My Lords, among the many briefs that I received before and after the gracious Speech, there is one from the BMA indicating its initial response to a number of proposals in the Queen’s Speech that impact on health and healthcare. While welcoming the Care Bill, which has been promised for some time, I am not sure whether the House would have tolerated any more healthcare legislation. However, I am aware of the recent statements in the popular press claiming that soaring charges have caused a fifth of people to give up going to their dentist, that as many as 500,000 patients have been wrongly told they must pay privately for treatment, and that the surge in the sales of dental kits in pharmacies is risking 200,000 DIY dentists harming themselves. I do not recognise these problems, but they must be addressed. I hope that your Lordships will allow some brief comments about the current general dental services, which provide free treatment for all children and nearly one-third of adult patients and have enabled 1.25 million more people to see an NHS dentist than in May 2010.
Having worked as a dental surgeon for more than 40 years, and declaring that interest, I welcome the progress that the Government have made in piloting a new NHS dental contract in line with the undertaking that was given in the coalition agreement. September 2011 saw the beginning of piloting of a new contract, based on registration, capitation and quality, with a focus on the quality of clinical outcomes and on promoting a preventive approach to oral health. Seventy practices were involved.
Building on this work, the Government recently embarked on a further stage of piloting, involving a larger number of dental practices. There are now 98 practices taking part, testing how the different elements of a proposed contract can work together most effectively to deliver the Department of Health’s goals of improved access to dental services and improved oral health. So far, the feedback from staff and patients taking part in the pilots has been largely positive, and I hope that it will not be too much longer before the department is in a position to begin discussions with the profession on the details of the new contact. I commend the Government for taking the time to get these reforms right.
These reforms have transformed the commissioning of dental services. Although dentists have been largely supportive of the shift to central commissioning by NHS England, there are concerns that the transition to the new structures has not gone as smoothly as it might. Dentists do not know who to engage with in the 27 NHS England area teams and the teams have yet to develop a consistent approach for working with local dental committees, which are a valuable source of up-to-date local information. Additionally, there is concern that local professional networks are not being allocated the funding necessary to enable them to provide the detailed clinical advice that NHS England’s dental commissioners will require from them. There are also worries that currently Public Health England has an insufficient number of consultants in dental public health to deliver on the aims set out in the public health outcomes framework. All of these teething troubles will need to be addressed if the Government want the NHS reforms to deliver real improvements to the population’s oral health.
At the end of last month, it was announced that NHS England is setting up a task group to look at how to improve dental services and outcomes for hard-to-reach groups. This is a very welcome initiative. The British Dental Association recently published a report on the future of salaried primary dental care services, the part of the NHS that provides dental care to special care patients who present challenges that can prevent them being treated in general practice. This report highlighted a series of issues, including a lack of funding, inadequate provision of facilities and a predicted increase in demand for this service, which will need to be overcome if the needs of these patients are to continue to be met. I hope that this is one of the issues that NHS England will be able to address as a matter of urgency, perhaps through the new task group.
Recent changes to decontamination requirements have also been welcomed by dentists. The new requirements, which include an extension to the shelf life of wrapped instruments, will continue to ensure patient safety while making more reasonable demands of dental practices. Dentists have also welcomed the Department of Health’s recent confirmation that a full review of the guidance will take place by the end of 2014, and I hope that the Minister will soon be in a position to say when this review is going to commence.
I would like to draw the Minister’s attention to the ongoing issue of the annual shortage of foundation training places for UK dental graduates. I appreciate that this is an extremely difficult issue to resolve, but it cannot be right that this year 185 applicants, many of whom will have studied in UK dental schools at a cost to the public purse in the region of £155,000 each, will have to endure months of anxiety that their career in dentistry is over before it has even started on account of there being insufficient foundation training places available. Without this training, it will not be possible for any of these students to take up jobs providing NHS dentistry after they graduate. I know that the Minister will do all he can for each of these students, and I expect that places will be found for many of them in the coming months. I hope that it will also be possible to find a long-term solution to this issue, so that future dental students will be spared deep uncertainty at a time when all of their attention should be focused on doing as well as possible in their final exams.
In conclusion, I shall make some comments on the statutory regulation of the practitioners of herbal medicine which was briefly discussed in Grand Committee on
“kindly intercede on our behalf with the Department of Health to find out what is happening with our promised statutory regulation”.
His reply stated that,
“the Department of Health expects to consult on draft legislation to establish a statutory register of people who are authorised to supply unlicensed herbal medicines and for legislation to be in place by 2013”.
After a series of consultations, the Health Secretary, Andrew Lansley, announced in February 2011 that he had decided to ask the Health and Care Professions Council to establish a statutory register for practitioners supplying unlicensed herbal medicines. Nothing has happened.
It is rumoured that the Minister now concerned with this regulation, Dr Dan Poulter, is set on making an announcement on regulation without properly consulting representatives from the herbal medicines profession, who now believe that the 2011 decision is about to be reversed. The move to statutory regulation has been endorsed by the House of Lords Select Committee on Science and Technology, by two Department of Health-sponsored steering groups under independent chairs and by the overwhelming majority of the public, who responded in huge numbers to two public consultations. My noble friend has been very helpful with meetings, letters and general advice. I hope that he will be able to update noble Lords on the current situation and confirm that representatives from his department will do all they can to meet in order to discuss and enable this long-promised legislation.