Clause 157 - Provision of primary dental services

Part of Health and Social Care (Community Health and Standards) Bill – in a Public Bill Committee at 8:55 am on 19 June 2003.

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Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon 8:55, 19 June 2003

I am delighted that we are finally, at least in this clause, discussing the role of commissioning. The Minister is aware of earlier exchanges during which regret was expressed at the fact that a great deal of this piece of legislation is designed to change structures and systems relating to the provision of service. This generally very welcome clause recognises the importance of commissioning, particularly local commissioning according to local decisions.

The amendments seek to examine more carefully the basis upon which commissioning decisions will be made. Proposed new section 16CA(1) does not give enough priority to the importance of first assessing local need and then commissioning services designed to meet it. Instead, it simply allows primary care trusts to judge what it is reasonable to commission. I should be grateful if the Minister would explain how that qualification, and the basis on which local commissioners have a duty to commission dental services, compare to the commissioning of other services by health authorities or their replacements under the National Health Service Act 1977. The comparison seems to be a fairly loose one, and it may be more appropriate to place a requirement in the Bill to deal with local need.

Dentistry, the provision of dental services and the level of public dental health vary considerably across the country. That variation is too great, which implies that there are pockets of great need. Commissioners may decide to increase the level of provision to a degree that they consider reasonable given all the circumstances. However, if that level comes nowhere near meeting the identified need, or if they do not take

steps to identify the needs of public dental health, health promotion, access to dental care, access to screening services and access to emergency and elective treatment, the commissioners may fall short.

In tabling amendment No. 635, the Liberal Democrats have the support of the Consumers Association, which requested that we raise the issue with the Government. It too recognises that access to dentistry is poor and that dental services are under great pressure in many areas. We have also heard from the British Dental Association that the share of funding for dentistry under the national arrangements has fallen from about 5 per cent. to nearer 3 per cent. of NHS spend. That constrains the ability of dental services to obtain sufficient resources to keep up with the level of need or demand, which is why the Committee and the Government have faced the problem of poor access to NHS dentistry.

Providing the ability for local commissioners to commission services and to be responsible for making contractual arrangements with providers—a matter to be dealt with in later clauses—is a sensible move away from a nationally negotiated and nationally organised system of contracting with dentists, and I support the Government in their intention. However, reference to need will be important.

We are concerned at the continuing failure to provide the ability for people to register with an NHS dentist. The Government made a limited pledge to ensure universal access to dentistry as much as possible. However, that really meant access in emergencies and did not result in people registering with dentists, as was the case before the drift away from NHS dentistry to private dentistry.

Primary care trusts should be required to identify the need for people to be registered with a dental practitioner, just as they register with a medical practitioner in primary care. Without that, there will not be the holistic and preventive care provided by dental practitioners that is an important part of dental health care, but simply a dental sickness service that deals with problems as they arise. There will not be the continuity of care that registration with an identified dental practitioner gives, and patients will not receive the advice that regular check-ups provide. Whether the practitioner is salaried or on a contract is immaterial; the question is whether that holistic care will exist.

If the Government were minded to look kindly on amendments Nos. 635 and 636 and consider the necessity to identify and cater for need, they would find that there was more pressure on local commissioners to ensure that they provided not just a holistic and preventive service, but one that was actually cost effective. If more dental disease were prevented by advice and appropriate evidence-based, effective screening techniques, and by dealing with problems early rather than in an emergency, the cost of dental care would ultimately be lower than if people were allowed to drift into problems that a firefighting system would rectify.

The wording of the clause is far too loose, because a PCT might consider it reasonable to maintain the current level of services and registrations. After all, the

Government consider that level to be adequate because they claim to have met their access pledge to dentistry. Members on both sides of the House know from their constituencies that current dental provision is simply inadequate, especially the levels of holistic and preventive work that I mentioned. The Government are running the risk of ensuring that commissioners continue to view dentistry and related care as a lower priority than other areas, and it is unreasonable to allow that to continue.