Column 859place in the NHS sector. The NHS was born in Wales and we have no intention of allowing the Tory regime to kill it off.
In terms of dental services, the NHS is certainly not safe in Tory hands. The Government must stand up and be counted--and perhaps the Minister can start tonight with a suitable apology.
The Parliamentary Under-Secretary of State for Wales (Mr. Gwilym Jones) : I assure the hon. Member for Caernarfon (Mr. Wigley) that the Government remain entirely committed to an effective and accessible NHS dental service. The facts speak for themselves. More NHS dentists are practising in Wales than ever before ; more NHS patients are being treated than ever before ; and more money is being spent on NHS dentistry than at any other time in our history. The progress made is obvious to all who examine the figures. The number of general dental practitioners in Wales has risen from 592 in 1979 to 807 in 1993, an increase of more than 36 per cent. ; during that time, the population rose by only 3 per cent. Patient registration levels, at more than 1.7 million, are the highest ever, with 67 per cent. of all children and 57 per cent. of all adults currently registered with an NHS dentist. No wonder the number of courses of treatment for adults has risen to nearly 1.4 million in 1993.
With more patients registered and more treatment provided than ever before, expenditure levels are also at an all-time high. In the last financial year, nearly £74 million was spent on NHS dentistry in Wales, in real terms an increase of 87 per cent. since 1978-79. I was disappointed when the hon. Gentleman lapsed into the usual "knock the NHS" conclusion at the end of his speech. He came out with, in effect, the same gross insult to the excellent staff who are working for the NHS in Wales. They are our greatest asset. They continue to achieve record increases in the number of patients being treated in Wales--and, moreover, to achieve improvement in the quality of health care. The most recent survey conducted by the National Association of Health Authorities and Trusts showed that 87 per cent. of the public were satisfied with the NHS in Wales.
We in Wales are, indeed, fortunate to enjoy a good and productive relationship with the dental profession. Its members talk to my officials and to me. I last met representatives of the British Dental Association and the General Dental Services Committee on 8 December. They know that my door is open if they wish to explore any matter of mutual concern.
I am pleased to maintain an open door, if only because I recognise the huge strides that have been made, particularly in recent years. The other day, I talked to a constituent who, as a boy in the valleys, had had his teeth ripped out with no thought of conservation or health promotion. Not surprisingly, he took great pleasure in the fact that his two children--who are in their late teens and have grown up under the present Administration- -have but one filling between them. That story can be repeated many times, and is an eloquent testimony to standards that the Government are committed to retaining.
I recognise, however, that if those achievements are to be sustained and improved in the long term, there is an overriding need to tackle the roots of the current problems
Column 860in the dental remuneration system. The hon. Gentleman may be aware of some of those problems, but it may be helpful if I explain the background. Dental remuneration is determined by the Government on the basis of the recommendation of the doctors' and dentists' review body. In 1991-92, the review body recommended that dentists should receive an average net income of some £32,000 ; in the event, they received an average of about £12,000 more than that.
A cut in fees of some 23 per cent. would have been necessary if the target pay for dentists were to be brought into line with the review body's recommendation for the following year. We decided, however, to introduce a cut of just 7 per cent., which should still have enabled dentists to receive, on average, about £4,000 more than the net income of nearly £36,000 recommended by their review body. Although their income remained higher, on average, than that recommended, dentists, inevitably and understandably, reacted badly to the fee adjustment, and some decided that they would no longer accept new NHS patients or provide emergency treatment for unregistered patients. Others decided to offer only private treatment to patients not exempt from NHS charges. As independent contractors, they are, of course, free to do this if they wish.
Clearly, the situation was far from satisfactory and needed to be addressed in the interests of all parties. A fundamental review of the dental remuneration system was requested by the pay review body in its 22nd report and that request was repeated by the profession in 1992. The Government met the professions's request for an independent review, and Sir Kenneth Bloomfield was asked to produce a report identifying options for change. The report was published and widely circulated last year. Consultation was drawn to a close five months later, at about the time the Select Committee on Health published the report of its inquiry into dental services.
Unfortunately, and despite out extensive consultations, there was no consensus about solutions. That had been noted by both Sir Kenneth and the Select Committee in their inquiries. Indeed, it is significant that the Committee noted in its report :
"there was . . . more consensus amongst witnesses concerning the problems than concerning solutions".
Against that background, it was imperative that we should take time to consider all of the many options for change and all the views submitted on them. I am pleased to advise that we are now close to announcing our proposals. We shall, of course, be consulting closely and fully with the profession and others interested in the proposals. In the meantime, we are determined that the profession should be properly rewarded for its work in improving the oral health of the nation. Our commitment is underlined by our recent decisions to increase the level of fees paid to dentists--a 2.9 per cent. increase from 1 January and a further 3 per cent. from 1 April.
That does not sound to me like a service abandoned by the Government ; rather, we see pay recommendations accepted and implemented in full and a willingness to inquire into the universally acknowledged problems in the present system, to consult and listen to the profession and to consider with the greatest care the many representations received. There is no hint here of lack of commitment.
The general dental service provides the vast majority of dental services, but we should acknowledge also the contribution made by other branches of the profession. The hospital services have an important role to play in dealing
Column 861with the more complex and difficult cases. That sector, too, has seen growth in its activity, with a corresponding increase of 62 per cent. in the number of dental specialists employed since 1979. Wales now has more restorative dental consultants outside teaching hospitals and located in district hospitals than any other part of the United Kingdom.
However, the Government are not complacent--far from it. It would be misleading for me to imply that all in the garden is rosy. The hon. Gentleman has quite rightly highlighted the difficulties that are experienced in some areas of Wales in obtaining dental treatment in the location of choice. That has been caused largely by the less-than-ideal distribution of the services that are currently available.
We should recognise that dentists put their own money at risk when they open a new practice, and they may see that risk as greater when the population is sparse or where they feel that it would be difficult to establish a viable practice. But for every area where there is a problem, there are others where no difficulty is experienced in obtaining NHS treatment. Indeed, Gwynedd is the only area in Wales where the family health services authority has reported being unable to arrange NHS treatment for an inquirer. Even there, such treatment would have been available if the patient had been prepared to travel.
I am happy to report to the House that, as a direct result of the Secretary of State's permission to employ salaried dentists, the situation has improved. No one in Gwynedd should now be denied or totally refused NHS treatment, although I acknowledge that patients may have to travel. I recognise the need to address this problem. Patients should not have to travel long distances or wait for treatment.
The hon. Gentleman referred to the number of dentists who have closed their books. Those figures need to be interpreted with caution. Before 1990, dentists did not have lists as such. Following the new contract, all practising dentists would have open lists because their remuneration depended in part on the number of registered patients. It was equally inevitable that, in time, some lists would become full and would close. What matters is not the number of open lists but whether treatment is available. I can tell the hon. Gentleman that in Pwllheli the salaried dentist is offering two days' cover a week from Monday and that there is one whole-time equivalent community dentist available to provide emergency cover. In Dwyfor there are four dentists, all treating existing registered national health service patients but not accepting new NHS patients. In Pembroke the family health services authority and the profession's representative body advise that NHS dentists are available to new NHS patients.
Mr. Wigley : The Minister has stated that all four dentists in Dwyfor were accepting people currently on the NHS. That is not true. I have quoted letters from people who have been told that they have to move away from the NHS or go on to a private plan if they wish to remain with their dentist. If 300 of the 850 dentists in Wales have withdrawn from taking on new patients, does the Minister realise that most will continue not to accept them, whatever happens ? How on earth will he get the NHS dental service back on the rails ?
Mr. Jones : I am seeking to give the hon. Gentleman the latest information. The advice to me is that the four dentists in Dwyfor are treating existing registered NHS patients but not accepting new NHS patients. That is the latest information.
The Welsh Office is doing much to assist family health services authorities to attract dentists to the areas of greatest need. We have introduced the highly successful location incentive scheme. Under it, grants are available to dentists who wish to set up or expand their practice in areas where there is a shortfall of dentists. Seven schemes are funded in the current year.
In addition, the Welsh Office is funding various local initiatives throughout Wales that aim to improve the standards and level of services available. Those initiatives are usually targeted on areas of greatest need, and the hon. Gentleman will be pleased to know that 50 per cent. of the current funding is directed to the Gwynedd family health services authority to finance initiatives in that area. Further initiatives from Gwynedd and elsewhere are under consideration.
However, those initiatives and the location incentives that I have already mentioned are not always sufficient in themselves to secure comprehensive general dental services for an area. In those circumstances, the community dental services are providing a valuable safety net function to patients who would otherwise be unable to obtain treatment. We are committed to the continuation of this service, and the health authorities who manage it are charged with keeping the need for such services under review and with making appropriate provision for it.
My officials are exploring innovative ways of expanding and strengthening the community dental services safety net function in Wales. There have been discussions with the staff side of the profession with a view to identifying arrangements particular to our needs. Those discussions are well advanced and principles are agreed. I hope that the outcome will provide greater flexibility of services and better targeting of resources, particularly in those areas of Wales where general dental services have been weaker.
It is also open to family health services authorities to apply for approval to appoint salaried dentists if they consider that that is necessary to ensure adequate provision. This scheme can be attractive to dentists who, for whatever reason, do not wish to practise on their own account or as part of a managed service. To date, five authorities have made applications and seven posts have been approved. Three salaried dentists are already in post--two in Gwynedd and one in Dyfed. A further dentist is shortly to commence work in Powys. Other applications are under consideration, and I expect shortly to announce approval of additional posts.
I have already shown that I support innovation. Family health services authorities bringing forward proposals for new authorities will find that I shall deal with them sympathetically and expeditiously, provided that they demonstrate need. The picture is not one of failure and complacency, such as the hon. Gentleman sought to paint.
The motion having been made after Ten o'clock and the debate having continued for half an hour, Mr. Deputy Speaker-- adjourned the House without Question put, pursuant to the Standing Order. Adjourned at twenty- three minutes past Eleven o'clock.
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