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The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I congratulate my hon. Friend the Member for Burton (Mrs. Dean) on securing this important debate on NHS dentistry in east Staffordshire, on the interest she shows in these important matters, and on the constructive way in which she put her case. I sympathise with her and understand how she feels let down by those dentists who have taken the NHS shilling in order to expand their practice, then decided to abandon the NHS.
I am well aware of the keen interest that my hon. Friend takes in access to dentistry in her area. I know that she raised the matter with the Secretary of State at oral questions last week, as she has on other occasions, and that she has written to the Minister of State, my hon. Friend the Member for Doncaster, Central (Ms Winterton), on the subject. I want to address not only the specific issues that she raised, but to talk about the programme of action that is under way nationally to reform the overall system. First and foremost, as my
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hon. Friend said, my right hon. Friend the Secretary of State for Health will make an announcement tomorrow that will detail the Government's plans for improving access to dental services in future. I know that she is eager to hear that announcement, but I hope that she will forgive me if I do not let the cat out of the bag, as that would not do my career any good at all.
The oral health of the population has improved enormously since the NHS was set up, and the number of dentists has increased year on year. There are now more dentists than ever before—more than 19,000 dentists provide NHS care, compared with just 15,411 in September 1992. While the number of dentists has been going up, we accept that the commitment of dentists to the NHS has fallen. As a result, in some areas people have difficulty accessing NHS dentistry, despite the fact that the Government have increased dentists' fees in line with the doctors and dentists pay review body recommendations, resulting in an increase in fees of 32 per cent. since 1997. We accept that some areas have a serious shortage of NHS dentists. The problem is not new, however, and has its roots in the actions of the previous Government, including the contract debacle of 1990 that led to a fee cut in 1992 and caused dentists to start to move away from NHS dentistry. That might explain how the problems came about but, of course, it does not help us to make progress and solve them. One set of clauses in the new Health and Social Care (Community Health and Standards) Act 2003, however, which was welcomed by Members from all parties in both Houses, covered the reform of NHS dentistry, and represents the most significant reform of dentistry since NHS dental services were established in 1948.
The reform will provide a better deal for patients, dentists and the NHS. It will allow dentists to spend more time with patients and provide patients with the dental care that they need. Our policy, therefore, is not to maintain the status quo but to rebuild NHS dentistry and provide a more up-to-date legal framework that will better allow primary care trusts to develop and plan those services strategically. It will enable services to be more responsive to patient needs while improving the working lives of dentists and their teams. The general principles of the new primary dental service were set out in the report "NHS Dentistry: Options for Change", which was published in August 2002. One of its key recommendations was for the local commissioning of a high-quality dental service. It proposed that funding should be devolved to the local level to allow PCTs to secure the provision of a new service. The implementation of the Health and Social Care Act 2001 will enable those changes to be made.
The existing patterns of NHS expenditure on dentistry reflect the varying willingness of dentists to treat NHS patients. However, we need to move to a system in which the NHS locally decides what is necessary to meet the needs of the local population, and the new arrangements will enable us to do so. Under the new system, we are giving PCTs the responsibility for £1.3 billion of financial resources that are currently held centrally. We have transferred decisions about the commissioning of local services to the local level. At the same time, current spending will be protected. The devolved funding will be used to commission more dentistry locally, for example, through extra sessions for NHS patients. In the short term, however, we accept
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that there are serious problems with access. Since last year, we have provided new investment totalling £90 million to support PCTs as they get to grips with the new agenda, of which £59 million will support access and £30 million will support IT. The balance of £1 million will support organisational development locally.
In my hon. Friend's constituency, East Staffordshire PCT is working closely with Shropshire and Staffordshire strategic health authority. They are being supported by the Department of Health in their efforts to improve local dental access by using their share of the access funds—some £1.4 million in Shropshire and Staffordshire in 2004–05. We also aim to bring more dentists back to practice after a career break, and have recently placed advertisements in the national press. The keeping in touch scheme is designed for people on a career break who want to return to practice. We have also begun to recruit dentists from abroad, including Europe and further afield.
It is not just about dentists but about the whole dental team. We have already increased training places for dental therapists from just 50 to 200, and the first newly trained therapists will be entering the work force in autumn 2006. In addition, there are a number of avenues available to support the training of dental nurses. We are exploring how best to make those more readily accessible to dental practices.
In the longer term, NHS funding allocations for dental services will need to take oral health needs into account, as general NHS allocations currently do in relation to general health needs. We already have the experience of five years of local commissioning of dentistry under the personal dental services pilot programme, where resources are devolved to the front line. The pilots, now treating 750,000 people a year, have shown what works well and what works less well. The field sites are building on that learning experience to refine a simple but robust base contract, which all PCTs and dentists can have in place for 2005. PCTs are already building up relationships with their local dentists, and we are confident that devolving commissioning responsibility for dentistry to PCTs will enable areas to tailor more appropriate local solutions to any particular access issues that they may have.
I appreciate the real concerns that my hon. Friend has raised, and can well understand that her constituents may be worried that they will have to wait for those changes to come into effect. East Staffordshire PCT is aware of the problems that local people are having in accessing NHS dental services. At the moment, there are two practices in the area, one at Burton, and the other at Uttoxeter, which are accepting new NHS patients. I am informed by Shropshire and Staffordshire strategic health authority that in the past both of those practices have been forced to stop accepting new registrations due to the high demand.
Mrs. Dean:
My hon. Friend might like to be aware that although one of those practices is accepting new patients, there is a waiting list of several months before someone can see a dentist and join the list properly.
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Dr. Ladyman: I accept that point entirely, and that is why the local PCTs are working so hard to try to address those issues.
While there are dentists in other PCT areas that may have been able to take some of the demand, it is recognised locally and by me that that does not really tackle the underlying problem. The PCT has therefore been working hard to develop a range of local solutions to those difficulties. For example, the PCT has commissioned a dental access centre in Burton, and dental access centre services are now available for two days a week in Uttoxeter. The PCT has used previous grant initiatives to support local practices under the investing in dentistry and modernising NHS dentistry programmes.
The PCT received £113,000 in grants for 2004–05 under the general dental services initiative scheme and is in negotiation with local dental practices about stabilising and expanding capacity. The PCT is also looking into pooling its £11,000 share of salaried primary care dental service capital funding with other PCTs in Staffordshire in a fund of £55,000, which can be used to improve premises and efficiency across the area.
The PCT is also in discussion with three dental practices about the potential transfer to personal dental services arrangements in advance of the move to local commissioning in 2005. It is hoped that that will stabilise practices, which otherwise could move further towards private treatment. Work is also under way within the PCT to establish the extent of inequalities in dental health between affluent and relatively deprived communities. In addition, the Department of Health is working closely with local NHS organisations to ensure that they have appropriate support. With the additional funding from the Department, PCTs are now in a position to develop firm plans for the future and are now developing dental action plans to set out how they will use that additional funding.
I have listened carefully to all of the issues raised by my hon. Friend today. At a national level, a reform programme is in hand, and national support is being provided to those areas that are most challenged until those reforms are safely in place. I know that my hon. Friend wants more practical action, however, so I am happy to announce that further support should soon be available to east Staffordshire from the Department of Health. The Department's dental support team has just decided its next programme of visits, which will include east Staffordshire. The Shropshire and Staffordshire SHA, including the East Staffordshire PCT area, will be prioritised for around 10 of the next tranche of dentists who will shortly be recruited from Europe by the Department of Health. I am pleased to tell my hon. Friend that as a result of her campaigning, and that of her Labour colleagues in the area, two have been identified for specific vacancies in East Staffordshire PCT.
I hope that that additional help will please my hon. Friend and, of course, her constituents. The changes will take time, but the framework is in place, and the extra investment and support from the Department should enable much-needed improvements in dental services to be delivered in east Staffordshire.
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