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NHS Dentists

5. Mrs. Annette L. Brooke (Mid Dorset and North Poole) : If he will make a statement on progress in implementing the new contract for NHS dentists. [182185]

The Minister of State, Department of Health (Ms Rosie Winterton): Since the Health and Social Care (Community Health and Standards) Act 2003 received Royal Assent in November, my officials have had several meetings with the British Dental Association about the new contract. Further meetings are scheduled in the next two months. We will shortly be making a further statement on the implementation of the new contract.
 
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Mrs. Brooke: What guarantee does the Minister think she may be able to give that the new proposals will improve access to NHS dentists? That is an enormous concern for my constituents. Given the latest research from the British Dental Association, which found that nearly 60 per cent. of high street dentists are likely either to reduce their commitment or quit the NHS, I seek reassurances from her today.

Ms Winterton: Our evidence that the new contract will work is based on five years of work in pilot sites around the country. We already have about 1,500 dentists coming over to the new system of personal dental services. The hon. Lady will be aware that we worked up the proposals for the new contract with the British Dental Association because it told us that it did not like the current way of working—the treadmill effect. We are changing the system so that all the money that is currently held centrally will go to local level and primary care trusts can plan properly, in conjunction with local dentists, the NHS dentistry that is required in their area.

Mr. John Denham (Southampton, Itchen) (Lab): I thank my hon. Friend for agreeing to visit Southampton on Thursday to discuss dentistry, and may I encourage her to do two things when she does? First, will she do everything that she can to reassure NHS dentists about the nature of the new contract, because the misconceptions about it are one reason why some are considering reducing their commitment? Secondly, I urge her to press the primary care trust to monitor dentists' intentions much more closely, so that it can intervene quickly if there are any signs of dentists planning to leave the NHS for erroneous reasons and fears in particular.

Ms Winterton: My right hon. Friend is right: there are some misconceptions about the new contract. On PCTs ensuring that they are aware of what is happening locally, we have dental leads in every PCT and in the strategic health authorities. Earlier this year, we announced £59 million to improve access, and dental personnel working at PCT and strategic health authority level have access to that money. They can work with local dentists, so that if dentists indicate that they want to leave the NHS, money can be accessed and ways of improving services considered so that they remain NHS dentists.

Dr. Andrew Murrison (Westbury) (Con): These are not just misconceptions. The dental profession seems to be united in its opposition to the new dental contract. Why does the Minister think that that is so? Could it be that, with nine months to go until the start of the contract, we have yet to be given the details of it? Could it also be because nine out of 10 dentists believe that PCTs are not up to the job of managing that contract, as the National Audit Office also seems to think?

Ms Winterton: One problem is that dentists were completely united against the contract introduced by the previous Administration and we have had to pick up the pieces resulting from that. On dentists' attitude to the new approach, 1,500 dentists are moving over to the new system and they say that they like the new way of
 
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working. The chairman of the British Dental Association said that there are many happy practitioners working under the new system—a fact that we should be celebrating. We have put together the dental work force review and worked with the BDA on the new contract—the new way of working—which, as we have demonstrated, is working after five years of piloting. I had hoped that the hon. Gentleman would support the action that we are taking, particularly given that we are putting right the problems created by his Administration.

Breast Cancer Screening

6. Mr. Bill Tynan (Hamilton, South) (Lab): How many women have benefited from the extension of the breast cancer screening programme to those aged between 65 and 70 years. [182186]

The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): Over 250,000 more women have been invited for breast screening in England since the extension to women aged 65 to 70 began in April 2001.

Mr. Tynan: My hon. Friend will know that statistics show that currently, a third of all women aged over 70 suffer from breast cancer. Although I congratulate the Government on extending the programme to those aged 70, will she consider a further extension to take into account giving an automatic recall to those aged over 70?

Miss Johnson: We have looked at the evidence on screening for the over-70s and the Advisory Committee on Breast Cancer Screening is currently reviewing it. However, there is little evidence to suggest that screening would be effective for that age group; indeed, I understand that no major country offers routine screening for the over-70s. It is possible, however, for women aged over 70 to continue to be screened, and such screening is already freely available. Women who have participated in the programme will be informed of that right at the age of 70.

Gregory Barker (Bexhill and Battle) (Con): The expansion in screening is to be greatly welcomed and it is to the Government's credit, but for women suffering from breast cancer it is by no means the whole picture, particularly if follow-up care is not available. In my part of the world, we are extremely worried about the situation at the Maidstone and Tunbridge Wells NHS Trust, the chief executive of which wrote to all Members of Parliament in our area. He said that waiting times for breast cancer patients needing radiotherapy is now an urgent issue, and that

"waiting times have started to increase for all patients who require radiotherapy treatment, the longest waits now being for those with . . . breast cancer".

This is not a new problem; we experienced it two years ago, and the numbers started to come down. Will the Minister undertake to get in touch with the trust to see what can be done to help tackle this very important problem?
 
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Miss Johnson: As the hon. Gentleman said, we have improved outcomes enormously through the screening programme. About a third of cancers are being detected in this way and we have detected 1,500 extra cancers through the programme in the last couple of years. I welcome his congratulations on the work of staff across the country, including, no doubt, his constituency. To a degree, we are the victims of our own success: as a lot more women are identified, a lot more women need treatment. There is a maximum waiting time for front-line treatment and, in terms of follow-up treatment, we have doubled the number of radiography training places and increased the number of clinical oncologists by a quarter since 1997. We recognise that there is still more to do to address the issues raised by the hon. Gentleman, which is why we have asked the national cancer director to undertake a stocktake on the issue.

Dr. Jenny Tonge (Richmond Park) (LD): "Celebrate" seems to be the in word this morning and I do celebrate, if modestly, the huge improvement in detection and treatment of breast cancer in this country; that should be recognised. However, the causes of heart disease are now well known and much has been done to prevent heart disease. What resources are we putting in to the causes of breast cancer so that we can prevent this terrible disease and not just treat it when it occurs?

Miss Johnson: I welcome the hon. Lady's congratulations on and support for the achievements so far. A number of research programmes are going on, but we already know that some things will reduce people's risk of getting cancer—including breast cancer—such as eating five pieces of fruit or vegetables a day. The hon. Lady screws up her face, but such things clearly improve outcomes across the board in relation to several cancers and coronary heart disease. There are a number of things that people can do already such as undertaking more physical activity, and we will come to those as part of the White Paper in the autumn. I am happy to undertake to write to the hon. Lady on the details of the research programmes.

Mr. John Baron (Billericay) (Con): We welcome any extension of the breast cancer screening programme, but the fact remains that three quarters of all breast cancer cases are still diagnosed through the GP referral system, with which there are a number of problems. For example, whereas the Government's two-week target for women urgently referred by their GP to see a specialist is being met, Breakthrough Breast Cancer, among others, has pointed out that something like 10,000 women each year are routinely referred by their GP and subsequently misdiagnosed with breast cancer. Those women have to wait, on average, six to eight weeks—and, in some cases, up to 17 weeks—to find out whether they have breast cancer. The Government's two-week target is not helping the large number of women who are, in effect, misdiagnosed because they have been routinely referred and who must wait much longer to see a specialist at a time when they may be suffering much anxiety and stress. That also puts GPs in a difficult position, as around half of them have expressed the view that they find it difficult to distinguish between urgent and routine referrals, upon which so much depends. What is the Minister going to do to correct this lottery in breast cancer care?
 
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Mr. Speaker: Order. Before the Minister replies, I want to explain that when I call Front Benchers, it means that Back Benchers will not be called, because I have given Front Benchers that privilege. I therefore expect shorter questions—indeed, I demand them.

Miss Johnson: Obviously, women are hugely better off than they were under Conservative Governments. Presently, 98 per cent. or more of women with urgent referrals are being seen within two weeks. The hon. Member for Billericay (Mr. Baron) dismisses that out of hand, but those are people categorised by their doctors as the most important cases. They are now receiving speedy treatment, which could never have been guaranteed—and, indeed, people did not receive it—in the past, when only a comparatively small percentage were getting hospital referrals within two weeks.

As to the hon. Gentleman's point about non-urgent referrals, we are interested in improving the referral accuracy of GPs. Work is being done on the guidance given to GPs about whom they should and should not refer urgently. Overall, the effect of the Government's policies and investment is hugely positive for women with breast cancer. The outcomes demonstrate that, with more than a 10 per cent. overall cut in cancers reflecting similar cuts in breast cancer mortality across the piece.

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