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14 Jan 2003 : Column 535continued
The Minister of State, Department of Health (Mr. John Hutton): Following the ballot of British Medical Association members in October, we are carefully considering the options in relation to the best way forward and will make an announcement shortly.
Mr. Edwards : May I urge my right hon. Friend to resist and overcome the opposition of consultants to the reform of their contracts? Constituents who need an orthopaedic operation feel deeply frustrated when they find out that they could have it done in the next couple of weeks by the same surgeon at the same hospital. The situation is so intolerable at the Royal Gwent hospital where my constituents go that the Minister for Health and Social Services in the National Assembly for Wales, Jane Hutt, has set up an inquiry. Will my right hon. Friend do everything in his power to ensure that those consultants who are dedicated to working full time for the national health service are rewarded for that? We should not have a two-tier system.
Mr. Hutton: I agree strongly with hon. Friend. It is important to make it clear that no one has a veto on reform in the national health service. It is our job to find the best way to proceed with the reforms that we wanted to make. Our objective, however, is clear and it remains the sameto better reward NHS consultants who do the most for NHS patients. As I said, we will be making an announcement shortly about the way forward.
On my hon. Friend's specific point about private practice, he will remember from the agreement that we negotiated with the BMA last year that we proposed a way forward for dealing with the perceived conflict between NHS practice and private practice. The need for clarity around the relationship between private practice and NHS practice remains the same, and we will be saying something about this in the near future.
Sir Nicholas Winterton (Macclesfield): The hon. Member for Monmouth (Mr. Edwards) has raised an important point. While we have to give full credit to the overwhelming majority of consultants for their skill, dedication and commitment, is it not important that any contract should encourage a consultant to carry out as many operations as possible within the national health service in accordance with safety, hygiene and all other considerations that are important when using theatres? Will the Minister give me an assurance that that objective will lie behind any decision that the Government take?
Mr. Andrew Miller (Ellesmere Port and Neston): I have in front of me a letter from a consultant who says that he voted in favour of the reforms. He goes on to explain that as specialists in one of the smaller trusts, he and his colleagues are becoming increasingly frustrated with our region's attempt to rejuggle the management of some of the smaller trusts. As we need to build on the trust of good consultants such as my constituent, will my right hon. Friend look closely at what the north-west region is doing in terms of mergers of small specialist trusts, which are the jewels in the crown of the local service?
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): The Government are committed to providing NHS dentistry for all who need and seek it. In addition to the annual general dental services budget, more than #125 million has been made available to the NHS to improve local services over the past three years.
Despite the increase of nearly 2,000 dentists since 1997, we recognise that in some areas it can be difficult to find an NHS dentist. We therefore propose to legislate for far-reaching reform of NHS dental services.
Mr. Pike : I thank my hon. Friend for that answer. Is he aware that Burnley, Pendle and Rossendale primary care trust supported a bid, made under one of his Department's initiatives, for an improved NHS dental service in east Lancashire, but that the bid failed? Does he recognise that people in Burnley cannot get on to NHS dentists' lists? There is much poverty, as a result of which people cannot afford private treatment, and
Mr. Lammy: I am grateful to my hon. Friend. Of course the Department recognises the issues relating to poor dental health in Burnley. That is why Burnley has benefited from a number of other pilots, including dental access centres. Burnley has also received a substantial increase in its primary care allocation, which my right hon. Friend the Secretary of State announced shortly before Christmas. That, too, will improve dental access in my hon. Friend's constituency.
Colin Burgon: I am glad that the Minister has a strategy for improving access to NHS dental services, as the problem is also present in my constituency, even though it is a reasonably affluent one. Recently, a Garforth constituent gave me a letter that he had received from his dental practice, informing him that it was going private. Two things disturbed me about the letter. There was a strong implication, first, that unless my constituent signed up for a dental care plan, the practice could not guarantee treatment; and, secondly, that NHS dental care was of lower quality and that inferior materials and techniques were used. What is my hon. Friend's comment on that letter?
Mr. Grogan: Many NHS dentists feel strongly about fluoridation. What is the Government's current policy, following the Medical Research Council report that built on work carried out by the university of York?
Mr. Lammy: My hon. Friend will understand that the subject is controversial, but the MRC supported the benefits of fluoridation in improving health inequalities, especially for children. My right hon. Friend the Secretary of State has asked the chief medical officer and the chief dental officer to look further into the issue.
Mr. Colin Breed (South-East Cornwall): Will the Minister give me his definition of access? Does it include, for instance, the five to six-hour journey by public transport to fulfil an appointment that is often experienced by my constituents in south-east Cornwall?
Mr. Lammy: The hon. Gentleman has, I know, been concerned about a case in his constituency that arose over Christmas. It is important that people ringing NHS Direct have access to a dentist within a reasonable distance. We must continue to strive to ensure that there is investment to improve dental access in the hon. Gentleman's areaas in others.
Mr. Lammy: Of course I am concerned about dental access in Sleaford and I am tremendously concerned about why we arrived at this position in the first place. The then Administration introduced a contract in 1990, but there was a 7 per cent. cut in 1992. The Conservative party currently supports a 20 per cent. cut, which would make things worse for the people of Sleaford. We have 17 dental access centres in rural areas and investment is being made to improve access. That will benefit the right hon. and learned Gentleman's constituents.
Mr. Andrew Turner (Isle of Wight): Is the Minister aware that a mother in Freshwater in the west of my constituency cannot access an NHS dental practice unless she travels to Southsea, which involves public transport by way of bus, train and ferry? Does he recall the Prime Minister making a promise at the Labour party conference in 1999 that everyone should have access to an NHS dentist within two years? Why has the Prime Minister broken that promise?
Mr. Lammy: The Prime Minister has not broken his promise. We remain committed to that investment. We will improve access by enacting legislation that will propose local commissioning for primary care trusts. Will the hon. Gentleman vote with us on that measure, or will he propose a 20 per cent. cut?
Chris McCafferty (Calder Valley): Will my hon. Friend look carefully at the need for extra funding for primary care trusts, such as the one in Calderdale, that cover large semi-rural areas and face specific problems? There are pockets of need where access to dental care is not available. Those areas do not qualify for extra funding under the current arrangements because they are pockets rather than larger areas of specific need. The Government could help such areas by carefully considering their special needs.
Mr. Lammy: My hon. Friend will know of the recent announcement on allocations; Calderdale will certainly have benefited from an increase. As I have explained, the legislation will enable her primary care trust to ensure better local commissioning and to provide better access for her constituents.