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14 Nov 2002 : Column 232—continued

Dr. Murrison rose—

Mr. Pound: There was much talk earlier of the Swedish model, but before I move to the Swedish model, I will give way to the hon. Member for Westbury (Dr. Murrison).

Dr. Murrison: Does the hon. Gentleman share my concern that because bed blocking is particularly acute in London and the south, the transfer would actually represent a bed-block tax that would disproportionately affect London and the south of England?

Mr. Pound: I saw the hon. Gentleman stooped in the posture that I assumed to be that of the thinker. Had I but realised that he was crouching like a footpad to ambush me, I might have resisted his intervention. This is not a bed-blocking tax, and it would be absurd to describe it as such. It is a matter to which the Government must give their attention, and I have every confidence that they will.

The annual social services conference in October was honoured by the presence of the Secretary of State for Health, and there was much discussion of the Swedish model. May I point out some of the differences between that model and what we have been discussing today? In Sweden there was a two-year lead-in time before the proposals were implemented. In addition, local authorities had responsibility for a vast range of alternative provision, including direct commissioning of health care. There is very little exposure to the variable pressures of an independent care market—that simply does not happen in Sweden. So there are structural advantages in Sweden, plus the two-year lead-in time.

Sweden also has additional investment in sheltered housing schemes to increase capacity, because this is a capacity issue. Before we start referring to the model that was tried in Sweden, let us consider what else that meant. Bed blocking is ultimately about capacity; it is not about sloth, incompetence, medical malfeasance or local authorities not doing their job. I cannot believe that there is any right hon. or hon. Member in the Chamber tonight who has not dealt with the relatives of elderly people who have lived independently all their lives but suffer a serious medical operation and move to some sort of sheltered accommodation. They do not like this home, they do not like that one. They want the place that is closer to the bus route, near the post office or near the Royal British Legion. It is not simply a matter of placing person A in home B. A delay can often be the result of good practice, not bad practice. As long as there is that constraint of capacity, the time delay will exist and lengthen.

I have confidence in my right hon. and hon. Friends on the Front Bench. I know that they take cognisance of this issue and they have the intelligence to see their way around it. I hope that they will look at the report of the Association of Directors of Social Services. Its members have made a powerful presentation, which I know that the Under-Secretary of State for Health, my hon. Friend the Member for Salford (Ms Blears) has seen. It would

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be churlish of me to say other than that 99 per cent. of the Queen's Speech was excellent, fine and represents a great future for the country. I would just like that one area to be addressed.

5.53 pm

Mr. Edward Garnier (Harborough): The hon. Member for Ealing, North (Mr. Pound) is an example of someone who can make a speech that contains many serious points, but does not burden it with seriousness. I will leave the philosophy to the hon. and learned Member for Dudley, North (Ross Cranston). The speech of the hon. Member for Ealing, North was the more powerful for containing elements of humour. He is, if I may not quote Dr. Spooner, a shining wit.

I should like to talk about an aspect of the health service that was not dealt with in the Queen's Speech or in the remarks of the Secretary of State for Health this afternoon. I refer to national health service dentistry. I have been concerned about the absence of such dentistry in my constituency, particularly in Market Harborough, for about eighteen months. I have asked questions twice of the Prime Minister. Once was at Prime Minister's Question Time, either late last year or earlier this year, and I received no answer—or certainly no comprehensible answer—from him on that occasion. I intervened upon him on Wednesday when he opened for the Government in this debate. Again, it seemed that he was wholly incapable of getting to grips with the problem, which, I am afraid, his Government have delivered to my constituents. I asked the Secretary of State for Health about what he proposed to do about the absence of NHS dental provision in my constituency. He, too, has been unable to provide any sensible answer.

I was first alerted to the problem in July 2001 when the chief executive of Leicestershire NHS health authority wrote to me to say that the largest dental practice in Market Harborough was intending to deregister its NHS patients. From memory it had about 10,000 patients on its register. There was a three-month delay period for the notice to bite, so it was November until those NHS patients were taken off that practice list. As a consequence they either had to become private patients of that practice, which is expensive, or to search the county and over the boundary in Northamptonshire to find alternative NHS provision. That was not easy.

Leicestershire health authority let me know by letter that it would take the following steps. It was going to advise NHS Direct of dental practices in the Market Harborough area accepting NHS patients. There was one and it soon filled up. Sadly, this spring, that practice deregistered its NHS patients. The health authority said secondly that it would deal with calls received as a result of the letter that this particular dental practice had distributed and would provide information to patients on dental practices in the Market Harborough area currently accepting NHS patients. As I have said, that has proved fruitless. It said that it would advise other dentists in the area of the action that it was taking to ensure regular communication on progress in re-registering patients in the Market Harborough locality. Those were all well intended actions, but useless in their effect.

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The position got no better between July and the beginning of this year. It is not surprising that I, as the constituency Member of Parliament, received many letters from people living in and around Market Harborough asking what I could do to assist them in finding an NHS dentist. Once again, in February, I wrote to the health authority. In March the director of public health of Leicestershire health authority told me that he had been able to reach agreement in relation to two further mini-personal dental service sessions based in Oakham in Rutland. I do not know whether he has ever looked at a map, but Oakham is not readily accessible by public transport from Market Harborough and is about 20 miles away. He told me that two practitioners had entered into an agreement to set aside a total of four hours a week to provide care of individuals with urgent treatment needs. The round journey by public transport from Market Harborough to Oakham is about four hours. He said that the service would be charged through NHS Direct and treatment provided under occasional treatment regulations. Together with the mini PDS scheme operating in Melton, 30 miles away, it would mean that sessions would operate on Tuesdays, Wednesdays, Thursdays and Fridays. He told me that the Melton scheme was operating and the Oakham scheme should come into operation by 27 March this year. That is all fine and dandy if one lives in Melton or Oakham, but if one lives in Market Harborough one can go and suck one's teeth.

One would have thought that after nine months, and questions to the Prime Minister and the Secretary of State for Health, the Department of Health might have thought that there was something amiss. It is not as though this is peculiar to Market Harborough. I do not suppose that anyone on the Government Front Bench listened to the BBC Radio 4 programme XYou and Yours" on the Wednesday before last, but the hon. Member for Rossendale and Darwen (Janet Anderson), my parliamentary pair, raised a similar question about the provision of NHS dentistry in her part of Lancashire. The problem of the absence of NHS dentistry—or at least of the decline in access to it—is therefore not limited to south-east Leicestershire. I suspect that hon. Members will have encountered the problem in constituencies across the country.

I have been sent a paper prepared by the body currently looking after the provision of NHS dentistry in my constituency. The Melton, Rutland and Harborough PCT came into existence on 1 April this year. It published the paper in July, in an attempt to set out the background to the problem that I have described. It said that NHS dentistry was available in three ways—through general dental services, through community dental services, and through something called personal dental services. It said that there were short-term solutions, and that there were a number of future developments that needed to be looked at.

The long and the short of the matter is that the PCT had no funding to provide that important aspect of NHS provision that it felt under a duty to provide. The paper concluded by stating:


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I cannot imagine why the best way forward—or any way forward—has not yet been identified. The paper added:


The trust is providing some short-term solutions, but they are wholly inappropriate for Market Harborough, and the paper said that they


In parenthesis, I should add that the PCT covers a geographical area that borders on Nottinghamshire in the north and Northamptonshire in the south, and covers almost all of eastern Leicestershire. It is a large rural area with a dispersed population, and it is no good for the Government, through their officials in the country, to say that setting up portakabins here and there miles away from Market Harborough is any answer to a real problem.

The paper concludes by stating:


I have yet to hear from any Department of Health Minister what intellectual activity is going on to sort out this problem, or what communication they have had with the Chancellor and the Treasury about the funds that will be made available to ensure that the NHS can do its duty to my constituents. It is a picture of indolence and incompetence that I see when I recite the history of the absence of NHS dentistry in my constituency.

I concede that there are practical and other difficulties in arranging for the purchase by the NHS of private dental services, but something needs to be done—and done quickly—if the absence of NHS dentistry in any meaningful sense is to be dealt with in the near future. We cannot go on wishing that something may happen. We cannot go on Xlooking into the matter", as the saying goes, without some firm proposals being made in the near future.

I therefore ask the Government to use their best endeavours to rearrange the way in which my PCT is funded so that the NHS dentistry that my constituents pay for through their taxes can be provided to them. Like all other citizens of this country, they are entitled to access to the NHS for dentistry as well as hospital services. They are not getting that access, and they are being short-changed.

That is bad enough, but matters are made worse when one considers that, if we are not careful, children may not get into the habit of going to the dentist, with all the health consequences in later life that that will entail. I therefore urge the Government to get off their bottom and do something about this problem very quickly indeed.


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