Examination of Witnesses (Questions 96
- 99)
THURSDAY 15 FEBRUARY 2001
LORD HUNT
OF KINGS
HEATH, DAME
MARGARET SEWARD
AND MISS
HELEN ROBINSON
Chairman
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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