at scale, which is what we need to do. Frankly, without an agreed and realistic budget, the scope for accelerating reform remains highly limited. Protecting health service dentistry requires funding decisions that are aligned with the realities of delivering the service. I will turn to a couple more points that were made by Members. Some Members talked about DIY dentistry. My officials have no evidence of that happening in Northern Ireland, but, if it is, I am very much open to hearing about it. I want to talk also —.
The first thing that I need is evidence of it, and I repeat that I am being told by my officials in dentistry that, while there is evidence of it happening in Great Britain, there is no evidence of it here. If the Member can bring me evidence — if it is happening, it is incredibly serious — I will talk to officials about how best to handle it. I want to touch on the issue of payments, because it was raised by Members. An additional £2·5 million was allocated to general dental services on a recurrent basis to support the increase in National Insurance contributions. That is being distributed in line with the proportion of practice allowance received by practices in the 2025-26 financial year. It is being paid in two instalments, and that is aligned with the practice allowance payments for the 2025-26 financial year. The first of those was paid in December last year, and the second is scheduled for payment in May this year, following the next practice allowance payment. Mr Durkan talked about orthodontic assessments. I have to say that there are additional payments for those. Mr Gaston talked about dental amalgam and blamed the issue on the Irish Sea border. He is entirely wrong — he is entirely wrong. It is UK-wide, following an international agreement. I am happy to put that correction on the record.
I accept that it is a crisis in dental services, but I ask Members to accept that my ability to rise to that challenge is constrained primarily by a budget that is currently forecast to be between £750 million and £800 million light, which means that some very hard choices will have to be made. The Chairman of the Health Committee said that stabilisation is not good enough; I agree with him, but it is the essential first step.

1,906 words. Text as published by the Northern Ireland Assembly.

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