21st Report - Fixing NHS Dentistry

Select Committee

Public Accounts Committee HC 648 4 April 2025

Report Status Government responded

Conclusions & Recommendations 33 items (1 rec)

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Government Response (AI assessment · 33 of 33 classified)

Accepted 13

Accepted in Part 4

Acknowledged 2

Deferred 14

Government response

Treasury minutes: Government response to the Committee of Public Accounts on the Twenty-first report from Session 2024-25 · published 10 Jul 2025

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Recommendations & Conclusions

13 results

2 Conclusion Accepted

Publish a detailed evaluation of the dental recovery plan's spending, initiatives, and impact on NHS dentistry access.

Conclusion

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 … Read more

Government Response 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 2025.

HM Treasury

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3 Recommendation Accepted

Explain how DHSC and NHSE will strengthen dental analytical capabilities and implement business-critical changes in practice.

Recommendation

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 … Read more

Government Response 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.

HM Treasury

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4 Conclusion Accepted

Articulate improved central-local coordination and support for ICBs in future NHS dentistry plans.

Conclusion

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 … Read more

Government Response 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 monitoring.

HM Treasury

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5 Conclusion Accepted

Publish analysis of actual NHS dental care costs, reflecting treatment complexity and community deprivation impacts.

Conclusion

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 … Read more 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. Show less

Government Response 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.

HM Treasury

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1 Conclusion Accepted

Committee heard evidence on NHS dentistry and the dental recovery plan.

Conclusion

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 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.

HM Treasury

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9 Conclusion Accepted

Significant funds recovered from dental contracts due to under-delivered care.

Conclusion

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 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.

HM Treasury

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12 Conclusion Accepted

Government commits to preventative oral healthcare measures including supervised toothbrushing and water fluoridation

Conclusion

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 … Read more

Government Response 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 generation as part of its commitment to prevention.

HM Treasury

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16 Conclusion Accepted

Conflicting data on new patient numbers and high cost of the New Patient Premium

Conclusion

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 … Read more

Government Response 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.

HM Treasury

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17 Conclusion Accepted

Limited progress and insufficient data for evaluating other dental recovery plan initiatives

Conclusion

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 … Read more

Government Response Summary

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19 Conclusion Accepted

Significant error identified in initial modelling of dental recovery plan, underestimating New Patient Premium cost

Conclusion

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, … Read more

Government Response 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.

HM Treasury

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21 Conclusion Accepted

Modelling for dental recovery plan proved unreliable and lacked robust quality assurance

Conclusion

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 … Read more

Government Response Summary

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23 Conclusion Accepted

Centrally planned dental initiatives failed to increase activity or influence local behaviour

Conclusion

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 … Read more

Government Response 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 2025 and planned 2026 reforms.

HM Treasury

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31 Conclusion Accepted

NHS dental workforce maldistribution creates shocking regional inequalities in access to care.

Conclusion

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 … Read more

Government Response 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, ICBs are responsible for commissioning tailored local dental programs.

HM Treasury

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