In a rare display of unanimity, Members of the Legislative Assembly (MLAs) have passed an Assembly motion which calls on the Minister of Health to develop a new oral health strategy to reform dental services, address workforce challenges and expedite dental payment reform. Also, to introduce specific measures to address barriers to accessing dental care in all communities.
The very real crisis unfolding in Health Service dentistry was the focus of a second debate on dentistry in as many weeks, the latest being a full Assembly debate at Stormont brought forward by Diane Dodds MLA and Alan Robinson MLA from the Democratic Unionist Party (DUP), and amended by the Alliance Party.
Members from across all parties were united in expressing alarm at the widespread access issues arising from the scale of the disappearance of Health Service dentistry, quoting the massive reductions in registered patients and NHS dental activity.
MLAs acknowledged this is entirely the outworking of a dental payment model which bears no resemblance to the true cost of providing care. They also recognised that it has become unviable for practices to deliver, and is resulting in the most rapid decline of NHS dentistry anywhere in the UK.
They also stressed the urgency of having the Cost-of-Service review published without delay, emphasising the need to make rapid progress in the weeks and months ahead if dentistry in Northern Ireland is to have any chance of being put on a stable footing.
They urged the Minister to make significant progress before the end of this Assembly mandate.
Politicians spoke about how dental access is a major issue impacting on constituents right across Northern Ireland. MLAs contributing to the debate quoted official statistics which showed registration lapses in the region of the 20,000s and 30,000s in their constituencies in the year 2024-25 alone. This is a service which the Chair of the Health Committee said has ceased to exist for many “if people cannot find an NHS dentist with the capacity to treat them”.
Mark Durkan MLA was clear that this crisis was not created by dentists: “It was created by a system that no longer works. It is a broken model designed, funded, albeit inadequately and overseen by the Department of Health…the issue is not a lack of willingness to care for patients, but the fact that the current model is no longer financially viable”.
Órlaithí Flynn MLA asked the Minister for timelines; Timothy Gaston MLA warned of, “the slow collapse of NHS dentistry in Northern Ireland”, and said that ”no amount of warm words about access will change that reality”. Gerry Carroll MLA said this was “a crisis that the Minister and successive Governments have allowed to fester year-on-year without getting a grip on the crisis” culminating in “just half of the population” now registered with a Health Service dentist, “and almost 400,000 people have been lost since 2023”.
Claire Sugden MLA said, “dentistry is not optional. It is part of our health system”. She added, “dentistry is one area in which, if we intervene earlier to prevent problems, we can reduce that pressure. It is about investing to save, which is a phrase that the Executive could do well to consider”.
Responding to the debate, Health Minister Mike Nesbitt acknowledged 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.” He continued “I am determined to look at that in the remainder of this mandate”. He added he wanted to have the final version of Cost-of-Service review with him, “in a matter of weeks”, and added, “I expect to go into negotiations with dental representatives about the conclusions”.
Once again, the Minister warned that his Department faces a projected deficit of £800m in this financial year, and is operating without an agreed Budget. He said “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”.
Winding the debate, Deputy Chair of the Health Committee Danny Donnelly MLA stated, ‘there has been clear recognition during the debate that it is not a short-term pressure nor a localised difficulty; it is a deep structural problem that now requires a serious and strategic response”. Alan Robinson MLA added, “dentists want a payment model that reflects the true cost of providing care. NHS dentistry needs to be stabilised before more practices walk away from it”.
Efforts to ensure our issues are firmly on the political radar have been relentless. The imperative of moving on dental payment reform, informed by Cost-of-Service review came across loud and clear from this debate, and the motion that was passed.
For our part, as momentum builds we will continue to work to ensure this vital service is put on a firm financial footing in what is left of this Assembly mandate.
Read the assembly motion on tackling barriers to accessing an NHS dentist passed on 28 April in Hansard
