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BUSINESS OF THE HOUSE
Ordered,
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Brandreth.]
Mr. Graham Allen (Nottingham, North):
I should like to raise the topic of dentistry, particularly dentistry in my constituency of Nottingham, North.
It is important to place it on record that there has been a vast and quiet privatisation of dental care by the Government since 1979, which has gone unnoticed by the press and the public. Dentistry is one of those things that affects individuals only when they feel the need for dental care. In many ways, the Government have escaped proper public scrutiny of what they have done.
A local dentist in my constituency recently said to me:
Denplan, the health and dental insurers, found that only 60 per cent. of dentists were treating any NHS patients. In 1989, that figure was 90 per cent. and it was probably even higher than that in 1979. We must confront the problem that as a result of Government policy the era of free, regular dental checks in constituencies up and down the United Kingdom is well and truly over. There has been a process of back-door privatisation of which people are not aware. I am afraid that we are looking at a dental--or oral--health disaster in the UK owing to the failure to take adequate preventive measures.
Since 1992, more than 1 million people nationwide have been taken off NHS dental lists. In the Trent area, which covers my Nottingham constituency, 65,000 people have been deregistered. These people are being denied treatment on the NHS because dentists can no longer afford to take on NHS patients. Instead, they must devote ever-increasing time to their private patients to balance their books.
Countless constituents of mine have been approached to go private. The regular mailshot for NHS patients is a common occurrence. I repeat that neither patients nor practitioners in Nottingham want to be in that position. The Government, as a matter of policy, have made a
systematic attempt to force adults out of NHS dentistry, deliberately opting out of a service which we have taken for granted and which many of us believed that we had already paid for. The next toothache might be the stimulus that we need to consider whether the recent 1p tax cut was really worth it. Even Conservative Members share my view. According to a recent Harris poll, 44 per cent. of Conservative Members of Parliament believe that NHS dental care will be restricted to children and those on low income if present trends continue.
The recent farce regarding the Government's contract with Nottingham dentists has aggravated many problems. Dentists have had to spend three years wrangling with the Government. Dentists' fees have only just returned to their 1991 levels, not allowing for inflation, following a fee cut of 7 per cent. in 1992. Now all but the simplest dental work must be referred, with a lengthy wait, for what is called prior approval. One third of all patients on dental lists, mainly children and those on low income, are still entitled to free dental treatment, but the two thirds of adults who pay some of the cost of their treatment contribute more than 80 per cent. of dental costs, so the Government pay only 20 per cent. of the cost of treatment.
Nottingham dentists, like those elsewhere, have a choice. They may choose the contractual confusion and mess of that 80-20 split between private and NHS funding and the requirement to fight through the bureaucracy and fight with Government about fee levels. Or they may choose the simplicity of charging 100 per cent. privately, avoiding the difficulties with the Government that have been so apparent in recent years--a Government who do not give a damn about NHS dentistry.
The Government have deliberately designed a policy to underfund NHS dentistry and drive dentists into private practice. Sadly, the policy has been a success. Increasingly, and reluctantly, many of the dental practitioners whom I have met in Nottingham are being forced by it into one of three categories: those who no longer take on NHS patients, those who no longer roll their patients' registration forward when it expires--even that period has been reduced from 22 months to 15 months--and those who are actively deregistering their patients.
None of the local dentists whom I have spoken to wants to make those choices, but when one dentist reduces the number of NHS registrations that they will handle, that demand does not go away. People look elsewhere for a dentist who will register them, putting increasing pressure on the declining number of dentists in the district until they, too, have little alternative but to limit the number of NHS patients, and so it goes on: a local snowball develops until most local practitioners move into the private sector, excluding vast numbers of people from effective dental treatment.
In recent years, there has been a massive but largely unnoticed switch. The 1994 survey by Denplan, which I mentioned, found that only 60 per cent. of dentists were treating any NHS patients compared with 90 per cent. in 1989. Wholly NHS dentists will soon be an extinct species, replaced by a tiny, overworked band of community dentists. Dentistry is becoming a safety net welfare service for the underprivileged and the very young rather than something that we have taken for granted ever since the modern dental service was established.
The former family health services authority that is now the Nottingham health authority is swamped with people searching for an NHS dentist. In the Trent region, more than 20,000 people asked for help between July 1992 and September 1995. In less than six months last year, the corresponding national figure increased by 25 per cent. Put simply, the provision of NHS dentistry in Nottingham, like many other urban areas, is shrinking and patients are beginning to suffer. Health authorities have a duty eventually to find those people a dentist, but many of my constituents must travel 10 to 20 miles to reach dentists who will take them. It is not easy to travel those distances with children or shopping and it certainly does not encourage people, particularly children, to visit the dentist. Many of the vast improvements in oral health since the NHS was established 50 years ago are bottoming out as tooth decay, particularly among children, shows signs of increasing. That is what the Government will be remembered for as privatisation continues.
The Government estimate that the new rigorous prior approval proposals will reduce the amount of expensive complex work done on the NHS by about 5 per cent. According to the BDA, that will save £10 million this year alone. Knowing that prior approval is a lengthy and difficult process, dentists either prolong NHS treatment or do it quickly privately, which is yet another obstacle to people taking up effective NHS dental care. Once again, the screw is being turned on dentists as they are encouraged to shift patients to private contracts, a process that has taken place inexorably and as a matter of policy since the Government came to office in 1979. Incredible damage has been done over that period and it will be extremely difficult to halt and reverse it.
We must look urgently at how to attract more dental practices to inner-city areas and rapidly halt the privatisation of dental services. Once dentists have had enough of trying to wring sufficient funds out of the NHS and go private, it will be hard to bring them back. Sadly, that shows the success of the Government's agreed policy. The few remaining dentists who will take on new NHS registrations are in huge demand and can no longer cope. The Government's plans to introduce grants for new dentists in areas with specific problems are like sticking a plaster over a haemorrhage. We must prevent a further drift towards private dental work, and actively encourage and support NHS dentistry as the foundation of proper oral care. Decimating NHS dentistry, then throwing in a few extra community dentists, is no way to run a national health service for dental care.
This century has seen massive improvements in dental care for all, but that is now under threat. In the past half century, we have seen that oral health can be effectively tackled only through preventive medicine--free regular check-ups and easy, cheap and convenient treatment. That is the approach that must now be taken. I understand that the next Labour Government will work closely with dentists to establish how that can most effectively be done. We shall seek to make progress with voluntary fluoridation, which has been shown to be one of the best ways of preventing tooth decay.
That, at the sitting on Wednesday 24th July--
(1) notwithstanding Standing Order No. 9 (Sittings of the House), the second Motion in the name of the Prime Minister for the adjournment of the House shall lapse one and a half hours after it has been made;
(2) the Speaker shall put the Questions necessary to dispose of proceedings on the Motion in the name of Mr. Tony Newton relating to the draft Code of Conduct of Members not later than two hours after their commencement, such Questions including the Questions on any amendments to that Motion which she may have selected, which may then be moved; and
the said Motions may be proceeded with, though opposed, after Ten o'clock.--[Mr. Brandreth.]
2.30 pm
"I am trying to remain in the NHS but quite frankly it isn't possible. There is a surplus of patients who . . . can't afford private treatment, which is putting me under increasing pressure. My list is now closed, I can't take any more NHS patients."
In talking to local dentists in my constituency, I am struck above all by their dedication. They do not want to leave NHS dentistry, but they are being forced out of it by Government policies. That fact became evident to me during the numerous meetings that I have had with local dentists; it has also become evident to the Select Committee on Health. In its fourth report for the 1992-93 Session, it concluded:
"For present and potential non-exempt NHS dental patients access to NHS services is becoming increasingly difficult".
That difficulty has, of course, affected everyone. In my region, a recent Harris poll commissioned by the British Dental Association stated that 25 per cent.--one in four people--in the east midlands had trouble finding a local dentist willing to treat them on the NHS. We are now reaching the position where about half the adult population of the UK is not registered with an NHS dentist. Probably even more tragically, 41 per cent. of children are not registered with an NHS dentist. In short, British dentistry is not safe in the Government's hands.
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