---

Mr. Malone: We have just heard the usual drivel from the hon. Member for Fife, Central (Mr. McLeish), whose view of NHS dentistry is totally unsupported by the evidence. The truth is that NHS dentistry is succeeding. It is receiving record funding from the Government. The number of people who are maintained on registers is broadly the same as it was in the past, in spite of the perverted statistics put out by the hon. Member for Southwark and Bermondsey (Mr. Hughes)--who, rather interestingly, counts those who come off the register automatically and then refuses to look at the figures for those who go on the register, which gives an entirely different picture.

The hon. Member for Fife, Central raised yet again the bogus issue of privatisation. Health service dentistry is receiving additional investment.

Mr. McLeish: What about costs? What about registrations?

Mr. Malone: I shall come to each of those points. The hon. Gentleman need not butt in from a sedentary position.

The hon. Gentleman spoke about the undermining of preventive care. Nothing will do that. He made some spurious suggestion that funding for children's treatment will come from adult care. I explained to the House in my statement that the weighted payments that are presently given will fund the fees for patient care for children, and that there will be a ceiling within which the treatment will take place. That has always been the case.

I now come to the hon. Gentleman's point about the 15-month period. The reason why there is a continuous care period of 15 months is that some 4.5 million people were rolling off the register each year, which suggests that they were not receiving treatment. The 15-month period will encourage dentists to provide a course of treatment for patients who need it, and they will then remain on the register. It is in the interest of dentists that they do so.

The hon. Gentleman also raised the issue of prior approval. It will improve dental care, because it will ensure that what is clinically necessary and appropriate for patients will be delivered. What is important is that the protocols will be decided with the dental profession and will be developed during the coming months. Dentists very much welcome that.

Yes, things are different under this Government compared with the previous Labour Government. The hon. Gentleman may be interested in the notice from the British Dental Association, which is headed "Notice to Patients". It says:

"For the time being some patients may be unable to obtain dental treatment under the National Health Service . . . The British Dental Association regrets that this situation has arisen and hopes that a viable and progressive NHS Dental Service can be restored in the very near future."

It was, in 1979. It has been developed since, and that is an achievement of this Government.

Sir Peter Emery (Honiton): Although I thank my hon. Friend for that statement, which certainly goes a long way

12 Jun 1996 : Column 315

to meeting many of the difficulties in the profession, I believe that it has not immediately met one great worry. Being parochial, I think of Sidmouth, Budleigh Salterton and Exmouth, where people are having to travel perhaps 20 miles to register with a dentist.

Will my hon. Friend consider providing capital to attract dentists into setting up a house and clinic, so that they can take on the great registration that exists not just in my area, but in many areas of the south-west? That would much more quickly get over the immediate problem, which I am sure my hon. Friend wishes to do.

Mr. Malone: Yes, indeed. The fund I have announced to the House this afternoon is designed precisely to meet such a need, where it is clearly demonstrated that there is a requirement for NHS dentistry that cannot be met. Many of my right hon. and hon. Friends have written to me about access, and I have listened to them most carefully.

My right hon. Friend will be well aware of the legislative framework within which we normally provide NHS dentistry if no dentist wishes to provide NHS care. There are two means of doing so: either through the community dental service or through the appointment of a salaried dentist. That system has proved to be too inflexible, and that is why I have announced in principle to the House today a scheme that will meet local flexibilities and needs--which is why it is not prescriptive. It will be up to local health authorities to devise schemes that match the local situation.

The representations have been listened to and responded to. I very much hope that my right hon. Friend will now take up the matter directly with his local health authority, so that it may bid for the fund that has been put in place.

Mr. Simon Hughes (Southwark and Bermondsey): I and my colleagues give a cautious welcome to the Minister's statement, as far as it goes. Does he agree that, unless there is both the commitment and the finance in the next few months, we shall not be able to rescue NHS dentistry from the jaws of disappearance?

Specifically, is it Government policy to reinstate to the NHS all the work that has been lost over the past four years? Is it Government policy that the 1.8 million net patients who have been lost to the NHS will go back to being inscribed on NHS rolls? Is it Government policy that, not just in the south-west but all over the country, there will be access for every citizen, adult and child, to a local NHS dentist?

If so, will the Minister answer the last crucial question? Does the new settlement mean that there is more money for dental remuneration, and does it mean that, once again, there will be free dental checks on the NHS for all adults and all children all over the country, as needed?

Mr. Malone: I will answer the point about additional resources first, because that is at the core of the matter. Since 1979, this Government have provided, on an on-going basis, dramatic additional resources for NHS care. Total real expenditure is £1.4 billion up--60 per cent.--on the 1978-79 figures. It is all very well for the Labour party to talk about fiddling figures; it is nothing of the sort. These are the facts, and to try to suggest by simple assertion that they are not is an absurdity into

12 Jun 1996 : Column 316

which Opposition Front-Bench Members fall far too often. Net spending is up by 37 per cent. on 1978-79 figures.

The hon. Gentleman lives in a fantasy land. He totally fails to understand the system if he thinks that people who may have required NHS dentistry in the past and now need it will receive it in terms. I do not know what system of compulsory treatment the Liberal party proposes to employ to seek them out. Time and again, the hon. Gentleman has fiddled the figures relating to NHS dentistry. What is more, when he is discovered fiddling the figures, he changes the ground rules.

I shall tell the House exactly what the hon. Gentleman has done. He has claimed that one patient is deregistered every two minutes, but depending on the basis of calculating the two minutes--I took it to be the normal division of time by two minute segments--some 45 are registered at the same time.

Having been found out on that, and the facts not suiting him, the hon. Gentleman then moved on to something that proved more esoteric. More recently, he claimed that one patient has disappeared every eight working day seconds. So we got out the calculator. We assumed working days to be Monday to Friday, and, giving the hon. Gentleman the benefit of the doubt, we worked out relatively shortly that more than four are registered at the same time. So once again the hon. Gentleman has got it wrong.

Mrs. Marion Roe (Broxbourne): I congratulate my hon. Friend and the representatives of the dental profession on finally settling their long-standing pay dispute and on the major strides forward that have obviously been made during the negotiations. As Chairman of the Health Select Committee, I welcome the introduction of a new system of rewarding activity, with particular reference to children's oral health. However, as the Minister will know, the continuing trend of improvement in children's oral health has not been maintained in recent years. Will he confirm that children's oral health will now receive the focus it deserves, and will be put at the top of the priority list?

Mr. Malone: I agree entirely with my hon. Friend. I thank her for drawing attention to the co-operation of the profession in setting the agenda in lengthy discussions that she acknowledges are now productive.

My hon. Friend referred to children's oral health. It was precisely because it had become evident that the rate of improvement in children's oral health was not being maintained that we decided to look into the issue. My hon. Friend is quite right. We are seeking to ensure that activity relates to oral health and not just to the weighted payments that were previously in place, which meant that a dentist got more cash for putting on to his or her list a child with a bad oral health problem.

However, that did not generate activity. The purpose of the new scheme is to generate such activity, which should improve oral health dramatically. I can confirm that we shall continue to monitor the scheme as it unfolds, and ensure that it promotes the increased activity and improvement in oral health that we believe it promises. If, however, it does not fulfil that promise, I have no hesitation in saying that I shall be prepared to approach the issue again.

---