NHS Dentistry

– in Westminster Hall at 1:00 pm on 7th June 2005.

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Photo of Christopher Chope Christopher Chope Conservative, Christchurch 1:00 pm, 7th June 2005

I warmly welcome you to the Chair, Mr. Illsley, and I also welcome the new Under-Secretary of State for Health, Mr. Byrne, who will answer the debate. While doing so, however, may I express my concern that the Minister of State, Ms Winterton, whose brief is dentistry—as it was in the last Parliament—is not here to respond to this debate on an issue of great concern not only to my constituents but to the population at large? Her absence, coupled with the fact that she did not attend the conference of the British Dental Association, shows a lack of interest in this important subject. I hope that the Minister will do his best as her substitute—perhaps in due course he will be promoted to the important post of dentistry Minister if he demonstrates his interest in the subject.

I hope that the Minister shares my belief that healthy teeth and gums are very important for a good quality of life. Dental care should, therefore, be a core responsibility of the national health service, so that our citizens can enjoy healthy teeth for life through preventive treatment. Without healthy teeth and gums, people suffer pain, discomfort, bad breath and low self-esteem. Ultimately, they can be rendered unable to masticate and digest, and that affects other aspects of their health.

If the Minister is with me so far, I hope that he can answer this question, which I put to him on behalf of my constituents and millions of others who contribute through high taxes and national insurance to the NHS and believe in its avowed principles: is the phrase NHS dentistry now an oxymoron? How can NHS dentistry be safe in this Government's hands when all the evidence suggests that it is being relegated to the status of a fringe NHS service, as eye care and chiropody have been?

Let us consider access to NHS dentistry. In 1999, at a dental conference in Bournemouth, the Prime Minister pledged that by September 2001, NHS dentistry would be available to all who wanted it. Not only has that pledge been broken, but things have got far worse. The traditional and surest guarantee of access to an NHS dentist is to be a registered patient of an NHS dentist.

"All treatment necessary to maintain oral health is available on the NHS and dentists cannot refuse any necessary treatment to a registered patient."

That statement is contained in the Government policy document, "NHS Dentistry: Delivering Change", published in July 2004. Superficially, it sounds fine, but the catch lies in the use of the phrase "registered patient". If one is not a registered patient, one cannot be guaranteed access to NHS treatment.

I am sure that the Minister will try to spin the fallacious line that people do not have to be registered with a dentist to access NHS dentistry. However, Ministers fail to say that a patient who is not registered with the NHS and needs emergency or other treatment has no guarantee of being able to obtain it locally on the NHS. Indeed, in my constituency it is normally nigh on impossible to obtain it at all.

Let me give an example. This very morning I was pleased to welcome to the Palace of Westminster pupils and teachers from Somerford school. One of the teachers said that, within the past fortnight, a 10-year-old Chinese pupil at the school who needed to have a tooth extracted had to travel all the way from Christchurch to London in order to obtain access to NHS dentistry. That is a vivid, appalling local example of what is happening in practice.

The key to access to NHS dentistry is registration. That is why sensible people want to enjoy the security of being able to register with an NHS dentist. Surely it is not asking a lot for citizens of the fourth richest nation in the world, who pay large contributions to the NHS through tax and national insurance, to be able to register with an NHS dentist. However, the percentage of the population aged 18 and over who are registered with a general dental surgeon in the high street has declined to 39 per cent., and the percentage of those aged under 18 registered with a dentist has fallen to 54 per cent. That means that some 39 million adults are not registered with an NHS dentist, and some 6 million patients aged under 18 are unregistered. Contrary to Government assertions, the proportion of registered NHS dental patients—both adults and children—is declining. That is supported by a recent report from the Consumers Association, which found that 49 per cent. of NHS dental practices in England could not offer an urgent appointment for unregistered patients, 58 per cent. of NHS practices were not taking on any new NHS patients and only 8 per cent. of dental practices were able to offer an emergency NHS appointment within 24 hours.

Within the last fortnight, Robinson's dental practice in Castle street, Christchurch, has given three months' notice to all its NHS-registered patients that they are to lose their registration. It is offering instead private treatment, funded through regular Denplan payments, which start at £8 per month. Robinson's is the latest in a long line of dental practices in my constituency to have adopted that approach. It is not that those dentists do not support the NHS; they do. The problem is that, under this Government, the NHS is not prepared to support them in their aspiration to provide a high-quality professional service to their patients, even when they are funded by the NHS.

This morning, talking to the group from Somerford school, I spoke to Mrs. Sue Read. She is one of those who have received the letter from Robinson's dental practice, and she is concerned about what she is meant to do now. Will she be able to get access to an alternative NHS dentist, or will she have to pay the £8 per month? She pointed out that that is only the start, because if she and her husband, who is also registered with that dentist, want treatment beyond the regular inspections, they will have to pay for that on top. That is the reality of the problems faced by my constituents. I hope that the Minister can explain what they should do, and give some specific advice to Mrs. Read.

Meanwhile, the Government are offering the prospect of a new NHS dental production line in new premises funded by capital grants from the NHS, to be staffed predominantly by dentists recruited from overseas. Why are they putting minimal effort into retaining existing, well qualified and respected NHS dentists, while providing capital grants for new facilities staffed by foreign-trained dentists willing to engage in lowest common denominator dentistry? The Government's policy does not make sense unless one ascribes to them the motive that they wish to drive patients and their providers into the private sector if at all possible, and to produce a substitute, lower-quality service for those who cannot afford that or do not wish to move.

It would be wrong to suggest that all foreign dentists are not up to scratch, but it would also be wrong for the Minister to close his eyes to the many instances in which foreign dentists have been found seriously wanting in their professional standards. Mrs. Holsworth of Scarborough challenged the Prime Minister about the issue on 30 March, citing the example of three dentists recruited from overseas: the first went home with a criminal record, the second turned out not to be qualified and the third made so many mistakes that he was sacked. I am happy to give way to my hon. Friend Mr. Goodwill and, in so doing, to congratulate him on his great victory in a constituency in which NHS dentistry is a big issue.

Photo of Robert Goodwill Robert Goodwill Conservative, Scarborough and Whitby

I do not know whether this problem is particularly associated with seaside constituencies. Is my hon. Friend aware of the situation that has arisen in Scarborough since the one that he referred to, and which was exposed last month by the Yorkshire Post? Polish dentists on full pay are not being effectively deployed because there is a shortage of chairs for them to work in. Is that not yet another example of the waste of NHS funds?

Photo of Christopher Chope Christopher Chope Conservative, Christchurch

That is another example of the chaos caused by the Government's policy. Existing dentists cannot obtain new contracts or even details of new contracts, and foreign dentists are being brought in who, as my hon. Friend says, are not even being properly and effectively deployed.

I have heard stories from as far away as west Cornwall of embarrassing incidents of foreign dentists failing to meet British standards. Why, people ask, are the Government driving British-trained dentists out of the NHS while welcoming foreign dentists with open arms? The prospect of a new dental practice in Fairmile, Christchurch, which I understand from my local primary care trust is to be opened soon by Integrated Dental Holdings, may seem superficially attractive. It is obviously better than nothing for people who have been deprived of their NHS registration, but I do not believe that it is the complete answer to the problem that the Government are creating for themselves.

Under the headline, "Mass NHS uncertainty," the current edition of Dentistry magazine reports:

"Up to two thirds of dentists remain unsure about the future of NHS practice . . . One third are likely to convert to private practice and a further third are still deciding".

What more evidence does the Minister need that the Government have lost the confidence of UK dental practitioners? I do not believe that dentists want to abandon the NHS, but they cannot equate Government demands that they work harder for less money and maintain proper professional standards and patient care. Indeed, Robinson's dental practice makes that point in its letter to the patients who they are now saying can no longer be on their list as NHS patients. It says:

"We have postponed making changes for several years, in the hope that the situation would improve. However, fundamental changes planned by the government indicate that the situation is likely to deteriorate further.

Under the circumstances, we feel that the practice has reached a crossroads. The NHS no longer allows us to keep the practice viable, nor provides our patients with the high quality care that we wish to offer. As a result, I will no longer be offering NHS services to adult patients from this September."

That is a cry for help from a dental practice that has held out in the hope that things would get better, perhaps having been seduced into thinking that the Government's actions would follow their words but now realising that that will not happen.

For years, the Government have denied dentistry a fair share of increased NHS spending. Like other colleagues, I was shocked to hear from John Renshaw, chairman of the executive board of the British Dental Association, that although spending on the NHS as a whole has increased by 75 per cent. in the past 15 years, spending on dentistry has risen by only 9 per cent. How does the Minister justify that?

In the current year, the total net NHS budget for dentistry is £1.6 billion, which works out at about £27 per person per year—a paltry sum when set against the vast tax take of the NHS and the increased national insurance contributions imposed by the Government. The Government are crowing about the fact that that sum is some £4 per person per year higher than last year. Is it any wonder that NHS dentistry is in such crisis?

There is also the stealth tax of increased NHS patient charges, which is yet to be revealed. In 2003, the Government commissioned the Clayton report into dental charges. It has been sitting on the Minister's desk for the best part of a year. When will it see the light of day? Why has it been so delayed?

Photo of Christopher Chope Christopher Chope Conservative, Christchurch

No; I do not have time.

Does the Minister accept that the report could lead to a massive increase in patients' financial contributions to dentistry from the current levels of about £5 million per annum?

As at July 2004, patients liable for dental charges paid 80 per cent. of their dentist's fees, which ranged from £3.50 for an X-ray to £297.70 for a fixed orthodontic appliance. The maximum patient charge for one course of treatment was £378. We understand that the report is likely to recommend substantially increased charges, inherent in which are increased stealth taxes. When will the report be produced, and why has it not seen the light of day so far?

When will the Government publish an enforceable protocol for the employment of foreign dentists? When will the Government accept that the surest way of being able to realise the Prime Minister's pledge of ensuring universal access to NHS dentistry is to enable everyone to be registered with an NHS dentist and for the Government to provide from their expanded NHS resources funding needed for the purpose?

My final point relates to dental training. The Government have presided over a substantial decline in the intake of pre-clinical students into UK dental schools, which was as high as 937 in 1996–97. The Government are now talking about creating a new dental school. Will the Minister give an assurance that it will be centred at the university of Southampton, which has put together a coherent and persuasive case for funding and development? Or was the Government's commitment to expand dental training merely pre-election salesman's puff?

My constituents are angry. Dentists are angry. The people are angry. The Minister now has the chance to set out a fresh and coherent policy to address these concerns and to reject the ill-judged comment of the previous Secretary of State for Health, now Secretary of State for Defence, in a press conference launching the White Paper, "Choosing Health: making healthy choices easier", that NHS dentistry had been "sorted."

NHS dentistry needs sorting urgently. I hope that this debate will spur the Government into action.

Photo of Liam Byrne Liam Byrne Parliamentary Under-Secretary (Department of Health) (Care Services) 1:16 pm, 7th June 2005

I congratulate Mr. Chope on securing the debate. It is a pleasure to respond to him this afternoon. He will not remember this, but some years ago, when I was a humble student of political science researching the emergence of competitive tendering under the Thatcher Administration, I spent a great deal of time familiarising myself with his former work, and he did me a very great kindness in his former role as a Minister by spending time with me to help me to complete my dissertation. He will be delighted to learn that it came top of the class. I also learned that there is a great centre of expertise on this subject in Wandsworth, and I am pleased that all that expertise has been brought to bear in this afternoon's debate.

In the time allotted to me, I shall reprise the Government's approach, as the hon. Gentleman requested, before addressing some of the issues that he raised, not least the urgent issues that affect Christchurch, about which I was concerned to hear. He is right that there are crucial challenges and important concerns that must be confronted if we are to improve NHS dentistry. The Government's ambition is to do that not only in Christchurch, but throughout the country.

Our policy for effecting that transformation is extremely ambitious, to say the least. We propose the biggest programme of investment in, and reform of, NHS dentistry since the service began in 1948. Execution of that policy rests on three foundations: unprecedented new levels of investment; a new relationship between the NHS and dentists, expressed in local commissioning arrangements and in the new contract; and extraordinary new efforts to increase the number of dentists working in and for the NHS.

Let me first highlight the investment that is being made, because it will be of some comfort to the residents of Christchurch who are in part at the heart of our debate this afternoon. Last July, the former Secretary of State for Health, now Secretary of State for Defence, announced the unprecedented investment of £368 million. That means that funding for NHS dentistry is set to increase by 19 per cent in the financial year 2005–06, compared with spending in 2003–04. That is an extra spend of £250 million.

We have always made it clear, however, that that investment must be accompanied by reform. Central to that reform has been the devolution of commissioning, not to the man in Whitehall but to local health professionals who are in touch with the day-to-day needs of their local communities. At the heart of our plan to spend this new investment is the devolution of £1.6 billion to local primary care trusts, which will use their devolved budgets to ensure that local expenditure on dentistry is spent in accordance with local needs.

Photo of Lembit Öpik Lembit Öpik Shadow Secretary of State for Northern Ireland, Northern Ireland Affairs, Shadow Secretary of State for Wales, Welsh Affairs

I have a question to ask the Minister. If he cannot answer it today, I should be grateful for a written response. How much of that money has been earmarked for Wales? Presumably, there has been an increase in the Welsh block grant to ensure that we can resolve the varied difficulties and debilitating problems that there are, particularly in rural areas. As in Christchurch, people simply cannot access NHS dentistry because none is available.

Photo of Liam Byrne Liam Byrne Parliamentary Under-Secretary (Department of Health) (Care Services)

Those figures are not at my fingertips, so I will ensure that I write to the hon. Gentleman with that information.

Photo of Paul Beresford Paul Beresford Conservative, Mole Valley

The Minister is talking about the funding going to the local sources, so to speak. It is interesting that dentists are waiting for the base contract but that has been delayed and delayed and delayed, while in the meantime an enormous effort has been put in on PDS contracts. Dentists are beginning to wonder whether that is the way that the Government wish to go—contracting dentists through PDS contracts alone and moving away from the traditional service, which allows a more mixed-economy approach.

Photo of Liam Byrne Liam Byrne Parliamentary Under-Secretary (Department of Health) (Care Services)

I am grateful to the hon. Gentleman for that point and for the contributions that he has made in the past about fluoridation, which has been extremely important and is now enabled by the 2003 health legislation.

The best test of the position dentists are taking towards the new contract is what they do in practice. Already, 25 per cent. of dentists have signed up to the PDS. The Government statement has already been made to ensure that, together with the proposed changes to regulations on charges that will be subject to affirmative resolution in both houses, the contract will be across the piece by April next year.

The PDS contracts between PCTs and individual dental practices promise a great deal. They have been successfully piloted across the country and dentists are already taking up that new way of working, because it removes them from the treatment and paperwork treadmill. The figures to which I refer have been particularly successful in places such as Cheshire and Merseyside, and South Yorkshire, where more than half of the practices are signed up to the PDS.

The third important element of reform is the commitment to the increase—

Photo of Paul Beresford Paul Beresford Conservative, Mole Valley

I thank the Minister for his answer, but it was not the answer to the question. I was asking whether the Government intend that national health dentistry will be provided by PDS-contracted dentists, hospitals and teaching hospitals only.

Photo of Liam Byrne Liam Byrne Parliamentary Under-Secretary (Department of Health) (Care Services)

Will the hon. Gentleman intervene again? I did not quite understand where he was going with that.

Photo of Paul Beresford Paul Beresford Conservative, Mole Valley

To a cynical dentist the Government's drive appears to be that the draft contract has not come—it has been wait, delay, wait, delay, wait, delay—and in the meantime, a huge effort has been made to promote PDS contracts. The cynical dentist assumes that the Government are moving down the road of providing NHS dentistry by PDS contracts or by hospital services, be that through teaching hospitals or otherwise.

Photo of Liam Byrne Liam Byrne Parliamentary Under-Secretary (Department of Health) (Care Services)

The cynicism is perhaps misplaced. Although there have been delays, some were inspired by the recommendations of the National Audit Office and some by comments made by colleagues. Indeed, earlier this year the BDA and, I think, John Renshaw welcomed the fact that a slight delay had been injected into proceedings in order to ensure that the biggest reform of dental services since 1948 was conducted in a correct and effective manner, but also in a manner that allows primary care trusts the time and space to ensure that value for money—a subject that the hon. Gentleman and the hon. Member for Christchurch are familiar with and pioneers of in local government—was embedded in the new arrangements. My understanding is that the delays have been simply in order to ensure that the implementation of the new policy, which is important and far-reaching, is got right.

Photo of Martin Salter Martin Salter Labour, Reading West

I welcome the Minister and congratulate him on his recent appointment. I intended to make a helpful intervention, but I have decided otherwise given that the Minister is clearly on top of the brief. Given the cataclysmic effect of the implementation of a renegotiated dental contract by the previous Government some time in 1992, which saw a significant number of NHS dentists go across to the private sector, why has it taken the Government nearly eight years to come forward with proposals to deal with a problem that has been around for a long time and where there is clearly precedent and a track record?

Photo of Liam Byrne Liam Byrne Parliamentary Under-Secretary (Department of Health) (Care Services)

We make no apologies for the scale of our ambition for change in dental services, although the drift to the private sector highlighted by my hon. Friend began under the previous Administration, compounded by the 7 per cent. cut in fees that was part of the new contract.

The best response that I can give is to point my hon. Friend to some of the basic statistics over the past eight years. If one considers the number of dentists in the system in 1997, which was 16,387, and compares that with the number in 2005, there has been a 22 per cent. increase, to 20,000. There have never been as many dentists practising in this country. Let us also consider the number of adult registrations. In 1997, there were 19.7 million. That figure changed as the period of registration was altered down to 15 months. However, if we look at the increase in registration under the new recording statistics, they show an increase of 180,000. The numbers increase in four out of the six years for which data are available. There has been consistent progress in the number of dentists employed, the number of adult registrations and the number of treatments that have been made. It was the Government who commissioned a report into the viability of the future work force, and that in turn prompted the unprecedented investment announced last year by the then Secretary of State for Health.

To conclude, I want to turn to a number of the important local issues raised by the hon. Member for Christchurch. It is important to stress that investment, reform and new practices are arriving in Christchurch. Dorset and Somerset strategic health authority, which covers the hon. Gentleman's constituency, was allocated £814,000 capital and £349,000 revenue of the £50 million central funds to improve access to NHS dentistry for people in those counties.

The plans for the local primary care trust are set out in the dental action plan.

Photo of Liam Byrne Liam Byrne Parliamentary Under-Secretary (Department of Health) (Care Services)

In the interests of making two more points, I will plough on, if the hon. Gentleman will forgive me.

The dental action plan is wide-ranging and ambitious. It involves a degree of international recruitment, but at the centre is the proposal for six PDS-based contracts to be implemented in the hon. Gentleman's constituency. It involves three new practices and the expansion of three more. The three extra dentists would involve something like 6,300 extra registrations. If we take the global proposal for delivering PDS services in and around Christchurch, that is a potential new registration number of about 26,000. If we look at the specific example of Robinson's dental practice at 1 Castle street, today something like 2,500 adults and 994 children are registered at the practice.

Tomorrow, there will be a meeting between local practitioners and the Department of Health to go through some of the problems that emerged in the PDS proposals put to the Department earlier this year. If that meeting is successful and people are satisfied that the proposals constitute value for money, the local PCT's proposal is to migrate the NHS registrations to the Whitecross dental care practice, which is about a mile away, where there are five full-time dentists providing capacity for about 10,000 patients. My specific advice to the hon. Gentleman's constituent would be to look to Whitecross towards the end of this week, when the proposals are finalised.

Photo of Christopher Chope Christopher Chope Conservative, Christchurch

Why have the Government driven Mr. Robinson out of NHS dental practice?

Photo of Liam Byrne Liam Byrne Parliamentary Under-Secretary (Department of Health) (Care Services)

It is a red herring to pretend that the Government are in the business of driving dentists out of NHS practice. If we consider the overall number of dentists practising in this country, the trend is clear. The fact that the number of dentists has increased by 22.6 per cent. since 1997 speaks for itself, as does the increase in the number of registrations.

Photo of Christopher Chope Christopher Chope Conservative, Christchurch

indicated dissent.

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Photo of Liam Byrne Liam Byrne Parliamentary Under-Secretary (Department of Health) (Care Services)

Although the hon. Gentleman shakes his head, he must remember that that is in sharp contrast to the figures under the last Conservative Administration, when in 1992 adult registrations fell from 21.8 million to 19 million and a bit: a decline of 2.1 million registrations in the space of about four years.

In conclusion, the Government's approach—for investment, reform and international recruitment to plug the gaps that we inherited—warrants and promises good news for the hon. Gentleman's constituents in Christchurch.