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Ms Lynne: The Minister has not answered my questions in detail.
Miss Widdecombe: From a sedentary position, the hon. Member for Rochdale is complaining that I did not answer all her questions. She asked me about drugs, about security, and about assaults, and I have addressed all those questions. If there is any question that I have not answered to her satisfaction, she has a pen and paper, and she knows very well that I shall always give her the courtesy of a reply.
Dental Care
1.29 pm
Mr. Geoffrey Clifton-Brown (Cirencester and Tewkesbury): I am grateful for the opportunity to raise the subject of dental care. It is a tribute to my hon. Friend the Minister of State that when I discussed with him the possibility of raising the matter on the Adjournment, he readily agreed. I am grateful to him for that, and I welcome him to the Front Bench today.
The debate has three purposes: first, to highlight one highly unsatisfactory constituency case of unnecessary and unsatisfactory dental treatment; secondly, to reveal the shortcomings of the way in which the General Dental Council--the dentists' regulatory body--can deal with such cases; and, thirdly, to demonstrate the shortage of dentists providing NHS treatment in Gloucestershire.
I am well aware of the vast annual growth in state spending on NHS dental services. Since 1979, there has been a 69 per cent. increase in real terms in spending, reaching £1.3 billion in 1992-93. The problem is that, as in other areas of the NHS, technology has moved on at such a rate that ever more complex dental treatments are possible. People's expectations are higher than ever before, and some new treatments are extremely costly for the NHS to provide. Everyone should be entitled to receive reasonable treatment under the NHS, however, and most people should now, with correct dental care, expect to keep their real teeth for most of their lives.
Before I outline the facts relating to the case of my constituent, Mrs. Gee, I should state that I went to great lengths to check the facts, including corresponding with the dentist concerned and the independent consultant who reviewed the work. Mrs. Gee came to see me at the House so that I was able to question her face to face. I am convinced that there are a small minority of rogue dentists who undertake treatment that is unnecessary, or who augment basic treatment merely to earn increased fees. Of course, such cases are difficult to prove.
Mrs. Gee's case began in October 1993 when, after some minor dental treatment involving a filling costing only £55, Mr. Scott-Holeyman of Moreton-in-Marsh, suggested that some additional dental work to replace an existing denture would be ideal. A new bridge would be fitted, and root treatment carried out. It was explained that the work would cost £1,500 and that having the work done privately would ensure top-quality bridgework with well-fitting crowns and pure gold posts. Mrs. Gee took the word of the dentist that the work was necessary and would improve her quality of life. In reality, as she was to find out later, the work was possibly unnecessary and could offer only a marginal advantage over the existing denture.
My constituent was in constant pain from the bridge as soon as it was fitted. She endured 17 visits to the dentist--totalling more than 30 hours--where, on each occasion, minor adjustments were made, such as grinding down the teeth. The bridge, however, remained in place. Eventually she asked for a second opinion from the dentist's partner. It became clear from using a mould that the bite was seriously wrong, with the top and bottom teeth failing to meet.
To this day, the dentist who treated Mrs. Gee cannot accept that his treatment was unsatisfactory. In a letter to me dated 28 February 1996, he stated:
But the evidence is clear, because Mrs. Gee immediately sought a report from a consultant in restorative dentistry, which stated that a fixed bridge of the type that was used may not have been appropriate, and that the pre-existing removable denture may well have been better in the circumstances.
Mrs. Gee finally went to have restorative work done at Birmingham dental hospital more than a year after the original treatment, and the bridge was removed. Five teeth were affected by the attempted bridge work, two of which have been lost and the remaining three extensively restored. The major point is that, two years later, remedial dental treatment continues at the taxpayer's expense in the NHS hospital at Birmingham. Mrs. Gee has had to endure 28 separate and very painful visits to the dental hospital to put right work that may not have been necessary in the first place.
On my constituent's behalf, I took up the case with the General Dental Council which in theory has a remit to regulate the profession under the Dentists Act 1984. The GDC investigated Mrs. Gee's complaint, but concluded that there was not a prima facie case of serious professional misconduct by the dentist. The GDC can suspend a dentist only when serious professional misconduct has been proved. Although I am not a lawyer, that would amount in my opinion to something as serious as pulling out all of someone's teeth, or rape or a similar act. My constituent underwent unsatisfactory treatment, but it did not amount to serious professional misconduct and--under its present constitution--the GDC had no power to act.
Court action would be difficult without access to all the documents relating to Mrs. Gee's treatment. There are double standards on the part of the GDC, because it is reluctant to co-operate with her since completing its own investigation. Mrs. Gee supplied a copy of her own report and an assessment of the original treatment before the restorative work commenced for the GDC disciplinary hearing to which I referred. The GDC happily passed that report on to the dentist so that it could be used in his own defence. Mrs. Gee, however, cannot get from the Birmingham dental hospital a document relating to her own treatment that would form a central part of any court action. That is unsatisfactory, and I hope that my hon. Friend the Minister will request a copy of the report from Birmingham dental hospital so that he can satisfy himself as to the seriousness of the case.
The House would be entitled to ask why the dental profession is dragging its feet. A sceptic might say that the dental profession is aware of the three-year time limit within which medical negligence cases must be brought. This period is fast approaching its end. But why must we have this limit at all? The Minister will know for example, that negligence claims against employers can take much longer than three years to come to court, and can take six or more years to do so.
It has been important to highlight the issues surrounding Mrs. Gee's case because they highlight the shortcomings of the GDC's regulatory structure. All treatment under the NHS is subject to a complaints procedure that is not open to private dentists. Therefore, people such as Mrs. Gee have no redress under the NHS. It is high time that the GDC modernised its
procedures in line with those adopted for doctors by the General Medical Council. Dentists who fall short of the serious professional misconduct category could then be disciplined for persistent professional misconduct. In particular, there must be powers to suspend dentists temporarily while they undergo re-training and to ensure that all dentists undergo continual professional development throughout their careers. That happens in many other professions, including my own--chartered surveying.
I urge my hon. Friend to initiate an urgent consultation with the dental profession to implement these changes and all the changes recommended in the GDC consultation paper put out in November 1995, with a view to legislation along the lines of the Medical (Professional Performance) Act 1995 which will give the GMC powers to regulate GPs from next year. The people of this country need to be reassured on this matter.
Action is vital because the provision of NHS dentistry in the rural areas of Gloucestershire is unsatisfactory. My constituency has one of the highest proportions of NHS dentists either opting out entirely of providing NHS treatment or merely treating children and those with exemption certificates. The health authority has attempted to alleviate the situation by employing salaried dental staff in local clinics. But the health authority provision lags behind potential local demand by a long way. For example, there is only one NHS salaried dentist in the Tewkesbury area every other Friday from 9 am to 1 pm and from 2 pm to 5 pm--this, Mr. Deputy Speaker, to serve a population of about 14,000.
How can the situation be improved? The health authority is keen to have at least one extra salaried post, but its hands are tied by the national Department of Health rules on salary levels which mean that the health authority is unable to employ the extra salaried dentists that it needs.
Gloucestershire health authority has unfilled posts because it cannot attract dentists. Health authorities should be given more flexibility in, for example, the fringe benefits that they can offer salaried dentists, such as moving expenses and increased housing allowance, to fill unfilled posts. Ultimately, there are no other mechanisms whereby the NHS can provide NHS dentistry, if there are unfilled posts.
I hope that there will be action as a result of this debate. First, I look to the Minister to demand the document from the Birmingham dental hospital which catalogues Mrs. Gee's ordeal and is central to her being able to pursue successful legal action.
"I am unsure about exactly what it is I am supposed to have done."
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