House of Commons
Tuesday 9 December 2003
The House met at half-past Ten o'clock
PRAYERS
[Mr. Speaker in the Chair]
Oral Answers to Questions
HEALTH
The Secretary of State was asked—
Worcestershire Health Economy
1. Mr. Peter Luff (Mid-Worcestershire) (Con): If he will make a statement on the financial situation of the Worcestershire health economy. [142542]
The Minister of State, Department of Health (Mr. John Hutton): Primary care trusts in Worcestershire will receive a total increase of £118.9 million over the next three years, representing a cash increase of more than 30 per cent. All primary care trusts in Worcestershire are forecasting financial balance for this financial year. However, as the hon. Gentleman will know, discussions are continuing between the strategic health authority and Worcestershire Acute Hospitals NHS trust to ensure that the trust achieves financial balance over the next two financial years.
Mr. Luff : I am grateful for that answer. The Minister will know that the budgetary problems of the South Worcestershire primary care trust, which were caused at least in part by an obligation to meet centrally imposed targets, led to significant cuts in local health services early this year. As the Worcestershire Acute Hospitals NHS trust struggles with its own precarious financial position, caused in part by an obligation to meet the new waiting time targets, can the right hon. Gentleman assure me that there will be no further cuts to patient services in Worcestershire, and that the new GP contract will be fully implemented?
Mr. Hutton: Yes. There will not be any cuts in front-line health care services in Worcestershire—quite the opposite: we are looking to expand health care services in the county because there is a need for that. The new GP contract will be fully funded and it will be properly implemented, as we have repeatedly made clear. We are trying to address the issues, of concern to the hon. Gentleman and many others in Worcestershire, affecting the hospitals trust. That task would be greatly furthered if we had the hon. Gentleman's support for the additional investment that we are providing.
Mr. Michael Foster (Worcester) (Lab): Has my right hon. Friend made an assessment of the impact on the
finances of the Worcestershire health economy of diverting cash from the NHS to pay for tax relief on private medical insurance?
Mr. Hutton: Yes, I have made such an assessment—and it would wipe out the additional £118 million of investment, so I really do not think that the Conservative party's proposals would help to enhance the NHS in Worcestershire. Indeed, they would make the job of the NHS in Worcestershire immeasurably more difficult.
Sir Michael Spicer (West Worcestershire) (Con): When will work begin on the long awaited new hospital in Malvern in Worcestershire? If the Minister does not know the answer to that, will he write to me about it by the end of the week?
Mr. Hutton: I do not know the answer, but as the hon. Gentleman has asked me to, I will write to him by the end of the week.
Mr. Tim Yeo (South Suffolk) (Con): Are not the people of Worcestershire being let down by the Government? Tax is up, spending is up, but activity has barely increased. Only six days ago, the NHS chief executive admitted that average waiting times are getting longer. Last year only one patient in 400 was able to exercise choice and then only if they had been waiting for more than six months. Against that background and in view of the delays to the NHS information technology project, will the Minister confirm that the promises made this morning by the Secretary of State in No. 10 Downing street about increasing patient choice are just pie in the sky?
Mr. Hutton: No, I would not accept that, but I welcome the hon. Gentleman to his new responsibilities. There are no delays to the NHS IT programme, which will be delivered and implemented on time—because of the additional investment that we are putting into the NHS, which the hon. Gentleman is obviously not prepared to match. As to waiting times, they are falling, rather than rising as they did under the previous Government. Given the hon. Gentleman's desire to represent a new type of politics, he might have had the courtesy and the manners to acknowledge that in the House today.
NHS Dentistry
2. Mr. Colin Breed (South-East Cornwall) (LD): If he will make a statement on his Department's proposals to improve access to NHS dentistry. [142543]
The Minister of State, Department of Health (Ms Rosie Winterton): The Health and Social Care (Community Health and Standards) Act 2003 is the most radical reform of NHS dentistry since 1948, and means that the £1.2 billion currently held centrally will be devolved to primary care trusts to commission NHS dentistry. In the meantime we have allocated £59 million to improve access to NHS dentistry where there are currently acute short-term problems.
Mr. Breed : I thank the Minister for that response, but her predecessor told me in January that the Government
would indeed strive to put more investment into NHS dentistry services in Cornwall. We have seen no visible evidence of that. Indeed, children are now being deregistered from NHS dentistry. Such inequity cannot be allowed to continue on. Can the Minister direct any specific investment into areas such as Cornwall so that NHS dentistry can be brought up to at least the average in the UK nationally?
Ms Winterton: I understand the points that the hon. Gentleman makes and, in the longer term, we will radically overhaul NHS dentistry. However, in the meantime, we have set up 22 new dental clinics in Cornwall since 1998. They provide treatment on the NHS to people who are not registered with an NHS dentist. We are also considering the hon. Gentleman's area as one of the pilot areas for the new system of local commissioning of NHS dentistry, so that we can ensure that dentists stay with the NHS and encourage others to return to it.
Mr. Peter Pike (Burnley) (Lab): My hon. Friend will know that Burnley is one of the worst places in the country for obtaining NHS dental treatment. There is a gaping hole in provision. We welcome what the Government have done and the changes that will take place in 2005, but what can be done to provide urgent dental treatment on the NHS for people who need it now?
Ms Winterton: I refer back to the £59 million that I have announced in the past few months that will be used to address exactly the problems that my hon. Friend mentions. That will happen through the NHS support team, which is funded by £9 million, backed up by around £35 million in revenue support. The NHS support team visited my hon. Friend's area in August, October and again in November. A local action plan is being drawn up to address some of the real problems that I know exist in his area and I will let him have further details in due course.
Mr. Hugo Swire (East Devon) (Con): When the Minister wrote to me in answer to a query that I raised about the critical state of dentistry in east Devon, she mentioned the figure of £65.2 million to support the changes. I notice that this morning that figure has fallen to £59 million. Does the Minister agree with me and my constituent Dr. Kenneth Croft that there is no point in improving access to dentists if they do not exist in the first place? Will she consider ensuring that some of the new money is spent on general dental practitioners, who are at the forefront of dentistry, rather than on IT training, recruitment and so forth?
Ms Winterton: Some of the money will go to dentists in general dental service. That is the whole idea. Some of the money can be used for capital expenditure—for example, if a dentist wishes to expand the surgery area or provide extra facilities in the clinic. In terms of revenue, extra money can be spent on more sessions for NHS patients. In the longer term, we are reviewing the dental work force to ensure that we have more trainees and encourage more people to return to dentistry, especially women. Overall, the hon. Gentleman should
remember that this state of affairs arose because of the way in which the Conservatives behaved in the 1990s, which led to NHS dentists—
Mr. Speaker: Order. I call Ian Lucas.
Ian Lucas (Wrexham) (Lab): Will my hon. Friend join me in condemning those many dentists, some from the Wrexham area, who have unilaterally withdrawn from NHS practice? What sort of professional sends a patient of 20 years' standing a letter to say that they can no longer treat him unless he signs up to a private dental plan? That is disreputable behaviour. It is time that such dentists recognised that they have a professional obligation to offer health care, not just to seek private profit.
Ms Winterton: Dentists are independent contractors and, as such, they have the absolute right to withdraw their services if they wish to do so. The problem has been not necessarily the amount that dentists are paid but the way in which they are paid, leading to the treadmill effect of the current system. We are changing that round so that the money that is held centrally will be devolved to local level. The system of payment will change, and we believe that that will encourage more dentists to stay in the NHS and encourage more to join it in the first place.
Mrs. Patsy Calton (Cheadle) (LD): Now that more than half the population are not registered with an NHS dentist, it is clear that access is not the whole story. What will the Government do to ensure that more people are registered with an NHS dentist?
Ms Winterton: Only some 5 per cent. of dentists offer only private care. Some 60 per cent. of dentists provide some 90 per cent. of NHS care. However, the hon. Lady is right to point to a problem. We need to improve access and encourage registration. The measures that I have outlined—including devolving money held centrally to local level, allowing local commissioning and addressing the issue of the dental work force—will change the situation round. It will be a radical overhaul of the present system.
Mr. Stephen McCabe (Birmingham, Hall Green) (Lab): Cosmetic teeth whitening is, I understand, a simple but costly procedure much beloved of some Opposition Front-Bench Members. Is cosmetic teeth whitening available on the NHS and, if not, how much would it cost the NHS, and what would be the impact on availability, if it were to be provided under the patients passport that the Opposition love?
Ms Winterton: If teeth whitening were for purely cosmetic reasons it would not be available under the NHS, which is purely for clinical procedures, unless there had been a recommendation that it was necessary for clinical purposes. I agree with my hon. Friend about the policies of the Opposition; not only will the patients passport undermine the NHS—[Interruption.]
Mr. Speaker: Order. I call Dr. Murrison.
Dr. Andrew Murrison (Westbury) (Con): Deteriorating dental health in the UK is but the latest in
a string of public health disappointments, including tuberculosis, obesity and sexual health, that have become more acute since the creation of the post of a public health Minister. Successive postholders have done little more than tweak management wiring diagrams, from the creation of directorates of infection control to the transfer of responsibility for primary dental care. Does the Minister agree in all candour that in public health terms the Government's impact on preventive oral health has been marginal at best? What comfort can she give the British Dental Association, which has highlighted its concerns to her on repeated occasions?
Ms Winterton: In fact, we are working extremely closely with the BDA. That is exactly why we have come up with our plans. The BDA told us that it did not like the present system of payment, which was introduced by the previous Administration—who, by the way, at the same time cut dental fees by 7 per cent. while we have increased them by 26 per cent. We have worked with the BDA so that the money currently being spent centrally will be devolved to local level. That is what the BDA told us it wants and that is what we are delivering.
Shona McIsaac (Cleethorpes) (Lab): My hon. Friend will know that I have been haranguing Ministers for some time about the appalling problems of access to dentistry in Grimsby and Cleethorpes. For example, a vulnerable adult on incapacity benefit, who cannot obtain NHS treatment, was quoted £500 for fillings, while a pensioner who is in severe pain following an accident and needs urgent treatment can get no treatment, not even private treatment, until the new year. I know that initial discussions on improving access in my area have taken place, so will my hon. Friend tell me what progress is being made to ensure that my constituents have access to good dental treatment?
Ms Winterton: I am well aware of the problems that my hon. Friend has highlighted. She has been as assiduous as ever in bringing them to our attention and I hope that I can offer her some reassurance. The dental support team has made three visits to her area to meet the local primary care trust. As a result, grants have been allocated for about 3,000 extra patients to be registered on NHS dentists' lists, and £50,000 has been allocated for a new service for non-NHS registered patients who need urgent treatment. My Department has also allocated £95,000 to employ full-time salaried dentists in the area. Furthermore, the PCT is working with Sheffield university on a scheme to locate newly qualified dentists in the area. I hope that gives my hon. Friend some reassurance that progress is being made.
3. Mr. Andrew Turner (Isle of Wight) (Con): If he will make a statement on the number of dentists in NHS practice. [142544]
The Minister of State, Department of Health (Ms Rosie Winterton): On 30 September 2003, there were 18,500 dentists in England—up from 16,728 in 1997. We have also undertaken a dental work force review, which we will publish shortly.
Mr. Turner : I thank the Minister for that answer. I am sure that she is aware, because she gave me the
information, that in 1999 41 per cent. of adults in my constituency were registered with an NHS dentist. That figure has now slumped to 30.6 per cent. I have raised this matter with her predecessor. My PCT chief executive tells me that the Department of Health counts the Isle of Wight as
- "amongst the twelve most challenged populations"—
Ms Winterton: I can quite understand why the hon. Gentleman's constituents feel rather challenged. I reassure him that the NHS dentistry support team has, as he suggests, visited his constituency and met the local PCT and the local strategic health authority. It is important that the priorities are agreed at that level because that is how we can improve the system. Of course I understand the point about the hon. Gentleman's constituents. We are very aware of the difficulties that they face, but we have to sort those difficulties out strategically. Not only have those meetings taken place, but a local action plan has been drawn up to ensure that the situation is improved. A recruitment package has been produced. That has been attempted before in the hon. Gentleman's constituency to try to recruit dentists to the area. It was not successful, but that is being looked at again, and emphasis will be put on the fact that the access should not be required off the island and that priority should be given to children. I hope that that will improve the situation.
Mrs. Ann Cryer (Keighley) (Lab): Is my hon. Friend aware that many of my constituents cannot register with an NHS dentist? There are many good NHS dentists in Keighley, but unfortunately, there are none in Skipton, so people from Skipton flood the Keighley area to use our dentists. What help can my hon. Friend offer to my constituency?
Ms Winterton: Again, I can assure my hon. Friend that, through the NHS support team, we are trying to ensure that particularly challenged areas receive extra help. I will certainly ask the support team to consider the points that she makes and to find out whether we can do anything further to assist her area.
Hywel Williams (Caernarfon) (PC): I am the victim of an assault—an assault by treacle toffee offered to me by a seven-year-old at a school Christmas fair. I could find no dentist either in London or in my constituency, and I eventually had to pay £400 for emergency treatment. Given that many hon. Members will shortly risk their dental integrity at school fairs throughout the country, can the Minister assure us that emergency dental treatment on the NHS is available in all parts of the United Kingdom?
Ms Winterton: I can perhaps refer the hon. Gentleman to NHS Direct, which will be able to advise him on the nearest centre where he can get emergency care. That is what we pledged to do: to ensure that
anyone who telephones NHS Direct can get advice on where the nearest source of emergency care is—either through a dental access centre, or through an NHS dentist who provides emergency treatment.
Lawrie Quinn (Scarborough and Whitby) (Lab): My hon. Friend has done much work with the British Dental Association, which she mentioned in an earlier answer, but crucial to maintaining the number of dentists is continued professional post-graduate training. A very good scheme has been developed on the Yorkshire coast in my constituency. Will my hon. Friend take the opportunity in the new year to come and see that work, which I very much congratulate her and her officials on helping to get started?
Ms Winterton: I thank my hon. Friend for those remarks. He is absolutely right. That is why we have undertaken the dental work force review to consider training, recruitment and how we can ensure that more dentists stay in the NHS when they have trained. I would be more than happy to visit my hon. Friend's constituency. The NHS support team has already visited the area to consider ways in which it can improve access for his constituents, following representations that he has made, but looking at some of the schemes that he has outlined would be extremely helpful.
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