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Tariff-based Trust Funding

5. Steve Webb (Northavon) (LD): What assessment he has made of the effects of his proposals for tariff-based funding of NHS trusts on the financial position of (a) the North Bristol NHS Trust and (b) the South Gloucestershire primary care trust. [195003]

The Minister of State, Department of Health (Mr. John Hutton): NHS trust income will move to tariff-based funding by 2008–09. Financial modelling on the impact for NHS providers will be completed by December. For primary care trusts, the introduction of payment by results will be cost neutral.

Mr. Webb: I am not sure that that response told me anything. North Bristol NHS Trust has run up cumulative deficits in excess of £40 million in the past few years and is now undergoing financial recovery, which involves some difficult decisions about current services. The movement to tariff-based funding will affect a relatively high-cost trust particularly badly coming on top of financial recovery. I am aware that the Minister plans to phase in the move to tariff-based
 
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funding but will he pay particular attention to trusts that are in financial recovery, lest he wreck the very financial recovery that they are trying to achieve?

Mr. Hutton: Yes, we will certainly do that.

Health Check-ups

6. Simon Hughes (Southwark, North and Bermondsey) (LD): What plans he has to provide the opportunity for a regular NHS health check-up for NHS patients in England. [195004]

The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): NHS patients already have the right to request a health check-up from their general practitioner if they have not been seen by their GP in the previous three years. People aged 75 or more can request a check-up if they have not been seen by their GP in the previous year.

Simon Hughes: I am grateful for that reply. While I share the Secretary of State's view that the last thing we want is a nanny state, will the Minister tell us how her proposals will ensure that the people who are most vulnerable and least likely to go to see a doctor are encouraged to have the check-up? What is the difference between the policies this month and the ones that were announced by the Prime Minister in July 2000?

Miss Johnson: We accept that people want more support to improve their health and we are looking at a range of ways to do that, which will be announced in the White Paper. My hon. Friends have also made some announcements in relation to health checks for people with mental health and learning disability.

Mr. David Chaytor (Bury, North) (Lab): Does my hon. Friend accept that, if a regular health check is good enough for Members of Parliament, it should be good enough for every citizen in the United Kingdom, and that this is the biggest single change that could bring about the transition from a national sickness service to a national health service? What more can the Government do to encourage GPs to take such screening seriously?

Miss Johnson: We have just undertaken the biggest ever consultation on prevention and public health and there will be a White Paper coming out before the end of the year. I am sure that that will address the point that my hon. Friend has made. In addition, the contract itself already incentivises quality checks, and GPs are already operating within that new framework.

Mr. David Tredinnick (Bosworth) (Con): Does the Minister not think that these health checks should look carefully at the likelihood of allergies developing, given that some 250,000 children in this country suffer from
 
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them? A Health Committee report was highly critical of the Government's ability to deal with allergies. What is she going to do about this issue?

Miss Johnson: The chief medical officer and the Secretary of State will look at the Health Committee's report very carefully over the next few weeks, and we will publish a detailed response as soon as possible.

Mr. David Kidney (Stafford) (Lab): With advice, we can all do more to look after our own health through a healthy diet and regular exercise. When will the new White Paper on healthy living be published?

Miss Johnson: Before the end of the year.

Chiropody

7. Mrs. Jacqui Lait (Beckenham) (Con): What measures he is taking to improve access to chiropody services. [195005]

The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): An increasing number of chiropodists are working in the NHS and entering training. Since 1999, the number of qualified chiropodists and podiatrists employed in the NHS has increased by 13 per cent., and the number of students has increased by 33 per cent.

Mrs. Lait: The Minister's robust defence of NHS chiropody provision is interesting, but if what he says is so, why are so many people being forced to leave the NHS and to go private for chiropody?

Dr. Ladyman: People are not being forced to leave. Many primary care trusts are choosing to focus specialist podiatrist services on those in greatest need, while organising other methods of access to services such as nail cutting. That is the change that is taking place, and it is a perfectly rational one.

Mr. Andrew Miller (Ellesmere Port and Neston) (Lab): I accept my hon. Friend's point that the change is a rational one, but does he agree that somebody who is suffering pain as a result of such a condition should not be excluded from NHS treatment?

Dr. Ladyman: Yes.

Mr. John Baron (Billericay) (Con): Despite what the Minister says, the latest Government figures clearly show that the number of patients receiving chiropody care in the NHS has fallen significantly in recent years, and that many hundreds of thousands of mostly elderly patients are being denied any form of NHS foot care altogether. The Society of Chiropodists and Podiatrists has confirmed that many patients are simply being bumped off waiting lists. I put it to the Minister that there is a lottery in chiropody care, as a result of which many elderly patients are needlessly suffering. Will he now stop blaming the PCTs, which have to juggle a number of Government targets and priorities—chiropody is not one of them—stop ignoring the situation, and do something to put it right?
 
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Dr. Ladyman: It sounds to me like the hon. Gentleman is asking for a target. The figures that we collect cannot be used in any way, shape or form to draw the conclusions that he draws, which are a complete distortion of, and misuse of, those figures. What the statistics do show is that the level of access to chiropody services is stable and has been for many years.

NHS Dentistry

8. Mr. George Mudie (Leeds, East) (Lab): If he will make a statement on the numbers of NHS dentists. [195006]

The Minister of State, Department of Health (Ms Rosie Winterton): More than 19,300 dentists currently work in general dental services and personal dental services, but not all have a full-time commitment to the NHS. That is why we are increasing that figure by 1,000 whole-time equivalent dentists by next October, and increasing the number of dentists in training by 25 per cent.

Mr. Mudie: I thank the Minister for that reply. Faced with the latest withdrawal from the NHS of a large dental practice in my constituency, I have been saddened by the PCT's slowness in assuring patients that replacement NHS facilities will be provided, and its slowness in telling them that they should not sign expensive private dental treatment contracts. Will the Minister join me in reassuring my constituents in that regard, and in helping to persuade the PCT to act a little quicker and more positively in dealing with their genuine concerns?

Ms Winterton: I certainly sympathise with my hon. Friend's point. Sometimes a PCT's ability to communicate with patients can depend on the amount of notice given by the dentist, and dentists do not always stick to giving the amount of notice that should be given. I am sorry that the practice has decided to leave the NHS, particularly when we are putting significant new investment into the service. I also understand, however, that the PCT has made arrangements for other dentists across the east Leeds area to take on additional patients. All the patients deregistered by that practice will be able to find a new dentist. I accept my hon. Friend's point about ensuring that PCTs move quickly in such circumstances.

Dr. Richard Taylor (Wyre Forest) (Ind): Despite the Minister's assurances about numbers, the availability of NHS dentistry to our constituents does seem to be declining. Has that been mirrored by a decrease in spending on NHS dentistry?

Ms Winterton: One of the difficulties that arose in the past when NHS dentists moved away from the service was that the money reverted from local to national level. In changing how the contract operates, we are now trying to ensure that, if a dentist leaves the NHS, the amount of money that he would have been paid remains at local level. That will stabilise the situation. On top of that, we have also announced an extra 20 per cent. of growth money—something like £368 million—that will
 
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go into NHS dentistry from October next year. Putting in those very necessary extra resources will bring about a vast improvement in the position.

Andy Burnham (Leigh) (Lab): May I tell the Minister about the shock that hundreds of patients in Leigh felt when, without warning, they received a letter from their dental practice announcing that it was opting out of the NHS and that patients would have to pay £15 a month? As she knows, my constituency, like hers, is not an area where most people are readily able to afford such fees. I would make two suggestions. We could have more salaried dentists, making it easier to control their work load, or we could have much more widespread water fluoridation and put all these dentists out of business.

Ms Winterton: My hon. Friend is absolutely right on the first point. When we move towards local commissioning, we are able to increase the number of salaried dentists because local PCTs will be able to make a judgment about what is most appropriate for their area. On the second point, I know that my hon. Friend feels passionately about fluoridation. He is right that, where water fluoridation is introduced, we expect the number of children with no dental decay to increase by about 15 per cent. within five to 10 years. As he knows, strategic health authorities are now looking into the wishes of local populations and we shall be setting out regulations soon. I am sure that my hon. Friend will continue to play an active part in promoting water fluoridation in his constituency.

Mr. James Gray (North Wiltshire) (Con): Dentists covering the area of Box and Colerne in my constituency have recently joined a long string of dentists who have completely withdrawn from the NHS. That means that there is simply no NHS dentistry available at all in large parts of my constituency. Does the Minister remember that on 28 September 1999 the Prime Minister promised at the Labour party conference that an NHS dentist would be available for all who wanted one within two years—in other words, by 2001? Will the Minister now update us on when the whole population of Great Britain will have access to an NHS dentist?

Ms Winterton: As the hon. Gentleman probably knows, we have set up some 47 dental access centres, increased the availability of one-off and emergency treatments for patients, and provided the option to ring NHS Direct, so people can access a dentist. However, the situation is unsatisfactory, as I would be the first to accept. That is precisely why we are taking the measures that we are at the moment. SDA estimates mean that approximately 700,000 extra places will be found by using short-term access money. We estimate that the overall figure is about 2 million, but as we move to local commissioning, we are confident that it can be achieved.

Ms Joan Walley (Stoke-on-Trent, North) (Lab): May I tell my hon. Friend that Stoke-on-Trent has been identified as an area where more NHS dentists are urgently needed? There is now a proposal for an outreach teaching centre in Stoke-on-Trent under the auspices of the Birmingham dental school. Will she take account of the urgent need to establish such a training centre for new dentists in the town as soon as possible?
 
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Ms Winterton: Outreach centres are certainly an issue we have been looking at. A lot of evidence suggests that dentists tend to cluster around dental schools, so in considering training it is important to look at how we can put people into different areas. I have had some discussions about that with the chairs of the dental schools, and proposals will be put forward. A working group has been set up between the Department of Health and the Department for Education and Skills to look at some of the issues, and I shall make further announcements shortly.

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