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Mr. Peter Luff (Mid-Worcestershire) (Con):
On a point of order, Mr. Deputy Speaker. You know how anxious I always am to help the House authorities, so it may interest those responsible for such matters to know
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that the hon. Member for South Swindon (Ms Drown) snuck into the No Lobby as the Doors were about to be locked and took the selection lists. I think she thought that they related to today's amendments and took them to be recycled. Sadly, she took tomorrow's selection lists, so they are now not available to Members in the No Lobby. I hope that you can put that right.
Mr. Deputy Speaker: I note the hon. Gentleman's point and we will see what we can do to rectify the matter as soon as possible.
DELEGATED LEGISLATION
Mr. Deputy Speaker: I propose to put together the Questions on the seven motions.
Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6)(Standing Committees on Delegated Legislation),
That the draft Anti-social Behaviour (Northern Ireland) Order 2004, which was laid before this House on 28th June, be approved.
That the draft Criminal Justice (No. 2) (Northern Ireland) Order 2004, which was laid before this House on 29th June, be approved.—[Paul Clark.]
That the draft European Communities (Definition of Treaties) (Stabilisation and Association Agreement between the European Communities and their Member States, and the Republic of Croatia) Order 2004, which was laid before this House on 21st June, be approved.—[Paul Clark.]
That the draft Motor Vehicles (International Circulation) (Amendment) Order 2004, which was laid before this House on 14th June, be approved.—[Paul Clark.]
That the draft Community Radio Order 2004, which was laid before this House on 15th June, be approved.—[Paul Clark.]
That the draft Representation of the People (Form of Canvass) (England and Wales) Regulations 2004, which were laid before this House on 16th June, be approved.
That the draft Representation of the People (Form of Canvass) (Scotland) Regulations 2004, which were laid before this House on 17th June, be approved.—[Paul Clark.]
Question agreed to.
SITTINGS OF THE HOUSE
Motion made,
That, at the sittings on Monday 19th, Tuesday 20th, Wednesday 21st and Thursday 22nd July, the Speaker shall not adjourn the House until any Message from the Lords has been received, until any Committee to draw up Reasons which has been appointed at that sitting has reported, and until he has reported the Royal Assent to any Act agreed upon by both Houses.—[Paul Clark.]
Mr. Eric Forth (Bromley and Chislehurst) (Con):
Object.
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PETITION
BUPA Seven
6.13 pm
Mr. John Horam (Orpington) (Con): I wish to present a petition on behalf of Eileen Chubb of the BUPA seven and others. BUPA seven is composed of former care workers who spoke out against elder abuse in a care home in Bromley.
That silence is a major contributory factor in elder abuse in care homes and that unless whistleblowers are fully protected, the silence will continue, along with the suffering of those who are unable to speak out for themselves. The Petitioners further declare that the case of the "BUPA Seven" has raised real concerns that the Public Interest Disclosure Act is failing to protect those who speak out in defence of the legitimate interests of others. Amongst these failings is the fact that if the employer contests disclosures then the whistleblower is left in a situation where the only court that can hear the cases has no jurisdiction to hear criminal evidence. The Petitioners further declare that the verdict in the case of the "BUPA Seven" will serve to encourage others not to report cases of abuse, and they note the conclusion of the Health Committee in its Report on Elder Abuse that further measures to make staff aware of their responsibility to report abuse, and to allow them to do this in a confidential manner, may be needed.
The Petitioners therefore request that the House of Commons urge the Government to hold a full public inquiry into the case of the "BUPA Seven" in order to address in full the concerns raised and to ensure that whistleblowers can speak out without fear of reprisal or victimisation and that fear and silence are not encouraged.
And the Petitioners remain, etc.
To lie upon the Table.
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NHS Dentistry (East Staffordshire)
Motion made, and Question proposed, That this House do now adjourn.—[Paul Clark.]
6.15 pm
Mrs. Janet Dean (Burton): I welcome this opportunity to raise the concerns of my constituents who have difficulty in finding an NHS dentist. This problem is not confined to east Staffordshire; nor has it recently arisen. It stems from the reduction of dental training places in the 1980s and the dispute between the dental profession and the Conservative Government in 1992, which led to many dentists moving into the private sector. Those practices that loyally remained with the NHS were placed under pressure by patients moving from dentists who had left the NHS.
It is impossible to determine the exact number of whole-time equivalent dentists offering NHS treatment, because many dentists undertake variable amounts of both private and NHS work. However, the answer that I received in response to a written parliamentary question in March this year showed that the number of dentists per 10,000 population, on a head-count basis, was 2.8 in east Staffordshire, compared with 8.8 in Westminster. Not only do we have a comparatively low number of NHS dentists, but we also have a high demand for regular, routine dental care in east Staffordshire. The uptake rate per hundred of the local population is good compared with the figures for the midlands and for England generally. To some extent, that masks the problems that people have in accessing NHS dentistry in my constituency.
Those problems can arise when people move into the area, or if they fail to attend for a check-up within 15 months of their last appointment. However, a more difficult situation arises when dentists decide to de-register patients en masse. Such a situation arose in Burton in 2001 and, in March this year, two dentists at one of the only two practices in Uttoxeter notified their NHS patients that they would no longer treat them as NHS patients, following their next appointment. The patients were offered the opportunity to join a private dental health insurance scheme. Indeed, it appeared that the notification letters had been distributed by that scheme, as they had been posted in Winchester, where the company is based.
Many of my constituents in Uttoxeter who received those letters were extremely angry because, in many cases, they had been with the practice, and the previous dentist at the practice, for most of their lives. They were angry because they were faced with the difficult choice between joining the private scheme, paying for private treatment or having to find an alternative NHS dentist. Some constituents were also angry because they knew that the dental clinic in question had received investing in dentistry funding in 1999, which had helped to increase the amount of NHS dental treatment available in the town.
It was with great sadness that I reported the decision of those dentists to de-register their patients to the East Staffordshire primary care trust on Monday 1 March 2004, following phone calls from my constituents over the previous weekend. I was particularly saddened by the dentists' decision because I had supported their bid for investing in dentistry funding in 1999. I had also had
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the pleasure of accepting the invitation to open their new premises in Uttoxeter. Somehow, it felt like a kick in the teeth—no pun intended, but there had to be one, did there not?—that they should decide to take a decision that so badly affected so many of my constituents at a time when the Government had recognised the problems with the current general dental service contract and were in negotiations with the British Dental Association regarding a new contract. The receipt of the letters by my constituents followed about a week after I had publicly welcomed the extra Government funding being made available to support dentists in east Staffordshire from the beginning of the financial year. There is something wrong with a system that leaves 3,500 people without an NHS dentist and where a decision taken by an individual dentist affects so many people. I am disappointed that dentists who have stuck with the NHS through all of the years of pressure within the system since the early 1990s should feel the need to cease to treat NHS patients.
Dentists give several reasons for ceasing to treat adults as NHS patients. They claim that remuneration has been inadequate in the past and that the proposals put forward in the new contract do not address the perceived underfunding of the service. They also suggest that patients' quality of care will be compromised under the new proposals. Looking at the reduced opening hours of those practices where dentists decide to leave the NHS, it appears that their quality of life improves, but those constituents who cannot register with an NHS dentist pay the price. Some dental practices in my constituency have remained totally or mainly with the NHS, increasing or maintaining their NHS registrations, and I pay tribute to them for their loyalty and dedication to their patients.
Since 1997, the Government have made dramatic improvements to our health service. In my constituency, that investment has increased the number of people employed at Burton's Queen's hospital by 35 per cent. The number of consultants whom the trust employs has risen from 65 to 92. There are 255 more nurses and midwives, 41 more ancillary staff and a 68 per cent. increase in the number of doctors. There has been an improvement in primary care for my constituents in Winshill, with the opening of a medical centre, made possible by the employment of a GP by the East Staffordshire PCT.
In spite of funding initiatives for dentistry, such as the investing in dentistry and modernising NHS dentistry programmes, the lack of capacity within NHS dentistry in east Staffordshire remains. I know that the Government are committed to tackling the problem. The importance of retaining NHS dentistry for adults as well as for children cannot be overstated. The issue is about not only the care of teeth, but overall oral health and the early identification of wider disease, which is important. Oral health care should not be jeopardised because people cannot afford to pay into private insurance schemes.
In east Staffordshire, we are fortunate that our children have low levels of tooth decay because our water supply is fluoridated—naturally in Uttoxeter, and artificially in and around Burton upon Trent. However,
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we have difficulty in recruiting dentists. I understand that there are currently vacancies for four associate dentists, three in Burton and one in Uttoxeter. The primary care trust has paid for adverts in the "British Dental Journal", but to no avail, and discussions have occurred between the PCT and the Department of Health regarding the recruitment of overseas dentists. Will my hon. Friend indicate the time scale for overseas recruitment and how PCTs can support such dentists?
The difficulties in recruitment have their origins in the decision in the 1980s to close two dental schools and to reduce the number of places at the Birmingham dental school. One reason why we have a particular difficulty in recruiting dentists in east Staffordshire is that we are on the fringe of the west midlands, and some distance from the nearest dental schools in Birmingham, Sheffield and Manchester. There is a tendency for dentists to practise close to the area in which they have trained, because after five years at university they have often developed close ties to that area.
I welcome the Government's commitment to open two new dental schools. May I seek my hon. Friend's reassurance that one of those will be in the midlands, bearing in mind the work force problems in the area? At present, all training of dentists, hygienists and therapists takes place in Birmingham, so not only is there a tendency for them to stay in that area, but local students may be hindered in accessing that training in the first place. There are also concerns about the capacity for dental nurse training in the area, as dental practices in east Staffordshire also report difficulty in recruiting and retaining dental nurses, especially as salaries are higher in the private sector. Can my hon. Friend tell me whether an increase in the local training capacity would assist east Staffordshire?
I commend the efforts of the NHS dentistry support team and the East Staffordshire PCT over recent months in looking for ways to improve the situation in my constituency. Following my representations to the Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central (Ms Winterton), I know that representatives of the new special health authority have been in close contact with Staffordshire primary care trusts and the strategic health authority. I am pleased to say that a new dental access centre has been opened at the Balance street health centre in Uttoxeter for two days a week. That will complement the full-time service at Cross street clinic in Burton and help many people who are displaced by the deregistration of NHS patients to access urgent treatment and pain relief.
The East Staffordshire PCT has been in discussions with three local dental practices over their potential transfer to personal dental services contracts in advance of the move to local commissioning in April 2005. They are also in negotiation with five practices over grants under the general dental services initiative scheme. I am pleased that the Government made £113,000 available for 2004–05 to East Staffordshire PCT for that purpose. That will help to stabilise capacity at some practices and help others to expand. Will my hon. Friend say whether East Staffordshire PCT could be considered in any further round of funding available through the dentistry support team? Will he also confirm when PCTs are likely
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to receive their indicative dental services budget, which would allow them to test the requirements for live commissioning in 2005–06?
I turn to the funding arrangements from 2005. I understand that my hon. Friend the Minister of State has made a commitment to the British Dental Association that
"if any dentist wishes to increase his or her NHS commitment now or in the run-up to the new arrangements we will fund that extra commitment and make sure their PCT is adequately resourced to sustain that funding level under the new contract."
If it proves difficult to fill vacancies for some months, will it still be possible for the necessary funding to be made available to PCTs for the three years from 2005? Indeed, will the historic inequalities in NHS provision be addressed in the funding of dentistry through primary care trusts from next year?
Can my hon. Friend assure me that it will possible to avoid a postcode lottery in dentistry in future? There is a fear that when PCTs are given cash-limited budgets, they will, after the three-year base contract guarantee period has ended, be forced to prioritise what is commissioned in order to maximise the impact of funding. That could mean that some traditionally provided services might no longer be supported if PCTs are to address the challenges on access of service and oral health inequalities. It is likely that PCTs will vary in the decisions they take at that time.
I am aware that the Secretary of State for Health is due to set out the Government's plans to strengthen NHS dentistry tomorrow. I hope that that announcement and my hon. Friend's response today will give reassurance that the problems in NHS dentistry that we have seen for many years can be overcome. I hope that dentistry provision can experience the same expansion that has taken place in other sectors of the NHS. I believe that if we can increase the number of NHS dentists in east Staffordshire and elsewhere where there are shortages, more people will be treated as NHS patients rather than as private patients or through private insurance schemes. We may then see the end of the downward spiral, and some of those dentists who have left the NHS may choose to return to the fold.
6.28 pm
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