Recommendations & Conclusions
13 items
2
Conclusion
21st Report - Fixing NHS Dentistry
Accepted
The dental recovery plan was never going to deliver its headline ambition that everyone who needs to see an NHS dentist would be able to, and has failed even to deliver the hoped for 1.5 million additional courses of treatment in 2024–25. The plan’s initial promise to expand access in …
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The dental recovery plan was never going to deliver its headline ambition that everyone who needs to see an NHS dentist would be able to, and has failed even to deliver the hoped for 1.5 million additional courses of treatment in 2024–25. The plan’s initial promise to expand access in 2024–25 so that everyone who needed to see a dentist would be able to was never aligned to its actual target of an additional 1.5 million courses of treatment. Even this target would have left overall delivery still around 2.6 million courses of treatment short of pre–pandemic levels. The dental recovery plan has failed to deliver the promised additional courses of treatment, the number of new patients seen is actually falling, and slow or no progress has been made on other initiatives. At least £88 million has already been spent on the new patient premium, but 3% fewer new patients have been seen since it was launched in March 2024. Given the public money spent on initiatives that have yielded little or negative results, it is important that NHSE and DHSC produce a transparent evaluation of what government spent on the plan and why it has not had the desired impact on access to NHS dentistry. recommendation DHSC and NHSE must publish their evaluation of the dental recovery plan and what was spent on it. They should write to the Committee as soon as is practical to confirm their final analysis of the plan’s performance in 2024–25, including details of: • how many additional treatments the plan as a whole delivered; • for each of the four main initiatives a breakdown of what they individually achieved; • the final amount spent on each initiative; and • how far the performance in the 2024–25 plan can be continued into 2025–26
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Government response AI summary
The government agrees to publish an evaluation of the dental recovery plan, confirming data will be available from Summer 2025 and NHSE expects to report on individual initiatives by Autumn 2025. An initial evaluation on the plan's continuation into 2025-26 will be completed by Summer …
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HM Treasury
3
Recommendation
21st Report - Fixing NHS Dentistry
Accepted
DHSC and NHSE’s modelling of what might be achieved, and how much this would cost was wrong and it took too long to identify the error, raising wider concerns about the quality assurance processes in place for such plans. DHSC and NHSE only identified an error in their assumptions about …
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DHSC and NHSE’s modelling of what might be achieved, and how much this would cost was wrong and it took too long to identify the error, raising wider concerns about the quality assurance processes in place for such plans. DHSC and NHSE only identified an error in their assumptions about the cost of the new patient premium during preparation for our evidence session, a year since the publication of the plan in February 2024. 4 While they assured us that the error was not material to the delivery of the plan, we were concerned that something as fundamental as the cost of the plan, and the number of appointments it could deliver, was based on flawed analysis. The NAO report in November 2024, and the Health and Social Care Committee’s inquiry into NHS dentistry in March 2024, had previously raised concerns over how robust this modelling was. We heard that DHSC and NHSE have now designated dentistry a “business–critical model”, and that additional resource and quality assurance will be available in the future, but they have yet to make clear what this change will mean in practice. recommendation In their Treasury Minute response to this report DHSC and NHSE should set out how they are strengthening their own analytical capabilities in dentistry, and explain what will change in practice as a result of dentistry being designated as ‘business critical’.
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Government response AI summary
The government is undertaking a lessons learned exercise due Summer 2025 to understand modelling errors and incorporating dental modelling into the 'Business Critical Model' process from April 2025 for additional scrutiny. Analytical teams are also working more closely together to improve quality assurance.
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HM Treasury
4
Conclusion
21st Report - Fixing NHS Dentistry
Accepted
The dental recovery plan relied on centrally planned and imposed initiatives that ultimately failed to positively influence the amount of care delivered by dental practices. The dental recovery plan set out national initiatives that relied on take–up and delivery at a local level, hoping to influence the behaviour of individual …
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The dental recovery plan relied on centrally planned and imposed initiatives that ultimately failed to positively influence the amount of care delivered by dental practices. The dental recovery plan set out national initiatives that relied on take–up and delivery at a local level, hoping to influence the behaviour of individual dental practices. This approach ultimately failed, with the example of mobile dental vans particularly illustrative of a nationally–planned idea failing to address issues on the ground. Going beyond this national plan, it is imperative that regional disparities in access to NHS dentistry are resolved–access to NHS dentistry ranged from 382 courses of treatment delivered per 1,000 people in Somerset ICB to 800 delivered per 1,000 people in South Yorkshire ICB in 2023–24. NHSE and DHSC must support ICBs to use what flexibilities they have in their commissioning powers to deliver improvements that will work for their particular areas, and where necessary there should be clear lines of accountability for how ICBs manage NHS dental services under their responsibility. Commitments like the new government’s proposed 700,000 urgent appointments will rely on NHSE and DHSC’s ability to work with the people who deliver the service to translate that national priority into a local reality. recommendation NHSE and DHSC must in their future plans for NHS dentistry: a. clearly articulate how they will improve on previous efforts to co–ordinate between central and local initiatives. b. explain how they intend to support ICBs to innovate within their commissioning powers, while holding them to account for improving dentistry in their areas. 5 c. explain how they intend to support ICBs where, contrary to Government initiatives to expand access to dental treatment, practises may be experiencing a reduction in funding for 2025–26.
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Government response AI summary
The government is extending the dental ringfence into 2026-27, increasing its value to £4,104 million in 2025-26, and uplifting contract values. They are also supporting ICBs through continued Golden Hello payments and the inclusion of an additional 700,000 urgent appointments in planning guidance, with regular …
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HM Treasury
5
Conclusion
21st Report - Fixing NHS Dentistry
Accepted
DHSC and NHSE have not undertaken the analysis needed to understand the actual cost of delivering NHS dental care, without which any efforts at reform will fail to address fundamental issues around the affordability of NHS work. The discrepancy between what a dentist can earn delivering NHS work and private …
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DHSC and NHSE have not undertaken the analysis needed to understand the actual cost of delivering NHS dental care, without which any efforts at reform will fail to address fundamental issues around the affordability of NHS work. The discrepancy between what a dentist can earn delivering NHS work and private work is a fundamental issue for improving access. The current NHS dental contract, and its reliance on Units of Dental Activity (UDA) rates that were set nearly two decades ago, is unfit for purpose. Recent attempts to address disparities in what practices can earn for delivering NHS work by increasing the minimum UDA value first to £23 and then to £28, and to better reflect the different costs of treatments of greater complexity, have failed to deliver any identifiable improvements. We agree with DHSC when it says that fiddling around with the contract fails to address the real problem. In April 2023, there were 34,520 dentists registered to provide dentistry in England, but only 24,193 of these provided some NHS dental care in 2023–24. Without proper remuneration it is likely that even more will move exclusively to the private sector. However, it does not appear that NHSE and DHSC yet have a sense of what level of funding would provide a realistic incentive for dentists to prioritise NHS work. Until there is a clear and evidence–based proposal for remuneration that reflects the true costs of dentistry, that issue is unlikely to be resolved. recommendation DHSC and NHSE should commit in their Treasury Minute response to conducting and publishing analysis of the actual costs of providing NHS dental care as part of any future work on reforms to NHS dentistry, reflecting the full range of complexities of treatments that patients might need. This should include an explanation of how the current structure of payments to dentists, in terms of the range and complexity of treatment, has different impacts depending on the deprivation of the community served.
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Government response AI summary
The government agrees to conduct and publish analysis of the actual costs of NHS dental care, engaging with the BDA on this work which is expected to be published in due course. They also note interim changes to UDA payments to incentivize more complex treatments.
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HM Treasury
1
Conclusion
21st Report - Fixing NHS Dentistry
Accepted
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department for Health and Social Care (DHSC) and NHS England (NHSE) on NHS dentistry and the dental recovery plan.1
Government response AI summary
The government, noting the committee's work, highlights its commitment to rebuilding NHS dentistry and focuses on prevention by introducing supervised toothbrushing programs, expanding water fluoridation, and efforts to reduce sugar and create a smoke-free generation.
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HM Treasury
9
Conclusion
21st Report - Fixing NHS Dentistry
Accepted
The NAO report reflects this last point, finding that in 2022–23 £479 million was recovered from dental contracts where practices had not delivered the full amount of care that they had been contracted for.17
Government response AI summary
The government acknowledges the committee's observation by explaining that funding is recovered from dental contracts due to practices reducing commitments, ICBs reallocating funds from under-performing contractors, or reclaiming payment for undelivered activity, all of which supports access and value for money.
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HM Treasury
12
Conclusion
21st Report - Fixing NHS Dentistry
Accepted
The new government’s commitment to contract reform includes reference to a focus on prevention,27 and also to a programme of supervised toothbrushing for three, four, and five–year olds “most in need”.28 Tooth decay is a leading cause of hospital admissions for children in this country,29 and as DHSC told us …
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The new government’s commitment to contract reform includes reference to a focus on prevention,27 and also to a programme of supervised toothbrushing for three, four, and five–year olds “most in need”.28 Tooth decay is a leading cause of hospital admissions for children in this country,29 and as DHSC told us in the session, prevention is preferable to needing treatment from a dentist.30 Strengthening preventative oral healthcare measures is an important accompaniment to ensuring access to dentists, particularly for children. The government has now published further information on its proposed supervised toothbrushing scheme,31 and has confirmed its intention to expand community water fluoridation in the 20 C&AG’s Report, para 1.25 21 Q 27 22 C&AG’s Report, para 1.26 23 Q 25 24 NHS Dental Contracting Framework, 15 October 2024 25 Qq 77 and 97 26 Letter from the Interim Permanent Secretary of the Department of Health and Social Care and the Chief Executive Officer at NHS England relating to a follow up on the oral evidence session held on 13 February 2025 on Fixing NHS Dentistry, 18 March 2025 27 NHS Dental Contracting Framework, 15 October 2024 28 Schools: Dental Health, answered 4 February 2025 29 C&AG’s Report, para 1.10 30 Q 18 31 DHSC, Supervised toothbrushing for children to prevent tooth decay, published 7 March 2025 11 north–east.32 However, as DHSC noted, a relatively low percentage of the UK population has water fluoridation in comparison with some other countries, and there are other measures (including fluoride varnish) that can also be highly effective at protecting teeth.33 The 2024 dental recovery plan
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Government response AI summary
The government agrees with the observation and states that it has already introduced a national supervised toothbrushing programme for 3-5-year-olds in deprived areas and announced the expansion of water fluoridation in the North East. It also highlights ongoing work on sugar reduction and a smoke-free …
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HM Treasury
16
Conclusion
21st Report - Fixing NHS Dentistry
Accepted
NHSE did tell us that “roughly 2.7 million new patients” had come through during the year so far, which they claimed was “on track with what we would have expected” based on last year.44 However, DHSC and NHSE published information in February 2025, shortly after our evidence session in the …
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NHSE did tell us that “roughly 2.7 million new patients” had come through during the year so far, which they claimed was “on track with what we would have expected” based on last year.44 However, DHSC and NHSE published information in February 2025, shortly after our evidence session in the same month, that stated there was a 3% decrease in the number of new patients accessing NHS dentists since the introduction of the NPP, and that the NPP has cost £88 million.45
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Government response AI summary
The government commits to NHSE carrying out analysis of the New Patient Premium, Golden Hellos, and UDA uplift initiatives, with data collected by July 2025 and a detailed breakdown provided by Autumn 2025.
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HM Treasury
17
Conclusion
21st Report - Fixing NHS Dentistry
Accepted
In terms of the other initiatives, NHSE confirmed that it is too early to say whether the uplift to £28 minimum UDA value has had any impact.46 It said that it will only be after the year end that data will be available on the UDA uplift.47 For ‘golden hellos’, …
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In terms of the other initiatives, NHSE confirmed that it is too early to say whether the uplift to £28 minimum UDA value has had any impact.46 It said that it will only be after the year end that data will be available on the UDA uplift.47 For ‘golden hellos’, as of February 2025 only 39 (less than 20% of the hoped for 240) ‘golden hello’ dentists had been appointed. NHSE acknowledged that this was a “slightly slower start than we had hoped” but felt that a longer time scale will be needed to evaluate whether that initiative has generated benefits.48 No ICB has decided to commission a mobile dental van.49 NHSE has begun publishing data on the NPP, and a programme of evaluation has commenced, but beyond that will need more time to definitively say what impact, if any, the plan has had.50 40 Q 13 41 Q 14 42 C&AG’s Report, para 3.5 43 Q 14 44 Q 14 45 DHSC, Dental patients to benefit from 700,000 extra urgent appointments, published 21 February 2025 46 Q 26 47 Q 14 48 Qq 41–42 49 Q 49 50 Q 73 13
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Government response AI summary
The government commits to NHSE carrying out analysis of the New Patient Premium, Golden Hellos, and UDA uplift initiatives, with data collected by July 2025 and a detailed breakdown provided by Autumn 2025. The national mobile dental van program will not be included as it …
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HM Treasury
19
Conclusion
21st Report - Fixing NHS Dentistry
Accepted
Shortly before our evidence session in February we received a letter from DHSC and NHSE explaining that an error had been identified in their initial modelling of the dental recovery plan.54 The error related to the cost of the NPP, which NHSE and DHSC had estimated would be £164 million …
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Shortly before our evidence session in February we received a letter from DHSC and NHSE explaining that an error had been identified in their initial modelling of the dental recovery plan.54 The error related to the cost of the NPP, which NHSE and DHSC had estimated would be £164 million for an additional 1.13 million courses of treatment in 2024–25.55 Their modelling did not, however, account for the cost of the premium for new patients who would have seen an NHS dentist in 2024–25 without the additional incentive. Factoring this in meant that the £164 million attributed to the NPP would only be able to deliver 690,000 additional treatments. Delivering all 1.13 million additional treatments would cost an additional £33 million.56
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Government response AI summary
The government has put additional analytical resources into dental modelling, is undertaking a lessons learned exercise to be reported by Summer 2025, and has incorporated dental modelling into its "Business Critical Model" process from April 2025 to improve quality assurance following the identified error.
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HM Treasury
21
Conclusion
21st Report - Fixing NHS Dentistry
Accepted
Given this error, NHSE assured us that additional analytical resources would be put in place for the dental service, which would in future be designated a “business–critical model”.59 We were told that there had been 51 DHSC, Faster, simpler and fairer: our plan to recover and reform NHS dentistry, published …
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Given this error, NHSE assured us that additional analytical resources would be put in place for the dental service, which would in future be designated a “business–critical model”.59 We were told that there had been 51 DHSC, Faster, simpler and fairer: our plan to recover and reform NHS dentistry, published 7 February 2024 52 C&AG’s Report, para 12 53 Q 57 54 Letter from the Interim Permanent Secretary of the Department of Health and Social Care and the Chief Executive Officer at NHS England relating to the modelling error in the plan to reform NHS Dentistry, 11 February 2025 55 C&AG’s Report, Figure 10 56 Letter from the Interim Permanent Secretary of the Department of Health and Social Care and the Chief Executive Officer at NHS England relating to the modelling error in the plan to reform NHS Dentistry, 11 February 2025 57 C&AG’s Report, para 13 58 Letter from the Interim Permanent Secretary of the Department of Health and Social Care and the Chief Executive Officer at NHS England relating to the modelling error in the plan to reform NHS Dentistry, 11 February 2025 59 Q 2 14 quality assurance in place on the figures in the plan, although we note that the NAO found a lack of analysis on why the costs between initiatives were allocated as they were and that it was unclear how NHSE’s models had arrived at the final numbers included and published in the plan.60 Concerns about the quality of the modelling involved were raised by the Health and Social Care Committee in March 2024, when the then responsible minister acknowledged that there was a “high likelihood” of the modelling not being reliable.61 Delivering changes at a local or central level
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Government response AI summary
The government has put additional analytical resources into dental modelling, is undertaking a lessons learned exercise to be reported by Summer 2025, and has incorporated dental modelling into its "Business Critical Model" process from April 2025 to improve quality assurance, consistent with assurances given.
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HM Treasury
23
Conclusion
21st Report - Fixing NHS Dentistry
Accepted
The dental recovery plan’s four main initiatives were centrally planned by NHSE and DHSC with instructions given to commissioners as to how to carry them out.65 The plan’s delivery, therefore, was heavily reliant on ICBs implementing these initiatives at a local level and delivery by dental practices. The NAO’s report …
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The dental recovery plan’s four main initiatives were centrally planned by NHSE and DHSC with instructions given to commissioners as to how to carry them out.65 The plan’s delivery, therefore, was heavily reliant on ICBs implementing these initiatives at a local level and delivery by dental practices. The NAO’s report notes that ICB’s had “mixed experiences” of engaging with NHSE and DHSC, and that while some met with the national team to discuss local initiatives and any overlap with the proposed national schemes, these were not always fully taken into account.66 Given the failure of the plan to deliver any increase in activity, it seems clear that these nationally–planned initiatives failed to influence behaviour at a local level, although NHSE told us that they have seen feedback that the initiatives were 60 Q 3; C&AG’s Report, para 2.9 and 2.12 61 Health and Social Care Committee evidence session on 19 March 2024, NHS dentistry, see Q186 62 C&AG’s Report, para 1.5 63 NHSE, Opportunities for flexible commissioning in primary care dentistry: A framework for commissioners, published October 2023 64 C&AG’s Report, para 2.11 65 DHSC, Faster, simpler and fairer: our plan to recover and reform NHS dentistry, published 7 February 2024 66 C&AG’s Report, paras 2.11, 2.15 15 welcomed.67 The NAO’s report notes that there was some flexibility at a local level, for example where the new patient premium potentially overlapped with existing local schemes, and that regions were taking different approaches to implementing the ‘golden hello’ incentive payments.68
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Government response AI summary
The government acknowledges the need to strengthen relationships with ICBs and regions, stating that NHS England has already taken active steps to engage them. This is evidenced by their work with ICBs in preparing for the delivery of 700,000 additional urgent dental appointments from April …
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HM Treasury
31
Conclusion
21st Report - Fixing NHS Dentistry
Accepted
It is also clearly the case that NHS dental workforce issues are much more pronounced in some parts of England than others and that this is leading to some shocking regional inequalities in access to dental care.92 At the lowest end of the scale, Somerset ICB delivered 382 courses of …
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It is also clearly the case that NHS dental workforce issues are much more pronounced in some parts of England than others and that this is leading to some shocking regional inequalities in access to dental care.92 At the lowest end of the scale, Somerset ICB delivered 382 courses of treatment per 1,000 people in the region, whereas South Yorkshire ICB was delivering more than double this, at 800 courses of treatment per 1,000 people.93 Neither NHSE or DHSC denied that there are regional inequalities in the provision of NHS dentistry though, for context, NHSE noted that “maldistribution of the dental workforce is a worldwide issue”. DHSC also added that the issue around attracting dentists to work in coastal, rural and remote areas is very applicable to GPs and other types of medical professionals too.94
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Government response AI summary
The government acknowledges regional inequalities and states it is addressing them by delivering 700,000 extra urgent dental appointments from April 2025 and implementing the Golden Hello scheme, which has recruited 45 dentists and has 250 posts advertised to work in areas of most need. Additionally, …
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HM Treasury