Examination of Witnesses (Questions 120
- 129)
THURSDAY 15 FEBRUARY 2001
LORD HUNT
OF KINGS
HEATH, DAME
MARGARET SEWARD
AND MISS
HELEN ROBINSON
120. You recognise you have got to alter the
structure of your contract with GDS?
(Lord Hunt of Kings Heath) I think we have got to
have a very good, constructive discussion with the profession
to see if it is possible to make changes in the contract which
will be in the benefit of NHS patients.
121. That is almost a "yes", Minister!
(Lord Hunt of Kings Heath) I have probably gone too
far then!
(Miss Robinson) I think the Minister has really covered
the main points, that we have not been putting in access centres
where there has been free access to the GDS. They are very much
to supplement what is available and to make provision where, for
one reason or another, there is not good access to GDS. In some
areas that is where there may be a lot of private dentistry and
that is why you cannot get NHS Dentistry. In other areas it has
been specifically areas of great deprivation. There have been
several which are specifically targeted at areas where the GDS
probably would not thrive immediately because the population has
no tradition of going to a dentist. In many areas, as the Minister
has said, initially patients have been told that there will be
priority for those who have not been able to get treatment and
for those who have specific pain, but in all cases we would expect
a Dental Access Centre to offer a full course of treatment not
just pain relief.
Chairman
122. Minister, could I pick up your point where
you more or less said one of the tasks is to get health authorities
to take dentistry seriously. Certainly the witnesses we had in
the earlier session from Birmingham ,and Cornwall and the Isles
of Scilly Health Authorities gave us the impression they certainly
tried to take it seriously, but they feel to some extent handicapped
by the lack of levers, as they put it, to affect dentistry at
a local level, certainly the issue of recruitment of dentists
to difficult areas, the balance between the business interests
of dentists who will be attracted to the wealthy areas, and the
service element in the poorer areas is a problem. How do you see
your role in offering health authorities more levers in enabling
them to undertake this serious role that you recognise?
(Lord Hunt of Kings Heath) First of all, you have
had this morning two health authorities who have a long record
of being concerned and being proactive in the field of dentistry.
The challenge that I face is ensuring that every health authority
in the country takes a similar robust and proactive role. We have
ensured that dentistry issues are in the planning guidance and
priorities for the Health Service, which is very important because
that gives the clearest message possible to the NHS that looking
at dentistry issues is important. Second, we have established
a robust process of performance management in relation to dentistry
so that we will be reviewing very, very carefully over the next
new weeks the action plans that they have developed specifically
in relation to access issues. In addition, those authorities which
we consider to be struggling or not having produced an effective
action plan or strategy will receive a visit from departmental
officials.
123. You can send all the officials you want,
it does not overcome the problem that we have picked up this morning
very clearly that there are some nice attractive areas in the
South of England to pull in loads of dentists who are very willing
to practise there but in the north and areas like mine perhaps
less so.
(Lord Hunt of Kings Heath) I can assure you—
124. I am concerned about how we help authorities,
like the one in my area, to develop the strategies we are all
wanting to when they are disadvantaged by the lack of a national
strategy over many years, and that predates your Government to
be fair.
(Lord Hunt of Kings Heath) I accept the point. These
are going to be robust visits. This is going to be strong performance
management, but it is not just about that. In relation to waiting
lists we have set up what we call the NPAT Team, which is very
much about sharing good practice across the system so that you
can help people develop new ideas.
125. But you know with doctors who treat patients,
it is all very well having nice visits from the Department of
Health and officials around at a local level but you have got
to have the people who can do the work. The worry I have got is
you can send your people from Richmond House up to wherever but
if you have no dentists to do the work anyway you are not going
to have a great deal of success.
(Lord Hunt of Kings Heath) I understand that but the
point I am trying to make is a lot of health authorities have
not really tried to do this at all. We know some have been successful.
The whole purpose of some of this supportive work is to take the
good ideas that some people have been successful in implementing
and actually getting it implemented throughout the country. In
addition, in the strategy we proposed, and we are putting it into
practice, that the NHS can pay what we call extra sessional payments.
That means that they can actually use their general resources
for the first time to actually provide incentives to local dentists
to provide more services. So, for instance, if with the access
issue, with your DACs, your Personal Dental Service schemes, you
have still got an access problem, it will now be possible for
health authorities to sit down with individual dentists, and with
the Local Dental Committee and groups of dentists, and say "can
we collectively solve the problem of access?" and come to
some agreement about payment. That is a very, very important development.
We should not-under-estimate the ability of PDS pilots for health
authorities to actually lead change by having much more flexible
arrangements to employ dentists. If you take that with Dame Margaret's
work on encouraging more women dentists to come back into the
profession and do more work, I think the combination of that will
give health authorities more leverage in the future.
Chairman: I have trespassed to some extent on
John's territory on manpower.
Mr Gunnell
126. You have talked about the manpower strategy
already but with what we have heard from Mr Renshaw and with what
we have heard from you it is very clear that what you are doing
is not generally recognised. You have obviously looked very carefully
at the manpower problem whereas Mr Renshaw felt that nobody was
really taking hold of it and plotting the position, but you have
obviously done so. You are obviously prepared to consult with
people but there was a feeling from him that there was not sufficient
consultation with the Department of Health and that you were not
grasping the problem. I do not know whether he is still here but
I hope he is able to hear or get an account of what you had to
say to us because it really seems you are doing far more and you
are far more open to what dentists have to say than we got the
impression. Are you convinced that we shall have sufficient dental
manpower in the future to deliver the strategy, especially when
we consider the changing composition? We have already talked about
the increased proportion of women but there is also an increased
proportion of new registrations from foreign countries. How do
you see that affecting the manpower numbers? We learned earlier
on that the number of students entering the universities are sufficient
in a sense from the universities' point of view because they have
to have very high grades to get on to the dental courses, but
one wonders whether there are sufficient university places to
provide the number of dentists we are looking for in the long
run. Have we got plans to increase the number of places so, in
fact, far more people can get started on dental training?
(Lord Hunt of Kings Heath) This is a crucial question
of workforce planning. I think that the reality is that the last
proper study of the number of dentists required was undertaken
in 1987.
127. That was mentioned earlier on.
(Lord Hunt of Kings Heath) They came up with a figure
that we needed to train just over 800 dentists per year. The latest
figures we have show that we have just over 900 who came in over
the last year, so there has been an increase, but what there has
not been is the same approach to workforce planning that the Department
has traditionally had in relation to doctors. There has not been
an annual, standard review so that the figures are constantly
changed according to the needs of the service. One of the issues
that we are now considering is whether we need to go back to basics
to look at workforce planning in relation to dentists, and take
into account, one, as you rightly say, the impact of women coming
through the dental schools, secondly, the issue of workload. If
our discussions are successful in relation to looking at the contractual
arrangements and the work of dentists, what impact would that
have? I would hope over the next few weeks we would be able to
conclude some thinking about that and make some announcement.
The point is at the moment I cannot answer the question in terms
of how many extra dentists we need. What is clear is we need to
do some work in that area.
Mr Amess
128. Unless you do not smile at all teeth are
pretty important and, so I am advised, wearing dentures is rotten.
It is appalling in this day and age that our children's teeth
are still so rotten. I am very interested in prevention. Can I
first of all for the record have your views on fluoridization
of our water?
(Lord Hunt of Kings Heath) Can I just say that all
dental disease in children is something to be avoided, but I have
to say that over the last 50 years there has been a dramatic improvement
overall in the teeth of the people of this country as the strategy
makes but clearly there is more we can do and, equally, there
are pockets of variation that we need to iron out. On fluoridation
we commissioned the effectiveness people at York University to
undertake a study on the effectiveness of fluoridation and also
to look at research in relation to some of the allegations that
have been made that fluoridation is harmful to general health.
The York people reported a few months ago and essentially concluded
that, yes, fluoridation is effective and, second, that they found
no evidence that it was the cause of some of the illnesses that
people had alleged, although it did cause fluorosis (and that
could be easily dealt with). The other point it did make, which
is very important, is it criticised the fact that the research
they had been able to look at was not as robust as they would
have wished because most of the research on fluoridation was done
30 or 40 years ago when they had very different ideas about how
research should be conducted. We have asked the Medical Research
Council to see if they could come up with further proposals for
research we could commission to make sure this is bottomed out.
In the meantime I think it is clear that in areas of dental deprivation
fluoridation remains one of the tools which health authorities
can use. I should say I live in Birmingham so I am well acquainted
with fluoridation and the beneficial effects it has on children's
teeth. You then come to the issue of whether new fluoridation
schemes can be brought in under the present law and the reluctance
of the water companies to agree to new schemes. I started a process
of meetings with the water companies to see to what extent they
would be prepared to agree to schemes. We will see how these talks
proceed before we decide to take any further action.
129. Very, very quickly, I asked Ministers at
one of our previous sessions about the problems with head lice
and there is no doubt, as I far as I am concerned, that when we
had the nurses going around it did not seem to be the problem
that it is now, it is ridiculous. Again, when I was at school
we used to have nurses going around showing children how to brush
from the top of the gums and all that but we do not have that
now. We do not have enough dentists. I would not fancy looking
in people's mouths all day long, it is a rotten job, but obviously
I hope you recruit the number of dentists we need. Is there any
chance that you are going to target getting these nurses back
into our schools to educate our children about brushing their
teeth?
(Lord Hunt of Kings Heath) The School Screening Service
is an area that we need to look at. I have not been convinced
that we have been getting the most out of that. I think we need
to focus them, first of all, on identifying the most vulnerable
children. Perhaps I could take that away.
Chairman: Minister, can I thank you and your
colleagues for that very helpful session. There may be issues
we may want to write to you about subsequently. We are grateful
for your co-operation in this inquiry, thank you.
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