Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 96 - 99)




  96. Can I welcome you to the last part of this session. Can I particularly welcome the Departmental team, the Minister and his colleagues. We are very pleased to see you and appreciate your co-operation in this inquiry. We are hoping to conclude by 1pm because there are certain announcements that are of interest to me—hopefully—in the Chamber later on. Can I begin by asking you briefly to introduce yourselves to the Committee.

  (Lord Hunt of Kings Heath) Thank you very much. I have responsibility for dentistry services within the Department. On my left is Dame Margaret Seward, who is Chief Dental Officer. Before that she has been President both of the GDC and the British Dental Association. On my right is Miss Helen Robinson who is a senior official on dental issues in the Department.

  97. Can I begin by asking you for your thoughts on the background to the current problem. Clearly we have decided to undertake this brief inquiry because of broad concerns that have been drawn to our attention about the difficulties in various parts of the country. These are not concerns that have arisen particularly recently, they are long-standing concerns that obviously the Government is having to wrestle with. I would be interested in particular in your thoughts about why we are having the current difficulties.
  (Lord Hunt of Kings Heath) Thank you very much. Can I welcome your inquiry because I think that one of my key aims as Minister is to raise dentistry up the agenda. I think it is very, very important that we do see dentistry as being a core part of National Health Service provision. The problems that have arisen really probably go back to the early 1990s, to the introduction of the new contract in 1990 which was done without pilots and the calculations did not work out. I think the sum total of it all was that in the end dentists saw a seven per cent cut in their remuneration. Perhaps also at that stage some dentists did wish to expand their private treatment and what we saw was really a disengagement between the profession and the National Health Service. We have seen that continue since those years and it is shown by the figures in terms of the increase in the number of patients treated privately and the problems of access in some parts of the country. This disengagement is key because if we come to the strategy, which I see as the start of a process of re-engagement, the key message for us all is we have to get back to an effective working relationship and engagement both at national and local level. The strategy is really the foundation on which we are going to do that.

  98. Can I put to you some of the comments that were made earlier in this session. Obviously you were not present so I am paraphrasing the previous witnesses, and in particular Mr Renshaw in the first session from the BDA who made the point that preventive work does not pay. Other comments made by the witnesses were that the Government's strategy pays no attention to the root causes, it is a short-term fix and there is no long-term plan. It strikes me, listening to the witnesses we have had, that there is a tension between independent contractor status, the private business interests and the community interests and the service interests. Do you feel these comments are fair?
  (Lord Hunt of Kings Heath) No, I do not. Clearly there are a number of fundamental issues that have to be addressed in relation to the way dentists work with the National Health Service, but I see the strategy as doing two things: first of all, yes, it is designed to help us deal with some of the short-term issues of access to build on some of the initiatives we have already started with Personal Dental Services, with Dental Access Centres, with the commitment scheme and the modernisation fund, but it is much more than that because it is also focused on issues to do with raising quality, and issues of inequality in dental health which are much more long term. The other thing which people have overlooked in the strategy is that it also begins to address the issue of work patterns. Indeed, you suggested that the incentives are perhaps not quite right in relation to treatment as opposed to prevention. We therefore state that we want to engage with the profession in looking at the whole issue of the work pattern of the GDS dentist, and as an example we give the issue of the six-monthly recall. There is emerging evidence that for many patients it is too short an interval. We are perfectly prepared to engage with the profession in looking at that, in looking at other work plan issues to see whether we ought to be making changes to provide the kind of space that they want but also the satisfaction that they wish to receive in terms of what they do. So we are very open to a debate with the profession. The strategy is the beginning of this process. We are talking about really the first major strategy in relation to dentistry for many, many years and that is very important. It is not the end game; it is the start of what I passionately believe is going to be a more constructive relationship in the future.

John Austin

  99. What is the problem that Modernising NHS Dentistry is designed to address?
  (Lord Hunt of Kings Heath) It is aimed to do a number of things. In the first place, yes, it is aimed at dealing with the immediate access problem that patients are encountering in some parts of the country, and that is why we are focusing on more Dental Access Centres, more Personal Dental Service pilots, because these are the new initiatives that give us greater flexibility to target resources in the places where they are most needed, but I think the strategy goes much further than that, particularly looking at the issue of quality, better regulation, and workforce issues. There are a number of issues that we have to look at in relation to workforce planning. Are we training enough dentists is clearly a key issue. Are we using the dental team sufficiently? Could we have more from dental hygienists and dental technicians? One of the issues we face is that there has been an increase in the number of dentists who are contracted with the GDS but there are many more women dentists, dentists working part time. Dame Margaret, before she became Chief Dental Officer, has been leading a project looking at how we can attract more women back into the profession. It is those issues together with the issue of workforce pattern, and looking with the profession to see if we could organise the dentist's day in a more effective way.

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