I beg to move,
That this House
notes with concern the crisis in NHS dentistry, together with problems in accessing other primary care services;
recognises that many dentists chose to undertake more private practice as a consequence of the new contract introduced under the Conservatives in 1990 and the subsequent reduction in dentists' fees in 1992;
notes that the Conservative government closed two dental schools;
further notes that the number of adults registered with an NHS dentist fell by five million between 1994 and 1998;
recalls the Prime Minister's pledge in 1999 that 'everyone within the next two years will be able once again to see an NHS dentist just by phoning NHS Direct', but notes that less than half the adult population is now registered with an NHS dentist;
and calls on the Government to work with the dentistry profession to ensure that the new contract delivers more dentists spending more time working in the NHS.
As one who is relatively new to shadowing the Department of Health, it strikes me that NHS dentistry is a subject that I can get my teeth into—[Hon. Members: "Oh!"] I should add that it is good to have a Minister of the Crown responding to the debate. The Minister will know that all is not well in the world of dentistry. At oral questions—appropriately enough—a couple of weeks ago, the first question was about dentistry in south-west Devon, the seventh was about dentistry in Hertfordshire, the eighth about dentistry in the Isle of Wight, the 10th about dentistry in Milton Keynes and the 17th about dentistry in Leicestershire.
As the hon. Gentleman has just mentioned Milton Keynes, I thought that I would update him on the situation. After asking that question, I visited the brand-new practice that has opened by Milton Keynes station. Its wonderful facilities provide well over 7,500 new places for NHS patients through the personal dental services contract. I am immensely grateful to the Labour Government for providing that practice, as are my constituents. I am sure that Liberal Democrat Milton Keynes council will pass that news on to the hon. Gentleman.
I am delighted for the hon. Lady and her constituents, but I wonder whether she has read the Labour amendment. Being a reasonable man, I did so, thinking that if it was good, solid stuff I might vote for it. It includes a surprisingly long litany of all the good things that the Government have done for dentistry, but in the final sentence it congratulates
"the Government for this investment and programme of reform that has delivered a better quality of life for staff, and improved services for all patients".
I find that incredible. I read Government amendments with the aid of an "out-of-touchness" meter. Most Government amendments are only a little out of touch, but this one is completely off the scale, if the Government genuinely believe that over the past eight years they have improved dentistry for all patients.
As usual, the hon. Gentleman is making an excellent speech. Following the last intervention, is he aware that since I raised the lack of NHS dentistry in south Devon two weeks ago, we have not had any more NHS dentists? I am not pleased with the Labour Government, who have failed to deliver on a clear promise in 1999.
I can feel a Liberal Democrat survey coming on. [Interruption.] Indeed, and a petition—perhaps that will come later.
I remind the House that the rot set in—if I can use that phrase—some years ago. It is widely accepted that the problem started in the early 1990s, when dentistry fees and contracts were changed. The change was well intentioned—instead of dentists simply receiving a set amount for every filling or treatment, there was a per patient element, which undermined the inducement to do more work just for the sake of it. The thinking was right, but the implementation failed because budgets spiralled. Only a couple of years later, dentists' fees were cut and, as a result, they started to leave the NHS. The National Audit Office says that
"in the early 1990s, many dentists reduced their commitment to the NHS".
A long-term problem has therefore developed under successive Governments of both larger parties.
If the hon. Lady would allow me to develop my argument a little, I shall certainly give way.
The situation was probably not helped in 1992 by the previous Government's decision to close two dental schools. The Conservatives sometimes demand more NHS dentistry and more places in dental schools. I do not know whether dental treatment generates amnesia, but they display plenty of it on the subject. In 1997, a bright, shiny, new Government came to power, with all sorts of new ideas. Immediately, they introduced an Act of Parliament—if in doubt, legislate. The National Health Service (Primary Care) Act 1997 created personal dental services—so called because no person can access them—with the aim of trying to tackle the legacy of a decline in NHS dentistry. Two years later, we were given something that everyone fears—a promise from the Prime Minister, who said in 1999 that
"everyone within the next two years will be able . . . to see an NHS dentist just by phoning NHS direct".
It is not obvious how one could see a dentist by phoning NHS Direct, but we were promised that everyone would be able to do so two years after 2001. Six years later, however, NHS dental registrations are at low levels, and there is little sign of an upturn.
Does the hon. Gentleman agree with Mr. Burstow that there is not a magic solution to fix NHS dentistry? Is he likely to give us any magic solutions today, and are there any attempts by the Liberal Democrats to help solve the problems with dentistry? Are we likely to hear, for example, anything about the introduction of personal dental plans, as promised in their manifesto? I should be grateful to hear something positive from the Liberal Democrats for once.
I congratulate the hon. Lady on the way she read that out. One of the themes that we will be developing is the fact that the present problems are of long-term origin—
Indeed. Because of that, the Government on day 1 in 1997 should have been tackling those problems. For example, it takes five or six years to train a dentist, so if they had got on with it on day 1, we would not now have a shortage of dentists, but only now are they talking about expanding places for dentists. There are no quick fixes—I agree with my hon. Friend Mr. Burstow, who researched the matter thoroughly. It takes time to train dentists, which is why the Government's lack of effective action over eight years is all the more culpable.
"radical reforms of NHS dental services".
The more one sees the word "radical", the less is substantively changing. We had had the Health and Social Care Act 2001, primary care trust commissioning and so on. The idea of a new dental contract, which is the key to the whole issue, was due to be implemented in April just gone, but that did not happen. It was postponed, first until October, then until next April. One of the reasons for that was the dental profession's lack of trust of the Government. The failure to negotiate a new dental contract was described by a dentist to whom I spoke recently as the best recruiting sergeant for Denplan that he has ever come across.
Is the hon. Gentleman aware that despite the Prime Minister's promises, hundreds of my constituents have no access to dentists? They are forced to go private and spend many hundreds of pounds to get treatment that the Government have a responsibility to provide. Is it not a bit rich for the hon. Gentleman to be lectured by Ms Thornberry about dentist provision, when you have failed miserably and we are facing yet another of the Prime Minister's—
Thank you, Mr. Speaker. I echo that, but the hon. Gentleman makes a good point. We get the promises and the rhetoric. He may not have read the Labour manifesto of 2005, which promises:
"We will undertake a fundamental review of the scope and resourcing of NHS dentistry."
So here we are, eight years on, and what are we to get? A review. Am I missing something here? It has taken so long to get to the point of a review—yet another reform, yet another radical change. I hope Ministers will tell us what the plans are. Did they know in April, when they published that manifesto, what they had in mind?
I thank the hon. Gentleman, my constituency neighbour, for giving way. What obligation does he think there is on the dentistry profession to work in the NHS? Like him, I believe in the NHS, and it greatly saddens me how many dentists have willingly gone private. They ought to come back into the NHS. How does he think that will happen?
Many dentists share the hon. Gentleman's and my commitment to the NHS, and are moving out of it with great reluctance. I have come across many who have hung in there while many more have gone private, because they believe in the principle, but the Government have made it impossible for them to carry on.
My hon. Friend is making an incisive speech. Many members of the dental profession have, as he says, reluctantly moved out of the NHS, not because of the financial considerations, but because they are not able to provide the professional service to their patients that they believe they should be providing. That is why they have sought an alternative way of providing a service to their patients.
My hon. Friend is right. Many dentists who went into dentistry to provide a quality service are finding that they cannot do so within the constraints of the existing NHS arrangements.
What is the root problem? Clearly, the fact that there are not enough dentists. It is not a complex matter. The Government's work force review stated that there were 2,000 dentists short, but that that number would rise to 5,000 over the next few years. Given that it takes about six years to train a dentist, how will we bridge that gap? The work force review did not take account of the impact of the new contracts, which could make matters worse. How many dentists short do the Government believe that we are? What is the grand plan?
The Government said that they wanted 1,000 more dentists by October, but Lord Warner suggested in another place that they were only half way there, yet we are only a few months away. Will the Government hit that target of 1,000 new dentists? They speak of more training places, which are clearly welcome, but the number of people who teach dentists is falling. I hope that the Minister will tell us what she is doing to ensure that the clinical experts who teach the next generation of dentists are there. Like many parts of the NHS, dental schools are in financial deficit. If they have to cut corners and spend less clinical time with new dentists, can we be confident that dentists will be as well trained as they need to be?
The Government strategy is essentially a temporary filling. It is to employ overseas dentists—from Poland, Brazil, India and wherever they can get them.
In Shrewsbury, we are getting more dentists, but the vast majority are from Poland. As a Polish speaker, I was recently invited to meet them. They are highly qualified, hard-working people. However, the Government should do more to train people in this country to provide the service rather than poaching dentists from Poland.
The hon. Gentleman makes an interesting point. Dentists from this country say that dentists from other countries clearly have different practices and procedures. I think the phrase was, "Brazilians don't do root canal work." Different dentists with different levels of training and different practices are coming into the country. I mean no disrespect to many of the highly qualified dentists who come here, but it is only a short-term response to the problem.
Perhaps an obvious symptom of a system that is not working is what happens when a new NHS dentist service opens in an area. There are queues around the block. Hon. Members will know that I am a regular reader of The Sun, which on Monday printed a photograph of a queue around the block for a new dentist in Manchester. The article states:
"Hundreds of patients queue for four hours in the rain—to register at an NHS dentist.
People came from 50 miles away . . . Bill Woodman, 70 . . . said, 'I knew it would be busy—so I started queuing hours before it opened.'"
What does it say about us when pensioners have to queue for hours simply to get what should be a basic right: entitlement to NHS dentistry?
No, I have already given way to the hon. Lady.
The Government amendment states that all patients have got a better deal. How can the Minister put her name to it? How has the 70-year-old gentleman from Prestwich got a better deal if he has to queue around the block even to get his name on the list? It is unacceptable, and redolent of what happens in a third-world country. I am embarrassed when British people have to queue around the block simply to register with a dentist.
Does the hon. Gentleman honestly expect hon. Members and people outside the House to take him seriously when he takes advice from a Conservative Member, whose party when in government closed at least two dental schools and cut fees, and from The Sun about queues for NHS dentists? Today, I found on the internet at least 10 dentists in Tooting who are willing to take NHS patients.
Unlike in Shrewsbury, the number of dentists in Bournemouth has fallen. It is interesting to note that some hon. Members say that the number of dentists has fallen and others say that it has risen. The places where the number has risen appear to be Labour constituencies—I do not know whether that is significant. However, to revert to standards of dentistry and age, pensioners are especially affected by the number of dentists—that is certainly true of Bournemouth. They require more treatment because of their age and the state of their teeth. Does the hon. Gentleman agree that those people have been particularly affected by the lack of dentistry in this country?
The hon. Gentleman is right. I came across a startling statistic recently—it may or may not be true—which was that one in seven people in this country have no teeth of their own. That would predominantly involve older people, as the hon. Gentleman rightly says, and for those people, quality of access to dental services is not a luxury but an absolute necessity.
A 75-year-old constituent wrote to me recently to say that she had been quoted £3,000 for a pair of dentures, as she could not find a local dentist who would treat her on the NHS. These are the people who can least afford such costs. Is my hon. Friend aware of this happening in other parts of the country?
We have become increasingly aware of the patchy nature of dental coverage. In some places there have been improvements, but many people still face just the kind of problem that my hon. Friend has outlined.
Two in five children and more than half of all adults are not registered with an NHS dentist. I cannot believe the scale of this. There was a fall of 3 million in the number of people registered between 1997 and 1998.
Does my hon. Friend share my concern that, if the NHS Direct helpline provides a parent with young children with the name of a dentist 10 miles away—in my part of the world, that would probably involve two bus journeys, which can take a long time—the parent might not be motivated to register with that dentist?
If the hon. Gentleman will forgive me, I want to make some progress.
"there has been a levelling off. It is early days, so the extent to which it is sustainable is not yet clear".—[Hansard, 14 June 2005; Vol. 435, c. 143.]
So the Government's grand, vaulting ambition is to halt the decline and to hope that that is sustainable. But what is their long-term vision? What is their grand plan? What was their manifesto promise? What is their goal? Where do the Government want to end up?
No, I have said that I want to make some progress.
One of the problems resulting from the lack of registration is a lack of preventive work being carried out. Surely if we believe in anything, we believe that the best thing of all is to prevent people from getting bad teeth in the first place. It is far cheaper, and far better for the individuals concerned.
No, I have said that I want to make some progress.
The National Audit Office reports that the incidence of tooth decay among five-year-olds is now gradually starting to get worse. Long-term general improvements in public health are now starting to get worse at the margins, which is a symptom of the lack of registration, because if people are not registered with a dentist, they will not have routine check-ups and the problems will not be spotted early.
A consequence of the lack of preventive work is that the problems build up, and people then need emergency cover, which is far worse for everyone. Yet access to emergency cover is not brilliant either. A recent Which? report found that half of England's dentists were unable to see patients requiring urgent treatment for toothache, and that the majority of the rest would not see them on the NHS. So, half the dentists will not see such patients at all, and the other half will probably ask them to pay, if not through the nose, at least a substantial amount.
No, I have said that I want to make some progress.
The conclusion of the Which? report on emergency access to dentistry is:
"At best, many people needing urgent care are forced to go private, often at considerable cost. At worst, serious problems could go untreated, at significant risk to the general health of individuals concerned."
We have a real problem with emergency access. The Prime Minister has said that the answer to the problem is NHS Direct. The number of calls to NHS Direct about dentistry has risen by three quarters over the past couple of years. That is clearly a symptom not, as the Government's amendment to the motion suggests, of everyone getting a better service, but of far more people having to turn to the hotline number because they cannot get the regular service that they used to have. I have another interesting statistic here, and I apologise if Members know it already: toothache is now the fourth most common reason for ringing NHS Direct. That, too, is a symptom of a system that is not working.
What does NHS Direct have to do to keep the Prime Minister's promise? It has to give the caller the name of a dentist, according to what are called "locally agreed standards", but what does that mean? In a rural area, that means a dentist within 50 miles. That could involve someone making a 100-mile round trip to see a dentist in a rural area, yet it gets a tick in the box for the Government's targets. How absurd! We also find that the data on the website might not be accurate or reliable, and that the Government are not checking whether people are getting the service that they need, because they are not following up the inquiries. A person might ring up NHS Direct and be given the name of a dentist, but the Government do not then monitor whether the person is able to access that dentist, whether they actually do so, or whether they register with them.
The Government have said that, because there is a struggle to get enough NHS dentists, they will introduce something called "dental access centres". There are already 40 or 50 of these in various cities, and anyone who does not have a dentist can turn up at one. But are they good value for money? Surely anyone who goes to one because there is nowhere else to go will think so, but is this as good as seeing a dentist regularly? A dentist I spoke to recently told me that, typically, it cost £50 to deal with one NHS patient, while the cost at one of these dental access centres is £160 per patient. So three regular NHS patients could be treated at a surgery for the price of treating one at an access centre. This is a very expensive sticking plaster solution to the underlying problem.
No, I want to keep moving on.
One of the unspoken issues today has been charging for dental treatment. Charging is a central feature of NHS dentistry, unlike in most areas of the NHS, in that people are already paying very large sums of money for their treatment. The Government commissioned a review into charging, which was produced in March 2004. They are still thinking about it. They have had a year, and an election, since then, but they are still not telling us their conclusions. They have promised us a response shortly, and I hope that they will publish not only their response but the review itself.
The danger is that the Government will fill the gap with charges. In other words, they could say, "We've put some money into the NHS. It's not enough. Dentists are going to get less income because they are doing fewer of the unnecessary treatments that they used to be paid for. If their income falls, where is the filling going to come from? The answer is that it is going to come from charges." That is the danger. Will the Minister tell us whether that is the Government's strategy? Charges are not the answer to this problem. We are keen on prevention rather than cure, but charging people the earth will simply put them off.
The central issue now is the new contract for dentists. Current funding rules have resulted in dentists feeling that they are on a treadmill, trying to get through as many patients as they possibly can. If the new contracts are inflexible, however, more dentists will leave the NHS. This is not my scaremongering; the National Audit Office has said that
"given the scepticism of some dentists, compounded by a lack of detail on how the new system will operate, we consider that there is a risk that dentists will reduce their NHS commitments, as they did in the 1990s".
A recent British Dental Association survey found that six out of 10 of the dentists remaining in the NHS are thinking of leaving, and that only a tiny fraction think that, on the basis of the Government's proposals, they would do more NHS work.
The hon. Gentleman took an intervention earlier in which it was pointed out that many dentists would like to work in the national health service, but have moved out so that they can provide the full spectrum of care. Does he believe that NHS dentistry should provide the same full spectrum of care that a patient would receive from a private dentist?
My judgment is that the concept of the national health service that we apply elsewhere should also be the starting point for NHS dentistry. In other words, we need to get to the idea that people have a basic entitlement to it. For too many people, that entitlement exists in theory but not in practice, with only half of all adults being registered with an NHS dentist. At the moment, the right to an NHS dentist is like the right to eat at the Ritz; we all have such a right in theory, but in practice we cannot exercise it. If that entitlement were to cover the whole breadth of treatments—including, for example, cosmetic dentistry—it could result in a very expensive commitment, but there must be a basic right to core NHS dental services. That must be the principle.
No, and as the hon. Gentleman will see if he reads the record, that is not what I said. One of the key principles is a foundation entitlement to NHS dentistry services, but as I made clear to his hon. Friend Sir Paul Beresford, boundary lines will have to be drawn. As he should know, however, we do not currently have such a core entitlement to NHS dentistry.
When the National Audit Office examined Britain, it found that NHS dental coverage was worse in the north of England—we saw an example from Manchester in The Sun. I have therefore taken just one case study of a northern constituency, Cheadle. To find out the level of NHS dental coverage there, I typed "Cheadle" into the national health service website, as any resident might do. It came up with the names of 18 NHS dentists, which I thought was great. The first one, however, was not accepting any new NHS patients for treatment, while the second was offering an emergency dental service only, and accepting no new NHS patients for treatment. Nor was the third accepting any new NHS patients for treatment, and that was the case all the way through to the 18th on the list. So not one of the dentists that the Department's own website came up with was taking NHS patients. How can it be, therefore, that according to the Government amendment, all patients are getting better dental care under this Government?
To pursue the issue further, our campaigners in Cheadle, led by Mark Hunter, phoned 13 NHS dentists in Cheadle to find out what is behind those figures. The answers are revealing. Based on those calls, their impression is of
"a lot of NHS practices working full pelt and operating to what they consider their full capacity, which is why they are closing their books . . . to further NHS patients."
It is important that the Government Front-Bench team hear what dentists are saying about the current situation. One of those dentists said that they were "inundated". Another said that there were
"too many people and not enough money".
"The situation is now hopeless—it's gone too far".
There was a sense of being beleaguered, and that the Government were not with them in providing a quality service. Another dentist said that the new contract was at the heart of the problem. Another said he was
"Not taking on any more because fees are fixed on existing patients."
Another said, "It's the sheer numbers". There is a sense that numbers are at the heart of the problem.
Has the local dental association in Cheadle taken steps to meet regularly the primary care trust to discuss the difficulties that they face? In very few areas of the country are local dental associations doing so.
The hon. Gentleman will be aware that primary care trusts are taking on the commissioning role for dentistry, so it seems implausible that they are not having such dialogue. When we talk to dentists, however, we get feedback that they feel beleaguered and cannot cope. It is not a lack of commitment to the NHS, but a feeling that they cannot do the right thing by their patients by staying in the NHS.
I shall conclude my remarks in a moment.
One of the most worrying findings of the research undertaken by Mark Hunter and the team was that most of the dental practices to whom they spoke were taking on children only if their parents were existing patients. Given the drop in adult registrations, we are storing up trouble for our children.
I am about to conclude my remarks.
One of those dental practices would only take children under the age of three. We have therefore reached an extraordinary stage. What strikes me most is that dentists are telling us that they must turn away people who come to register, and who are in genuine need, because the provision and capacity are not there. The fact that the Government can table an amendment saying that everybody is getting a better service marks an extraordinary level of complacency and shows that they are not in touch.
In conclusion, this is a long-term problem that started under the previous Government but has been neglected for far too long under this Government. If it takes five or six years to train a dentist, action should have started years ago. Desperate measures are now being taken to fill the gap while dentists come on-stream. The normal understanding is that the NHS is based on two basic principles: that there is universal local access and that it is free at the point of use. That is not the experience of the majority of our constituents with regard to NHS dentistry, and this Government should be held to account for it.
I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
"welcomes the Government's record levels of investment in the National Health Service, with expenditure set to rise to over £92 billion in 2007–08;
congratulates the Government and NHS staff for improvements in primary care;
notes that the Government's ambitions for NHS dentistry will deliver a modernised, high quality primary dental service;
congratulates the Government on supporting this with a record level of investment, which has been increased by 19 per cent., or £250 million a year, over 2003–04 levels;
further welcomes the increase in NHS primary care dentists from 16,700 in 1997 to 20,192 in April, the creation of 53 dental access centres across England treating some 400,000 patients a year and an NHS support team to improve access to dentistry in areas where there are problems, and the introduction of additional capital grants of £35 million to fund practice improvements;
and further congratulates the Government for this investment and programme of reform that has delivered a better quality of life for staff, and improved services for all patients, regardless of their ability to pay, true to the founding principles of the NHS."
I know that NHS dentistry has been a key concern of many right hon. and hon. Members in recent years and I am glad of the opportunity to explain to the House the situation and what the Government are doing to reform and modernise NHS dentistry for the benefit of patients and dentists.
First, I want to set out some basic facts about dentistry. The number of dentists registered with the Dental Practice Board has risen from 16,700 in 1997 to more than 20,100 at the end of April 2005. Courses of NHS treatment have risen from 24.6 million to 32 million in 2004–05. In addition, the oral health of the UK population, which Steve Webb mentioned, is improving. Dental decay for 12 to 15-year-olds, for example, is at its lowest levels since records began—levels that are lower than those in all European countries.
Yes, I am aware that that is the situation in the hon. Lady's constituency. Interestingly, it is true that many parts of London do not have shortages of dentists, as my hon. Friend Mr. Khan pointed out. One problem is getting people to register, and encouraging people to register where they are not doing so is part of many of the oral health and public health strategies that we are considering.
At the height of NHS dentistry registration, 58 to 60 per cent. of people were registered. A certain number of people have always not registered and the task is to ensure that they do so in future. That must be combined with water fluoridation policies, because in areas where water is fluoridated, the number of children without tooth decay has risen by 15 per cent. As right hon. and hon. Members know, the Water Act 2003 allows fluoridation of the remaining water supply where there is local support, which will further improve the oral health of the nation.
Does my hon. Friend agree that local partnerships are crucial in delivering services? The quality of the local PCT is critical. In Shropshire, Mike Prendergast has done a tremendous job in developing a dental action plan, and new practices are opening up on the sites of regeneration projects. One very large new dental practice is opening in Telford in the next few months, with five of six new dental chairs providing thousands of new places for NHS patients. Can she therefore confirm that partnerships are important, and that we need to be positive about encouraging people to register? Some of the stories of doom and gloom are problematic.
My hon. Friend is right. When I visited his constituency, it was encouraging to see the action that the primary care trust was taking, in partnership with other agencies. There is no doubt that, for example, local authorities can be helpful in examining local action plans with primary care trusts to see what they can do, even in planning terms, to assist with registration. As he said, thousands of new places are coming on stream in his area, with encouragement from him. It makes a difference locally to know that Members of Parliament are working with primary care trusts.
Can the Minister give the figures behind the increased number of registered dentists? Do they confirm that the number of foreign-born or foreign-trained dentists is growing considerably as a proportion of the total? If, as I believe, that is the case, would the Minister be willing to go with me to talk to the dean of Guy's, King's and St Thomas's dental school, just across the road at London Bridge? The school wants to train more people, and more people want to be dentists, but we are still withholding opportunities from those who want to train here, work here and service the NHS here.
We have already increased the number of training places, as can be seen from the number of new dentists. There is no doubt that more are working for the private sector, and I shall say more about that shortly. As for international recruitment to the NHS, I hope that it is increasing, because part of our strategy is to provide better NHS care. Those people are very welcome. They are doing an excellent job in all parts of the country, and I hope that all Members of Parliament will encourage the trend.
The hon. Gentleman suggested that I meet the dean of the dental school. From next October, a further 170 places are being found at dental schools. As the hon. Gentleman knows, it takes about five years to train a dentist. That is the reason for our strategy.
Despite the changes in the number of dentists and the improvement in oral health, there are undoubtedly problems in the NHS. The Government are determined to implement a plan of action, which I shall describe. The speech of the hon. Member for Northavon was, I have to say, full of holes, but the crowning moment came when he set out the roots of the problem created by the Conservatives. As he said, the contract that they introduced was extremely unpopular with the dental profession. It gave dentists incentives to undertake invasive treatment rather than adopting a preventive approach—the drill-and-fill treadmill, as it is known. Dentists' fees were cut in 1992 and two dental schools were closed. The drift to the private sector began, and I am sorry to say that it has continued.
Is my hon. Friend as surprised as I am by the failure of Steve Webb to tell us how many dentists the Liberal Democrats would employ, how many patients they would register, how much any of that would cost and how it would be paid for? Was that not the same menu without prices—the same list of uncosted commitments—with which the hon. Gentleman and his party always present us, and did it not provide further evidence of why no one will take anything that they say about this subject seriously?
My hon. Friend is right. As usual, the Liberal Democrats are quick to jump on the bandwagon but not so quick to come up with a solution. Perhaps they are following a new trend in making uncosted spending commitments. Their new habit is not having a policy at all. We were astonished by the so-called alternative programme that they presented to us.
There is no doubt that the drift of NHS dentists to the private sector has caused real problems in parts of the country. That is why in 2002, following wide consultation with the dental profession among others, we published the paper "Options for Change", which was implemented through the Health and Social Care Act 2003. I will explain how those measures will fundamentally reform and modernise our dentistry system.
My hon. Friend speaks of the drift to the private sector. I believe that there is more to it than that. In my area, Dumfries and Galloway NHS trust has employed salaried dentists. When they arrive in local communities, local NHS dentists move to the private sector. That development involves economics and the marketplace, and a strong dislike of salaried dentists who arrive on the scene to treat NHS patients only. The local dentists do not like the competition.
That is an interesting point. I hope that I shall be able to explain what we are doing to make the NHS more attractive to dentists. I hope that many dentists who have received five years of detailed training at the taxpayer's expense will feel that a commitment to the NHS should come at the end of that. I hope that they will not see salaried dentists as a threat and move to the private sector, because we are trying to build an NHS dentistry system that serves all our people.
Is it not worrying that where the NHS has provided capital funds to establish a new NHS practice, as it did in Swadlincote in 2002, three years later the practice should choose to go private and retain only its core NHS commitment despite substantial public funding? That is certainly of concern to my constituents. Does my hon. Friend share their concern?
My hon. Friend is right. I looked into that when a number of Members brought it to my attention. If an NHS dentist leaves the NHS completely rather than merely reducing the number of NHS patients, the primary care trust can reclaim some of the grant. It is important for the PCT to be able to do that. However, I think that our tightening of the arrangements will prevent the same thing from happening in future.
I realise that the debate is mostly about dentistry, but it is also about primary care. Perhaps I could briefly bridge to that. In my constituency, I have campaigned for several years for expansion of the small health clinic in the town of Southwood and Ferris. Maldon and South Chelmsford primary care trust is reviewing the possibility of expansion, but as yet there is no firm plan. May I write to the Minister next week with the full background to the proposal? I hope that the campaign can be brought to fruition, because it is very important to my constituents.
Of course the hon. Gentleman can write to me next week. I am sure that he is discussing the matter with the PCT, because he knows that that is where the decisions will be made, but he is more than welcome to write to me.
I was talking about the changes that resulted from "Options for Change" and the Health and Social Care Act. They have three key elements. First, funding and commissioning responsibility will be devolved to PCTs so that they can plan local dental provision. A problem often cited by Members is that, if an NHS dentist, under the current contract, decides to leave the NHS, the local PCT has no funds to fill the gap, so to speak. The money returns to the centre and is redistributed if another NHS dentist comes in. That is not a satisfactory arrangement. The key element of our proposals is to devolve that funding and decision making, so that local PCTs have the responsibility and the funding to plan properly for NHS dentistry.
Let me deal with the second element, which is the introduction of a new contract for dentists, so that, rather than being paid for each individual treatment—we have discussed the drill-and-fill treadmill—dentists are paid for looking after individual patients, with a particular emphasis on preventive oral health advice. Thirdly, we gave a commitment to simplifying the system of patient charges, to reducing bureaucracy for dentists—another of their key complaints—and to increasing transparency for patients.
NHS dentists need give no notice at all to PCTs before they go private. The PCT in my constituency, for example—it is responsible for NHS care in my area—was given no notice that the dental practice in Longton intended to go private and, as a result, had no time to prepare an alternative strategy. Surely there should be some mechanism that forces NHS dentists to give at least a minimum period of notice if they are going into the private sector, in order to allow PCTs to plan properly and to bring in alternative dentists.
I agree and, in fact, such dentists should give approximately three months' notice to the PCT, but in practice some avoid doing so, which makes it very difficult for the PCT to plan, as my hon. Friend says. The new contract and the new way of commissioning will ease that problem. Dental leads in PCTs have been discussing with dentists their commitment to the NHS and their future plans. That has eased the situation because, as a result, they have been able to secure more notice from dentists who are thinking of leaving.
I want first to make some progress.
We recognise that, in certain parts of the country, access is an increasing problem. That is why we announced in 2003 the establishment of the NHS support team, which works with specific PCTs, and backed that up with £9 million-worth of additional funding. In 2004, a further £50 million was allocated to strategic health authorities to help address access problems.
I am grateful to the Minister; I recognise that I am being persistent. Does she accept that getting the right contract is likely to be the key solution to the problem if we are to avoid having a two-tier dental service in the long term? Just after the election, a dental practice in the town of Inverurie sent letters out on the Friday, stating that patients could queue on the Monday to sign up for a private plan. Some 700 people queued all day to sign up because there was no alternative. We must ensure that we bring these dentists back into the NHS or we will finish up with no NHS dental service at all.
The hon. Gentleman is right and we should also bear in mind the point that the hon. Member for Northavon made about queuing. We have made it absolutely clear to PCTs that where new NHS dentists are opening, it is important to manage the situation properly. There is no reason why lists should not be kept of people who are waiting to gain access to an NHS dentist. We have made it very clear to PCTs that we expect them to put in place systems that prevent people from being put through the indignity of queuing. Obviously, that point does not apply in this case, as the hon. Member for Gordon is talking about a dentist who gave just three days' notice that he was quitting. He will doubtless take up that issue with Scottish Ministers.
In July 2004, the then Secretary of State announced that we intended to recruit the equivalent of an additional 1,000 dentists by October 2005, through a mixture of attracting back NHS dentists and international recruitment. We also said that we would train another 170 dentists per year, starting from this October, supported by additional investment of £80 million. We announced that we would increase funding for dentistry by 19.3 per cent.—an extra £250 million—from April 2005, and that we would encourage dentists who wished to do so to move to new ways of working under the personal dental services pilot schemes.
In January 2005, in response to representations and to the National Audit Office report, we agreed to postpone implementation of the full reform package until April 2006.
Can the Minister assure those of us in the southern part of the country, in particular, that regional circumstances are being taken into account, especially in areas where costs are clearly higher? Given the affecting story that we heard from David Wright about the impact of the Minister's recent visit to his constituency, perhaps I might invite her to visit mine, so that she can see for herself the substantial problems in registration for NHS dentistry. According to a recent survey by my local newspaper, the Southern Daily Echo, not a single dentist in my constituency was prepared to take on NHS patients. Will she put in her diary the need for an urgent visit, so that we, too, can benefit from the effects that appear to have been visited on the hon. Member for Telford?
Perhaps the hon. Gentleman would like to encourage his PCT to follow the example of that of my hon. Friend David Wright, with which my hon. Friend has clearly worked very closely. The hon. Gentleman could then invite me to visit his constituency, so that we can see what his PCT has learned from another area.
As a result of extra funding, recruitment initiatives and PCT activity, a quarter of dentists—5,800 in 2,100 practices—have moved to the new personal dental services contract. That shows that dentists are attracted to ending the treatment and paperwork treadmill. Patients are benefiting from a more preventive approach and, as new PDS dentists build up their patient base, access is increasing.
My hon. Friend is correct: the PDS is making a huge difference to the provision of, and the approaches taken by, NHS dentists. It has certainly given them the confidence to invest in the future. As a result of the PDS, Roman Melnyk of the Silverdale medical practice, in Dukinfield in my constituency, is investing £80,000 of his own money, together with funding from Tameside and Glossop primary care trust. He intends to take on two extra dentists and one orthodontist, which is surely good news for the people of Dukinfield. Is my hon. Friend aware, however, that there are some delays in getting the agreements in place to take on these extra staff? Will she do all that she can to ensure that in Roman Melnyk's case—I will pass on the details—we can secure the two extra dentists and the orthodontist?
I certainly will. I am sure that the people of Dukinfield are benefiting greatly from the changes that my hon. Friend outlined, and it is good to see local PCTs taking that sort of initiative. All PDS applications are processed through the Department. Sometimes there are delays if the Department wishes to get further information in order to ensure that good quality services and value for money are being offered. There may be some delays and I shall look carefully into the points that he raised. As I said earlier, from October this year, 170 extra undergraduates are starting their dental degree and we are considering applications for a new dental school.
Since last April, the equivalent of approximately 830 additional dentists are treating NHS patients through a mixture of domestic returners, international recruits and additional NHS commitment from existing dentists. Another 117 Polish recruits are due to take up posts in England between now and the end of October, so we are well on the way to meeting the 1,000 target.
May I raise a matter peripheral to the training of dentists, but nevertheless important for the dental profession—the training and regulation of dental technicians? Will she tell us more about her thoughts on ensuring quality among dental technicians, which is crucial to providing a good dental service?
The hon. Gentleman raises an important point and we want to look further into extending the roles of the whole dental team. He may be aware that, through the section 60 order laid before the House, we are seeking ways of ensuring high-quality standards. Over and above that, we want to increase training for all members of the dental team and ensure that there is greater provision as a result of the new roles.
As I have said to many hon. Members, primary care trusts have been asked to put together action plans to deal with any particular problems. Some have experienced success stories in their constituencies. For example, in Blackburn, five German dentists started work in April looking after 10,000 extra patients and in Newhaven, Sussex, a Polish dentist started work in April on a three-year PDS contract, providing NHS care to an area where access was particularly difficult. Indeed, I understand that Norman Baker was photographed with the new recruit. I am sorry that he is not in his place today, as we have a nice picture of him with the new dentist. My hon. Friend Dr. Starkey mentioned domestic recruitment and the importance of getting NHS dentists back to ensure increased access for NHS patients.
As well as recruiting from Europe, we have looked into how to speed the process for people waiting to take the international qualifying exam that enables dentists from non-EU countries to practise in England. We have been working with the General Dental Council to reduce waiting times and it now takes only 12 months, instead of two years as previously, to complete all stages of the exam.
As I said earlier, we have laid before the House a section 60 order that will allow reform of the dental team so that dental therapists, hygienists and nurses can take on new roles and, in some cases, undertake some routine dental work currently carried out by dentists, thereby freeing up their time for more complicated interventions. The order will also make it easier for patients to distinguish between what work a dentist has done on the NHS and what work has been charged for privately. I am sure that many right hon. and hon. Members will have heard complaints from their constituents about failures in respect of being properly informed beforehand about what work was done on the NHS and what was done privately.
I want to move on, if the hon. Gentleman will forgive me.
I hope that the history and context that I have outlined make it clear that we recognise that there are problems, but that we have in place fundamental reforms to improve the system.
My hon. Friend the Member for Telford—and many hon. Members previously—asked about the Government response to Harry Cayton's report and about the details of the new contract. I shall announce next week our response to the Cayton report on patient charging and outline aspects of the new contract that we are introducing from April 2006. I hope that the House will understand that I cannot share all the details today, but I thought that it might help Members if I set out some of the principles underpinning the proposals that we will announce.
On the new dental contract to be introduced from next April, we want to encapsulate the new ways of working that are already apparent in personal dental services contracts—an end to the treatment and paperwork treadmill, more time with patients and creating the capacity for dentists to take on more NHS patients. We want to make dentistry more attractive to dentists, building on the success of PDS, which has already been enthusiastically taken up by about 29 per cent. of existing dentists. We also want to reform the system of monitoring NHS dentistry to ensure value for money, detailed information on the level of activity and high-quality service provision.
Dentists are already working with PCTs locally in many areas to make the reforms work and I certainly want that to continue. To make the contract work, we need a partnership between PCTs, local dentists and their representatives—locally and nationally—and the Department of Health. Other agencies, such as local authorities, are also relevant. I believe that the success of PDS last year shows the way forward and I am confident that the new contract will be successful.
On patient charges, the original remit of Harry Cayton's working group was to devise an improved system that would raise the same proportion of revenue and no more—approximately a third of the total expenditure—on primary care dentistry. Our response will enshrine a number of key principles. We want a system that is simpler and more transparent to both to dentists and, critically, their patients. There are currently more than 400 different items of service with associated charges, which is obviously not a straightforward system. Patients, their representatives and others tell us that dental charges are bureaucratic—a charge commonly made by dentists themselves—and not easy for patients to understand. It is often difficult to distinguish between private and NHS care.
We also want a system that reflects the new ways of working in respect of how dentists spend their time and that takes into account the National Institute for Health and Clinical Excellence guidelines on recall intervals, which recommend fewer visits for regular recall and scale and polish. Dentists take the decision as to whether the patient needs to come back within three months, if the dentists are worried, extending up to 18 months if they feel that a recall is unnecessary. That represents a much more effective use of dentists' and patients' time. We also want a system that encourages preventive treatment to improve oral public health.
I am sure that many hon. Members will say, as did the hon. Member for Northavon, that it has taken a long time for the Government to respond to the report. However, it has been vital to reflect on the findings of this important report in the light of the changed patterns of treatment and ways of working that have emerged in many of the PDS pilot sites. We learned a lot from that and it has been extremely useful in shaping our response. We will discuss our proposals with the British Dental Association, as has happened in the past, and we will publish our final contractual regulations in the new few weeks. We are determined to get this right, and I believe that we will.
The principles that we will follow in the new system will make charges more transparent for patients and less bureaucratic for dentists. They will reflect new ways of working and, in particular, they will emphasise long-term oral health promotion.
The hon. Member for Northavon talked about the fundamental review. We are considering the terms of that review at present and will pay special attention to the changes that are in hand. We want to see how they are bedding down and whether they are succeeding in drawing dentists back into the NHS. Other aspects that we need to look at include increasing the commitment of dentists to the NHS during their training. We will announce other matters to be considered in due course, but we want to make sure that the reforms are welcomed by dentists and that they are attracting dentists back into the NHS. Given that the reforms have been the subject of long discussions with the dental profession, I am confident that they will be welcomed.
Earlier, there was a suggestion that one of the difficulties faced by dentists was that the broad spectrum of equipment, services, treatment and materials was not all available on the NHS. Is what the NHS offers going to be broadened or will the NHS stick to offering only a core service?
The NHS will continue to offer what is considered clinically necessary. The hon. Gentleman rightly distinguishes between the core service and some of the cosmetic treatments that are available, such as white fillings, teeth whitening and so on. We firmly believe that the NHS should continue to provide what is clinically necessary for good oral health, but it will not extend into cosmetic surgery, as that is for individuals to decide. Those services are available in the private sector, but we do not believe that they are suitable for NHS provision.
Earlier, I asked for a reassurance that the reforms would take account of the problems faced in different regions of the country, especially in respect of costs. I am told that the costs of dental provision are substantially higher in some parts of the country than in others. Will the Minister give the House the benefit of her analysis of those differences? Will they be taken into account in the reforms, and especially in the new contract? In my constituency, registration for NHS dentistry is very poor. The local newspaper found that not one dentist was prepared to take on any new NHS patients.
The hon. Gentleman needs to remember that, under the new system, commissioning is done at local level. There are always variations: for example, some dentists will be fully committed to the NHS, some will be 50 per cent. committed, while the commitment of some dentists will be lower still. The PDS system has involved negotiations with local PCTs to determine the historic amount paid to NHS dentists in that PCT area. In that sense, therefore, the new system reflects the income that dentists received previously, and we have guaranteed that that amount will continue to be paid for three years. In many cases, however, new ways of working mean that dentists' time can be freed up and that new patients can be taken on as a result.
The Government's proposed amendment makes clear our intention to improve the delivery of NHS dentistry. There is no doubt that access problems remain in parts of the country. I hope that the House will recognise that the drift away from NHS dentistry began some years ago under the previous Administration and that this Government have embarked on a programme of radical reform and modernisation backed by significant new investment.
Changes are taking place already. I am confident that, when the programme of reform is complete in April next year, we will have a service that promotes oral public health and tackles inequalities. The service will be better for both patients and dentists, and I urge the House to support the Government's amendment.
I begin by congratulating the Minister on her usual polished performance. [Hon. Members: "Oh!"] I assure the House that I have lots more like that. Unfortunately, I have to condemn Steve Webb for scaling new heights in by-election opportunism.
In the debate, I have counted phrases such as "holes in the argument", "crowning moments", "bridging the gap" and "getting to the root" of problems. One I liked particularly, which I made up earlier on account of my recent root canal work, was "touching a raw nerve". If I may say so, that is particularly good.
I think that we will draw a line under that.
Reference has been made to what most Opposition Members regard as ancient history. Reports were produced in the 1970s suggesting that dental caries would decline dramatically for a number of reasons, including the fluoridation of various products, notably toothpaste. At that time, Governments of all parties had to base their plans on what the best available evidence suggested. It could not have been predicted that the incidence of dental caries would not improve as had been suggested, nor that the take-up of cosmetic surgery would increase to the point that it has characterised dentistry over the past 30 years.
The House must recognise that any party in government must base its plans for the NHS on the best available evidence. That is what both Conservative and Labour Governments in those far-off days did.
The fees were cut in the early 1990s, so the hon. Gentleman needs to get his facts right. The closure of the two dental schools was predicated on the predicted fall in the incidence of dental caries. I hope that when Labour Members are in opposition and looking back at the record of this Labour Government, they will be happy to say that decisions were based on the best evidence available at the time. It beggars belief that anybody would think that any party in government would be mendacious enough to close something down without evidence to support doing so. We all have to make decisions based on the finite resources available to us and in the best interests of patients. That was what was done at the time.
Governments must make decisions based on the best available evidence, and it would be extraordinary if they did not. At the time, that was precisely what was done. I hope that the Minister makes her decisions based on the best available evidence and advice from professionals and others.
I have spent some time cantering around the history of the issue, and I turn now to the history contained in the motion, because it consists largely of an attack on the Conservative record. That is extraordinary for a party that considers itself an effective Opposition, because any Opposition must examine the Government of the day. That is our job. I wondered why the Liberal Democrats should attack the Conservatives in that way—perish the thought that it might be due to the by-election that will sadly be held in Cheadle.
The hon. Member for Northavon did himself no credit by using a large chunk of time in illustrating his remarks with reference to Cheadle. As he did so, I think that I am at liberty to say that earlier today I spoke to our candidate there, Mr. Stephen Day. The difference between Stephen and Mr. Hunter, of course, is that Stephen lives in the constituency. He is living there and winning there, and therefore he knows well the needs of the local community, especially their dental needs. When I spoke to him this afternoon, he confirmed that NHS dentistry is practically non-existent in Cheadle, despite eight years of a Labour Government.
I listened carefully to the speech by Steve Webb. He spoke for more than half an hour in the parliamentary equivalent of a Liberal Democrat "Focus" leaflet. He criticised everybody else, but said barely a word about what the Liberal Democrats would do differently—
I shall certainly do so, Madam Deputy Speaker, but I must say that I agree entirely with my hon. Friend's remarks.
This is a serious matter and it deserves serious consideration. It is an issue that is raised weekly by our constituents. It is also raised with the citizens advice bureaux, which tell us that it is one of the most frequently raised issues. This morning, I met representatives of Which? magazine. I commend the magazine and its stop the rot campaign to the Minister. The hon. Member for Northavon mentioned that campaign, and it is extraordinary that half of England's dentists are unable to offer an emergency appointment to people in dental pain. I have had dental pain—I suspect that most hon. Members have—and it is a truly dreadful experience. The thought of having to put up with it for any length of time is frightful. The lack of emergency appointments also puts pressure on other parts of the health care system, such as accident and emergency departments and doctors. I have in the past been required to treat people in dental pain in an emergency because there was no access to a dentist—although admittedly that was in unusual circumstances.
Which? is holding a reception later today and the Minister could usefully attend to hear what is said. I am sure that she would be welcome—
I have not been invited to the reception and I would hate to gatecrash it. In his discussions, the hon. Gentleman might raise with Which? the fact that we have opened 53 dental access centres across the country to address the problem of providing emergency treatment.
Well, the Minister has received an invitation, but has failed to reply to it. Which? also mentioned to me that 4.1 million people have had difficulty in registering with an NHS dentist in the past two years in England, according to its survey, which is full of useful information. I recommend to the Minister that she attends the reception.
Unfortunately, the Minister did not attend the British Dental Association conference in Glasgow earlier this year, which was a serious omission given the state of negotiations between the BDA and the Government. I hope that the Government will repair the bruised relationship with the BDA, because that is essential if we are to achieve the sensible contract to which we all aspire.
I am pleased that the motion includes primary health care. I am not sure whether it was done by design or default—it was probably by default, as it is a Liberal Democrat motion. In either case, it was very sensible, because dentistry should be considered as part of the mainstream national health service. I fear that that concept may be withering on the vine, but I was encouraged by much of what I heard from the hon. Member for Northavon and the Minister. I hope that the Minister will not allow it to wither away, because dentistry is a fundamental part of the mainstream national health service and it certainly is not a bolt-on extra. I welcome in particular the Minister's commitment to oral public health.
I was interested in what the Minister said to my hon. Friend Sir Paul Beresford in connection with what might be on the list of appropriate treatment under the NHS, because that is important. What dentists say to us is that they want to do national health work, but it would mean working with inferior materials or doing procedures that are possible if done privately but not under the NHS. The Minister looks confused, but that is the case. I am surprised by her perplexity, because if she has been discussing the issue with the BDA and dentists that concern will have been raised. It is important that whatever we provide is of adequate quality, for the sake of patients and the professionals who are keen to provide the best possible service they can, within reason. Nobody would promise—we would not, and I imagine that the Liberal Democrats would not—to provide everybody with a perfect smile on the NHS. We cannot do that, but serious attention needs to be given to the quality of NHS dentistry that we can allow dentists to provide. I hope that the Minister will give that some thought, perhaps in connection with her report on Cayton.
I am disappointed that the hon. Gentleman did not start by congratulating the Government on the record investment delivered for the NHS and dentistry. It is up by 19 per cent. or £250 million more a year and some 3,500 more dentists are now working in the NHS. It is no use trying to explain away the mistakes of the past as based on the advice given at the time, because Labour Members told the then Government what the effect of the new contracts would be and the consequences of closing the two dental schools. If the hon. Gentleman accepts that the Conservatives were wrong then, why does he expect anybody to believe what he says about the NHS dental service now?
When the hon. Gentleman reads those remarks in Hansard, I suspect that he will be less than thrilled with his contribution, which sounded as if it were drafted by the Whips Office. It is all very well to say anything one likes in opposition, as the Liberal Democrats know full well. They are perpetually in opposition and can say whatever they like in the sure and certain knowledge that they will never be called on to carry out their promises, with one exception. That of course is in Scotland, where they are the coalition partners with the Labour party.
It would be interesting to know the situation north of the border. I am told that it is not 1,000 miles from where we are, despite the fact that Scotland has a far more generous settlement than this country. The hon. Member for Northavon did not mention that. Of course it is a devolved issue, but it would be interesting to hear from him how his party has managed dentistry where it is in a position to make a difference.
The hon. Gentleman seems to be failing to notice that the Scottish Executive has to live with the same contract, and that the closure of the same two dental schools is now denying the supply of dentists to the Scottish Executive.
I am very grateful to the right hon. Gentleman for that intervention. He is right that it is the same contract and that we all operate from the same pool of dentists, but I think it is reasonable to accept that dentistry is now focused around primary care trusts, or the equivalent thereof in Scotland presumably, so his party in coalition has some way of making an impact on dentistry. He must appreciate that it is not all down to the number of dental schools, or the contract; there is more to it than that. Nothing in the speech by the hon. Member for Northavon gave me any confidence that his party in office is able to make the difference that it constantly tells us it would make. I am sorry if I have missed something; I would be more than happy to allow an intervention from the hon. Gentleman.
I am concerned about the commodification of health care across the board, both in primary health care and in dental care; I would not want to make a distinction between the two. In recent weeks and months there have been announcements about dental access centres, walk-in centres and megasurgeries. We know about falling dental registration rates. We know about the threat to registration with GPs. We have heard about the 48-hours-in-advance conundrum that faces many practices, which are not permitted, apparently because of their fiscal settlement, to allow patients to book surgery appointments a long way in advance. All these things, and more, mean that there is far less personal one-to-one contact between practitioner and patient than there used to be.
The unique thing about health care in this country has always been that personal contact, be it in terms of general practice or general dental practice, and nothing in the Government's actions in the recent past has given me any confidence that they fully appreciate the importance of that personal service—that one to one. Arguably, it is far more important in general medical practice because one is dealing with long-term chronic disease, very often with life-threatening disease, and very often with elderly people who need that contact. I fully accept that very often in general dental practice contact tends to be a little more one-off, but most of our constituents would say that they value an ongoing relationship with an identifiable practitioner, and I fear very much that both in medical care and dental care the Government are moving away from that important model of registration and an ongoing relationship. I hope very much that the Minister will give us some idea in her remarks whether she associates with that and if not, why not, because it seems to me very much that we are indulging in the commodification of health care, in that less personal model, rather than the personal model that is so important for most of our patients.
The Minister is about to embark on a consultation exercise on health outside hospitals, and it will be interesting to learn to what extent that will involve dentistry. I have said that I very much welcome her enthusiasm for associating dental care with mainstream NHS care, so I assume that the consultation exercise will fully involve dentistry, because it really must do so. It is hailed as a major public engagement exercise. Being a bit of a cynic, I am concerned that this might be yet another tick-box exercise. I hope that that is not the case and I very much hope that the Minister will give some thought to the results. Recently we have had the results of referendums in France and the Netherlands in relation to the constitution, and it would appear that the results of those referendums are largely going to be finessed by the EU and by the countries involved. I hope very much that the Minister does not agree with such a model, and that she will truly reflect on the outcome of the consultation exercise, because I know full well that some of the messages that she will receive have to do with the value that people place on personal contact between practitioner and patient.
In terms of what needs to be done—[Interruption.] I hear the hon. Member for Northavon huffing and puffing, but as my hon. Friend Mr. Francois pointed out, we heard precious little about what the Liberal Democrats would do, and we have heard very little about what they are doing in Scotland. All I can do is refer to our discussions with the British Dental Association, which have been carried out in an extremely warm atmosphere. Our proposals are broadly welcomed by both the General Dental Practitioners Association and the BDA, and they appeared in our manifesto for the election just past.
We have proposals on capitation. We have proposals on the use of dental hygienists and nurses—which, incidentally, the Minister has not mentioned yet; I hope that she will. We have proposals on registration. Registration is a recurring theme and I am very pleased that there appears to be cross-party unity on its importance.
Finally—I know that the Minister did not mention this—we need to place an emphasis on child oral health because we know that good dental practice is established very early indeed.
I heard the hon. Gentleman use the word "finally", having devoted 19 of his 20 or so minutes to not saying what should be done. He obviously had the opportunity to table an amendment to our motion to say what should be done, and yet we have a blank sheet of paper from the Conservatives. What actually does he propose, other than saying that child oral health is a good thing, which we knew?
I have just been explaining what we would do. It was contained in our manifesto. I am sorry if the hon. Gentleman feels that child oral health is not important; as the father of five children, I can tell him that it is fundamental. If we establish good dental practice early on—that means regular check-ups early on, and if the hon. Gentleman had taken the trouble to read our manifesto he would have seen how we were going to do that—we stand a good chance of ensuring that the next generation has far better oral health than this one does.
I have never been to Cheadle in my life, so I cannot contribute to that aspect of our discussions, but I will try to convey a flavour of the situation across the Pennines, in Yorkshire, on this issue. It is a pleasure to follow Dr. Murrison and I listened to both his speech and that of Steve Webb with great care.
The hon. Member for Westbury made some interesting points. He said that Governments make decisions on the basis of the best available evidence. They certainly should, but that seems to me to be a rather technocratic approach to government. Decision making must be guided by a political will, a political vision and a political strategy. In response to some of the criticisms by the hon. Member for Northavon, I honestly do not think that as a Government we focused on dentistry soon enough, and it took a while to put the political strategy and the vision into place. But I think that we are there now, and the next year will be crucial. If I have one criticism of the hon. Gentleman's speech, it would be that he was a little bit easy on some of the practices of dentists down the years. At times he sounded like a spokesman for the British Dental Association, which has a long and proud record and many members who are committed to the NHS, but dentists, like Governments of all colours, have lessons to learn from the past 20 years. I intend to reflect on that in some of my remarks.
I promised to impart a little bit of the flavour of the situation in Yorkshire. To be very parochial for a minute if the House will allow me, I think that in Selby and York, my local primary care trust, the commissioning that the Government have brought in is making a difference and is working. That is one thing that has improved in the past seven or eight years. It does give a very local focus. It enables MPs, councillors and others to speak to the decision makers, to get down to the detail of where NHS dentists are, where there are gaps and where improvements could be made.
In Selby and York, for example, 15,000 extra places have been approved under personal dental schemes for the next three years. It appears that they will be delivered within the next year, and I understand that we will be up to about 56 per cent. coverage in Selby and York. We want to get a little higher than that, but that will not be bad in comparison with a lot of other areas in the country.
One dentist, Mr. Kelsey, made it on to the front page of the Yorkshire Post. The Minister and I discussed his case over tea and biscuits for no less than 45 minutes, and I bring her good news. He wants to retire. He could not find someone to buy his practice. He tells me that he is committed to that practice transferring to the NHS. A buyer has now been found, with two dentists in that practice, and the local PCT will propose a personal dental scheme to the Department that, I hope, will be approved, so that the 5,000 places that would have been lost in Selby can be replaced, possibly on a like-for-like basis.
If I have one criticism of some PCTs, it is that the local delivery of dentistry is important. It is not acceptable to have to take long journeys, perhaps on two or three buses, to get to a dentist. In rural areas, it is important that NHS dentistry is available in market towns, such as Selby, Sherburn and Tadcaster in my area.
I want to make two suggestions for improving the situation in Yorkshire. We have heard a lot about queues forming outside dentists' surgeries when they open up for additional NHS places. In some areas, PCTs have introduced waiting lists—Doncaster may be one of them, but there are certainly other examples throughout the country—whereby people who want an NHS dentist go on to a waiting list. Instead of having to queue or ring up every two or three weeks as the situation changes, those people will be informed—in a short period, we hope—when extra NHS places become available in the locality. I urge my own PCT in Selby and York to consider that development, which makes the system much more civilised and efficient. It allows a certain degree of preference to be given to local people to gain access to dentists in their own areas.
Clearly, the expansion of training places in dental schools is important. In both Leeds and Sheffield, expansion is occurring by a factor of about a third in the coming year. It would be remiss of me not to put in a plug for the merits of the very successful medical school at York and Hull. Indeed, one of the bids for a new dental school comes from York and Hull. I know that other hon. Members would advocate different areas, but that is a particularly good bid from God's own county.
I want to make a few comments about the nature of dentistry and dentists themselves. We are coming into an absolutely crucial period for the negotiations during the next few months. I remind the House that, despite the problems of the past few years, NHS dentists earn, on average, £75,000 or £76,000—considerably more than MPs—and most of them also do private work. We are talking about relatively highly paid people, many of whom are very much committed to the NHS, but it takes two to tango in negotiations, and there is a high expectation among Labour Back Benchers that if the Minister puts a reasonable offer to dentists, as I am sure she will, they should respond in kind. That will involve changes in working practices.
If we look back over the past eight years, another thing that has become apparent, for whatever reason, is drill-and-fill—I think that was the phrase mentioned by the Minister. Numerous reports, dating back to one in 2000 in the NHS prepared by Aubrey Sheiham, professor of public health at University college London, refer to practices such as dentists
"inflicting £200 million of extra scaling, X-rays and fillings on patients to boost earnings", and an economic model encouraged them to do so. The report states:
"Studies show that dentists replace fillings far more than necessary, and that if they suffer a drop in income, they will replace their patients' fillings more frequently."
There were economic incentives for dentists to adopt such an approach, but that will not happen under the new contract, and nor should it. Perhaps some patients will be seen less frequently. If there is less dental need for them to be seen every six months, perhaps a check-up every year or so will be sufficient, and a lot of dentists who are committed to the NHS realise that.
It is interesting that perhaps one of the better puns that has been coined in this respect appeared in the Yorkshire Post headline "Dentists set to bare their teeth". The Yorkshire Post has been running quite an effective campaign called stop the rot—a rather more hackneyed phrase—but nevertheless it has been pointing out some of the things that hon. Members on both sides of the House have mentioned today: the expansion of dental places, the need for a new contract and so on.
A few weeks ago, the front page of that paper commented on an attempt by the leadership of the British Dental Association to get its members to go on strike for a day and not to do routine NHS treatment. Rather less prominently, it reported the following day that that attempt had been rejected by two to one. The dentists themselves decided that a much better approach would be to lobby Members of Parliament, and they will do so in July.
The Yorkshire Post and, indeed, most people in Yorkshire would agree that we want value for money, that it is not a question of writing a blank cheque to dentists, as I am sure the hon. Member for Northavon would agree, and that those negotiations depend on a responsible attitude on both sides. Where that responsible attitude is not shown—I hope that that will not be countrywide, but there may be PCTs with particular problems—it is well worth reminding dentists that there is another model: a directly salaried model.
Many dentists from overseas are coming in on that model and are directly salaried by the PCT. If that is what is takes to fill the gaps in NHS provision, that approach will receive a great deal of support among Labour Members. Dentists cannot have the NHS over a barrel. They have earned reasonable amounts of money from the NHS in previous years, and I think that they will be offered that in the future. Many of them are committed to the values of the NHS. However, if it is a question of taking on local dentists in certain areas and ensuring that NHS dental provision is maintained and expanded, that is what Ministers must do.
Incidentally, we have an almost all-female team in the Department of Health, with a solitary male Minister. We have a number of strong female Ministers and I am sure that my hon. Friend Ms Rosie Winterton will, if necessary, show a good deal of Yorkshire grit and determination in those negotiations and ensure that, by the next election, we have a very good story to tell on NHS dentistry.
As dentists have been gently attacked, it is rather appropriate to get an opportunity to return that gently. I clearly have an interest, although my dentistry aspect is such that my income does not reach anywhere near that suggested by Mr. Grogan—would that it did.
I want to touch in particular on the point that was raised during the Liberal Democrat presentation—if we can call it that—and I refer to the fact that dentists feel that they are highly trained for five or six years. They have a broad spectrum of facilities that they wish for and a broad spectrum of opportunities to provide a wide range of treatments, but the NHS does not allow them to do that if they keep strictly to the NHS. The key thing—the Minister seems to be moving in this direction and it will be interesting to find out whether it happens—is that the NHS must work in partnership with the dentists providing a mixed service. Using that method, we can attract dentists back into the NHS, as well as providing an opportunity for those who leave the dental schools, move straight into the NHS and suddenly realise that they cannot do much of the work for which they have been trained. We hope that that method will thus prevent them from moving into the private sector, with the consequent loss to the NHS.
It is vital that we have NHS dentistry. One need only walk into an old people's home to see a lady with a broken denture to recognise that that is her means of eating and that she has no opportunity of having her denture repaired, particularly in the south and south-east, as she does not have an NHS dentist, and especially not one who would provide dentures or who would come out to provide dentures because she cannot travel to him. What does she do—live through a straw? We must consider those patients.
There is a crisis, but it is possibly not quite as bad as the Liberal Democrats say, and I do not intend to go through the figures. When I first came to this country, dentistry in Britain was seen by much of the western world as being absolutely appalling and, to a fair degree, the NHS was the cause. The hon. Member for Selby touched on that fact, calling it "drill-and-fill". The Australians used to call it "bash the gnash". They used to come here and fill anything and everything. I remember taking on two Australian dentists from Queensland—they will remain nameless—and the figures that they produced at the end of the week for the NHS work that they had done stunned me. I asked them how they had managed it and they said that they got the patients in the chair, filled them with local anaesthetics until they were grey with the stuff, turned up the air rotor and drove round. I saw one or two of their patients and I was absolutely appalled by what I saw. We sacked those dentists, but it took weeks to put right what they had done.
There have been dramatic changes since them. The first change is the addition of fluoride to the water supply, which must be the cheapest, simplest and most sensible way of dealing with dental decay. That is done in many other western nations such as Australia, New Zealand, Canada and the United States and it has got to come here. Fluoride in toothpaste has also made a dramatic difference. My recently deceased father was a dentist in New Zealand and he said that until fluoride in the toothpaste and in the water supply came along, trying to deal with dental decay was like trying to fill the bath with the plug out. He said that the changes it produced were dramatic. We will see that here—indeed, we are already seeing it to some degree.
The second issue that changed the system in the NHS was the introduction of patient charges. To a fair degree, that stopped the Australian-type practice that I have just described. I am not being particularly anti-Australian, because dentists of many nationalities, including English ones, engaged in "bash the gnash". However, when charges were introduced patients started to look at what they were paying for and they used to ask why work was being done again. They did not want the work done again, so they moved to other dentists and a few dentists actually went bankrupt as a result.
When patients realised that they had to pay, they started to ask whether they could pay for something different—whether they could have white fillings, crowns or whatever was available at the time. I know that dentists complained when the fees were cut, but that made them concentrate on what they were providing and look at whether they could provide a better and fuller service. Some of the bad dentists who I know—again, I mention no names—went bankrupt. The technicians carrying out crown and bridge work and making dentures often commented that the standard of dentistry demanded by patients went up as dentists moved into the private service. The standards of NHS dentistry then went up as well. The technicians were stunned because the change happened so quickly.
In the past 10 or 15 years, there have been dramatic changes in dental techniques. The changes have made different approaches available to patients, but they have also brought with them enormous costs. We now have new restorative materials, tooth-coloured composites, techniques of bonding, new ceramic to metal crowns and bridges, new all-porcelain crowns and bridges, inlays, inlay overlays, overlays, veneers and bleaching.
The Minister said that the NHS should not provide bleaching and, in many circumstances, that is right. However, the NHS needs to think again. If a teenager has badly stained teeth—perhaps as a result of tetracycline, which may, by then, have gone—the NHS's answer is for the dentist to pick up a high-powered drill, scream round and take all the enamel off and put on crowns that will have to be replaced again and again. Bleaching will stop that. Patients will have their own teeth that are properly bleached and looking right, and the process can be topped up every three to five years. This brings me to what I am after—a radical rethink.
Techniques have changed. We now have the new nickel titanium endodontic root canal instruments, digital x-rays, various hot seal endodontic filling materials—and many dentists use loupes and microscopes as well as new impression materials. We also have new and reliable dental implants, and orthodontics and oral surgery have also leapt ahead. I deliberately ignore those dentists who use Botox.
Those and many other improvements have meant that the dental treatment available offers the cosmetic approach to dental health care that is wanted by patients. That does not mean that patients are not being looked after, but that they are being looked after differently and that they are choosing, when they can, to pay. Over the past few years, the reactions of patients have been dramatic. It might be basic in some cases as in when they ask for a white filling rather than a black one, but it goes right through to requests in the full American style for a Hollywood smile makeover. The effect of television and magazines on demand over the past few years has been dramatic. Patients have started to get a better understanding of what they want. Sometimes that makes it difficult for the dentist. I remember a 5 ft 2 in lady coming in with a picture of Farrah Fawcett-Majors and asking whether she could have a smile just like that. I suggested to her that she would be more likely to win the Derby if I could manage it. [Interruption.] Sweetness and light.
The NHS has not kept up with the treatments that are available, and I do not think that it should. That is not its realm. However, I was a little surprised when, I think, the first Labour Secretary of State for Health said something along the lines that the NHS could compete with the private sector. It should not. According to a recent estimate, that would cost about £6 billion. There are better things that we can do with the money. The NHS's target should be health, although there are variations on that—I referred to bleaching a moment ago.
The new contract offers an opportunity to look at the issue again. Before the contract is set in stone, I hope that the close discussions with the dental profession will bring some changes. I have spoken about endodontics and root canal treatment, but such work is poorly paid in an item-based payments system. However, it is vital for many patients.
To give another silly dental example, an elderly patient with a few teeth left may have a tooth that is heavily filled and that has suddenly blown up because there is an abscess underneath it. The patient suffers the pain that my hon. Friend Dr. Murrison mentioned, and the dentist has several options. The first is to take the tooth out, and that is quick and cheap, but the patient's denture will not work anywhere near as well as it did. The other option is root canal treatment, but that is exceptionally difficult for a molar in an elderly patient. It takes one, two, three or possibly four hours and requires loupes, microscopes, nickel titanium reamers and so on. That is just the endodontics but, after that, the tooth then needs to be built up. The recompense for the capital outlay for the equipment—I have not touched on digital x-rays, for example—is pitiful. It should be possible to rethink our approach to try to slant the money towards such preventive treatment as well as towards the prevention involved in teaching children how to look after their teeth better, in improving their diet and in adding fluoride to toothpaste and to the water supply.
I am not attacking the Minister, but I am ignoring much of what the Liberal party has said in its classic approach of attacking everyone but not coming forward with solutions. We have an opportunity to move forward and my hon. Friend the Member for Westbury has described some of the options. The only part of the Liberal motion that has any credibility is the request for Ministers to discuss the issue with the profession. Let us take this opportunity, but without setting things in stone.
We must bear in mind two key issues: the fact that the nature of dentistry has changed dramatically, even though we often look at it in a stone-age way; and the fact that dentists must be encouraged to return to the NHS to provide a basic core service, but be allowed to offer private dentistry because patients demand that. I hope that the opportunity is taken.
It is a great pleasure to follow Sir Paul Beresford on one of the rare occasions in an Opposition day debate when someone brings a lifetime of experience to his contribution. The House is a great deal better off as a result of such a contribution than from the petty political point scoring that goes on.
I certainly welcome the Government's record levels of investment, and it is perhaps not surprising that those on the Opposition Front Benches did not refer to that. One reason why the Conservatives ran into difficulties on under-investment in so many public services was that by the end of their time in government they were having to spend 45p in every pound of new taxation on the economics of failure, paying for the national debt, which had risen to unsustainable levels, and financing the high level of unemployment. It is largely thanks to the Chancellor of the Exchequer and our stable economy that we are talking about making some progress in dental care, albeit somewhat belatedly from the point of view of many of us.
The Liberal Democrats rarely try to make even their own sums add up. They pay no tribute to the Government and take no cognisance of how hard it is to get government right, not simply on individual policies, but across the board in running the economy and making sure that money is available for all the necessary investment.
All Members can give examples of the sort that have been given at length today. The problems go back to the early 1990s. Even last year, when I spoke in an Adjournment debate in Westminster Hall on
We seem to have been indulging in fanciful word plays today. One idea from Plymouth city council's scrutiny committee was that we might bring the tooth fairy to the rescue. I am not sure what the committee had in mind—perhaps it was to bring a ferry full of dentists across the channel to tackle the problem.
At my Adjournment debate, I spoke about the work going on in the primary care trusts in Plymouth, which was an "options for change" field site, and a year later it is fair to say that steady progress is being made. Of course, it would be nice to report that everything in the garden is rosy—although perhaps I should refrain from using that phrase—but given the context in which we are working, where we have to come to an agreement with people who are independent contractors, the fact that we are making steady progress is something on which the Government should be congratulated.
Plymouth, in common with other hot spots, is receiving support from the Department's dental team. I understand from James Short of the PCT, who is doing a splendid job with his team, that the departmental team visited recently and that they are in the process of agreeing a dental plan for the PCT. That will secure the position of people who already have an NHS dentist, and slowly but surely the PCT is negotiating new NHS contracts to treat new patients.
The south-west peninsula and Plymouth have both achieved the target of 25 per cent. of dentists on local contracts, with the PCT's personal dental services contract. Again, I thank my hon. Friend the Minister for the urgent and immediate attention she gives me and the trust whenever we seek it in dealing with the fine details that can stand in the way of concluding an agreement. Dentists have signed up for three years, which has secured services for more NHS patients in Plymouth. That is not yet enough, but we are in the right direction of travel and, although it will be more difficult over the next year to achieve another 25 per cent. of dentists signing up to NHS contracts, if we succeed we shall be travelling at a speed that should make a difference in some of the difficult situations that my constituents experience.
The picture that the hon. Lady paints of Plymouth is much more encouraging than the picture in my constituency, where the direction of travel, far from being positive, is the reverse. To pick up on the comments of my hon. Friend Sir Paul Beresford, there is a brain drain to Australia rather than to the UK. When I was knocking on doors just before the election, I met a young dentist who had young children and could no longer make a living from his private practice in Bridgnorth, so he was planning to emigrate to Australia—perhaps to indulge in some of the practices to which my hon. Friend referred. That illustrates the problems of providing dentistry, whether private or NHS, in rural areas, which are compounded by the lack of NHS dental facilities. When a new practice opened in Ludlow earlier this year, the local PCT refused to provide details of its telephone number or address for fear of being inundated with applicants for registration, because there were so few available places. That problem in rural areas does not seem to be reflected as much in cities.
As I shall explain in a moment, the far south-west has some of the most difficult problems in the country. It is far from the situation that the hon. Gentleman describes, but I and many of my Labour colleagues work hard with our local PCTs. My PCT has my pager number and I have its mobile number. When there are issues to be sorted out my hon. Friend the Minister is always ready to help. Such things are a top priority for all of us.
It is difficult to achieve change. Plymouth and the south-west remain hot spots. There are difficulties everywhere, but especially at our end of the region: for example, in Devon and Cornwall the ratio of dentists per head of population is 1:3,549; at the other end of our region it is 1:3,081, but in Hampshire the ratio is 1:2,821. There are even more favourable ratios in other parts of the country.
A study by Rabinowitz showed that significant proportions of clinical graduates tend to stay on at the place where they studied. Given the above ratios, I hope that my hon. Friend and her colleagues in the Department of Health, especially the Secretary of State—she knows this is coming—will give serious consideration to the expression of interest from the Peninsula medical school in establishing a new dental school alongside its successful training for doctors. Apart from the good socio-demographic reasons that I mentioned, there are strong clinical arguments for a dental school in Plymouth. My hon. Friend Mr. Grogan asked where we would get the academics to train new dentists. Many academics are practising dentistry in the south-west and are not currently deploying their teaching skills. They could easily be brought back in if there were a local dental school in Plymouth, thereby avoiding the poaching of academics, which could be a problem as we expand our dental schools.
The Peninsula medical school makes extensive use of distributive clinical outreach facilities, which enable students to become familiar with current community morbidity patterns, to which the Minister referred in her speech. Plymouth has established a track record in high quality clinical teaching and one of its four centres of excellence in teaching and learning—there are only five such centres in the country—relates specifically to clinical placement learning. For those and a number of other reasons, which I should be happy to outline to my hon. Friends in the Health team, I hope that we shall be shortlisted for further consideration in the near future. I know that Devon and Cornwall Members from all parties will be approaching my hon. Friend on that subject, too.
While my hon. Friend is securing and steadily building NHS dentistry, we can look forward to that programme continuing year on year into the future. We shall look back on the difficult years and be proud of what we achieved to save and secure an NHS dentistry service for our constituents.
Does the hon. Lady agree that it is important for the Minister to tell us whether she intends to establish a new dental school, or whether we will in fact have dental outreach centres from existing dental schools, or satellite institutions, because that is obviously important in the context of Plymouth?
Perhaps it would help if I clarified the current situation. The 170 graduates who are starting from this year will be spread among existing dental schools, but we have invited applications for a new dental school, which will be considered over the next few months.
I thank my hon. Friend for that clarification. One of the problems with setting up a new dental school is that it could mean that it takes longer to bring dentists forward into clinic practice. A further advantage of establishing a dental school in Plymouth would be that we already have shorter learning models in the medical school, so by using a four-year learning model we could bring dentists on stream at the same time as if the increase in the number of dentists was achieved by expanding places in existing schools. Indeed, we could bring dentists on sooner in years to come.
I conclude by welcoming what my hon. Friend the Minister said and the fact that she will make an announcement next week on Harry Cayton's report, to build on the work that the Department has already undertaken to repair the damage that was done to NHS dentistry and to make charging simpler and more transparent for patients and dentists, which will be welcomed by both groups in my constituency.
I am grateful for the opportunity to take part in the debate and thank my hon. Friend Steve Webb for giving us a timely breakdown of the serious crisis in the dental health service. Had I listened to the Minister's speech without knowing about some of the realities in my constituency, I would have thought that everything in the garden was rosy, but unfortunately that is not the case. Over the past eight years, the situation in Rochdale has got worse. Fewer people in Rochdale are now registered with an NHS dentist and there are fewer NHS dentists. Although palliatives have been put in place, the walk-in centre is no longer a walk-in centre because people have a two-day wait before they can be seen there.
The Minister spoke about some of the issues that must be addressed. I agree with Sir Paul Beresford about fluoridation. Yet another debate is going on in the north-west about whether we should have water fluoridation and I have met one of the officers employed by the regional primary care trust who is involved in that. I believe that fluoridation should happen, so it would help if the Government gave clear advice and instructions so that it is not left up to individual areas and authorities to decide whether such a simple and cost-effective way of improving dental health could be implemented.
Just for clarification, guidance will be issued in the summer on the processes that should be followed when engaging in public consultation.
I welcome that.
I shall use an example from my constituency to demonstrate the problem with dentist numbers. I have received figures from my primary care trust showing that Rochdale needed 65 registered NHS dentists. We actually have 38, which is why the number of people registered with an NHS dentist has gone down. One of my constituents told me the other week that if people do not regularly attend for check ups, they get dropped off the list, which made my constituent less than happy. We need to change some working practices, such as drill and fill and the requirement for people to attend their dentist every three months if that is not necessary. I welcomed the comments made by the hon. Member for Mole Valley about that matter, of which he has a lot of experience.
There is also a problem with conditions of service and the contracts under which people work. A report appeared recently in the local paper about three young Rochdale-born dentists who wished to establish a new surgery in the town. They could get a grant if they joined an existing practice, but they could not get a grant to open their own surgery. As a result, the three dentists moved 10 miles down the road and now provide a service in Radcliffe in Bury, rather than in Rochdale, which was where they wanted to work.
Many dentists have moved out of the NHS because of the contracts under which they have worked. The Minister will face a big problem when trying to convince them that they will benefit both financially and in terms of their working practice by returning to the NHS. They are currently able to provide services at a cost that they would be unable to offer under the NHS. When the hon. Lady enters into the new contract discussions, she will need fresh thinking about what NHS dentists can offer, otherwise dentists who have got used to private practice and different working conditions will not move back to the NHS. We all want a viable NHS dentistry service, so we want the negotiations brought to fruition in a meaningful way, as the motion makes clear. I look forward to the Minister's statement next week and hope that she will think about what she can do to improve the situation in the north in general, and in Rochdale in particular.
Thank you, Madam Deputy Speaker, for calling me to speak. I have enjoyed the contributions made by hon. Members on both sides of the House. I pay tribute to Sir Paul Beresford, who has sadly left the Chamber, because his speech was extremely eloquent and interesting.
I am pleased to have the opportunity to describe to the House the successes of NHS dentistry in South Swindon and to inform my hon. Friend the Minister of the challenges that we still face. Happily, those challenges are by no means the mountains that they were in 1997 and I am sure that they will be resolved simply by her plans for NHS dentistry.
In 1997, one could not get an NHS dentist for love nor money in Swindon, but the Labour Government's commitment to, and investment in, dentistry, and especially their commitment to training more dentists, has dramatically changed the situation. Our financial investment would be stymied without an increase in the number of dentists, but of course it takes time to train people. It is easy to pass judgment when in opposition. If the training programme were circumvented, the Opposition would accuse the Government of endangering people's dental health. However, because the training programme takes time, Opposition Members complain that the Government are not acting fast enough. They are having their cake and eating it, and they might find that that leads to dental caries, if they are not careful.
I am pleased to say that Wiltshire is involved in the Government's initiative to train overseas dentists. Earlier this year, the primary care trust, the community dental service and the personal dental service investigated training overseas dentists who already lived nearby, but could not practise because they did not have the IQE—the international qualifying exam. The training will allow them to gain clinical experience here in the UK while they study for the IQE. Individuals on the programme fund themselves, but all the partners involved are seeking innovative ways to fund the training—for example, by getting those involved to practise as dental nurses first.
The Government's initiative to increase the number of places for undergraduates is also being supported in the south-west. Bristol dentistry school is, I am pleased to say, developing outreach teaching. The consultant dental manager at our PCT—a difficult phrase to say; I am glad that I still have my own teeth—met with Swindon medical academy and Bristol dentistry school earlier this year to discuss the possibility of outreach teaching at the medical academy. All the parties are keen, but, as always, resources are an issue. I hope that my hon. Friend the Minister of State will be able to reassure me that the enthusiasm of Swindon practitioners will be matched by the funding needed to realise their plans.
Swindon has already benefited from dental access grants to the tune of £170,000. Six applications for funding were made, five of which were successful. The PCT has allocated £95,500 to the successful applicants, which translates into 10,000 new registrations. The money is enabling the five existing services to expand and modernise by providing new equipment and, crucially, four more dental chairs. The PCT is using the remaining money to set up two new dental chairs at one of Swindon's medical centres. By the end of 2005, therefore, Swindon will have a total of six new dental chairs.
I am fascinated by the dental chairs and I wonder who will fill them, given that we have lost 100 dental academics since 2000 and that the research assessment exercise appears to be sounding the death knell of dental academia.
I thank the hon. Gentleman for enabling me to take my maiden intervention. I think that the Government's plans to increase the number of dentists by increasing the number of undergraduates and by employing people from overseas under strict licensing controls are the right way to proceed. I am sure that we will be able to fill the places.
I was pleased to visit one of the NHS dentists in my constituency a few weeks ago. Ambience dental practice opened in 1998 as a direct result of Government funding, and it has seen 32,000 patients since then. Ambience is one of the pilots in the Government's personal dental services scheme, which began in January 2005. The practice is strongly in favour of the scheme, because it releases capacity and gives the practice a steady monthly income, which helps financial planning.
Under the old general dental services scheme, which is still running in many practices and in many Conservative Members' constituencies, Ambience's maximum capacity was 13,500 patients. If a patient did not attend within a fifteen-month period, that patient dropped off the list—a problem described by Paul Rowen. If a patient who had once been on the list rang up in pain for emergency 24-hour treatment, Ambience was normally unable to help them and directed them to our local access centre, which we are lucky to have. Under the new scheme, the period in which patients may remain on the list without attending the practice is 30 months, the effect of which is to increase Ambience's capacity to 17,500 patients. That is one of the reasons why I welcome the new contract: the Minister is right to say that it points the way ahead. Because of the new contract, instead of turning patients away, Ambience is taking on an average of 10 new patients a week, which is extremely good news for my constituents.
Under the old budgeting system, a dental practice's income was based on the earnings of the practice in the previous year; in addition, fluctuating payments were made based on how much work was achieved by the practice each month, so when a dentist was on holiday, income fell. Under the pilot scheme, Ambience is given approximately £13,000 per treatment room—it has five—of which 50 per cent. represents salary and 50 per cent. costs. That gives Ambience a stable income and helps it to cater for the ebbs and flows of the dental practice.
With extra Government funding, Ambience could increase the number of treatment rooms available: it has the space to do so in the building in which the practice is located. The building is in the centre of town and would make an excellent extended practice. Each treatment room has the capacity for 2,000 to 2,300 patients per annum, so with two new treatment rooms Ambience could increase practice capacity by 4,600, which would greatly help South Swindon. Ambience dental practice is just one example of successful development by dental practices in Swindon: there are other NHS dental practices which I am sure are equally successful, and I look forward to visiting them.
In addition to the increase in capacity and in the number of patients being treated that I have described, Swindon has a dental access centre for emergency treatment. Sadly, I have had to use it myself, but I cannot speak highly enough of the prompt, efficient service that I received. As Dr. Murrison has reminded us, toothache is a dreadful thing. It was a relief to me to be seen within 24 hours—something that most NHS patients could only dream of before the Labour Government's investment in dental services.
I am pleased to inform the Minister that, earlier this year, I registered with an NHS dentist in Swindon. It was not difficult, as some would have us believe. I have received excellent service from my NHS dentist, including treatment for an abscess at 9 am on
There are two issues to which I wish to draw the Minister's attention. First, not enough of my constituents are aware of the availability of NHS dentists and they sometimes make erroneous value judgments about the quality of treatment. For example, a constituent attending my advice surgery last week—she did not come to discuss NHS dentistry, but she said, "Oh, and another thing," and launched in on the subject—complained that she and her husband had paid approximately £1,000 for private dental treatment, including root canal treatment. Not only did she think that there were no NHS dentists with open lists in Swindon, which is not the case, but she believed that complex treatment could be offered only by private practices. Nothing could be further from the truth. Expert root canal treatment is offered on the NHS—I paid approximately £60 for mine. Incidentally, I was cheered by the comment of the hon. Member for Mole Valley that root canal treatment on elderly patients takes three to four hours: given that mine took less than half an hour, the hon. Gentleman has knocked a few years off me, which alone makes getting elected worth while. We clearly need to publicise the treatments available to an excellent standard on the NHS.
Secondly, I am sad to say that some dentists are charging an initial registration fee before taking on NHS patients. Initial charges can be as much as £40 to £50 and apply to children as well as adults. For those on low incomes, that is a daunting sum to find, so I ask my hon. Friend the Minister of State to look into the issue. One of my constituents recently contacted me about her 10-year-old son, who had severe toothache. He was treated at the dental access centre, but could not be given follow-up treatment there. When my constituent, who is on income support, tried to register her son with a local NHS dentist, she was asked to pay £45, which she could not afford. I understand that there is some dispute about whether that charging practice is allowable within NHS dentists' terms of reference; in my opinion, it should not be, because it places an unacceptable barrier in the way of many who are most in need of treatment. Such charges might explain why the registration of children in Swindon as a whole has decreased slightly, whereas adult registration has increased. Despite that, 69 per cent. of children are registered, which is 6 per cent. above the national average. I do not want Opposition Members to run away with the idea that the situation is dreadful.
As I said at the start of my speech, the issues I have described are ones that the Minister can easily help us to overcome. We in Swindon have seen great investment in dental services and we look forward to it continuing. In addition, I look forward with great interest to hearing about my hon. Friend's plans for the continuing development of dentistry. There is more to be done, as she has acknowledged, but we have made great progress in this important area of health.
I support the proposals tabled by right hon. and hon. Friends, who have called on the Government
"to work with the dentistry profession to ensure that the new contract delivers more dentists spending more time working in the NHS."
I regularly receive correspondence from constituents—I am sure that hon. Members on both sides of the Chamber do so too—whose dentists have sent them letters telling them without prior warning that they are going to stop doing NHS work. Those patients are left to their own devices to find an alternative NHS dentist, which is a far cry from the Prime Minister's pledge in 1999 that everyone would
"be able . . . to see an NHS dentist just by phoning NHS Direct".
Figures showing that less than 50 per cent. of people are now registered with an NHS dentist demonstrate the lack of success of the Government's policy on dentistry. One of my constituents in Didsbury is in the unfortunate position of losing two successive dentists. After his local dentist in Didsbury stopped carrying out NHS work, the nearest NHS dentist that he could find was over the border in Cheadle. Not one local dentist in my constituency was able to accept him as an NHS patient. Now he has been told by Cheadle dental practice that it will stop doing NHS work from
Who is to blame? Some people might argue that it is the dentists themselves, who not interested in working in the NHS. At least one hon. Member asked why dentists should do NHS work when they can make much more money in the private sector. I do not believe that that is the case. Dentists are not to blame—it is the policies of successive Governments that have failed NHS dentistry. Speaking to dentists in my constituency, it is clear that the majority want to work in the NHS. They want NHS dentistry to be available to all, but it has become impossible for them to carry on working in the NHS. I have already written to Cheadle dental practice more in hope than expectation, urging it to reconsider its decision to end NHS treatment.
I have little reason to be optimistic. This is not about dentists just wanting to make money but about them being unable to deliver a decent service under the NHS contract. In a letter to patients, Dr. Campaigne—I apologise if I have mispronounced his name—of Cheadle dental practice wrote:
"You may well have seen on the television or read in the press that providing quality dentistry has become very difficult within the NHS. I have a loyalty to and from my patients and although I have been prepared to support the NHS in the past I find it increasingly difficult to provide the quality of care to which you have become accustomed and which I feel you deserve."
That sums up the situation. Dentists tell us time and time again that the pricing structure means that dentists are unable to spend time with their NHS patients, give advice on preventive care or carry out good-quality work. Without a complete renegotiation of the contract to give dentists time with their patients and put in place effective plans the situation will become worse, not better.
It was the Conservative Government who were responsible for the decline in NHS dentistry in places such as Manchester Withington and Cheadle. A new contract and reductions in fees in the early 1990s started the trend, but it is the failure of the Labour Government to do anything about it that has brought the NHS to a crisis point.
I would like to ask the hon. Gentleman a question that I tried to put to his hon. Friend Steve Webb. We have heard a great deal from the Liberal Democrats about the shortage of NHS dentists, but the only proposal in their manifesto on dentistry was for personal dental plans. How many extra dentists would personal dental plans require to be trained, recruited and employed, and how would they be paid for?
The hon. Gentleman has been in government for eight years. [Interruption.] Perhaps he has not been in power for eight years, but the Labour Government certainly have, and they have done nothing to deal with the decline started by the Conservative Government.
In conclusion, the Prime Minister's amendment is typical of a Government with their head in the clouds. I am happy to congratulate NHS staff on their efforts, but in dentistry, their work is made harder by a Government policy that appears determined to end NHS dentistry rather provide than NHS dentistry for all. I noted with interest that the amendment says that
"the Government's ambitions for NHS dentistry will deliver a modernised, high quality primary dental service".
The amendment fails to mention that most people will not be able to access that service, and that fewer individuals will benefit from it unless there is a radical shake-up of NHS dentistry.
It has been interesting to listen to today's debate. Sir Paul Beresford in particular made an interesting contribution. I will not focus on the ins and outs of what goes on in a dentist's room but on the wider issues in my Hackney constituency.
First, I shall comment on the opening speech by Steve Webb. In another life, I was a young journalist in the world of housing. When the hon. Gentleman was first elected we were all excited, because he knew a great deal about his subject and could make good, positive policy suggestions on improving the benefits system. When I sat down on the green Benches today, I thought that I would hear something interesting about dentistry, an issue that is important to my constituents and me, as well as to everyone in the Chamber. However, we were disappointed by the fluff and nonsense that we heard. There were no facts of any merit and no positive suggestions about what the Liberal Democrats would do. It was simply blatant electioneering, which is sad, because the issue is important for people in my constituency and the rest of Hackney.
The problems with dentistry in Hackney are very different from the problems experienced elsewhere. We have plenty of NHS dentists, but we lack the patients. The startling fact is that less than a third of residents are registered with a dentist. Just over 61,000 people are registered in a population of 222,000, according to the figures produced by the primary care trust. Locally, the PCT is working with dentists. Thanks to the Government's policies, the priorities are to register more children and to promote preventive work. Eight dental practices have already signed up to the new personal dental services contract. The PCT, particularly its visionary and highly effective chief executive, Laura Sharpe, has made a good start in tackling the problems in partnership with the Government. It is easy for people to carp about things they think the Government have not done, so let us remind ourselves of what they have done. There has been an extra £250 million in this financial year alone—an increase of 19 per cent. in investment in dentistry—and a new dental contract has been introduced.
I am delighted that my hon. Friend the Minister of State is willing to listen to points made in our debate, as there is not a simple answer to some of the problems in NHS dentistry. We do not live in the Liberal Democrat world of easy solutions but in the real world of government. I am delighted that under her stewardship we are working on long-term, sustainable solutions to problems. An extra £9 million has been provided by the Government to PCTs for training to help dentists to prepare for the introduction of the new ways of working from October this year.
While all that Government investment is much appreciated, is it not the case that much of it is lost on the public, because they would like more dentists in their community and the chance to get on to dental lists and receive treatment?
As I said, in my constituency there is no shortage of dentists in the community, but I accept that we must consider the need for information about the availability of dentists. As my hon. Friend Anne Snelgrove said, dentists are available, but people are not always aware that they can register with them. I hope that my hon. Friend the Minister will focus on the positive side of the question rather than the negative and untrue points made by the Opposition.
To return to Hackney issues, I am sure that my hon. Friend the Minister and others would agree that the low registration rate is a serious issue for the health of Hackney residents across the board. Hackney has the second highest proportion of 0 to 4-year-olds in London—just over 8 per cent. It also has a high population turnover—about 20 per cent. a year. That is well illustrated by a primary school that I visited a few weeks ago in Hoxton in the heart of a large number of council estates in my constituency. In year 6 of that primary school, just under 20 per cent. of the pupils have been there since reception. That is an indication of the challenges facing the promotion of registration and access to dental health in populations such as mine in Hackney, South and Shoreditch.
My hon. Friend outlined the Government's approach to increasing the registration of children, and I am delighted about that, but we have only just over 14,000 children registered in Hackney and we need to increase that. I would be keen to work with her and the primary care trust to ensure that boost. I am delighted that the primary care trust has taken the matter up with such vigour, but it is a challenge nevertheless.
Personally, I support fluoridation. In a previous existence, when I was a member of another Assembly, we discovered that, in London, it is particularly difficult to achieve because of the number of water companies and their geographical spread and cover, which makes it difficult under the new legislation to get an agreement to provide fluoridation across London. That leaves many of London's young people vulnerable to decay, especially in parts of east London, including Hackney, where literacy is not so high, population turnover is high and we have a number of migrant communities.
The Government's excellent Sure Start programme could embrace education in that regard, as well as the many other excellent things that it delivers in my constituency and elsewhere. Parents have an important role, as do nurseries and schools. We cannot provide the necessary education top-down from Government and I would not suggest that. There needs to be an awareness that dental health in children is a good indicator of general health and well-being. I thank the hon. Gentleman for his helpful intervention.
The Labour Government are making a difference in a positive way. Before I finish, I wish to pick up on a point made from the Opposition Benches. Simon Hughes expressed concern about foreign-born dentists. It is a shame that Sir Paul Beresford has already left. I am delighted to have foreign-born dentists working in London and in my constituency, and I was rather shocked that a London Member should raise that as an issue of concern. Clearly, we also need to secure places at home to train dentists, wherever they were born, which the Government are doing.
I hope that my hon. Friend the Minister will address some of the points that I have raised and that we can look forward to a greater emphasis on dental health care, for children particularly, in east London.
I have listened with interest to the contributions from both sides of the House. Like many other hon. Members, I am disappointed by the way in which the Cheadle by-election seems to have hung over so much of the debate. That has done the subject a grave disservice. Every time the Liberal Democrats have been asked to provide details of their policy with regard to dental provision, they have offered nothing but evasion and dissemblance.
Dental provision in my constituency, Copeland, is a problem, but there can no doubt that the Government's approach to tackling the problem is the right one. I am grateful for that. The West Cumbria primary care trust, within which Copeland falls, has seen some 2,600 new registrations in the past year alone. That is to be welcomed. In addition, the number of children being registered is 64 per cent. throughout the primary care trust, which is excellent.
In my experience, many dentists in my constituency are committed to the principles of the health service and everything that goes with that. However, it is clear that comprehensive dental provision, not only in my constituency but throughout the UK, cannot rely on the unique professionalism and philanthropy found by my hon. Friend Andrew Gwynne in his constituency. There needs to be some kind of compulsion in any new contract for dentists with regard to NHS provision. Would the Minister consider a golden handcuffs clause in any new contract, such as that commonly found in business, whereby a large investment in training individuals requires them to repay the organisation that provides that training?
Is the hon. Gentleman suggesting that, when dentists graduate from dental school, they should be required to spend perhaps five years providing dental services in the NHS before they start taking on private patients?
An element of compulsion should be considered. It is reasonable and realistic to expect that any organisation which invests so much time and taxpayers' money in the provision of a public service should expect some recognition and repayment of that service when it is required.
I should like to tell the House about one family in my constituency who contacted me during the general election campaign. The son had had persistent toothache for months. The family was on a relatively low income, although not on benefit, so they found the typical charges of a private dentist unaffordable. The son's toothache persisted and eventually they were able to get NHS treatment by being referred for emergency dental treatment. By that stage, and after months of discomfort and pain, the son was recommended to have three teeth removed. That is the state of NHS dentistry for some people in my constituency.
Anne Snelgrove said that, a few years ago, one could not get an NHS dentist for love nor money in South Swindon. That is still the case in Cheltenham. This morning, I looked at the primary care trust website, which lists all the dental practices not only in my constituency, but in the whole PCT area. There is page after page of dental practices not accepting any new NHS patients for treatment. Out of 30 practices in the PCT area, 27 are not accepting any new NHS patients at all, two are registering only children up to the age of 18, and only one is also accepting some adults, but only charge-exempt adults.
Has my hon. Friend had the same experience as I have had in my constituency? Although there are a few NHS dentists who will accept adult patients, there are virtually none who will do the more sophisticated treatments, such as dentures, porcelain veneers, bridges and crowns. That is an aspect of the failure of dentistry that is seldom discussed but is an acute problem for my constituents.
I thank my hon. Friend for highlighting that additional complication. In Cheltenham, apart from charge-exempt adults who qualify for that single dental practice, there are no NHS dental practices that will accept adult patients.
Does the hon. Gentleman recall that in questions on the subject on
I have not had that specific experience but I am alarmed to hear about it. It shows the extent to which NHS dentistry has collapsed, although as my hon. Friends pointed out, it was the last Conservative Government who were at the root of the problem when they changed the NHS contract in the first place.
The primary care trust is struggling hard to redress the situation. It increased funding for the number of dental chairs and the St. Paul's dental practice will consequently have more chairs. It has recruited two Polish dentists to start work in Cheltenham.
The problem is not the number of dentists. A recent study in The International Journal of Health Geographics revealed that Cheltenham and Tewkesbury primary care trust had one of the highest densities of dentists per head of the population in the country. The problem is the NHS contract. Unless those two Polish dentists are bad either at dentistry or economics, they will find the same position as in all other dental practices: if they try to pursue the NHS contract, they will ultimately face overdrafts and insolvency. That happened to dental practices in the early 1990s, when the previous Conservative Government first made the changes. The problem was not dentists being greedy, inefficient or trying to charge too much, but the increasingly large overdrafts that they built up as businesses. They simply could not sustain themselves.
If the hon. Gentleman is considering the international recruits that the primary care trust has brought in, I suspect that they will work under the new system of contracts rather than the old one. I cannot understand his contention that they will be in the same position as they would have been in the early 1990s.
It would be nice to know when the new contract will be introduced. This morning, I spoke to the chair of my local dental committee, who has waited for eight years under a Labour Government for something to be done about the NHS contract. It was promised two years ago.
If the new dentists are being brought in by the primary care trust through international recruitment, I suspect that they will work under the new personal dental services pilot contract, not the traditional general dental services contract. I hope that they find it reassuring that they are likely to work in that new way and will not therefore face the problems that the hon. Gentleman mentioned.
I am somewhat reassured but the proof of the pudding will be in the eating, if that is not yet another dentistry joke.
We have one of the highest densities of dentists per head in the country. Meg Hillier said that we should accentuate the positive, but there is little positive to be found. NHS registrations in the Cheltenham and Tewkesbury PCT have fallen below 40 per cent. That is a fall of some 30 per cent. since 1992, when the Conservative Government made the changes. The position under the Labour Government has got increasingly worse.
Moreover, according to the chair of my local dental committee this morning, the situation is set to deteriorate because Gloucestershire dentists are threatening to start deregistering NHS patients. Even if the two Polish dentists provide some NHS registrations, the increase is likely to be offset by other dentists in Gloucestershire deregistering NHS patients. The overview and scrutiny committee in Gloucestershire recently said that there was a genuine risk of NHS registrations deceasing even more unless something is done about the fundamental problem of the NHS contract. It was introduced by the Conservatives, but the Labour Government have done nothing about it for eight years. We have waited two years for a new NHS contract but it has not been provided. The time has come for something to be done.
I thank everyone who spoke for their contributions and for exhausting all the puns that can be made about teeth and dentistry. As a new Member, I fear that I might bite off more than I can chew if I attempt any more.
Many concerns have been expressed about a shortage of access to NHS dentists. We must remember that the problems began under the Conservatives with changes in contracts and a reduction in fees, which forced many dentists to take on more private work. That was not helped by the closure of two dental schools. I do not know what persuaded the Conservative Government that that was a good idea.
However, after eight years of a Labour Government, it is no exaggeration to say that NHS dentistry remains in crisis. As the Minister agreed, more than half the population are not registered with an NHS dentist. As she also conceded, dentists continue to drift away to the private sector. Given her words and the underlying problems, the evidence that has been provided here today is not reflected in the wording of the amendment. I welcome the fact that the Department will publish its response to the charging review, but I ask the Minister to publish the report so that we can see to what exactly the Department is responding. I was interested to learn that the Department is scoping the fundamental review of dentistry, which was promised in the Labour manifesto. The fact that such a review is necessary contradicts the words of the amendment.
What measures will the Liberal Democrats take to improve dentistry? I fear that I have been out of the Chamber doing other things and I should like my memory to be refreshed.
I shall deal with that in due course.
The necessity for the fundamental review and the fact that it will be scoped before it happens suggest that the Government are rowing away as quickly as possible from their general election manifesto pledge.
The access problems have been shown by contributions from hon. Members of all parties. I should like to add my experience to that of other hon. Members. Like my hon. Friend Mr. Horwood, I tried to find a dentist in my area who could offer me treatment under the NHS. I thought that I would ascertain whether the Prime Minister's pledge held up and whether I would be referred to an NHS dentist if I phoned NHS Direct. I gave NHS Direct a call and looked at the NHS website. Of a total of 15 practices in my constituency, only four are accepting new NHS patients. None offers occasional or emergency treatment for non-registered patients. Three were ruled out because they accepted new NHS patients from only their immediate area, where I do not live. I live in Camborne and there was only one option for me. I rang that practice directly and was told that I would have to wait between two and eight months. The person to whom I spoke said that they were very sorry, but they could not tell me how long I might have to wait to be registered. If I put my name down, they would try to get back to me. That would depend on what vacancies came up and when they were advised by the primary care trust to register more people.
Yes, it is worrying. When I spoke to NHS Direct, I asked about the provision for emergency treatment. I was told that there was one dental access centre 11 miles away and that I would not be given a contact number because I would have to be triaged over the telephone to determine whether it was appropriate to give me access even to try to book an appointment. I am not sure how it is possible to triage over the telephone.
That shows the difference between different areas. I turned up at my dental access surgery and was given an appointment in 24 hours, in which time I was treated. I advise the hon. Lady to speak to her primary care trust.
Unfortunately, I do not think that I shall be able to move to Swindon to receive such treatment. However, the Government have a responsibility to provide a minimum standard across the entire country. I hope that the example that I have given will highlight the fact that there are many access problems, as we have already heard today.
Like Anne Snelgrove, I too had an abscess, two weeks earlier in the election campaign. My dentist actually got out of bed on a Sunday morning and treated me so that I could continue to work. My agent had an abscess just after the election, however, and was told that she would have to wait two weeks for treatment on the NHS. She ended up having to go private because no relief was available through the national health service.
Fortunately, I have not had an abscess in the past few months.
The Government's amendment to the motion states that there has been extra investment and that the head count of dentists has increased. I would be interested to know how those dentists are splitting their time between NHS and private work, and what the full-time equivalent is of NHS dentistry provision. I am concerned that there appear to be mismatches between the Government's figures and people's real experiences on the ground, such as those highlighted by my hon. Friend Mr. Leech.
My hon. Friend Mr. Willis has helpfully passed on to me a written answer to a parliamentary question, which gives a very healthy head count of dentists in North Yorkshire. In contrast, the reality that my hon. Friend has experienced on the ground is completely different. He has been contacted by a practice in Ripon that has had to take 1,000 registered patients off its books because the PCT cannot provide the additional funding that it needs to recruit another dentist. So the Government's figures might appear warm and encouraging on paper, but they bear no relation to people's experiences on the ground.
I am worried about the many unknown factors that need to be investigated before these problems can properly be addressed. At present, the problems are not properly understood. For example, we do not yet know when all the dentists will be switching over to the personal dental services contracts, as negotiations with the British Dental Association have broken down once before. Furthermore, it is not yet clear whether the switch over to the new contracts will result in improved capacity for dental services, or whether the dentists who have already moved over to the PDS contracts have increased their ratios of NHS patients and treatments. Surely it will be vital to know whether the new contracts will help to address the problems that I have outlined.
Fears have also been expressed by the National Audit Office that there will be a reduction in NHS services as a result of the introduction of the new contracts, similar to that of the early 1990s. A further unknown factor relates to the recruitment of overseas dentists. While they are indeed filling a cavity in dental provision, we do not know how well PCTs are absorbing the cost of recruiting and inducting them. With so many PCTs already in deficit, this issue needs to be investigated further.
It is great news that the Government are planning to increase the number of new dentists by increasing the number of students being trained, but how will those extra places be filled when many dental schools are already in financial deficit and having huge problems recruiting academic dental staff?
Of course I am not saying that. I am saying that we do not have enough information about the factors that could be affecting this problem. I am worried that there is a lack of understanding among patients as to what they are entitled to. This is reflected in the number of calls that have been made to NHS Direct. As my hon. Friend Steve Webb pointed out earlier, toothache is the fourth most popular reason for calling the service, yet one in 11 people who call for that reason are not given a nearby treatment centre for their problem.
Another concern is that the information that callers are given by NHS Direct is simply not correct. To return to the example of the number of dentists in Cheadle—
I am grateful to the hon. Lady for giving way. She might not be aware that Cheadle is in Stockport, as is part of my constituency. The picture that has been painted by Opposition Members, in a blatant electioneering exercise, does not necessarily correspond with my experience, or with the conversations that I have had with health officials in Stockport. Is the hon. Lady aware that 60 per cent. of adults and 70 per cent. of children in Stockport are now registered, which represents a real improvement, contrary to what Mr. Leech suggested? That is way above the national average, which is to be welcomed—
I am not sure whether the hon. Gentleman will be reassured by the information that I am about to give him. The point that I am making is that the help that the NHS is trying to give is based on factors that may not reflect reality. The NHS website states that none of the 18 practices registered in Cheadle is accepting new NHS patients, yet a ring-around revealed that two of them actually are. The concern is that the facts are not right. How many patients looking to register with a dentist will go to the trouble of ringing dozens of practices to see whether, on the off chance, the facts might not be right? That needs to be addressed.
Concerns about access have also been illustrated by Members such as Linda Gilroy, who is lobbying for a new dental school in Plymouth, which I wholly support, and that reflects a need to get as many dentists as possible into the area because registrations are currently so low. Urgent action is required to rebuild NHS dentistry so that more people know what access they might have to services, as Anne Snelgrove pointed out, and so that they can access the services that they need. Will the Minister promise to investigate further how to fill in the current gaps in knowledge so that real and immediate progress can be made?
Of course I would welcome that, if it makes a positive impact on the serious problems that I hope the hon. Lady will concede that we currently have.
I also want to draw the Minister's attention to the contents of the Liberal Democrat manifesto for the previous election, which called for closer work with the dental profession to ensure that it is on board with reforms that will deliver more dentists working for the NHS.
Does my hon. Friend agree that it is pleasant to see that at least one party in the House is committed to consulting with professions before imposing things on them?
Certainly. As Mr. Grogan pointed out, the Government and dentists need to work together to resolve such issues.
The drill-and-fill payment system, which has caused so many problems, should be scrapped as soon as possible and free dental check-ups should be introduced to help promote good dental health, as they will pick up more than just cavities.
Is my hon. Friend aware that free eye and dental check-ups are to be introduced in Scotland as a result of the influence of Liberal Democrats in coalition government? The contrast between what is occurring in Scotland and what is occurring in England is testament to the influence that Liberal Democrats can have when we get into government.
The Government cannot expect to make adequate progress, no matter how much they invest, unless they understand the scale and nature of the problems that they face. I commend our motion to the House.
We have had an excellent debate this afternoon, which has forensically deconstructed the motion tabled by the Liberal Democrats via a survey of the battle lines of the Cheadle by-election. Some of us also caught at least an inkling of what the Liberal Democrat alternative is.
The Minister of State, my hon. Friend Ms Winterton, set out some inescapable points that helpfully framed our debate and illuminated the background to many of the excellent contributions that we have heard. She reminded us that dental decay is at the lowest level among children since records began, and that the figures for 12 to 15-year-olds are the best in Europe. She also reminded us that the number of dentists is up 20 per cent. since 1997 to more than 20,000, and that courses of treatment are up by 7 million a year.
One of my hon. Friend's many great strengths, however, is her frankness, and she was frank with the House when she said that our ambition is to go further still. The Government amendment encapsulates that way forward. It sets out an ambition to meet the challenges and build on the progress about which we have heard. Most importantly, however, it addresses seriously the fundamental question: where do we go from here?
I noted that when referring to progress, the hon. Gentleman again used figures relating to the key year—1998—in which the registration rules changed, and the registration period was reduced from 24 to 15 months. The figures for the succeeding years show a very different pattern. They show an increase of 180,000 in the number of registrations, compared with a 2.1 million drop under the last Conservative Administration.
The hon. Gentleman also spoke of establishing capacity for the future. I hope he agrees that the Government's approach—investment coupled with devolution of commissioning to local health professionals, international recruitment coupled with investment in training places for the future, and, most important, the creation of new contractual arrangements allowing NHS and private dentists to increase the capacity that they offer the NHS—represents the way ahead.
Let me ask the Minister a serious question about accountability. He mentioned the devolution of commissioning to PCTs. On a number of occasions during the debate when we criticised Government action, the reply was "It's the PCTs". We do not elect the PCTs; we elect Ministers. Where will the democratic accountability in dentistry be when commissioning is decentralised?
We need only remind ourselves of what was said by my hon. Friend Anne Snelgrove to understand the impact that can be made by working in partnership with PCTs. My hon. Friend Linda Gilroy made a similar point.
Sir Paul Beresford made an extremely well-informed speech, characterised by an enduring commitment to the principles of NHS dentistry. He was right to emphasise the importance of fluoridation: areas with fluoridated water have experienced declines of around 15 per cent. in tooth decay among children. He also emphasised the importance of the new contract, recognising the opportunity that it represents. I hope that during the consultation and the affirmative resolution procedure in both Houses, he will do his best to make his views known.
The hon. Members for Rochdale (Paul Rowen) and for Cheltenham (Mr. Horwood) described some of the access problems in their constituencies. I think that their speeches implied the same conclusion that Mr. Leech appeared to reach. I think that they were all arguing in favour of the new contractual arrangements that my hon. Friend the Minister of State will announce next week. I take issue only with the allegation by the hon. Gentleman that the Government had done nothing to address the inheritance of 1997. An extra £250 million is not an empty promise; the recruitment of 1,000 extra dentists is not an empty promise; a 20 per cent. increase in the number of training places is not an empty promise. All those things make a difference, not just in the country generally but in the hon. Gentleman's constituency. For a start, he will have an extra £144,000 in access money.
The hon. Gentleman must wait for the new arrangements that my hon. Friend the Minister of State will announce next week.
Members on both sides of the House spoke of the differences made to access throughout the country. My hon. Friend Ms Abbott explained how our reforms would benefit urban areas. I thank her for her recognition of the record investment in the NHS and NHS dentistry. I join her in celebrating the availability of dentists in Hackney. She, too, mentioned the important issue of fluoridation, to which I will alert my hon. Friend Caroline Flint, the Under-Secretary of State for Health.
My hon. Friend Mr. Grogan has not been to Cheadle for some reason, but I welcome his endorsement of our strategy. As he said, his constituency is benefiting from the changes. His local PCT has eight new recruits, and registration has increased by more than 8,000. That is a good example of the difference that can be made—not least in the widening of access—by transferring commissioning to PCTs, which are now in control of £1.6 billion. He concluded with some sage advice on contract consultations in the months to come, which will doubtless be of great benefit to my hon. Friend the Minister of State. My hon. Friend Mr. Reed added to those thoughts with a helpful contribution of his own.
My hon. Friend the Member for Plymouth, Sutton also congratulated the Government on the progress that has been made. I thank her for that, and in turn congratulate her on engaging with her local PCT. I am sure that its hitting its targets is not unrelated to the strong interest that she takes in local matters. She underlined the strength of her city's claim to be host to a new dental school; I am sure that my hon. Friend the Minister of State will have listened very carefully to what she had to say. What a welcome change to be debating where to open dental schools, rather than mourning their closure.
My hon. Friend the Member for South Swindon highlighted the sharp contrast in her constituency between the situation now and before 1997. Some of the innovation that she highlighted was especially useful. Her constituency has indeed benefited considerably. Her PCT has a growth in registrations of 4,500 coming its way. Her strategic health authority has nearly £2 million extra in capital and revenue resources, as well as an access centre. I must congratulate her on taking a close interest in dental matters in her constituency—so close that she was drawn into a little personal research in what sounded like the most pressing of circumstances. She highlighted the need to publicise the new dentistry services that are available, and I can only agree. She also raised a specific case, on which I shall write to her.
I want to conclude my survey of this afternoon's contributions with that of Dr. Murrison, who opened with some excellent jokes and then proceeded to tell some that were slightly less amusing. I was especially intrigued by his idea that, on the basis of evidence, dental schools will close. I was not sure which evidence he meant. Was it the number of registrations falling by 2.1 million or treatments falling by 600,000? He did not say. He did, however, underline the need for an NHS commitment to dentistry, with which I can only concur.
The hon. Gentleman also underlined the importance of a personal touch, but he said that he was unsure about our commitment to delivering it. Well, the best way to guarantee it is by recruiting more dentists, not by encouraging them to drift away. The best way to guarantee it is by training new dentists for the future, not by closing down dental schools. He emphasised the importance of registration, which intrigued me slightly. Mr. Lansley, who is not in his place, has said that the Conservatives' plans do not guarantee patients' ability to register, even in cases where they have secured insurance.
In conclusion, I celebrate the House's resolve time and again to address itself to the vital issue of the nation's oral health. This is our third debate on this issue in the past 12 months. Once again, we have spent an afternoon counting the cost of clearing up the Conservatives' legacy. Once again, we have heard of the damage done by their calamitous contract of 1990. Once again, we have heard of the price paid for their decision to close dental schools. And once again, we have heard from the Liberal Democrats a solution—
Let us look at the figures. The number of dentists is up by 20 per cent.; the number of adult registrations is up by 180,000 since 1998; the number of treatments is up by 6 million. So I have absolutely no apologies to make for this Government's record in office. It is a record of which we are proud.
A little earlier, I mentioned that one issue that the Conservatives perhaps have difficulty in getting their heads round is that in 1997 we inherited a situation in which some 42p in every new pound of taxation was being spent on the cost of economic failure, unemployment and the national debt, which had got out of control. I did not mention that that figure has now dropped to some 11p in the pound, which means that we have the money to invest in a sustainable way. Does my hon. Friend agree that that is a key point and that it should give us confidence in future?
I agree entirely with my hon. Friend. We can be very proud of the fact that investment in NHS dentistry is increasing by 19 per cent. over the next year.
That leads me to the question of finance. Once again, we heard from the Liberal Democrats a solution, the delicate foundation of which appears to rest on spending money spent once or twice before. Mr. Kennedy has told the newspapers that his party is embarked on a great adventure. It is embarked on a policy review without precondition or presupposition, a clean sheet and a move away from
"a brief, desultory debate in a largely empty hall", which I can only assume is a reference to the Liberal Democrat annual conference. I hope that what the Liberal Democrats have heard this afternoon has put them off writing on that blank sheet a break-up of the national health service, as proposed by some of their number in "The Orange Book". What this country wants is NHS dentistry rejuvenated by the reforms outlined by the Minister of State earlier this afternoon. These are the most ambitious reforms since 1948, which promise to accelerate the increased number of dentists, increased number of treatments and increased number of registrations already delivered in the last Parliament.
We will publish it in full, even though it is unusual to publish the full details of reports constructed by external working groups. The principles and the details set out next week will be extremely important and I hope that both sides of the House will join in a constructive debate on them. The Minister of State has set out a strategy this afternoon and the next steps will be set out next week. I commend the Government amendment to the House.
Question accordingly negatived.
Question, That the proposed words be there added, put forthwith, pursuant to
Mr. Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.
That this House welcomes the Government's record levels of investment in the National Health Service, with expenditure set to rise to over £92 billion in 2007–08; congratulates the Government and NHS staff for improvements in primary care; notes that the Government's ambitions for NHS dentistry will deliver a modernised, high quality primary dental service; congratulates the Government on supporting this with a record level of investment, which has been increased by 19 per cent., or £250 million a year, over 2003–04 levels; further welcomes the increase in NHS primary care dentists from 16,700 in 1997 to 20,192 in April, the creation of 53 dental access centres across England treating some 400,000 patients a year and an NHS support team to improve access to dentistry in areas where there are problems, and the introduction of additional capital grants of £35 million to fund practice improvements; and further congratulates the Government for this investment and programme of reform that has delivered a better quality of life for staff, and improved services for all patients, regardless of their ability to pay, true to the founding principles of the NHS.