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2.44 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Horam): I am delighted that the hon. Member for Nottingham, North (Mr. Allen) has raised this subject, even though it is close to the end of the Session, because it gives me the opportunity to point out that, contrary to the one-sided picture that he painted, the Government are committed to a comprehensive and effective national health service dental service. Our record speaks for itself.
On 31 March, the total number of dentists on family health services authority lists was 15,998, which is 3,900 more than it was in 1979 and the second highest figure ever. Since 1978-79, funding for NHS dentistry has increased by 54 per cent. in real terms. Over the same period, the number of adult courses of treatment rose by 7.82 million. At the beginning of this year, more than 6 million children were registered for capitation, helping to ensure that they receive regular care for their teeth at a critical age.
Our major investment in NHS dentistry has produced results--the oral health of the nation has improved. When seen over a longer period, that improvement is enormous. We forget all too easily the pain and discomfort that poor oral health caused in earlier generations. Perhaps hon. Members of my generation will remember the gloomy and inadequate dentists I visited. When the discipline of parental urging was removed when I got older, I forgot to go to the dentist for three or four years and, as a result, I have far more fillings than I should have for a man of my age. That is what it was like when we were young, and I do not believe that that would happen to anything like that extent today.
Our task is not to look back but to look forward. NHS dentistry cannot afford to stand still if it is to meet the challenges of the future, such as building on past improvements in oral health, targeting more accurately the groups of patients who are our highest priority and improving value for money. Those principles were underpinned in the recent wide-ranging statement on the future of NHS dentistry, which my hon. Friend the Minister for Health made not so long ago. A key element in the statement was the announcement that a year of detailed and constructive negotiations with the profession had resulted in an agreement on the reform of the general dental services pay system.
The package has a number of elements and implementation will begin in September. First, it targets the substantial existing resources more effectively, with
the aim of improving child oral health and giving value for money to the taxpayer. In addition to the capitation payment made for each child registered, a new set of fees for individual items of treatment will be introduced. That fee scale will replace the weighted entry payments that are currently paid where significant treatment is required. It will be a simpler system oriented towards children.
Secondly, for both adult and child dentistry, we are to harmonise the registration period at 15 months. That will provide a period of continuing dental care following each course of treatment, while streamlining administration procedures, reducing bureaucracy for dentists, and ensuring that the public secure the best value for money from the available resources. In other words, we are reducing administration, bureaucracy and waste--something the Labour party claims that it would do if it were in power.
The reforms also include an agreement to introduce more careful prior approval. That will ensure that all clinically essential services are available and are secured in the most cost-effective way. In view of the agreement with the profession, we have waived the overpayments that built up over a number of years to 1993-94. They amounted to some £16,500 per dentist and were the consequence of a remuneration system with a balancing mechanism that recovered overpayments in one year in subsequent years.
The British Dental Association has ended its long-running dispute with the Government as a result of the reform agreement, combined with the waiver of overpayments. Those developments remove the uncertainty that dentists have been under for several years and they should promote an atmosphere of stability and security in the NHS general dental service. More importantly, they draw a line beneath the past and allow us to concentrate on the future. That can be only beneficial for patients and dentists alike.
Accessibility to NHS primary care dental services is very important. I am aware that, despite a healthy national picture with the second highest number of dentists ever, patients experience difficulties obtaining treatment in some local areas. The hon. Gentleman referred to services in his area. It is particularly difficult to obtain treatment in rural areas, where the distances are greater and it is harder to find a dentist nearby. There also tend to be fewer dentists in the more affluent areas.
We must tackle those localised problems, so the Government have launched an access fund that will target local needs through local solutions. I look forward to seeing health authorities--wherever they may be located--working with the profession to devise innovative and effective schemes that help to improve access appropriate to their areas. In addition, health authorities are able to apply to the Secretary of State to appoint a salaried dentist, and they can use community dental services when there are shortages. As the hon. Gentleman will know, many salaried dentists have been appointed under the scheme.
Let me look further ahead. At present, dentists work within a fairly rigid national system. One of the lessons that we have learnt in other parts of the NHS is that bringing an element of local flexibility into service provision can prove invaluable in helping to target
resources to meet local needs and demands. That is why the Government intend to pilot and evaluate a system of local contracting for primary care dentists in several areas of the United Kingdom. Health authorities will be able to target local needs more effectively, using their knowledge of local conditions and of local patient needs.
The chairman of the general dental services committee of the British Dental Association has promised to work with us constructively--thus achieving the good, co-operative relationship between the profession and the Government that the hon. Gentleman called for. The pilots will require primary legislation, and the Government intend to seek an opportunity to introduce a Bill. I hope that the next parliamentary Session will be a long one, so that we may introduce that legislation. We hope that it will prove possible to publish a draft Bill for consultation this autumn.
We recognise that changes in organisation must be paired with measures that will secure the highest professional standards into the 21st century. Such a Bill would also provide an opportunity to make changes to the Dentists Act 1984. Those changes have been requested by the General Dental Council, which is charged with setting and maintaining professional standards. The changes include setting up new classes of auxiliaries and expanding the range of work that they can do. The aim is to allow dentists to manage their practices more effectively, to provide more professional opportunities for hygienists and other dental auxiliaries, and to increase the amount of patient care available.
The council also intends to create a statutory career redevelopment scheme for dentists who must improve their level of competence. It will introduce conditional registration in addition to the sanctions that are currently in place for disciplinary proceedings. In other words, rather than the current heavy-handed approach, we shall have a system that is much more conducive to ironing out the problems of dentists who are judged to be less than fully competent. The aim is to help rather than hurt.
Finally, the GDC wants to establish a complaints system for private patients. As hon. Members know, Parliament passed legislation this Session dealing with a new complaints system throughout the NHS. It is important to complement that with a complaints system for private patients. That would enhance the GDC's powers to deal with complaints against dentists providing treatment outside the NHS. The proposals mirror developments in the medical profession and will ensure that professional standards are maintained and developed.
I assure the hon. Gentleman that NHS dentistry is, and remains, a Government priority. The programme of initiatives unveiled recently is firm evidence of our commitment to effective and efficient NHS provision. We now have an agreed way forward, a constructive working relationship with the profession and adequate resources. Although I concede that there is still much work to do, I believe that we have taken the first important steps to strengthen the current service and to provide the firm foundations for future work.
Question put and agreed to.
Adjourned accordingly at seven minutes to Three o'clock.
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