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Delayed Discharges (York)

6. Hugh Bayley (City of York) (Lab): How many York Hospitals NHS Trust beds are occupied as a result of delayed discharge of a patient to a care home; and how many were occupied a year ago for this reason. [155723]

The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): York Hospitals NHS Trust has reported 12 delayed discharges for patients awaiting a care home place, compared with 32 a year ago.

Hugh Bayley : Delayed discharge has been a persistent problem in York, affecting at its peak well over 100 people. I have raised this problem with successive Conservative and Labour Ministers, so I congratulate my hon. Friend on getting on top of it and bringing it under control, because it is distressing for the patients involved and their families. Will he continue to monitor the availability and cost of care home beds local authority by local authority, in order to ensure that there are sufficient resources for those numbers, now that they have come down, to be kept down?

Dr. Ladyman: I can assure my hon. Friend that I will keep on top of this problem, and I am delighted that we are having such success in reducing delayed discharges and providing extra capacity in the York area. That has happened not by accident, but as a result of substantial extra investment and the assistance of an expert team of change agents, all of which have been provided by this Government.

Miss Anne McIntosh (Vale of York) (Con): Will the Minister tell us to which period the figures he has just announced relate, given that the latest figures that I have show that 24 beds were in fact blocked? Can he also give us the number of care home places that have been closed in the York district, which also serves the Vale of York, in the past year? Is that figure not a source of concern to him?

Dr. Ladyman: I can assure the hon. Lady that the figures I have just given, as reported by the local trust, are accurate, and are the up-to-date figures for the number of people blocking beds in respect of a care home place. Perhaps she has a different basis for her figures. The simple fact is that across York—throughout her constituency, as well as throughout that of my hon. Friend the Member for City of York (Hugh Bayley)—care home capacity is available as a result of the building care capacity grants that we have made available. There is substantial extra funding for social services to ensure that they can manage delayed discharges; indeed, the entire delayed discharge system is working very well. If the hon. Lady wants further advice on the buoyancy of the nursing home sector, she might like to refer to her right hon. Friend the shadow Secretary of State. The annual stock market reports of the company of which he is chairman describe how buoyant the industry currently is.

Mr. Speaker: Order. These matters are out of order. I expect better from the Minister.

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NHS Dentistry

7. Mr. Desmond Swayne (New Forest, West) (Con): What plans he has to improve access to NHS dentistry. [155724]

The Minister of State, Department of Health (Ms Rosie Winterton): In the past year, we have announced £90 million of investment to improve access to NHS dentistry. In the short term, we are providing support to primary care trusts where there are acute shortages of dentists, and in the long term we are radically overhauling the system so that the commissioning of dentists takes place at local level.

Mr. Swayne : It is now virtually impossible for an adult to secure NHS dental treatment in my constituency, and those who are fortunate enough to be registered are being deregistered as dentists abandon the NHS. Will the Minister consider providing patients with the subsidy that would have been paid had the procedure been available on the NHS, so that they can at least defray the bills that they will incur through having to secure such treatment in the private sector?

Ms Winterton: The hon. Gentleman is right, in that there are particular problems in his constituency, and as he may be aware, we have set up specialist support for areas such as his. The support team has had two meetings with his local PCT, and a follow-up meeting is planned for March. The PCT has been asked to produce a dental action plan to ensure that it is taking steps to rectify the situation. I also undertake to discuss NHS dentistry provision in the hon. Gentleman's area with the strategic health authority chief executive, whom I shall meet next week.

Lawrie Quinn (Scarborough and Whitby) (Lab): I thank the Minister for recognising the acute problems of oral hygiene in my constituency of Scarborough and Whitby. However, all my constituents recognise that the problem lies in the wreckage of the NHS dental service that was the legacy of the previous Conservative Government. What more can she do to recognise the strategic problem of the number of new dentists emerging from our dental schools and ensure that people have smiles on their faces because they have a sustainable dental service not only in Scarborough, but in the rest of the country, too?

Ms Winterton: My hon. Friend is right to say that we are suffering from the problems arising from the closure of two dental schools under the previous Administration. We have conducted a dental work force review to ascertain where the shortages are, and we will publish the results in the near future. We are also looking at how, in the short term, we can secure international recruitment and get some dentists to return to work. We have 12 advisers to examine how we can best encourage people, particularly women, who have taken time out from dentistry, to come back to it. That amounts to a whole series of measures to ensure that we can deal with the issues. I pay tribute to my hon. Friend's hard work in drawing to my attention and that

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of the strategic health authority the problems in his constituency, and I am glad that we have been able to help put some of them right.

Mr. Paul Burstow (Sutton and Cheam) (LD): More than half the population of England is not registered with an NHS dentist, and the position has not improved since 1999. The Government tell us that they are keen to promote dental treatment centres as the answer to the problem, so can the Minister tell us just how far people will have to travel to such centres? Currently, people have to travel many miles to do so. Indeed, we heard earlier that 70-mile journeys are sometimes required for people to get access to NHS dental treatment. Will the Minister tell us the maximum travel distance that an NHS patient should expect to reach a dental treatment centre?

Ms Winterton: We have more dentists than ever before, having increased the number by about 2,000 since we came to power in 1997. The hon. Gentleman mentions dental treatment centres. We have tried to assess where there are particular problems and to provide facilities for emergency treatment. However, we are well aware that that is not the long-term solution, which is to take steps radically to overhaul the system so that the money held centrally is sent down to local level, so that local commissioning can take place. We certainly want to increase the number of dentists in training and international recruitment. As to the specific mileage, guidelines are laid down and I will write to the hon. Gentleman about them.

Mr. Mark Todd (South Derbyshire) (Lab): While the opening of a new NHS dentistry in Swadlincote did not attract quite the queues that newspapers revealed in Scarborough, it still produced many dissatisfied residents who could not register. Even when the list was expanded, some people remained unable to register. Is not the long-term solution to review the contractual relationship between the NHS and dentists to make it more attractive to retain them within the NHS? Currently, temporary fixes are available, but a permanent arrangement surely lies within our grasp.

Ms Winterton: My hon. Friend is right. One of the basic causes of the problem was the new contract introduced by the previous Government, which was followed by a 7 per cent. cut in fees to dentists. That is when dentists started walking away from the NHS. The problem is not the number of dentists in training, but the number who are prepared to commit to the NHS. We need to change the contract, which is exactly what we are doing. Instead of being paid in the current item per fee way, they will be paid on a per patient basis. As I said, that will be combined with commissioning dentistry at local level, so that the money remains at that level and does not return to the centre, as happens at present when an NHS dentist withdraws from NHS activity.

Mr. Tim Yeo (South Suffolk) (Con): In 1999, the Prime Minister turned up at the Labour party conference and promised that everyone would have the chance to see an NHS dentist. In 2000, the Government published the NHS plan, which stated that NHS

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dentistry would be available to everyone by 2001. Both those promises have been spectacularly and shamelessly broken. Will the Minister apologise to those patients who cannot see an NHS dentist and admit that, when it comes to dentistry, people cannot believe a word that the Prime Minister, or any other Minister, says?

Ms Winterton: We certainly know that there is a problem, but we also know its cause. As I said, the previous Tory Government closed two dental schools, imposed a new contract on dentists, and cut their fees by 7 per cent. That was bitterly resented, and it started the trend for dentists to walk away from the NHS. It is no good the Opposition pretending that they have no responsibility for the problem. This Government have increased fees by 26 per cent. We have also increased the number of dentists by nearly 2,000, and next year we will introduce a radical overhaul of the way that dental health is delivered in this country. The Opposition cannot deny their responsibility for starting the problem: we are having to put it right.

Mr. Yeo: Is the Minister aware that, seven years after Labour came to power, the numbers of adults and children registered with NHS dentists have fallen? Is she aware that the British Dental Association has confirmed that the number of dentists in training has remained static throughout the period in which Labour has been in power, and that dentists are moving from the NHS into the private sector at the rate of 1,000 whole-time equivalents every year? Do not all those trends show not only that the Government have broken their promises shamelessly, but that they never intended to keep them in the first place?

Ms Winterton: There are more dentists than ever before. We have increased the number in training from something like 630 in 1997 to 710 last year. We have undertaken a review of the dental work force, and will publish the results soon. However, we know that the situation at present is a direct result of the actions taken by the previous Government, who drove dentists out of the NHS. The problem now is that, even though there are more dentists, more of them are undertaking private work. We have been working with the BDA to change that by introducing a new contract that will overhaul radically the way that dentistry is delivered. However, it is breathtaking arrogance for the Opposition to pretend that somehow they have no responsibility in this matter.

Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): Most people in Britain understand very well that the Government inherited an NHS dentistry system that was in crisis. However, is the Minister reviewing the effectiveness of the NHS walk-in centres, such as the one at Westcroft in my constituency? Might not the added flexibility that those centres give offer a way forward in the current crisis, until we manage to redraw the contracts and tempt dentists back into the NHS from the private sector?

Ms Winterton: With the dental access centres, we have made sure that emergency treatment is available. We recognise that, in areas where there are acute shortages, it is important that people who need emergency treatment can get it as quickly as possible. In almost all

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cases, they can get such treatment on the same day. Of course, we keep under review all the different provision that exists at the moment, from dental access centres and from personal and community dental services.

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