Motion made, and Question proposed, That this House do now adjourn. -(Mr. Mudie.)

As I have just had my tonsils removed, I intend to make an equally truncated introduction to this very important debate. The Minister has had a copy of my full speech since Monday, and it also appears on my website.

In essence, I should like the Minister to comment on how we can improve NHS dentistry in my constituency. The state of children's dental health in Nottingham is the second worst in the country-it is at the average level found in England 35 years ago. Half the under-fives have never been to a dentist. A local teacher told me about primary school children who had dirty or black teeth or who had lost their second teeth, and described the excitement of a six-year-old girl at having a toothbrush-she had never had one before.

Children in the most deprived fifth of schools, typical of my constituency, have four times as many decayed, missing and filled teeth as those in the top fifth. Local dentists, the local NHS and the Government have worked hard on the problems but it seems that recent reforms, including changes to the dentist contract and payments, may even have made the situation worse. Quick extractions are up, time-consuming repair work is down.

Three simple steps would help to put things right: first, registering every child and every adult with their local dentist; secondly, ensuring that the dentist contract rewards prevention, and not only extraction; and thirdly, giving every child and adult a free dental check-up every year. That dental MOT for everyone could be paid for through a reformed charging scale and revised dental contracts. Nothing less than that ambition will meet the scale of the problem in constituencies such as mine. Incidentally, Nottingham would be the perfect place to hold the pilot. I should like the Minister to comment on that.

I hope the Minister agrees that never again should the House hear of a girl in my constituency or anywhere else who only gets her first toothbrush when she is six years old.

I congratulate my hon. Friend Mr. Allen on securing the debate. He takes a keen interest in the challenges faced by commissioners of primary care dental services for Nottingham. I offer him my sympathy on his tonsillectomy, which comes at a most frustrating time, and means he is not able to make as detailed a contribution to the debate as he might like, but I certainly admire his fortitude in speaking when his throat is somewhat raw.

Before I deal with some of the issues relating to dental services in Nottingham, I shall set out the national context for dentistry. I certainly share my hon. Friend's view that children throughout the country should regularly be using toothbrushes and toothpaste well before they are six years old. Children should be taught at an early age how to clean their teeth, and I hope that we can reach a level of improved dental care.

We have increased spending on dentistry; it was up 11 per cent. in 2008-09 and 8.5 per cent. this year. Funding is running at a record £2.25 billion, net of patient charges. Since 2004, funding for dentistry has gone up by 70 per cent., which is an additional £900 million.

As a result of the increased investment that we have made since then, 850 dental students are expected to graduate next summer-an increase of 25 per cent. As part of our expansion programme, two new dental schools opened in 2007, in the south-west and in central Lancashire, thereby reversing the Conservative closure of two dental schools in 1991. The number of dentists working in the NHS rose last year by 528, on top of an increase of 655 in the previous year. More dentists in the NHS meant that last year an extra 1.4 million courses of treatment were delivered.

We believe that the best decisions are made as close to those affected by them as possible, so in 2006, in line with the rest of the health service, we reformed NHS dentistry. The new system gave power to primary care trusts to commission the right dentistry services for their communities. PCTs have provided incentives to encourage prevention and improve quality, but in some areas-I suspect Nottingham is among them-progress has been slow and sometimes much too patchy, so in December 2008, the then Secretary of State asked Professor Jimmy Steele to conduct a review of the new contract, and that was published in June. I am delighted that the review has joined the Select Committee on Health in supporting the principle of local commissioning and providing a firm basis for the future of NHS dentistry.

The review also showed the range of services that are needed; that different generations need different types of dental care; that simply drilling and filling is no longer acceptable; that we need to improve oral health; and that preventing decay and disease must become a real priority for NHS dentistry. We wholeheartedly welcome Professor Steele's review, and we will rigorously test its recommendations in a series of pilots throughout England over the coming months. I am very pleased that the British Dental Association, patient groups and other stakeholders have welcomed the review.

In the years since the foundation of the NHS, we have seen substantial improvements in our dental health. Half of adults in 1948 had no teeth at all; now, we are about to carry out the latest national adult dental health survey and we expect the figure to have fallen to about 6 per cent. Whereas 35 years ago more than 90 per cent. of all 12-year-olds in England had tooth decay, today the figure is less than 40 per cent. We are making substantial improvements, and it is arguable that our children have the lowest rate of tooth decay in Europe and are comparable with the best in the world, including countries such as America.

The association between social deprivation and tooth decay is clear, and we know that the link can be broken. Sandwell in the west midlands has only a slightly better socio-economic profile than Nottingham city; however, according to the most recent British Association for the Study of Community Dentistry survey of dental decay in the milk teeth of five-year-old children, from 2005-06 the average number of decayed, missing and filled teeth among such children in Sandwell was about one third of that in Nottingham. My hon. Friend may be interested to know that the North West Public Health Observatory will publish the latest figures, for 2007-08, next week.

Apart from rates of tooth decay, what are the differences between Sandwell and Nottingham? For a start, fluoride is added to Sandwell's water supply to bring it up to the 1 part per million level at which it can help to protect people's teeth. I realise that fluoridation is controversial, which is why no new schemes can be introduced until a strategic health authority has consulted the local population, but it offers one way of reducing inequalities in oral health which does not require individual parents and families to take action, because fluoride is in the water supply.

In addition to population-wide measures such as fluoridation, dentists and members of their team can intervene to improve oral health. For example, we have developed the Brushing for Life scheme, which targets young children in areas with the highest levels of tooth decay. When their families visit child health clinics or Sure Start centres, they get a free pack of fluoride toothpaste, a toothbrush and a leaflet containing advice on oral hygiene. Many such interventions will take place before children are six years old, and we need to ensure that at an early age they are able to get the benefits of fluoride toothpaste, a toothbrush and an explanation of the best way to protect their teeth and ensure that their full adult set of teeth is healthy. Parents or carers are also given a demonstration of how to brush their children's teeth, or of how to teach their children how to brush their teeth-obviously far better.

In June last year, Nottingham city primary care trust started the City Smiles programme to combat poor oral health in children. Its main objectives were to reduce tooth decay; to ensure that children received appropriate dental care; and to increase knowledge about oral health. The three principal messages were to improve diet, for example, by limiting sugars to meal times; to improve oral hygiene habits, for example, by brushing teeth twice a day; and to promote better access to dental care so that children saw a dentist at least once a year. Those messages are being given to all pregnant women and pre-school and school-age children in the Nottingham area.

In similar places to those where Brushing for Life applies, families with young children are given the opportunity to have their children's teeth treated with fluoride varnish, as recommended by the Department of Health. Then, because the varnish needs to be reapplied at six-monthly intervals, the families are advised about how they can access a high street dentist for their continuing dental care needs. That provides the initial contact with a dentist that some families need to ensure that they are subsequently in regular contact.

The regular application of fluoride varnish is one of the most effective ways in which to deal with dental health and prevent future dental problems. Where that has happened, it has reduced tooth decay in young children's primary or milk teeth by a third, and by 46 per cent. in adult, permanent teeth. We know that if children have healthy milk teeth, the chances are that they will have healthy adult teeth. If they have decayed milk teeth, that may well lead to problems with their adult teeth. Getting to children early-certainly well before they are six-is an important part of improving oral health in this country.

Does the Minister agree that early intervention is the key? If a child is registered with a dentist, that dentist can call the child in for a pain-free experience of understanding how the surgery works, and how to brush and look after teeth, well before the fear sets in and the feeling of, "Whenever I go to the dentist, it's going to be a painful experience."

I was going to come to registration, but given that my hon. Friend has raised it, let me deal with it now. There is a demand from some dentists to reintroduce registration. If we look back at the history of that, dentists when my hon. Friend and I were young did not have registration as it existed after 1990, when dentists were paid to keep a register. That practice was ended, mainly because it did not seem to make much of a difference. Before 1990, and by and large-though not in all cases-since then, dentists have kept a list of patients. That enables dentists to keep their customers-dentistry is a business, albeit contracted to the NHS. It enables them to keep in contact with their customers-their patients-and ensure that they send regular notices to those patients to get them to come in for check-ups. Then the dentists can make the appropriate claim under the NHS dentistry contract.

Whether we should pay dentists for doing what the vast majority currently do without payment is debated. Some people say that we should reintroduce registration, which would mean that dentists were paid a fee for doing what most of them already do, because some dentists do not keep a list. It appears, though, that the vast majority still do, and the evidence suggests that the numbers on the lists are similar to those when people were registered. It is difficult, because we do not have regular records, to be entirely sure about how many keep a full and proper list.

Of course, because it is in some sense voluntary to do so, dentists who are anxious to run an efficient business for their patients keep in regular contact with them, but those who are less efficient or who have enough patients without lists may well not do so. However, I am not convinced at the moment that reintroducing a system of registration would be the best way of using NHS funding. We will look at the evidence-my mind is not entirely closed on the matter. The position is that the vast majority of dentists try to keep in contact with their patients, which is how they generate income under the NHS contracts.

Nottingham City PCT has been paying dentists to apply fluoride varnish to children, in line with Department of Health guidance. There is a great deal more that we can do to prevent tooth decay in communities, but I accept that we also need to improve access to dental practices. As I said, access to NHS dentistry is already improving across the country. A recent Which? survey published in June showed that nine out of 10 people who tried to find an NHS dentist in the past two years were able to get one, but we need to go further to ensure that every person who wants an NHS dentist can have one. The 10 SHAs in England, with the 152 PCTs, have set themselves the task of delivering access for all who seek it by March 2011.

In the year to June 2009, just over 64 per cent. of people in the Nottingham PCT area saw a dentist. Unfortunately, that figure represents a fall on preceding years. Nottingham City PCT is aware of that. We have been assured that it is carefully monitoring the situation. I think that it needs to do a bit more than that and to be proactive in dealing with the situation.

The PCT has, however, conducted extensive research and consultation, including through focus groups and questionnaires, to understand why people in Nottingham are not going to the dentist and to find out which services they would use. As a result of the consultation, the PCT is opening two new dental practices, in Bulwell and Bilborough, with a mobile dental service to work flexibly across the city. In addition, it will be initiating a targeted communications campaign to promote uptake of dental services. Those initiatives will be backed by increased funding for dental services in Nottingham City, with £16.2 million allocated for the current financial year.

The expanded national dental access programme is helping Nottingham City PCT to implement its dental strategy. The programme, led by Dr. Mike Warburton, supports the NHS to expand dental services rapidly where they are needed. It will work closely with Professor Jimmy Steele's independent review of NHS dentistry. Professor Steele's review is helping us to understand how dentists can deliver consistently high quality care while providing the right level of preventive work, as well as looking at how we can go further to reduce inequalities in oral health.

The core of our dentistry reforms-that the dental budget is held locally and that PCTs commission dentists directly to deliver NHS care-is here to stay. We need to ensure that PCTs such as Nottingham City increase the work that they are doing to ensure that we get much more effective responses regarding dental care. Demonstrating that and echoing the national picture, the number of dentists in Nottingham City PCT increased from 138 in March 2007 to 143 in March 2009.

The NHS is confident that it can achieve its aim of delivering access to a dentist for all who seek it within the next 18 months. We strongly welcome the level of commitment from SHAs and PCTs to tackle dental access while we have that ambitious time frame in place. It is going to take quite a lot of work to ensure that we hit the targets; we do not underestimate the challenge. The problems of access are considerable and they have grown over time, so they will not be turned around overnight or without significant effort. I assure my hon. Friend that the NHS in general and Nottingham City PCT in particular are committed to improving oral health and that the development of dental services in Nottingham is an integral part of the PCT's priorities for local health services.

My hon. Friend raised a couple of other issues. First, he asked about an annual adult and child check for tooth decay and other oral health issues. He will know that there used to be a system of annual checks of children's teeth, which was done by the school dentist. It cost some £17 million, but an independent review found that it did not have any effect on improving oral health in deprived areas. What happened was that children would be looked at by the school dentist and be told that they had some decay, but they would not be taken to the dentist. That is a problem, because it is in deprived areas in particular that we need to ensure that we improve oral health. The question is what is the best way to spend that £17 million. The view is that a better approach is to target areas of significant deprivation and ensure that effective resources are put into a real programme to teach children and adults about the importance of dental health.

The British Dental Association has considered whether we should have children's dentists, and it takes the view that that is not the best way to spend such resources. We have acted on independent advice, but I hear what my hon. Friend says and, in principle, the idea that both adults and children should have an annual check for decay or any other problems is a good one. I shall discuss it with my hon. Friend the Under-Secretary of State for Health, who has responsibility for dental service issues.

My hon. Friend the Member for Nottingham, North also talked about the 2006 contract and how it has developed. Professor Steele's review of that contract is important and bears close examination. Issues did arise with the contract. It was not piloted, and we have lessons to learn from that. Indeed, in looking at Professor Steele's review we have decided that we do need to pilot his proposals so that we have a process for the introduction of changes to the contract that is broadly acceptable to dentists, the Government and the taxpayer. That process will also ensure that we do not create an over-complex contract by which we reward dental practices in a vast variety of ways. One of the problems with the old contract was its complexity, so we have tried to simplify it. We now need to examine the results of the independent review carried out by the team led by Jimmy Steele, and to ensure that the proposals in the document are considered carefully and properly piloted. If the pilots show that they are the best way of making changes, we should implement them as soon as possible.

Nottingham City PCT and East Midlands SHA are committed to ensuring improved oral health for the residents of Nottingham and to improving NHS dental services in the area. The increasing number of dentists demonstrates a real commitment. I applaud my hon. Friend's presence today, despite his operation just a couple of days ago. It demonstrates his level of commitment to, and determination to serve, his constituents. His contribution today might have been painful for him, but I hope that it will at least prove worth while in raising the concerns of parents and children in Nottingham about the future of children's oral health.

Question put and agreed to.

House adjourned.