NHS Dentistry

– in Westminster Hall at 12:00 am on 10th January 2006.

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Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Watson.]

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering 9:30 am, 10th January 2006

Thank you, Mrs. Humble, and a happy new year to you and other hon. Members. I thank Mr. Speaker for granting us permission to hold this important debate on NHS dentistry, the Minister for attending and those hon. Members who intend to contribute. I thank also Dr. Alisdair McKendrick, a local dentist in Kettering and the Northamptonshire representative of the British Dental Association, with whom I have had many discussions during recent months. I wish also to thank all the dentists in my constituency of Kettering who provide an extremely professional and enthusiastic service to many thousands of local residents.

There is a major crisis in NHS dentistry not only in Kettering, but throughout the country. That is a particular shame because in 2000, just over five years ago, the Prime Minister promised that everyone would have access to an NHS dentist within two years. I regret to say that that was all talk. Throughout the country, particularly in Kettering, fewer people are registered with an NHS dentist than was the case seven years ago. According to Government figures published in response to a parliamentary question that I tabled, since 2002, almost 7,000 local residents in the Kettering constituency have been thrown off the list of NHS dentists. Fewer people are registered with an NHS dentist in the constituency than at any time since the Government came to power.

Indeed, throughout the county of Northamptonshire, only 47 per cent. of local residents are registered with an NHS dentist.

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

I will, after I have read out a letter from a constituent—one of the victims who has been thrown off the NHS list. Last September, Katherine Clay from Channing street, Kettering, wrote:

"Dear Mr Hollobone . . . I am writing to make you aware of the appalling situation where it is impossible to get an NHS Dentist.

I have been registered with my dentist for a while as an NHS patient and have kept up my regular appointments. This week I received a letter saying that I was now being removed from their list and if I still wanted to receive NHS treatment I would have to find another dentist."

Mrs. Clay goes on to say:

"As far as I was aware Britain has a National Health Service—that is a free, or subsidised medical service. Increasingly this is no longer the case. People are being forced into paying for medical insurance out of the fear of not being able to get treatment when they need it, or the frustration of having to wait for long periods of time, often in pain, for routine or vital operations.

I am a single person on a reasonable income but with having to pay a mortgage etc I find that I would be in a difficult position had I to pay a monthly premium for dental treatment that I would perhaps never need (and pay on top when I did actually visit the dentist)."

Sadly, Katherine Clay's experiences are all too typical in the Kettering constituency.

Photo of David Taylor David Taylor Labour, North West Leicestershire

I am grateful to the hon. Gentleman for giving way. That was indeed a long extract from the letter of a constituent. In North-West Leicestershire and the county of Leicestershire, about half the people are not registered with NHS dentists, but Labour Members are fed up to the back teeth with being held responsible for all of what has happened in relation to NHS dentistry. In 1992, less than 10 per cent. of dentists' income came from private patients, but now more than 50 per cent. does, so the hon. Gentleman's party bears some responsibility. Yes, we are almost in our 10th year of government, but it takes time to train dentists and his party closed a number of courses.

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

I am grateful to the hon. Gentleman for that intervention. I do not know whether he heard my introductory remarks, but I quoted his own Prime Minister as pledging to the people of this nation that everyone would have access to an NHS dentist within two years. Three years on from the pledge, that is patently not the case.

Photo of Tony Baldry Tony Baldry Conservative, Banbury

The previous intervention demonstrates the complacency of Labour Members, who are trying to shuffle the blame on to something that happened 10 years ago.

My hon. Friend said that nearly half the people in Northamptonshire have access to NHS dentists, but in Oxfordshire the situation is considerably worse. Only a third of NHS dentists—43 out of 121—are accepting new children on to the lists. Worse than that, many other dentists are accepting children who are entitled to free NHS dental care only if their parents join their list but pay to go privately. That is monstrous. Large numbers of our constituents can get NHS dental care for their children only if they themselves are obliged to pay a monthly private subscription. NHS dentistry, under this Government, is dead.

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

I am most grateful for that intervention, which is similar to the point that Dr. Alisdair McKendrick was making on BBC Radio Northampton this morning. Adults not being able to find an NHS dentist is distressing enough, but it is particularly distressing when children do not have access to the free dental care that all of us would want them to receive. Of course, most dental decay is preventable and especially so in young children. Sadly, under the current regime, thousands of children are not getting the dental service that they deserve.

The organisation Which?, which has done a lot of survey work on dentistry, published a survey in January 2005 that questioned 2,000 adults across Great Britain. The findings are extremely interesting: nine out of 10 people believe that the Government should ensure NHS dental treatment for everyone whenever they need it; 55 per cent. of people who tried to register with an NHS dentist in the last two years said that they had found that difficult; two thirds of people think it is harder now to register with an NHS dentist for regular care and check-ups than five years ago; only 15 per cent. of people think that the Government are taking enough action to improve NHS dentistry provision; only 13 per cent. believe that the Government are giving enough funding to NHS dentistry; and 58 per cent. agree that dental care costs too much even when provided by the NHS.

Photo of David Taylor David Taylor Labour, North West Leicestershire

The Chamber would benefit from a more complete quote from the Which? survey, which at least reported with approval that some action was being taken to improve access to dentistry: the recruitment of more dentists from overseas, expanding the number of training places for dentists and providing dental access centres. The report was not entirely doom and gloom, even a year ago, was it?

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

No, it is not all doom and gloom, but it is pretty gloomy out there. I would suggest that the hon. Gentleman might like to spend rather more time talking to thousands of his constituents who are suffering from a lack of access to NHS dental care. He and his colleagues ought to take the issue far more seriously than the interventions heretofore suggest.

There are two fundamental problems with NHS dentistry. The first is an appalling lack of Government investment. To be fair, that is not entirely down to this Government, as the trend has gone on for far too long, although it is accelerating under the current regime. According to the National Audit Office, since 1990–91, overall spending on the NHS has gone up by 75 per cent., but overall spending on NHS dentistry has gone up by just 9 per cent. I am afraid that we are beginning to see the result of that lack of investment, which is being accelerated under this Government.

The other problem is that the contracts offered by the Department of Health to dentists for working as NHS employees are not attractive enough to retain them. This is a question not just of remuneration, but of the work load with which dentists have to struggle and the amount of quality time they can offer their patients.

One of the big myths is that dentists' main motivation for staying in the private sector is that they can earn more. That is certainly not the motivation for dentists in Kettering who leave the NHS. They are leaving because the new contracts offered to them do not reward them for the work, and the quality of work, that they want to offer their patients. I am afraid that as a result, despite the pledges, an important part of the health service is being privatised. There is no getting away from that.

The Government need to consider different ways to encourage the establishment of new dental practices. A gentleman from my constituency has approached me with a very innovative scheme to set up a new dental practice in Kettering, but because he is not a dentist he is finding it very difficult to get the appropriate funding and permission.

Photo of Philip Davies Philip Davies Conservative, Shipley

I am incredibly grateful to my hon. Friend, who is being generous in giving way. He is summing up the problems of NHS dentistry in an articulate and expert manner.

The point that my hon. Friend has just made is perfectly good. In Shipley, I have the same problem. Mr. Bostock, a local man, wants to set up an NHS dental practice and import dentists from other countries to run it, yet is unable to do so because he is not a dentist. He does not want to put his equipment into people's mouths—he is happy to employ experts to do that—but he is prevented from setting up the practice because he is not a dentist. Surely that anomaly should be addressed immediately. I have written to the Government about the issue, which provides a perfect example of what could be done quickly to help resolve the crisis in NHS dentistry.

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

I am grateful for my hon. Friend's intervention and distressed to learn that his constituent in Shipley is suffering from the same problems as my constituent in Kettering. I urge the Government and the Minister to give us some hope that the regulations on establishing new dental practices will be changed forthwith.

Photo of John Bercow John Bercow Conservative, Buckingham

I can tell my hon. Friend that his concern about the prospects of retaining skilled dentists in the national health service will resonate with large numbers of professionals in constituencies urban and rural across the country.

I am a relatively near neighbour of my hon. Friend, and in my constituency a prominent and respected dentist, Lynda Raybould, is anxious that the combination of the rigidities of the new contract, the work load envisaged and the remuneration promised will cumulatively cause her to have to reconsider her position as an NHS dentist unless the Government, at the 59th minute after the eleventh hour, are humble and wise enough to think again.

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

I am most grateful for that illuminating intervention, although I am sorry to learn of the experiences of my hon. Friend's constituent. He will realise that, under this Government, that situation, sadly, is all too typical for many of our local hard-working dentists, who want to work for the NHS, but find that the contracts offered by the Government are simply not attractive enough.

In highlighting the problem of the lack of NHS dentists in Kettering, I urge the Minister to look favourably on proposals for a new dental school in the Leicestershire-Northamptonshire area and on the bid made by the university of Leicester and the local strategic health authority, which are keen to set up a new facility for training dentists in the local area. I believe that a decision on that is due this month. One never knows; perhaps the Minister will give us some good news today.

Photo of Russell Brown Russell Brown PPS (Rt Hon Alistair Darling, Secretary of State), Scotland Office, PPS (Rt Hon Alistair Darling, Secretary of State), Department for Transport

I apologise for arriving late, Mrs. Humble. The hon. Gentleman makes a plea for another dental school to be opened. Is he saying that a mistake was made under the Conservative Government when dental schools across the country were closed?

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

I am simply trying to hold the Government to account for the pledge that they made five years ago to ensure that everyone has access to an NHS dentist—a pledge that remains unfulfilled three years on from the target date.

A new dental school in the Leicestershire and Northamptonshire area would go a long way to relieving the local NHS dental crisis. Under the proposals, up to 80 students a year would go to the new dental school. Four oral health academies would be established, two of which would be in Northamptonshire, and each one would treat up to 10,000 patients. In view of the crisis in dentistry in Northamptonshire, I hope that the Government will look favourably on that bid.

I stress that unless urgent measures are taken to support new dental schools and new NHS dental practices in Northamptonshire, the problem will get far worse. That is because, under the Office of the Deputy Prime Minister's housing expansion scheme for Kettering and Northamptonshire, there will be a growth in local population of between 30 and 50 per cent. by 2031. I do not claim to be an expert in mathematics, but if the population numbers go up by between 30 and 50 per cent., we will need at least 30 to 50 per cent. more dentists. Under the proposed contract arrangements, that simply will not happen in Kettering or Northamptonshire.

Finally, I make a plea to Health Ministers to visit Kettering to talk to local dentists' patients, dentists and the primary care trust about the dental crisis there. I invited the Minister of State, Department of Health, Ms Winterton, to Kettering, and she wrote back:

"Unfortunately, because of my diary commitments, I will not be able to accept your invitation to visit Kettering to discuss these issues further."

That was at the end of September. I have since learned that she will indeed come to Kettering on another matter on 7 March. I very much hope that she can spare us an hour of her valuable time to talk about the extent of this real problem in Kettering. My hon. Friend Mr. Bone and I also wrote to her asking to talk to her about dentists and other health service issues in Kettering and Wellingborough. A meeting was set up for 15 December, but was cancelled with three days' notice.

People in Kettering want the Government to take their concerns about the NHS seriously. Today's debate is an opportunity for the Government to show that they are listening to what local people have to say. I look forward to the Minister providing reassurance that he understands the scale of the problem in Kettering, and I hope that he will give concrete answers that provide the solutions that local people want.

Photo of David Drew David Drew Labour, Stroud 9:49 am, 10th January 2006

I am delighted to be here at the start of the new year, and happy new year to you, Mrs. Humble. I am not sure whether this Chamber will change the nature of these debates, but I fear that we have started with a slightly more adversarial issue.

I should tell Mr. Hollobone that I share many of his worries. We Labour Members are not complacent about the issue. I wrote to a dentist in my constituency yesterday, and this is probably the most difficult issue that I face there. I am largely an optimist, and always try to look at the best side of things, but in my eight years as MP for Stroud, the most difficult meeting that I have had was with my dentists in the town of Stroud. However, that does not necessarily reflect the situation in the whole constituency. In that meeting, I was completely disabused of what I went into the meeting thinking would come out of it—that is, reaffirmation of a belief in NHS dentistry. Most of those dentists had gone private, some entirely so, and they made things clear to me.

I welcome the Under-Secretary of State for Health, my hon. Friend Mr. Byrne, and I will be gentle with him because this matter is not part of his brief. I have already raised it with the Minister of State, Department of Health, my hon. Friend Ms Winterton. Those dentists made it clear that they did not really see any future in NHS dentistry, certainly not NHS dentistry as I take it to be. The meeting took place two years ago, at the start of the negotiations on the new contract, and the dentists saw the negotiations as setting a benchmark in relation to which they would improve their conditions. I got depressed as a result of that meeting. It is always a delight to see Sir Paul Beresford, and no doubt he will give us his view as a practitioner.

I will give an overview of my area. I live in a constituency that could be parodied as including this country's Berlin wall, in that it is divided. In the south of my constituency, most dentists are NHS. They believe in NHS dentistry and want to stay in the NHS. Those in the north, who are mainly based in and around the town of Stroud, have gone private. I do not know how we can bring them back. I have to hope that the new contract will assist with that, but there are difficult times ahead.

One of my dentists, Mr. Richard Gwyer, wrote to me and raised an issue, which I will raise in a series of questions to my hon. Friend the Under-Secretary, concerning the three new bands and what my constituent sees as a tax, although I do not see it that way. He thinks that there is an inflation of charges—a dramatic inflation of some charges. There has been a conflation of the different charges in this system, which I do not think anyone, including dentists, can understand because there are so many. Charges for some operations that dentists undertake will go up and some will go down, but some increases will be dramatic.

The other thing that utterly depressed me was the way that some dentists used the threat of deregistering children as an inducement to the parents to stay with them and to sign up to their particular private plan, whether it be Denplan or something else. I do not think that that approach is acceptable. One of the depressing things about the issue is that it involves people who were trained and paid for by the NHS, because in those days there were no tuition fees. Such people have an obligation to the NHS.

One thing that I would lay down—this has not yet been formally proposed—is that anyone who goes through dental school as a UK citizen should have an obligation, whether in the form of a contract or not, to do a number of years for the NHS come what may. That should be laid down to recoup some of the substantial investment that is made in training dentists. I hope that the Government take the issue forward.

Photo of Paul Beresford Paul Beresford Conservative, Mole Valley

If the hon. Gentleman wants a brain drain and an exodus of dentists, following his suggestion is the way to do it.

Photo of David Drew David Drew Labour, Stroud

We always have the threat of people going, but perhaps the hon. Gentleman is a good example of people who come here from different parts of the world. The reality is that something must be given back, at least in the early days of the training. For that, I would commute fees and give substantial help during the training period, so there would be some inducement. There is an obligation on people who work within the state to pay something back to it.

As one who takes a keen interest in this matter, I am somewhat confused as to where the contractual negotiations have got to. I have some sympathy with Health Ministers, inasmuch as I do not know where the British Dental Association has got to. Having welcomed the proposals initially, it has become increasingly critical of them. There do not seem to be any face-to-face negotiations at the moment, although those are vital. I agree with the hon. Member for Kettering that this crisis cannot be resolved only by inducement or by Government heavy-handedness.

We went along the inducement line with regard to GP contracts. Anyone who knows anything about the financial problems faced by primary care trusts knows that a lot of them have to do with how we have bought out GPs—lock, stock and barrel—who are doing incredibly well out of the new contractual arrangements. I put my hands up and say that perhaps it had to be that way, because the same threat of people leaving the NHS would have been advanced if we had not been very generous, but we have been more than very generous. My friends who are GPs are telling me, somewhat guardedly, that they have done well out of those arrangements. We must be careful not to make some of the same mistakes.

Photo of Graham Stuart Graham Stuart Conservative, Beverley and Holderness

Does the hon. Gentleman agree that the GP contract has been a failure because of the massive cost? The contract has been overly generous and helps explain how the Government have managed to increase NHS expenditure enormously, yet deliver no more for it. Does he not think that that has also happened with GPs?

Photo of David Drew David Drew Labour, Stroud

Expenditure on GPs is relatively small, compared with the overall NHS budget, but I have some sympathy with what the hon. Gentleman says. Learning from history and hindsight, the changes could have been made differently.

The problem is that GPs look at people such as dentists: the hon. Gentleman is right—this is not just about money, it is about the quality of life—but those two things go together. If people get more money, they can to some extent determine their quality of life and quality of working patterns much more easily. I am afraid that GPs have considered dentists and there was, among some, a view that there was life outside the NHS.

I shall return to my questions, although I do not want to speak for long because other hon. Members want to contribute to this important debate. It would be helpful if the Department ran a briefing session on charges with MPs—or at least made it clear what the three bands consist of—and justified the enormous operation inflation, where that has happened. Dentists raised with me the additional costs of dentures, which seem to have led to a dramatic increase. Likewise, it would be helpful if the Department gave some proof of which charges have decreased, given that the overall sum involved seems to have been reduced.

There is also the issue of those who have taken part in personal dental services contracts. There does not seem to have been a seamless move from the old contract to the new. We are changing the nature of the contract in respect of units of dental activity, but if we are to gain anything from the dental service contracts, we need to recognise those loyal servants of the NHS in dentistry, who have worked hard.

I name, among others, Steve Clarke, who runs a big practice in Dursley in my constituency and who has made clear his commitment not just to stay in the NHS, but to train new NHS dentists. He wants to build his practice and see NHS dentistry flourish there. The question is, how is someone who has been on a professional dental service contract, worked through with the PCT, to do that? I also need to mention Chris Morton, the operative in the PCT with whom I have had a lot of dealings. I am thankful to the Minister of State, because we got an additional dentist into the practice through the work of Chris Morton, but I am not sure how PDS translates into the new contract.

There is also the issue of list sizes, which relates to one of the sticking points in getting some help for my dentist, David Rees. There was a problem with how the Department defines list sizes. With the best will in the world, particularly if someone joins a new practice from abroad, the idea that a dentist can immediately step up to some of these numbers is not necessarily a good one. I know that there is a notion that dentists can have a list of about 2,000, but the Department was somewhat unrealistic in considering how quickly a dentist, particularly one from abroad, could take on the numbers necessary to make the figures balance.

I hope that my hon. Friend the Under-Secretary will take up those issues, although, as I said, this is not his brief. The issue is crucial, however, and I hope that all sides will work together. I hope that the BDA comes back to the negotiating table and, in a sense, becomes more representative of dentists. I am having a go not at the BDA, but at what has happened to dentistry. Dentistry has moved away from being represented by a collective body because many dentists have chosen to go along the private route. I want them back in the NHS.

Dentistry is part of the NHS. Dentists have always had some private aspects to their work—even people who work almost exclusively for the NHS have done some private work—but, in the main, dentistry should be an NHS provision and it should be carried out by NHS providers.

Several hon. Members:

rose—

Photo of Joan Humble Joan Humble Labour, Blackpool North and Fleetwood

Order. Several Members wish to be called. We have about half an hour before I want to call the Front-Bench spokespersons. May I make a plea to Members to keep contributions short? That will enable me to call as many Members as wish to speak.

Photo of Peter Bone Peter Bone Conservative, Wellingborough 10:02 am, 10th January 2006

Thank you, Mrs. Humble. It is a pleasure to follow Mr. Drew, who made some important points. I am thinking particularly of his questions, especially those relating to charges, which I will touch on later. I congratulate my hon. Friend Mr. Hollobone on securing the debate. As usual, his diligence and hard work shone through in his comments. Yet again, he is campaigning on an issue that is vital to his constituency.

As a fellow Northamptonshire Member of Parliament, I recognise and agree with the points that my hon. Friend made. NHS dentistry has reached crisis point. That is never more apparent than in my constituency. If my constituents want an NHS dentist, they have to travel outside the county, to Bedfordshire. In effect, dentistry in Wellingborough has been privatised.

Rushden is one of the major towns in my constituency, and 20 years ago there were eight dentists serving the town and surrounding villages. Now there is only one NHS dentist. In that particular dental surgery, there used to be four practising NHS dentists, with more than 10,000 NHS patients. Now there is only one, and his practice is full to capacity with 4,000 NHS patients. He is not taking on any new NHS patients. How can that be called progress? Yesterday, I did a survey of dental practices in my constituency. Of the 11 contacted, how many do Members think are taking on new NHS patients? None.

What is to blame for the privatisation of dentistry? In my constituency, and countrywide, it is not the dentists themselves. Dentists who have practised under the NHS find themselves drowned in bureaucracy and red tape. One dentist I spoke to told me that he felt more like an administrator than a practising dentist. Is that any wonder when we look at the long-winded, bureaucratic contract that NHS dentists have to sign up to and abide by? NHS dentists are frustrated that they are forced to use outdated equipment and techniques on NHS patients. I repeat that, in Wellingborough, dentistry has effectively been privatised. That has happened for a reason. The Government are unable to trust people. They are unable to trust trained professionals, who are hindered in carrying out the jobs that they know so well by being drowned in bureaucracy and central control.

The Government's need to micro-manage and control everything has led to that crisis in NHS dentistry. Their control and state planning have more in common with Stalin's Russia than a democratic, free-enterprise country in the 21st century. [Laughter.] Labour Members may laugh, but it is true.

From April 2006, the Government shall give primary care trusts a ring-fenced dentistry budget that represents the intended minimum investment in primary dental care services. That minimum investment will be subject to Government conditions on how the money can be spent; it will not be left to the professionals to decide. The Government show all the worst aspects of state planning. They give to dentistry the least amount that they think they can get away with, and then decide that they must know every single detail about how the money will be spent. The Government's need to know everything, without trusting the professionals, has led to the privatisation of dentistry in Wellingborough.

Photo of Susan Kramer Susan Kramer Shadow Minister, Treasury, Shadow Spokesperson (Business, Innovation and Skills), Liberal Democrat Spokesperson (Business, Innovation and Skills)

Is the hon. Gentleman aware that in my constituency, providers of highly specialised dental services, particularly orthodontic services, face exactly the problem that he describes? Budget pressures will squeeze them out of providing the range of services that people have historically expected. The providers' issues were neglected during the recent discussions with the Government on NHS dental provision.

Photo of Peter Bone Peter Bone Conservative, Wellingborough

I appreciate that intervention; it represents exactly what I have found in my constituency.

I am concerned that the people who are hit worst by the change are those on low incomes. Hard-working families who have paid their taxes and national insurance find that they are unable to receive NHS dental treatment. They have to find the money for private treatment or go without.

Many dentists require families to take out dental insurance, and an average family has to pay about £60 a month. The money has to come out of taxed income. For better-off families, that is an irritation and yet another stealth tax, but for those on low incomes, of whom there are many in my constituency, an additional £60 out of taxed income is a colossal cost and it causes real hardship. I am afraid that this is just another example of new Labour's agenda: its stealth taxes hit the poorest and most vulnerable in the community the hardest, which is a disgrace. It probably would not have happened under old Labour, and it certainly would not have happened under the Conservatives.

The situation is about to get much, much worse, not only for those who are unable to get an NHS dentist, but for existing NHS patients, as the hon. Member for Stroud mentioned. From April, NHS patients who pay £6.20 for a filling will have to pay £42.40 for the same filling. The cost, which comes from my local dentist, is seven times more expensive than at present, or, if one likes, a 684 per cent. increase. I hope the Minister tells me that my dentist has got it wrong, but somehow I doubt it. That is even more expensive than having the filling done privately. If that is not privatisation on a huge scale, I do not know what is.

I have another example. The cost of a partial denture will go up from £49 to £189—a 382 per cent. increase. That is unacceptable and it defies belief, yet the situation is set to get much worse. For many people, going to a dentist will become a luxury, not a necessity. The vulnerable, disadvantaged and those on low incomes will suffer the most under the new system. Owing to the Government's obsessive need to micro-manage NHS dentistry, the service is practically non-existent in my constituency.

I have come to the conclusion that the only way to rectify the situation is to have a Conservative Government. The Conservatives ran NHS dentistry for many years while in government, and my constituents never had a problem finding an NHS dentist. This Government have destroyed NHS dentistry in Wellingborough, which has hit vulnerable families the most. They should be ashamed of themselves. They should admit their mistakes, scrap the new dental contract and go back to providing proper NHS dentistry for the people of Wellingborough and the people of this country.

Photo of Paul Rowen Paul Rowen Shadow Minister, Transport 10:10 am, 10th January 2006

I thank Mr. Hollobone for raising this issue. It is important and, as several other hon. Members have said, NHS dentistry is certainly in crisis. While NHS issues have come and gone under this Government, the problems of dentistry have got worse. I fear that despite the new contracts—I hope the Minister will give us some assurance on those—things will not get any better.

The issue of expenditure has been raised. NHS dentistry accounts for only 3 per cent. of the NHS bill and its cost has risen a lot less in real terms than that of other areas of the health service. Unless the Government are prepared to offer commitment to and investment in NHS dentistry, there will continue to be a drift away from the NHS to privatisation. That is shown clearly in my constituency, where 58 per cent. of the population were registered with an NHS dentist in 1997. In March last year, the figure had fallen to 38 per cent. During the last-but-one Health questions, I asked whether the Minister of State, Department of Health, Ms Winterton, considered that progress. She admitted that it was not good progress. I wrote to her requesting a meeting, but have yet to receive an answer.

The situation is getting worse. This year, not in Rochdale, but in Langley in the constituency of Heywood and Middleton, and in the Radcliffe area of the Bury, North constituency, my constituents queued from 4 am to get on a registered list. That is not acceptable; it is completely deplorable. The body blow came over Christmas when the Balderstone practice, the last remaining NHS-only dentist in Rochdale, announced that it will withdraw completely from NHS dentistry from 1 April—the same day that the Government's newfangled contract starts. Every one of those four dentists' patients received a letter over Christmas informing them that they must look elsewhere.

I shall quote from one of the dentists at that practice because, as Mr. Drew pointed out, whatever the Government have said—they keep going on about what the new contract will do—the message is not getting to dentists, and more and more of them are voting with their feet.

Photo of Susan Kramer Susan Kramer Shadow Minister, Treasury, Shadow Spokesperson (Business, Innovation and Skills), Liberal Democrat Spokesperson (Business, Innovation and Skills)

To reinforce my hon. Friend's point, in my constituency of Richmond Park, one of the longest-standing and largest NHS practices, the Garden dental centre in Kew, announced in November that it would go private and no longer do NHS work. We have worked with local constituents to find an alternative NHS dentist, but we have yet to record a single success in finding them an opportunity to register with a new NHS dentist. This is a withdrawal of services, not even a shift from one dentist to another.

Photo of Paul Rowen Paul Rowen Shadow Minister, Transport

I agree—not one dentist in my constituency has opened its list for NHS patients. The dentist at the Balderstone surgery, John Booth, who has been a dentist for 14 years, said that

"it has got to the point where we are having to see up to 50 patients each a day. We're just herding them through."

I accept that that happened under the old contract, but, importantly, this is what he says about the new contract:

"The new contract does focus on prevention which means spending more time with patients but more talking means less work".

The subtext to that is less money, for which nobody will vote.

The Minister says that for two years the amount of money that dentists get will remain the same, but that will not solve the problem, nor will it bring more dentists into the system. My local PCT told me that another eight dentists are needed in my constituency, but we are not getting them. Unless the Government can do something to bring dentists into the system, things will go from bad to worse.

I would like the Minister to consider three issues, and I am surprised that new Labour is not considering the first. It seems that there can be privatisation everywhere else in the NHS. My mother, a 73-year-old pensioner, no longer has a dentist, and many people do not see a dentist regularly. Why cannot the Government, on a short-term basis, buy in the services of some private dentists to cope with the problem?

The amount of money under the new contracts was announced before Christmas, and, as the regulations have been prayed against, we shall be discussing the figures. I am concerned about whether the money allocated will be historical and whether it will do something to address areas such as Rochdale and Wigan, which the Minister has admitted are black spots for dental provision. Will more money be allocated to those areas to ensure that local PCTs can provide more dentists?

In July last year, the Greater Manchester strategic health authority stopped allowing new personal dental services contracts, which meant that three dentists in my constituency who wanted to open a practice were not able to do so. I want assurances from the Minister that there will be not just this contract, but long-term investment in dentistry and, as the hon. Member for Stroud said, real commitment to NHS dentistry. If the Government will not provide that, they may as well admit to doing what the Conservatives would do anyway and privatise things. [Interruption.] I am sorry, but the Conservatives' record is not one that I can condone.

If the Government believe in NHS dentistry, there must be commitment. Yes, we had a promise from the Prime Minister in September 1999, but it is yet to be delivered. In my book, two years—from 1999 to now—represents an awfully long time on the new Labour clock.

Photo of Russell Brown Russell Brown PPS (Rt Hon Alistair Darling, Secretary of State), Scotland Office, PPS (Rt Hon Alistair Darling, Secretary of State), Department for Transport 10:17 am, 10th January 2006

I apologise again to colleagues for arriving late. I shall be brief. I thank Mr. Hollobone for securing this debate. We all look back to the good old days of dentistry, but dentistry has moved on. I have heard Sir Paul Beresford refer to that. Cosmetic dentistry is only one additional aspect of dentistry, which has gone way beyond the drill-and-fill and extractions of the past.

As colleagues are aware, dentistry, like all other NHS matters, is devolved in Scotland, and as far as I am concerned this issue rests with the Scottish Parliament, but it is just as well to share with hon. Members exactly what is happening north of the border. I take no consolation from the fact that my area is the second worst in this respect in the whole of Scotland. Only Aberdeenshire fares worse than Dumfries and Galloway.

It is right to say that not all dentists are the same. People's hearts lie in different areas, and some people still work hard within the NHS. I have never been one who has advocated that the NHS system that we have all grown to love over many years is in any shape or form right for today. In each of the last three weeks before the general election, a dental practice in my constituency went private, and I had to ask whether something political was going on. The Scottish Parliament's Minister with responsibility for dentistry was to visit a dental practice on the Tuesday. On the Saturday morning, the patients of that dental practice received a letter stating that a new, exciting and innovative service was being introduced for them.

Many people whose dental practices have gone private have received such a letter. This was a long letter containing complaints about everything that was wrong. There were complaints about Governments—not just this Government—and at the end of the letter the patients were informed that if they wanted to sign up to the new service that the practice would be running, they should bring their bank details with them.

This is all about the laws of economics—about supply and demand. Some people have seized upon that. I have been condemned in my local press by certain individuals for calling dentists greedy, but I stand by those comments as some dentists have become too greedy. If we were to ask some retired dentists about what is going on across the country, they would shudder. They would never have carried out their business—we must keep it in mind that these are private businesses—in such a manner. People are being turned on to the street and asked to queue.

Photo of Graham Stuart Graham Stuart Conservative, Beverley and Holderness

Is it not typical of this Government that, having made unequivocal promises to the British people on NHS dentistry, they turn around and try to blame independent contractors—dentists? To call dentists greedy is nothing short of a disgrace. They are dedicated professionals, and it is up to the Government to meet their promises by providing a framework that encourages those professionals to do what they all train to do. They are all committed to helping the people of this country.

Photo of Russell Brown Russell Brown PPS (Rt Hon Alistair Darling, Secretary of State), Scotland Office, PPS (Rt Hon Alistair Darling, Secretary of State), Department for Transport

I am not sure whether I was right to take that intervention, but I will back up my claim about greed to the hon. Gentleman. It is only of late—and with some reluctance, I think—that the British Dental Association has condemned the practice of some dentists of turning people out on to the street and asking them to queue for hours to sign up.

I appreciate that this is not part of the Minister's brief, but I am not convinced that the new NHS dental contract will provide solutions to the problems that we face. Dumfries and Galloway health board has turned to an organisation called Integrated Dental Holdings to provide NHS dentists for the area I represent, albeit those dentists will come from overseas. The board turned to IDH because it has operated in Shropshire for the past seven or eight years. In seeking information on IDH, I turned to two of the four Conservative Members whose constituencies are served by Shropshire county primary care trust. They told me that they had a problem in 1997, and Mr. Paterson said that he got a significant haranguing in the run-up to the general election of that year. IDH came along and provided a service that meets the needs of the people of the area, and I hope that it will provide answers to some problems that my area faces.

Paul Rowen asked why the Government do not buy into what is happening. Dumfries and Galloway health board approached some dental practices that have gone private, and it would take a king's ransom to get any of them to do any NHS work. The cost would be exorbitant in the extreme—almost a waste of money in trying to get them back on board.

I use the word "greed" because this matter boils down to the fact that different dental practices in different parts of the country operate different payment systems. I have spoken to colleagues in the House. Some said, "Yes, I am with a private dental practice, and I pay for my treatment when I receive it." Others are signed up to a dental plan, which they pay for monthly. They do not have to pay for treatment when they receive it. However, I have to tell you, Mrs. Humble, that in my area the vast majority of dentists ask people to make a monthly payment of between £12 and £22, and they are then asked to pay for their dental treatment on top.

I ask the Minister to consider a simple calculation: if a dental practice asks people to pay £12 a month and takes on 1,000 patients, that equates to more than £140,000 a year. Even if the best part of a third of that is offset, that dentist will receive £100,000 per annum on top of what he earns. That is why I have made my point.

I am not convinced that any NHS dental contract will bring those people back into the fold. Regrettably, the answer comes back to the law of supply and demand. Flooding areas with dentists—albeit, I suspect, most will come from overseas—is the only way in which dentists will suffer pain. I discovered from Shropshire primary care trust that private dentists were not happy when IDH arrived on the scene. I suspect, and to some degree hope, that the same will happen when IDH arrives in my area.

Photo of Nick Hurd Nick Hurd Conservative, Ruislip - Northwood 10:26 am, 10th January 2006

I respect your desire for brevity, Mrs. Humble.

Last Friday, all three Members of Parliament who represent the London borough of Hillingdon met members of the local dental community and the message could not have been clearer: in the words of the chairman of the local dental committee, the contract as it stands is a disaster. Many of the themes will be all too familiar to the Minister, and I am sure that they will be elaborated on in Front-Bench exchanges.

I would like to focus on three issues that particularly concern local dentists. The first is chronic underfunding of dentistry; the second, to pick up the comments made by Mr. Drew, is the ability of the local primary care trust to handle new responsibilities; and the third, to pick up the comments made by Susan Kramer, is the future of orthodontics.

On funding, a 46-year-old dentist made the point that his fee for fitting a crown on a posterior tooth was higher when he qualified than it is now. The point was also made that there is no London weighting in the contract. I would be grateful if the Minister explained whether consideration was given to London weighting and the reason for the apparent dismissal of that option.

Another major concern over funding is the loss of the ability to charge for failed appointments. I have read the Minister's response on that and have not been convinced. If payment is to continue on the basis of payment for units of dental activity and if dentists do not have the opportunity to deliver a UDA because a patient does not turn up, dentists lose UDA points and income through no fault of their own.

I note the Minister's willingness to review the situation in the event of what is described as a sudden and dramatic change in the pattern of appointments and cancellations. It would be helpful to have some clearer parameters of what constitutes sudden and dramatic change.

The second area of major concern in Hillingdon lies in the PCT's ability to manage the change. That concern is reinforced by the PCT's announcement in August that no new orthodontic referrals to Hillingdon hospital would be paid for. The background of that decision—if that is what it is—is the severe financial difficulties of the PCT. It is not alone in that and is wrestling with a £31 million deficit. Cuts are the order of the day, and orthodontic referrals come first because they are deemed to be low priority and are lumped together with treatments such as homeopathy.

There was no consultation on the announcement, nor any apparent effort to understand the true nature of such referrals. Around 250 people are involved and we are not talking about cosmetic orthodontics. They are referred to Victor Crow because he does work that no one else in Hillingdon can do. I have seen pictures of the burdens that his patients must carry around and they are horrific, involving terrible facial deformities, clefts and so on. The message to those patients from Hillingdon PCT and the system it fronts seems to be to put up or pay up. That could be an irreversible decision if Hillingdon hospital responds to the drop in funding by closing a department that is recognised as doing unique and excellent work in the area. When it has gone, it is unlikely that we will get it back.

What is the saving to justify that loss of service? An estimated net £40,000 a year. That is false economics in the context of a £31 million deficit. This is not a local, parochial point. Hillingdon MPs have received representations from outside Hillingdon expressing concern that this is setting an alarming precedent for cash-strapped PCTs throughout the system, thereby doing irreversible damage to the future of orthodontics in this country. I urge the Minister to make inquiries about that initiative to ensure that any decision is fully informed, supported by cost-benefit analysis and taken with due regard to statutory procedure.

The wider point is that the initiative by Hillingdon PCT reinforces concerns about the ability of the PCT to handle new dental responses in just three or four months from now. If it can make such a mess over the £80,000 for which it is responsible today, what will it do with £10 million and what will happen to that money once the three-year ring fence is over? Just three or four months away from implementing new contracts, the leadership of the PCT is distracted by financial problems and has a short-term outlook, governed by uncertainty as to its own future. It appears not to have taken steps to access the expert advice needed to help it to shoulder that responsibility.

For my constituents who rely on NHS dentistry, the implication is bleak. The problem here is that the discontent is not the voice of Government employees. Dentists are independent agents over whom Government have few levers in a market with so much private provision. In truth, they will continue to migrate from the NHS. National statistics bear that out—dentists are leaving the NHS in roughly the same numbers as the Government are recruiting them. We are running very hard to stand still, but for me the local evidence is building.

The chairman of the Hillingdon local dental committee recently took a straw poll of 10 surgeons in my constituency who provide NHS care for patients. Seven of the 10 stated that, as of 1 April, they would be withdrawing from the NHS, leaving just three surgeries to cope with all the pressure from the PCT. How long before those three are also forced to go private? I expect the voice of my constituents to be raised then, asking exactly what the Government meant in saying that they were

"firmly committed to making high quality NHS dentistry available to all who want it by September 2001".

In commenting on the reform, Dr. Lester Ellman, chairman of the BDA general dental practice committee, said:

"This is the Government's last chance to get this right: there will be no second chance for NHS dentistry."

Based on the evidence that I see in Hillingdon, the Government are getting it wrong.

Photo of Julia Goldsworthy Julia Goldsworthy Shadow Minister, Health 10:32 am, 10th January 2006

I shall try to keep my remarks as brief as possible. I, too, congratulate Mr. Hollobone on securing the debate.

The vast majority of people here concede that NHS dentistry is in crisis and that the beginning of that story happened under the Conservatives, with the closure of two dental schools and the creation of the drill-and-fill treadmill. Yet, after eight years under a Labour Government, while there is some acceptance of a crisis—there have been plenty of strategy documents and reviews—there has been no significant or even discernible change in the percentage of the population registered with an NHS dentist, nor any change in emphasis toward more preventive dental health care.

We have heard about the Prime Minister's 1999 promise—anyone wanting to see an NHS dentist would be able to do so within two years, simply by calling NHS Direct. I tried to do that recently, to see whether the claim stood up in 2005. The information I was given was inaccurate; only one dentist was available to accept new NHS patients on his list. When I called to see whether I could make an appointment, I was told that the wait would be several months at least, or, possibly, as long as a piece of string. The practice did not really know. Even if I had emergency requirements, I would have to be triaged on the phone to see whether they really constituted an emergency.

The latest answers to parliamentary questions show that only 36 per cent. of practices are taking on any new patients. Despite celebrating the success of recruiting an extra 1,000 new dentists in the last year, the feedback I have had from those on the ground has been different. Cornwall has taken many overseas dentists to try to fill an acute shortage down there, but more than one practice has contacted me to say that it will have to lose them in the future.

Again, parliamentary questions show that 10,000 dentists have left the NHS since Labour came to government. That takes no account of the number of dentists who have scaled back their NHS work. I have spoken to a dentist in my constituency who was on the NHS books. He has two NHS patients—his wife and his daughter. The Government do not measure dentists by full-time equivalents, so we have no real idea how dentists who do NHS work split their time between that and private work.

We know that the shortfall could exceed 6,500 dentists by 2021, so even with the 1,000 extra dentists we are not, as Mr. Hurd said, even running to stand still.

An extra dentistry school would have some impact, but only over a long period, given the time it takes to train dentists, and only if the Government could employ the necessary academic staff and convince graduates to take on NHS work. As we have heard from many hon. Members, there is massive unmet demand. If that is combined with the projected fall in the number of dentists, we can see that the problem will only get worse. Clearly, dramatic change is needed if there is to be any serious attempt to meet this unmet demand. Training more dentists is not enough. Existing dentists must be attracted back to the NHS, although it is not clear that the new contracts will do that.

The new personal dental services contract will dramatically change how dentistry is structured. It will mean a shift towards units of dental activity, rather than a per item fee, but every dentist to whom I have spoken is concerned that it will result in a replacement treadmill. It will mean a move away from drill and fill, but it certainly will not be an end to treadmill dentistry.

The other concern voiced about the scheme is that, within units of dental activity, insufficient allocation is given to preventive work. Where is the shift towards preventive oral care that is talked about? Like other hon. Members who have contributed, I have spoken to a practice manager. The practice has 6,000 NHS patients on its books. The manager is desperately trying to negotiate a system under which the practice can keep all those people on its books as NHS patients, but it is facing up to the reality that not every single one of them will be able to seek treatment from that practice under the NHS.

All dentists in Cornwall have been surveyed, and 75 per cent. of those who responded plan to scale back their NHS work as a result of the new contract. If just a small proportion of those dentists go ahead with that threat, there will be a massive impact in an area where access to NHS dentistry is already very low. One dentist commented that the new contract is the best advert for Denplan he has ever seen.

The problem is that we do not know what impact the contractual changes will have, because the system is untested. Under the PDS pilot, some elements were tested, but huge aspects have not been piloted at all, including the patient charging structure. The problem is the impact that the charging structure could have not only on dentists' behaviour, but on patient behaviour.

Band 1, which is a check-up and preventive treatment, will effectively mean an increase in the price of a check-up. How will it encourage people to go for regular check-ups if it costs them more? Surely the incentive will be for them to store up their problems and wait until they need not one filling, but four or five, or until there is an emergency, when they can have those fillings for a much lower price. The higher band will undoubtedly save money for the people seeking the most expensive treatments, but as Lord Warner said:

"Around 42 per cent of patients fall into Band 2. We expect three-quarters of these patients to pay more than previously".—[Hansard, House of Lords, 15 December 2005; Vol. 676, c.1488.]

How will the Government ensure that patients understand the new pricing structure, which comes into force in April? The negations have only now been finalised, and the matter was debated in Parliament before Christmas. How will the Government ensure that patients seeking treatment from 1 April understand what is going on? Those are fundamental questions that are yet to be resolved.

To conclude—I am keeping my remarks as brief as possible—there are lots of unknowns as to what will be put in place in April. We do not know what impact the changes will have on patient and dentist behaviour. The chief concern is that they could result in a negative impact on the oral health of our nation. Regular, preventive work is most important; this is not just about toothache and cavities.

To give a brief example, a friend of a friend—a nightclub singer—found out, at a regular check-up with her dentist, that she had the early stages of mouth cancer. That routine check-up, and going to the dentist regularly, saved her life. Incidentally, if smoking in all workplaces were banned, that might help to prevent such cancer, but perhaps that is a matter for another debate.

People will go for regular check-ups only if they understand how the new system works, if they think it cost-effective and affordable, and if they can find a dentist who is still in the NHS system. At least Scotland, where check-ups are free, has gone some way towards trying to resolve some of the issues. I am concerned that, unfortunately, those issues look likely to remain unresolved in England and Wales.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health) 10:40 am, 10th January 2006

It is a pleasure to take part for the first time in a debate chaired by you, Mrs. Humble.

I add my voice to the tributes to my hon. Friend Mr. Hollobone. He rightly said that he was not only speaking for his constituents, which he did very effectively, but that right across the country people are having the same experiences. He highlighted most cogently the real human anxiety and suffering, direct responsibility for which he rightly laid at the Government's door.

The level of attendance in the Chamber today is evidence of concerns that are obviously widespread, particularly across English constituencies. It was unusual to hear from a Scottish Member today, given that the Minister has no direct responsibility for the issue in Scotland, but that is one of the trials that we in this place have to deal with under the current dispensations.

The steps the Government have taken to recruit and train more dentists will count for nothing without a sensible approach to the new dental contract. The problems in NHS dentistry will not be solved by simply creating more dentists or by persuading dentists to take on a few more patients. Rather, as the Dental Practitioners Association has correctly identified,

"the problem in reality is to redress the imbalance between working in the NHS and privately, which is causing a mass shift of dentists out of the NHS."

Photo of Ben Wallace Ben Wallace Conservative, Lancaster and Wyre

As a fellow north-west Member, does my hon. Friend agree with me that the £2 million given in July 2005 to Lancashire and Cumbria to try to increase dentistry provision was obviously wholly inadequate and that to spend that new money on distractions such as dental access centres rather than on building up practices is more a sign of the Government's panic than of a long-term strategic plan for improving access to NHS dentistry?

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

My hon. Friend makes an important and valuable contribution to the debate. If the fundamental issues are not addressed, no amount of patching up will address adequately patient and public health need. That point has not been over-emphasised during our discussion.

The ill-thought-out and untested regulations that we are discussing will only exacerbate the shift away from the NHS. The Government's record on NHS dentistry has been one of abject failure. I will not chide the Under-Secretary too often, not least because the Minister of State in his Department with real responsibility for this issue—Ms Winterton—has chosen not to attend; he is here in her place and we welcome him. However, I remind him that on 28 September 1999 the Prime Minister, as has been mentioned, promised that everyone would have access to an NHS dentist within two years. I should say for the record that that promise expired in 2001. The Government's failure to address the issue since then is a damning indictment of a succession of Ministers who never took the initiative to make the Prime Minister's wish a reality.

The new contract should have been in operation for almost a year, but it has twice been delayed—first until October last year, and now until April this year. In December 2004, the British Dental Association walked out of negotiations in disgust. The Government's response was to publish the new contractual arrangements last year for information only; there was no consultation and no negotiation. The Under-Secretary may seek to chastise the previous Government for the 1990 general dental services contract, but he should remember that that was at least agreed by the profession, and that, after all, it was a generation ago. I hope that the Under-Secretary acknowledges that being in office for eight and a half years brings certain responsibilities for the present situation.

We are now faced with the miserable situation of dentists being unable to negotiate a contract because of departmental intransigence and with the prospect of dentists walking out in disgust at what they are being offered. Responses to the dental charges consultation—dentists were at least consulted on those proposals—were negative in the extreme: 56 per cent. of respondents felt that the proposed charging system was unfair and 41 per cent. thought them unworkable.

"Uncertainty surrounding the start date of the new contract—not to mention the contract's terms and conditions—has created a climate where dentists have been unable to plan for their practices in the long-term".

Those are not my words, but the words of the Dental Practitioners Association. The business uncertainty created by the Department of Health is worthy of the Treasury. Maybe the Under-Secretary is lining up for preferment under the Chancellor's leadership. How else will he defend the Government's treatment of our dental practitioners? We should remember that dentists are business men and women as well. It is appalling that the Government encouraged dentists to negotiate new PDS contracts as late as eight months before they are scrapped and without making dentists aware of their intentions. What little goodwill that dentists had towards the Government has surely now been squandered. After all, they have to live in the real world. Like the rest of us, they have bank managers, who will demand that they have a business model that looks sustainable.

The Government's penchant for constant meddling is reflected in the Department's "pile it on" attitude to PCTs. In the last three years PCTs have been given primary care medical services, out-of-hours services and community pharmacies. They will shortly be given responsibility for general ophthalmic services, whilst having to juggle the implementation of the choose-and-book system, practise-based commissioning and payment by results. At present, and in addition, virtually every single PCT in the country is set to be merged. Into this mix is thrown the commissioning of primary care dental services. PCTs are even now attempting to juggle responsibility for GP out-of-hours care and pharmacies alongside their other obligations. I wonder whether PCTs will be able to keep all these balls in the air at once. Before the Under-Secretary demands to know whether we would slow the pace of reform, I remind him that he put so much on to PCTs' plates by delaying the implementation of the contract not once, but twice.

It is not as though the Government have not been warned. The NAO previously cast doubt on the ability of PCTs to commission dental services, saying in its report of 25 November 2004:

"Primary Care Trusts . . . have little experience of high street dentistry."

They

"have limited capacity and . . . will need to develop new expertise in dentistry."

They

"will need to ensure that priority is given to delivering appropriate contracting arrangements, including providing sufficient expertise and resources."

As far as I can tell, Ministers have not heeded the warnings, as highlighted in the helpful and important contribution by my hon. Friend Mr. Hurd. Perhaps the Under-Secretary would explain how he expects PCTs to manage the commissioning of primary care dental services without any acceptance of the NAO's conclusions and without offering PCTs any idea of how the system might work in practice. The Government have no idea of how the system will work because they did not pilot it. The NAO explained that no other country in the world had attempted to structure primary care dental services in the way that the Government have proposed and perhaps—just perhaps—piloting would have been advisable, as we urged.

The basis of the new contract is the meta-currency of NHS dentistry, the unit of dental activity or UDA. Like the new charging system, which according to the BDA seems little more than a cynical revenue-generating exercise, UDAs will be awarded in bands. As with the charging system, that results in a number of anomalies. For example, a dentist will get the same number of UDAs for taking a tooth out—20 minutes of surgery time—as for saving the tooth by root filling it—one to one and a half hours of surgery time. I can see how dentists may want to offer preventive advice—the avowed aim of the new contract—in the former case, but I have difficulty seeing how any dentist would choose to offer it in the latter. That simply costs too much in terms of chair time.

UDAs do not have a fixed price attached to them. I had assumed, like my hon. Friend Dr. Murrison, another member of the shadow health team, that UDAs would have a fixed national price attached to them. This would be consistent with operating a national tariff for other types of care. I was interested to learn that PCTs would have to determine the value of UDAs individually. Maybe setting a UDA price became too much of a headache for the Government.

I would be interested to learn the Under-Secretary's views on whether PCTs have the administrative capacity to negotiate their way around such a complex system. We should not forget that many of them are in deficit, with some, like Cheshire West PCT, having very big deficits. Surely this will eventually result in some sort of postcode—or PCT—lottery, with the Government again deliberately building in unfairness.

It is true that the Government's reforms seek to move away from the old so-called drill-and-fill culture engendered by having earnings fixed to the number of treatments provided, but the new system of UDAs will actually pave the way for a new drill-and-fill treadmill where dentists must chase a pre-agreed number of UDAs in a year. When the Minister of State was challenged last month, she said that it was inconceivable that a dentist would be able to achieve his or her number of UDAs in, say, nine months and then shut up shop for three months, because that would indicate serious flaws in the ability of PCTs to commission dental services. That is exactly the scenario that we and the National Audit Office have been trying to warn the Government about. It is surely conceivable, even possible, given that PCTs are novices at commissioning dentistry, that dentists may overperform against their contracts and shut up shop, or underperform. If either happens, where is the flexibility in the contract? Can dentists renegotiate their contract if they are likely to underperform? There is a tolerance figure of only 4 per cent. Admittedly, that has been doubled from the original 2 per cent., but it is still very narrow. Dentists are likely to overcompensate rather than risk a breach notice. Surely the Minister can see that, if dentists are not able to receive adequate payment for providing more treatment, that will hasten their exit from NHS dentistry. That would be a continuing disaster for the important matter of public health and public oral health in particular.

The new regulations are unpopular, untested and unsound. They will solve neither the problem of falling NHS dental provision nor that of the drill-and-fill treadmill. Dentists and dental organisations have scorned them and the NAO has deep concerns about them. The Department appears to be seeking to wash its hands of the problem, shifting the responsibility and blame on to PCTs, which do not have the expertise, the resources or the time to deal with dentistry.

As we heard, five years ago the Prime Minister said:

"everyone within the next two years will be able once again to see an NHS dentist".

I fear that the new contract will make NHS dentists an even rarer breed. Given the explicit warnings to the Government—not least in this excellent debate—whatever the Under-Secretary now says, he and the Government cannot disclaim full responsibility for the consequences of their actions.

Photo of Liam Byrne Liam Byrne Parliamentary Under-Secretary (Department of Health) (Care Services) 10:51 am, 10th January 2006

We have served on Bill Committees together in this room, Mrs. Humble, and it is a pleasure to serve under your chairmanship today.

I congratulate Mr. Hollobone on securing the debate. He has taken an interest in dentistry since his arrival in the House. There must be no complacency in this debate. It is vital that we recognise the precise point from which we start. We have increased the number of dentists, but not by enough. Since 1998, the number of dentists practising in this country has increased by only 22 per cent.—from 16,000 to about 20,000—but, of course, some of those dentists will have gone private. A 22 per cent. increase is good news, but is it enough? No, it is not. We have increased the number of adult NHS dentistry registrations since 1997, after a calamitous fall between 1992 and 1997, but by only 200,000. That is not enough. We need to do a lot more, which is precisely why the Government have put in place a three-point programme of action, which I shall explain this morning.

The first point relates to investment. The Government have increased investment in NHS primary care dentistry by about 20 per cent. or £250 million. For 2006–07, we are investing a further £65 million, before taking account of the uplift for pay and prices. Mr. Bone, who voiced concern about his poorest constituents, must support that investment. I know that Mr. Cameron has thrown a great deal of Conservative policy up into the air and I hope that he will take the opportunity of that review to argue against the formula that says that the proceeds of economic activity over the next two or three years will be shared between tax cuts and public investment. Tax cuts will mean one thing for NHS dentistry: a programme of cuts.

Photo of Paul Beresford Paul Beresford Conservative, Mole Valley

On that issue, the Minister we expected today—the Minister of State, Department of Health, Ms Winterton—was quoted in the Daily Express on 6 January as saying:

"under the new contract, the average earnings for a dentist with a reasonable commitment to the NHS is £80,000, plus £60,000 on top of that to be put towards . . . practice expenses".

If possible, will the Under-Secretary explain where that money will come from, how it will be allocated, how practice expenses will be defined and so on? If he cannot do that, but is prepared to write to me, I will be happy with that.

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

I shall be delighted to write to the hon. Gentleman, or for my hon. Friend the Minister to write to him, as I indicated before the debate.

A programme of new investment is not enough. We must also increase the number of dentists who work in the NHS. In 2004, we set ourselves a target of recruiting the equivalent of an extra 1,000 dentists. I am glad to say that we exceeded that by about 40 per cent. and recruited 1,450 dentists. In addition, we established 53 dental access centres. We are solving the long-term problems of our inheritance by not closing two dental schools and by proposing to open new dental schools. I shall, of course, pass on the remarks of the hon. Member for Kettering to my hon. Friend the Minister of State. It is nice to be able to do so.

What does the activity that I have described mean for the hon. Member for Kettering? In his primary care trust, Northampton Heartlands, there will be 20,000 extra NHS dentistry patients in the next year or two. Some 4,300 registrations have been made available already; set against the current number of NHS patients, that is an increase of 17 per cent. It is a significant increase and a clear indication that the programmes of reform we are implementing will make some difference. Those registrations will take the number of NHS patients to a level above that inherited in 1997, but we have to go further still.

Paul Rowen highlighted the following point. We could discuss whether 80 grand a year is sufficient take-home pay to keep a dentist fully employed in the NHS—it is more than most hon. Members take home, although many of us would argue that dentists do a greater service for their constituents—but the fact is that we have to change the relationship between the NHS and dentists. That is the third element of reform. One of the key problems, which the hon. Gentleman did not point out, is that under the old system when an NHS dentist quit the NHS, the money went back not to the local community but to the Department of Health. That has to change. I should have thought that hon. Members from all parties would welcome our attempts to put commissioning for NHS dentistry back in the hands of local professionals.

The hon. Member for Wellingborough calls the NHS Stalinesque, which was a nasty reminder of the remarks of Dr. Fox when he made his speeches in 1999 and 2000 advocating social insurance for the NHS. I hope that the Conservative party will absolutely rule that out during its forthcoming policy review. We have to make the changes so that NHS spending on dentistry can stay local. That is why the new contract is so important.

The new contract will bring a number of benefits to patients. New ways of working will reflect guidelines published by the National Institute for Health and Clinical Excellence, whereby patients are no longer automatically recalled for a six-monthly check-up and the new system of patient charges will be simpler and fairer.

Several hon. Members, including my hon. Friend Mr. Drew, have talked about the complexity of the new bands. I think that having three bands is simpler than having 400 different units of charges. My hon. Friend asked for further briefing and I shall ask my hon. Friend the Minister of State how quickly that can be arranged because it will be valuable for all hon. Members.

Many hon. Members will have received representations from dentists in their constituencies about the new contracts—

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

If the hon. Gentleman will forgive me, I have only two minutes left.

We must have the humility to listen, but some of the concerns that have been expressed are based on misunderstandings. Dentists will have the security of a guaranteed income, which will enable them to plan ahead. An NHS dentist's salary is about £80,000 a year. We have guaranteed that for the next three years, dentists' annual contracts will be worth at least the value of their NHS earnings, but with a 5 per cent. reduction in the courses of treatment they have to carry out. We are taking dentists off the drill-and-fill treadmill of the current system. Instead of being paid separate fees for individual items of treatment, they will carry out an agreed number of courses of treatment during a 12-month arrangement. The key elements of the contract were piloted in a number of sites and those lessons have been taken into account in the new contract.

The hon. Members for Shipley (Philip Davies) and for Kettering asked whether non-dentists would be able to establish dental practices. That will indeed be possible from April 2006. I hope that Mr. Hurd was not attacking local professionals and managers in primary care trusts. I know that the hon. Member for Witney recently made great play of the need to celebrate local managers in the NHS. Weightings are built into UDAs based on case load, dental health and local population—

Photo of Joan Humble Joan Humble Labour, Blackpool North and Fleetwood

Order. We must begin the next debate.