rose to ask Her Majesty's Government when national health dental services will be available for all.

My Lords, many people tell me that you should never ask a question unless you know the answer. I do not normally follow this advice and I ask questions in your Lordships' House because I do not know the answers and I am genuinely seeking information.

The Question tonight asking the Government when national health dental services will be available for all is different. I believe that I do know the answer. It is simple and can be given in one word: never. If pressed in the Gilbert & Sullivan manner, "Wot never?", I would have to concede, "Well, hardly ever". Your Lordships may be surprised to hear that I did not attribute that answer entirely to this Government's lack of dealing with the shortage of NHS dentists.

National health dentistry has never been fully available to all. For the Prime Minister to say in 1999 that,

"everyone within the next two years will be able once again to see an NHS dentist just by phoning NHS Direct", was foolishly optimistic to say the least. That optimism was compounded by the Department of Health, on behalf of the Government, in the 2000 NHS Plan, stating that it was firmly committed to making high-quality, national health dentistry available to all who wanted it by September 2001.

When the original 1948 public leaflet on the National Health Service was reprinted to celebrate 50 years of the NHS it contained an interesting qualification, regretting that there were not enough dentists to provide the service fully, right at the outset. Only arriving in the UK in 1954, I had not appreciated that that had been the position, although I knew from direct personal experience that Commonwealth dentists from Australia, New Zealand and South Africa poured into the UK during the 1950s. There was certainly a demand for dentists and one had only to open a practice for patients to arrive at once, although we never saw queues as are now shown on television when anyone opens a new NHS practice.

Access to dentistry now is very limited. Last week I met a pregnant woman who ruefully commented to me that for the first time in her adult life she was entitled to free dental treatment but could not find a national health dentist anywhere to accept her as a patient. About two weeks ago, an elderly woman's son phoned me to say that his mother was in great pain and how could he find out where to go for emergency dental treatment. I do not intend to categorise more cases as a plethora of examples have been quoted in the press. Those are just two recent incidents in which I was directly involved.

I was startled when recently at a citizens advice bureaux reception in the House, the guest Speaker said that queries about how to obtain dental treatment were one of the most frequent problems brought to them. The CAB has sent me details of specific cases involving travel, one of which was a man with mental health problems, who was unable to read or write. He came to the CAB in pain. NHS Direct told him that he would have to undertake a 40-mile round trip on public transport for emergency treatment. He could not possibly manage such a trip unaccompanied. In other cases, it was not only distance but also cost that was extremely difficult.

CAB acknowledges that the Government have tried to improve dental access, but believes that some primary care trusts (PCTs) are not maximising the opportunities available to commission local access sessions. It emphasises that it is crucial that the new dental services are planned around the needs of local communities, not the convenience of service providers.

I followed that up with the CAB and asked what answer is given to clients when they seek help. The reply was, "Contact NHS Direct", and they are given the number. I was told—I ask the Minister to note this point as I believe it is important—that between 60 and 70 per cent of those who apply to CAB for such help have never heard of NHS Direct and CAB is convinced that there is a clear need for it to be more widely publicised.

The NHS Direct number is not a freephone number, but I believe it is charged at the local rate. I decided to give it a try to see for myself just how it worked. A voice answers, saying, "You could try your Thomson Local Directory or use the interactive button on your television to get information; otherwise, please hold". I discovered one had to hold and hold. In all I had seven messages such as, "We are aware you are waiting", "Thank you for your patience" and "Your call will be answered as quickly as possible". I held for about 10 minutes.

The girl who eventually took the call was pleasant and tried to help. I was impressed that she seemed to be in the UK rather than in India, which appears to be more usual these days. She gave me the numbers of several dentists in central London and the number of the primary care trust, as it is responsible for providing a list of NHS dentists in the area. When I contacted a number of dental practices I was pleasantly surprised to be told they took national health patients. Less pleasing was the response when I asked about the minimum fee for an examination. The lowest quote was £14. The correct charge for an examination is £5.84, representing 80 per cent of the gross fee, which is £7.30. Clearly none offered an examination only. The patient's charge is 80 per cent of the national health dental fee, with a maximum payment of £390.

After that, I contacted the PCT to ask whether it could supply a list. The answer was that it should be able to do so, but unfortunately the lists had been transferred from another PCT, where they used to be kept, so I would have to be referred on. By now I had been on the phone for more than two hours, and I had had enough. Your Lordships will see how frustrating this process can be, and how much worse if you are suffering toothache.

The National Audit Office report in November 2004 found that since 1990–91 NHS spending on general dental services has increased by 9 per cent, compared with a 75 per cent increase in overall NHS funding per capita. Obviously, dentistry is the Cinderella.

There has been poor workforce planning. This is aggravated by dentists reducing the amount of National Health treatments they undertake. The new dental contract, twice deferred, has still not been settled. It seems to be on hold. No further discussion meetings have been arranged.

The estimated shortage of dentists now is 1,850. Of the 230 dentists recruited in Poland, 114 are now registered to practise. The fee paid to Method Consulting for that procurement was £3.8 million, which is more than £16,500 per dentist.

Dentists believe that they need to spend more time with their patients to provide a better service. Remembering the treadmill of my practice days when, like most dentists, I used two surgeries so as not to lose time while patients took off their coats, I think that it is very desirable for dentists to have more time to communicate directly with their patients and to deal more with prevention. However, that will certainly mean that fewer patients will be treated per dentist, and that must mean that the shortage of practitioners will be even greater than already anticipated.

The 170 extra places in dental schools in England sound good, but those students will qualify five years from now. What is being done about the 6 per cent decline in the number of clinical academics in dentistry who are needed to teach undergraduates and postgraduates? Why is the average National Health funding for dental academic posts less than half that for medicine?

Dentists support preventive dentistry and there is a need for it, particularly in areas such as Manchester where the decayed, missing and filled rate is high compared with Birmingham where residents have benefited from fluoridated water for many years. Tragically, in the north-west, many children every week are still facing extractions under general anaesthesia. The most deprived children have the greatest problem. Fluoridation of the water supply would help them.

There is no easy answer to how to provide a good NHS dental service. A salaried service is not the answer, but patients with special needs require special facilities. These must not be overlooked.

There has always been differentiation between treatment for dental health and cosmetic dentistry. Many expensive, sophisticated treatments and new materials are now available. Patients want them and are usually prepared to pay for what are almost fashion items.

Most family dentists now operate a mixed practice offering National Health and private treatment. Would it not be better to fit in with this style of practice by having a good strong basic National Health core service? By promising everything to everyone, the Government may deceive themselves, but not the patients.

Now, with the new contract in sight, I ask the Government to consider providing a soundly based National Health Service core dental service, as that could be available for all.

My Lords, I congratulate the noble Baroness, Lady Gardner of Parkes, on asking this topical question of Her Majesty's Government. Having heard her speech, I shall focus on the role of primary care trusts in making NHS dentistry available to local residents.

We are all familiar with press reports highlighting a deficiency of NHS dentistry, particularly in the south and south-east of England. But it is not the case in other parts of England.

Private dentists tend to predominate in areas where NHS dentists are in short supply. I propose to focus on the experience of the Wirral pilot site for personal dental services in the NHS Dentistry Reform Programme. The Minister might be interested to know that my report will cheer him up. I declare that I am a non-executive director of the Birkenhead and Wallasey NHS Primary Care Trust. I want to thank Dilys Quinlan, the head of our PCT Dental Services, for her assistance.

Two years ago, the Wirral's two primary care trusts—Birkenhead and Wallasey and Bebington and West Wirral PCTs—established a steering group to work towards the move from general dental services (GDS) to personal dental services (PDS). Six dentists, one from each dental locality in the Wirral peninsula, have been members of this steering group.

As a result of that steering group's work, this year 85 per cent of Wirral's dentists have changed their contracts from GDS to PDS. The Government aim to implement PDS contracts from April 2006. GDS, the prevailing contract for most dentists, is based on a fee per item of service and, therefore, encourages dentists to concentrate on as many cases of dental treatment as possible in order to ensure that their income stays at a good level.

One complaint with GDS contracts is the inevitable treadmill, as mentioned by the noble Baroness, of patients to be seen and treated every day by the dentist. On the other hand, the PDS contract guarantees the dentist a regular income every month, it gives incentives to focus on preventive oral health care, orthodontics and the care of children's teeth. I am encouraged to hear that the PDS contract can give an income of as much as £100,000 per year for the dentist. I shall look forward to the Minister's comments on such a generous salary scale.

In Wirral, the proportion of children who visit the dentist is only one in three instead of the national average of one in two or even fewer. Children living in deprived areas have poor dental health but are the ones who do not attend at the dentist. More needs to be done to encourage these needy children in Wirral to attend the dentist and thereby avoid the large number of caries they currently tend to have.

The four Chief Dental Officers in the United Kingdom agree that dental decay in children is our most important oral disease. It is also common in other countries, so we need to introduce preventive measures, such as the use of fluoride toothpaste and, in particular, the fluoridation of local water supplies for areas that want it. I fully support the comments of the noble Baroness on fluoridation of water. Older people, conversely, tend to make more visits to the dentist than the average adult. But this increase in our local experience can be reduced through preventive work by dental hygienists.

In the second half of 2004, the National Institute for Clinical Excellence (NICE) advised that the recall interval between routine dental examinations could be longer than six months, and particularly so for patients whose oral hygiene is good. With that degree of flexibility, dentists can see more new patients. I asked the head of dental services in our PCT about the result of that change. Since this NICE guideline was implemented, 16,000 new patients have been registered and seen by NHS dentists in Birkenhead and Wallasey PCT in the first 24 weeks of 2005. As a result of that expansion of service delivery through new ways of working, only one inquiry per week for registration with a dentist has been received by our local PCT on NHS Direct, instead of the 60 or more inquiries per week in other parts of England that are not participating in the dental pilot project.

The Wirral dental pilot project has demonstrated that dentists will accept NHS patients and increase the number of patients that they register under the NHS. Instead of dentists wanting to opt out of NHS dentistry, British dentists, who form the Majority of our dentists in Wirral, are willing to join Personal Dental Services and work with satisfaction in primary care trusts. Perhaps the Minister would describe the response of dentists to PDS and say when he considers that the majority of people in England would be covered by that programme.

We look forward to an increasing number of UK-trained dentists joining the NHS. When can we expect more locally trained dentists to work in our services?

My Lords, I am grateful to my noble friend Lady Gardner for initiating the debate this evening, as it gives those of us who passionately believe in the need for an adequate dental service the opportunity to question the Minister again. I declare an interest as a practising dental surgeon, although I must say that about 40 minutes ago I was playing some jazz at the Macmillan reception for the House of Lords/House of Commons tug-of-war competition, which we sadly lost, and have dragged myself away, perhaps to the benefit of the profession, to speak about dentistry.

The Minister kindly wrote to me following my speech on dentistry during the debate on the gracious Speech. In his final paragraph, he said:

"As you will know, in our 2005 Manifesto, we made a commitment to undertake a fundamental review of NHS dentistry. We are currently considering the scope and nature of such a review".

I suspect that that will be the line that he will take this evening, but it is possible that some further consideration will have already taken place and that he may be able to announce new measures that will resolve the problems with finding an NHS dentist.

The Government have made changes to a system that remains much the same as it was in 1948. The time has come to admit that there are deep problems with that system. Queues at newly opened NHS surgeries are the norm, and the 1999 pledge on dental access has been conveniently forgotten.

Despite a huge increase in funding, the National Audit Office has confirmed that NHS dentistry is still underfunded. I will repeat the figures given by my noble friend Lady Gardner: NHS spending on high street dentists has increased by 9 per cent per head since 1990, compared with an overall increase in NHS funding of 75 per cent.

The debate must include decisions about better spending, not just more spending—better spending in partnership with the private sector. The Government must decide what sort of service they want and how it will be paid for. NHS dentistry has not been free at the point of delivery since 1951. Whether it is free or charged for, it is no good if it is not available.

In her answer to Andrew Lansley on 14 June, at column 143, the Minister of State, Rosie Winterton, said that the Cayton report on dental charges had been received in March 2004 and was still being considered and reflected on—15 months later. The government response to that report is vital, to prevent the continuing movement away from the NHS into the private sector. Many of the dental magazines that I receive each month are full of advertisements for courses explaining to dentists how and when to get out of the NHS. Also in column 143, the Minister reminded Mr Lansley that there were about 5,300 dentists working in the new wave in 2000 practices across the country. Of course I welcome that, but there are questions to be answered and information that must be made available. Has the move to move to PDS increased NHS capacity? Has increased access been the principle in PCTs pushing PDS contracts locally? Have the dentists who have moved increased their NHS ratios? My profession is keen to learn what flexibility there is within the PDS contract for individuals to increase or decrease their NHS/private ratios. They want to know whether they can return to the GDS service if the PDS contract does not work out.

Moving from GDS to PDS without a fundamental change of approach, philosophy and skills is impossible. With local commissioning, the idea of basing contract value on historical earnings locks in the very factors that should be changed. This is the reason why dentists will tend to move to the private sector. Allowing patients to choose private options and allowing practitioners to provide them without penalty keeps everyone happy with the new-style NHS. Patients would not feel forced away from the NHS into the private sector and dentists would not feel as exposed.

Should not the department consider providing free NHS services for particular groups of the population? Perhaps NHS dental care could be reduced to a limited range of services. Why cannot more use be made of dental patient insurance schemes such as Denplan, which could be state, corporate or individually managed with different levels of payment for different levels of service?

I want to be brief, but I realise that I have posed many questions. I know that the Minister and his Right Honourable Friend will be keen to resolve the current situation and I assure him that I am trying to be helpful.

My Lords, I too would like to congratulate the noble Baroness, Lady Gardner of Parkes, on raising this Question, which seems to a relatively new Member of this House to be one that we debate fairly frequently. We have heard from the noble Baroness just how frustrating it is to get an NHS dentist and we know that a new system is being piloted and is working well in some places, as the noble Lord, Lord Chan, told us.

First, we know that the British Dental Association has welcomed the delay in implementing the new system as a whole until April of next year because it has considerable doubts about the preparedness of primary care trusts to commission dental services effectively. One has to say, as a wider point, that PCT commissioning is at an early stage generally. Many have inadequate expertise easily at hand for specialist services of any kind. That is an issue which the Government must address urgently, and it would be good to learn from the Minister what plans the Government have to, if you like, up the ante in order to increase the level of expertise in primary care trusts in commissioning dental services.

Secondly, the National Audit Office's excellent report published last November, Reforming NHS Dentistry: Ensuring effective management of risks, raised the need for primary care trusts to,

"develop expertise and resources to encourage dentists to maintain and increase their commitment to NHS dentistry".

That is something we all want to see. But the report goes on to say that:

"The Department of Health will need to ensure that it has effective oversight of the changes, capturing the necessary data for monitoring and analysis".

Yet it is quite clear at the moment that most primary care trusts are nowhere near able to do this and that until they are, the department cannot possibly capture the necessary data for monitoring or analysis since the systems for getting that data from primary care trusts will not be in place.

Thirdly, the recruitment of dentists from overseas, particularly from Poland, as we have heard, is not the ideal way to sort out the problem—a sticking plaster solution, one might say. With 170 extra undergraduate places in place from this coming October and a capital investment of £80 million to support the expansion, there is some hope that we will be able to have a largely UK-trained dental workforce within six years or so. The Government are much to be congratulated on that. But it is still not clear whether all this means establishing a new dental school or schools. In her reply to the Queen's Speech, the Secretary of State said that a new dental school in England was on the cards:

"We certainly do have a plan for a new dental school".—[Hansard, Commons, 24/5/05; col. 573.]

But the Council of Heads of Medical Schools and the Council of Heads of Deans of Dental Schools published an update of their 2004 survey of clinical academic staff numbers in the UK's medical and dental schools earlier this month. It showed that the number of clinical academic dentists has actually decreased by 6 per cent. Indeed, at the end of May this year, there were 444 clinical academics in dentistry, 30 fewer than those returned in 2003, as the noble Baroness, Lady Gardner, has noted.

Meanwhile, the General Dental Council's general visitation programme to dental schools has found several dental schools in financial deficit and most of them having problems in recruiting staff. So will we really be able to train 117 new dentists a year in the UK? Will we be able to staff the dental schools? If not, what will this mean for making NHS dentistry available for all?

Meanwhile, as we know, the Department of Health has committed itself to recruiting 1,000 extra whole-time equivalent dentists into the NHS by October this year. The ways of doing this are by encouraging existing dentists to increase their NHS commitments, which is wonderful; by encouraging those who have had a career break to return to dentistry, even better; and by overseas recruitment.

As to the career break possibilities, it cost £139,021 to fund the Returning to Dentistry campaign, and by the end of the campaign the call centre had received only 288 calls, which was roughly a cost of £482 a call. Although there is no collection of information on the numbers of people who had returned to dentistry as a result of the campaign, an announcement was made in the House of Commons on 9 February this year (Hansard col. 1616W) that 65 dentists—37 whole-time equivalents—had returned since April 2004. So it is looking a little expensive and possibly the campaign has not been successful enough. To echo the noble Lord, Lord Colwyn, has it really increased availability?

Add to that concerns that the costs of recruiting overseas dentists are unknown, that primary care trusts may well have to pick up the extra costs of induction training and relocation for individual Polish dentists, and that 10 per cent of posts in the community dental services, which tend to treat the most vulnerable people, are vacant, it is hard to see how NHS dentistry will be available to all by October this year or even April next year.

But we do have some dentists in the UK who would love to work in the NHS. This is a subject close to my heart. Take, for instance, the case of Sharif Gasmi, a 35 year-old dentist from Algeria who is an asylum seeker in Glasgow. She was featured in the Independent newspaper on 5 March this year when her husband argued:

"We are not here for the benefits. We want to work and be active people . . . Everyone talks of the shortage of dentists and doctors in Scotland. We have a dentist sitting here who is not allowed to work".

We know that three-quarters of Scotland's 6,000 asylum seekers and 4,000 refugees have qualifications. Why are we not using them properly? When the noble Baroness, Lady Andrews, replied to a question from the noble Lord, Lord Colwyn, on 23 February this year, asking how the Government were going to encourage more dentist asylum seekers and refugees to take up practice, she replied that there were 122 refugee and asylum seeker dentists on the database maintained by the Refugee Council and the British Dental Association and that 30 of them had been successful in passing the language test, 20 had passed the first part of the international qualifying examination, 11 the second part and three had become eligible to practise.

The noble Baroness also said that the Government have worked with the General Dental Council to reduce the backlog of non-EU dentists waiting to take the international qualifying examination and the Government are much to be congratulated on that. But we still need to do a great deal more to encourage, train, facilitate and generally support asylum-seeking and refugee dentists if we want to provide a full NHS service. One thing we can be certain of is that asylum-seeking and refugee dentists will work in the NHS, not in the private sector.

Perhaps I may make two final points. First, how will the Government clarify dental charges to the public under a new scheme? We know that the public are confused and that they want to know what is free and what they have to pay for. Secondly, will the Government support the Liberal Democrat policy and move towards free dental checks for everyone under the new system in order that the prevention theme of the new way of thinking about dentistry, welcomed by the British Dental Association and apparently central to the Government's thinking, can be achieved? Will they heed the National Audit Office's concerns about oral health and, particularly, its association with social deprivation and look hard at getting primary care trusts to offer real incentives to dentists to work in socially deprived areas? It was very good to hear from the noble Lord, Lord Chan, how some of that is working in Birkenhead and Wallasey.

After a month in which the newspapers seem to have focused entirely on the Which? report showing that the six year-old Government promise to improve access has gone largely unfulfilled, the very least that the Government should do is listen to the dentists' wish to focus on prevention and oral health, go for free dental checks for all, allow asylum seeking and refugee dentists to work rather more easily by supporting them through the registration system better and faster, and think hard about how to deal with workforce capacity in dental schools, as well as on the high street.

My Lords, my noble friend Lady Gardner has posed a Question, as she so often does, in a form that appears simple and straightforward, but which is actually anything but. We have seen from her very well-argued speech how many different layers there are to the issue that she has raised, which I am delighted she has given us the opportunity to debate. It is a subject on which she is, of course, one of the House's acknowledged experts.

She asked when NHS dentistry will be available to all. What that question consciously presupposes is that the universal availability of NHS dentistry is something to which the Government genuinely aspire. It is surely not unreasonable for us to ask the Minister that question head on. But in giving us an answer we should also insist that the Minister goes beyond a simple "yes" or "no". As my noble friend Lord Colwyn has made clear, we need to ask the Government to define what exactly it is that they mean by NHS dentistry, who should be entitled to it and on what terms?

I mean it as no criticism of the dental profession when I say that none of us can honestly look dispassionately at the current state of the NHS dental service and claim that it is something to be proud of. Any public service that is beset by such formidable barriers to access as dentistry needs some pretty radical remedial work. We know that it cannot be fixed overnight. We can look back over the past 15 years and no doubt point to one or two decisions by the government of my party which, in hindsight, accentuated rather than removed some of those barriers. Other decisions, by contrast, such as the introduction of the PDS contract, proved very positive for NHS dentistry. Similarly, the present Government can be awarded high marks in some areas, but not such high marks in others.

The high marks are for what I think we can all willingly grant has been the recent very substantial increase in the funding allocated to dentistry. There are those who might say "not before time", but I would prefer just to welcome it. We received a promise in July last year from the former Secretary of State, John Reid, of 170 extra undergraduate training places and 1,000 additional trained NHS dentists by October 2005. The deficit to be bridged is bigger than that. The BDA estimate that we are about 3,000 dentists short, but 1,000 extra dentists could make a real difference. We can talk about some of the logistical problems and the risks associated with bringing dentists in from abroad, but I do not think that we can criticise the intent, which is good. It remains to be seen, of course, whether the promise of 1,000 more dentists is deliverable. I hope that the Minister will tell us how well we are doing towards achieving that target.

But the question that my noble friend is asking is not about dentistry; it is about NHS dentistry. John Reid acknowledged last year that the two are separate. He said:

"There are over 19,000 dentists in primary care, which is more than ever before. But they are spending less time on their NHS work, which leaves some people unable to get the routine treatment they want on the NHS".—[Hansard, 16/7/04; col. 90WS.]

That statement was all too correct.

Not only are we continuing to see patients encountering huge difficulty accessing routine dental care, there even appear to be problems accessing NHS dentistry for urgent treatment. A Which? report in May this year said that half of England's dentists are unable to see patients requiring urgent treatment for toothache. Which? staff contacted 321 practices asking if they could get an appointment in 24 hours, yet only half were able to, even privately.

According to John Renshaw at the BDA, the problems of access are getting worse, not better. The much vaunted pledge made by the Prime Minister in 1999 that everyone would be able to see an NHS dentist within two years just by phoning NHS Direct has nowhere near been met, even six years on.

The key to solving the problem lies not just in the numbers of available dentists; it is a combination of several factors. It is the number of dentists willing and able to accept the terms of NHS service, a matter being addressed through PDS and the proposed GDS contract. It is also dependent on the number of patients willing and able to pay NHS dental charges at whatever level those may be set. And in the longer term, it is dependent upon recruits to the profession, which depends in turn on the number of clinical academic dentists in post. On that point, the Government have presided over a very serious decline in the number of professors, readers and senior lecturers over the past eight years, particularly in certain disciplines. The urgent need to reverse that trend has been highlighted by the Chief Dental Officer.

Equally concerning has been the consultation process on the new GDS contract. I hope it is not unfair to describe that consultation as having had a decidedly rocky ride. The BDA, which was initially enthusiastic, adopted a much more critical tone in April last year in responding to the framework proposals. A MORI poll of dentists commissioned at the same time revealed a depressingly negative view of the proposals. Only 11 per cent of dentists believed they would be of benefit, while the vast Majority—90 per cent—believed that the proposals would lead to dentists increasing their private work. Sixty per cent said that they would personally reduce their provision of NHS services or opt out of the NHS completely.

It was perhaps little wonder that when the National Audit Office reported last November, it drew particular attention to the scepticism within the profession as a reason for believing that dentists may reduce their NHS commitments. It also endorsed the concerns voiced by the BDA about the lack of detail on how the system will operate.

All that was worrying enough, but on 7 December it was announced that negotiations between the Department of Health and the BDA had completely broken down. In January, John Reid announced that the implementation of the new contract, already postponed once, was being put back still further, until April 2006. It is good to hear that talks have started again, but the Minister will recognise that there is a considerable credibility gap to be bridged between the Government and the profession as a whole if we are to see the star of NHS dentistry once again in the ascendant.

Dentists want to see a focus on prevention in the contract, as the noble Baroness, Lady Neuberger, said. They also want the ability to offer a high quality service as well as protected time for other priorities such as continuous professional development and clinical governance. At the moment, NHS dentistry is looked upon as a treadmill. Dentists cannot spend the amount of time they want to with their patients, nor are they allowed to use certain sorts of materials or offer the latest procedures. Those things have inhibited dentists from reducing the proportion of private work they do. It is not simply a matter of remuneration but a desire on the part of dentists to bring to their patients positive health gains over the longer term.

Even supposing that agreement is reached quite soon on the terms of the base contract and that dentists decide to sign up to it, there is another factor which will heavily influence whether dentistry becomes, as we all hope, more widely available—the level of dental charges.

We are still waiting for the Government to say anything at all about the options and recommendations put forward by Harry Cayton and his working group, which reported to Ministers in the spring of last year. There is a crying need to simplify the present, very complicated pricing structure. That is clear, and I am sure that some charges will have to rise. But if the overall level of charges rises too far, patients will be put off from seeking routine examinations and remedial treatment. If that happens, much of the effort that has been devoted to agreeing the base contract will have been in vain. The object of the exercise is to deliver better oral and dental health to those whose access to a dentist is currently inadequate or non-existent. Charges should not deter the least well-off. It is a very great shame that the Government have not been able to move more quickly on this front. I cannot avoid the sinking feeling that there is a very good reason why Ministers wanted to put off any announcement about patient charges until after the General Election. When are we going to hear the Government announce what they intend to do?

The new money for dentistry shows that the Government have at last recognised that a serious problem exists and has to be addressed. I like to believe the best of Ministers and certainly do so to that extent. But when it comes to answering my noble friend's Unstarred Question, the jury is well and truly out. If we look at how the dealings with the dental profession have been handled over the course of many months; if we look at the huge uncertainties that persist in the terms of the base contract, in charging, and even in such basic matters as the ability of PCTs to handle their responsibility for dental services; if we look at the suspicion and disillusion among dentists, it is difficult—and I am genuinely sorry to say this—to look forward with confidence to what lies ahead. We can only hope that the Minister, with his reputation for getting things done, can lead us all out of these rather dispiriting foothills and into the sunlit uplands.

My Lords, I am not sure that I am going to be able to act as Moses, but I certainly congratulate the noble Baroness on raising this important topic this evening. I thank her for all that she has done over the years and for the contribution that she has made to NHS dentistry. I am sorry that she had a rather disappointing experience as a mystery shopper, but if she were to give me the details, I would be happy to make some inquiries and give her some sort of explanation.

I shall respond to the points that have been made in the debate by setting out the Government's approach and the action that they are taking. Before I do so, I have to respond with great gentleness to some of the remarks that were made opposite and set out the position that the Government inherited.

A poorly constructed contract for dentists was introduced in 1990, resulting in unpredicted and unsustainable expenditure. The response was a 7 per cent cut in fees to dentists in 1992. That prompted many dentists to switch to private dentistry and change their styles of work. It is not just me who is saying that. We know from the Office of Fair Trading and from private market research that, following those disastrous changes, private dentistry doubled and NHS dental services declined dramatically. To compound matters, two dental schools were closed in 1992, reducing the number of dentists being trained by 10 per cent. That is the mountain that we have to climb. I am not making a cheap political point. That is the position that has had to be dealt with.

We are trying to undertake the biggest reform of dental care under the NHS since the service began in 1948. We are absolutely resolute in our determination to rebuild NHS dentistry, to deliver better access to NHS dental care and to improve the oral health of the country. We need to work away at the problem with increased funding; by recruiting and training more dentists; and by using new contracting systems and new models of service delivery.

We have committed an unprecedented level of funding for dentistry. For this financial year, 2005–06, funding for NHS dentistry in England is set to increase by over 19 per cent in real terms compared with spending in 2003–04, resulting in an extra cash spend of more than £250 million over the two-year period. That is more than the rate of increase for the NHS as a whole, which has also been pretty enormous over that period.

In July last year, John Reid announced that for England the equivalent of 1,000 dentists would be recruited by October 2005, including those dentists from overseas. Alongside this, we undertook to fund 170 extra undergraduate dental training places in England from October 2005—a 25 per cent increase—supported by capital investment of £80 million over four years. The good news is that all those extra training places are likely to be filled. People want to study dentistry at university, and we have the capacity to run those extra places—although I recognise that there are issues about dental academics. Opening, rather than closing, dental schools, is a more certain way of addressing access to NHS dentists.

In the mean time, we have recruited more than 480 dentists, domestically and from abroad. In addition, the NHS is itself "buying back" more time from existing local dentists. These actions were designed both to improve the medium-term and longer-term supply of dentists for the NHS. We have achieved a huge amount in less than a year since those targets were announced and, as a consequence, access to dentistry has started to improve, now and for the future.

As I said, we have made very good progress towards recruiting 1,000 whole-time equivalent dentists. Targets are important—despite what some people say—but what local people want to see is improved access to services. One hundred and thirteen dentists from Poland have started work in England since January in some of the hardest pressed areas—Cornwall, Shropshire, Cumbria and north Yorkshire. In Cornwall, 18 Polish dentists started work in January, in small towns where there had not been a dentist—let alone an NHS dentist—for some years. The Isle of Wight had severe problems with access to emergency treatment, so two Polish dentists work in the dental access centre there, providing easy access to NHS dentistry for people who need immediate treatment. We plan to recruit a similar number between now and the end of October, to make in total 230 Polish dentists recruited by the end of October. We are also recruiting in other European countries, including Spain and Germany. In April, seven Spanish dentists started work in Lincolnshire and five German dentists started work in Blackburn. We anticipate that more will be in practice by October 2005.

We are paying attention to other members of the dental team, too. Any enduring solution to access to NHS dentistry will not be solved by just recruiting more dentists. To that end, a new dental school for professions complementary to dentistry opened in Portsmouth last September, providing 48 places each year for therapists and nurses. I commend that development to extend the skills and responsibilities of all members of the dental team. To reflect those new responsibilities, later this year we shall make regulations which provide for the General Dental Council to register dental nurses and dental technicians. That will ensure that no one will be able use these titles unless they have had appropriate training and experience.

We have speeded up the process for people waiting to take the International Qualifying Exam—IQE—which enables dentists from non-EU countries to practise in England. The GDC previously had a two-year waiting list for the exams, with no details of exam dates published in advance. The Department of Health provided a subsidy to increase the sittings of IQE to address these problems. As a result of the department's interest, the GDC has now reduced the time to take all parts of the exam to 12 months and published a forward calendar of exams for 2005–06. More than 100 dentists who registered via IQE have subsequently taken up NHS contracts—another significant contribution to improving access to NHS dentistry.

I am glad that the GDC has responded favourably to the department's support for IQE, and I expect the GDC's positive approach to continue as the Government carry out their review of the regulatory bodies. I look forward to the GDC's review of IQE over the next year and its implementation from April 2007.

On the domestic front, the NHS locally has been recruiting dentists. The "Keeping in Touch" scheme has supported dentists back to practise after a career break. The scheme has yielded almost 60 whole time equivalent dentists to date, which represents about twice that number of dentists, mainly women, who have been helped back to work, often after a career break.

This has all been achieved by bringing dentistry centre stage into the performance management arrangements for the NHS. In addition, to ensure new recruits are offered posts in places where there is most need for NHS dentists, the department has established a central vacancy system. This provides candidates with extensive information about vacancies and ensures local NHS organisations locally fully report their vacancies to the department.

As well as improving access to dentistry for patients, reforms have begun to modernise the dental profession for the 21st century via a new contract for dentists—to which a number of noble Lords have drawn attention—making it possible for them to spend more time with patients and encourage preventive care. Personal dental services (PDS) contracts between primary care trusts and individual dental practices have shown that they carry benefits for patients and dentists alike.

The noble Lord, Lord Chan, eloquently described the Wirral PDS experience and changes. On the Wirral, one of our leading PDS sites, in the whole of Cheshire and Merseyside SHA area, almost two-thirds of the dentists are now in PDS, enjoying, as the noble Lord described, all the benefits of changes in approach and all the benefits that that brings for their patients.

Other dentists are already taking up this new way of working because it removes them from a treatment and paperwork treadmill. Patients are benefiting from a more preventive approach and improved access. Over 5,800 dentists in 2,100 dental practices have now opted to work under the new arrangements. That represents more than 25 per cent of dentists. It is vital that we now devise a sensible way of monitoring PDS that captures all the benefits of new ways of working, both for dentists and patients.

We have introduced, as noble Lords know, legislation to place dentistry alongside the other key primary care services so that it can become locally based and managed by primary care trusts. The new arrangements for local commissioning, managed by PCTs, will start next year, and all dentists working in the NHS will be working under the new arrangements so that the benefits they bring to both dentists and patients will become apparent. Of course, as the noble Baroness, Lady Neuberger, said, some PCTs may take a little more time to improve their commissioning than others; but we are going in the right direction. Alongside this, we intend to launch a consultation on the draft regulations for a new and simpler system of patient charges during the summer. I think that that is the answer to a point made by noble Lords on this issue.

We have also set up a specialist support team to improve access to dentistry in 31 particularly hard-pressed areas. This initiative has supported international recruitment and linked local developments with dentists recruited by the department from abroad.

I am afraid that, in the time available, I shall not be able to go over and answer all the questions that have been raised, especially those from the noble Lord, Lord Colwyn, who always makes an invaluable contribution in this area. I am grateful for the support he has given. I am sorry that he has been diverted from his jazz performances to come along here this evening.

In conclusion, I believe that, taken together, our actions to restore and improve NHS dentistry form an impressive and comprehensive programme. The changes we have set in train will produce good and demonstrable progress. We have 20 per cent or so more dentists practising today than in 1997. But we are not complacent and we think that more can be done. We are very well aware that the scope and complexity of this major enterprise require careful management—as the National Audit Office highlighted in its report on dentistry last year.

So the fundamental review promised in our manifesto will reflect the reform already under way with the personal dental services and the local commissioning of services. It is important that access and oral health, including fluoridation, are at the heart of the agenda. Patients need to be able to make informed choices about the dental treatment they require, as the Office of Fair Trading made clear in its report last year. We will listen to what patients say, as we will in the forthcoming white paper on out of hospital services. I hope that we will build on the current reforms to improve oral health and to provide good access to NHS dentistry for all those who require it.

House adjourned at six minutes before eleven o'clock.