The NHS general dental services contract came into force in 2006 in England and Wales. The contract pays dentists an annual amount for their NHS work through a unit of dental activity system. Now, this system consists of three bands that determine how much a patient is charged for their treatment and how much a dental practice is then remunerated. The payment is the same whether a dentist undertakes one or more similar procedures. The committee was told that there is no incentive for dentists to take on high-needs patients, as they would be paid the same amount for doing more work. This has clear implications for access to dentistry in Wales. We are concerned that the current UDA system may be discouraging dentists from taking on high-needs patients, particularly where poorer access to dental services already exists in Wales.

The Welsh Government has previously made changes to the UDA-based model, with the use of pilot schemes to test a reduction in UDA targets to allow dentists more flexibility and space to undertake preventative work. However, we heard clear concerns from dentists themselves that the changes to dental contracts over the last decade have not had much impact. That is why the committee’s first recommendation is to replace the current UDA targets system with a new, more appropriate and more flexible system for monitoring outcomes, to include a focus on prevention and quality of treatment. As I said, this system will focus on prevention and quality of treatment. We look forward to receiving an update from the Minister in November on progress in this area.

As part of the dental contract, practices are evaluated on the UDAs they achieve against their contracted allowance of UDAs allocated by their health board. The contract requires health boards to pay a dental practice 100 per cent if it has delivered at least 95 per cent of its contractual activity as expressed in its UDA. This is the percentage of activity that must be delivered if a practice is to avoid the health board clawing back funds. The committee heard in evidence that this clawback is not universally reinvested by health boards back into dentistry services. We believe that dentistry services in Wales could be further improved through the reinvestment of this money, and we recommend that the Welsh Government takes steps to ensure and monitor that all health boards reinvest this money until a new system for monitoring outcomes is in place, as recommended by this committee

A number of the available career pathways in Wales, including dental foundation training, dental core training and specialist training, are now part of UK-wide recruitment. We were pleased to learn that there are no major issues with recruitment into dental schools in Wales, although we are aware that these figures can be low for Welsh-domiciled students. The committee also heard evidence about the challenges with retaining dentists to work in Wales following their training period. We are aware that some of the barriers are the difference in salary in Wales compared to England, along with health boards' proximity to the dental school. We urge the Welsh Government to consider successful initiatives being used elsewhere in the UK to address issues of recruitment and retention. As such, our third recommendation is that the Welsh Government undertakes an evaluation of the UK-wide recruitment scheme to determine if it is effectively supporting an increase in Welsh-domiciled students and the retention of students following training. In his written response to our report, the Minister accepts that an evaluation is required and that he will discuss with Health Education and Improvement Wales how to take this forward. I look forward to hearing more detail about this today.

Turning to orthodontic services, the committee heard that inappropriate referrals to orthodontic services can put a strain on services and exacerbate waiting times issues. While we recognise that, primarily, long waiting times are as a result of recruitment issues, we are concerned about the method of referring and prioritising patients. We heard that some primary care dental practitioners refer patients too early in order to take account of long waiting times. This inevitably adds to the problem. We note the introduction of the electronic referral management system and recognise that, while the system may not increase capacity, we would expect it to have a positive impact on ensuring appropriate referrals, prioritising patients and reducing waiting times. The committee therefore recommends that the Welsh Government works with health boards to develop a clear strategy to ensure that the e-referral system for orthodontic services has a positive impact on ensuring appropriate referrals, prioritising patients and reducing waiting times.

Turning to the Designed to Smile scheme, the committee recognises the positive impact of Designed to Smile, which is the national oral health improvement programme for children in Wales. We welcome the extension of the programme to include very young children. However, the committee heard concerns around the Welsh Government’s refocus of this programme, placing more emphasis on children aged nought to five years, and a possible shift away from children above that age. As such, we recommend that the Welsh Government should fund the Designed to Smile programme sufficiently to ensure that those over five years of age receive its benefits. In his written response, the Minister refers to apparent misconceptions that, as a result of the refocus, those aged six and seven are being denied the benefits of the programme. I look forward to hearing more from him on this matter this afternoon.

We heard strong evidence that the oral health issues in older children and young teenagers can lead to the loss of permanent teeth. In some cases, many teeth are lost, and the committee expects effective action to be taken to address this. The committee is aware that the Welsh Government has commissioned an epidemiological study with the aim of assessing and understanding the needs of the 12 to 21 age group and to help inform future approaches to meet the needs of this age group. So, I look forward to receiving an update from the Minister on this area of work. Thank you.