Examination of Witnesses (Questions 120-139)
DEPARTMENT OF
HEALTH, CHIEF
DENTAL OFFICER
FOR ENGLAND,
DEPUTY CHIEF
MEDICAL OFFICER
FOR ENGLAND
14 DECEMBER 2004
Q120 Mr Steinberg: It is easier to win
the National Lottery than to get a dentist.
Sir Nigel Crisp: It is 14 million
to one on the National Lottery. It would be a good quotation on
Today.
Q121 Mr Steinberg: Exactly.
Sir Nigel Crisp: It is not 14
million to 1 to get an NHS dentist.
Q122 Mr Steinberg: You ask my constituents
who cannot get one whether it is easier to win the National Lottery
or not and they will say there is no difference.
Sir Nigel Crisp: Can I be clear
what I have been saying, which is that if you use NHS Direct you
can get access to emergency and urgent care.
Q123 Mr Steinberg: But that is not good
enough. I want to be able to ring up a dentist, as I have done
for 55 years, at least, my parents did it for me and then me since,
and for my own kids to be able to ring up a dentist and say, "I
have got toothache. Can I come and see you?", and they say,
"When can you come?". Now you have got to ring up NHS
Direct, who many people have never even heard of for a start,
and then they have to travel 70 miles to get treatment. Also,
we were told by the previous witness that no dentist would turn
away kids. He is living in cloud cuckoo land because kids are
being turned away in my constituency. I had a woman phone me up
and say that she could not get a dentist for a small child of
about five or six and NHS Direct eventually found her one. That
is not what NHS dentistry is all about. It is about people having
access to a dentist.
Sir Nigel Crisp: I absolutely
agree with you, which is why—
Q124 Mr Steinberg: Then why do you not
do something about it?
Sir Nigel Crisp: We are.
Q125 Mr Steinberg: You are not, though.
Nothing is being done at all.
Sir Nigel Crisp: Your colleague
to your right made the point that we do not want to over-treat
people. We want to introduce a contract which ensures that people
have got good dental health. The other thing in this Report is
that we have got very much improving oral health, the best figures
for children in Europe.
Q126 Mr Steinberg: That is fine. If you
look at paragraph 2.30, it says, " . . . the British Dental
Association surveyed 25,000 dentists and reported that 60% of
the 7,500 dentists who responded would either reduce their provision
of NHS services or opt out of the NHS altogether". We are
talking about 60% of dentists who are thinking of leaving the
NHS or reducing capacity.
Sir Nigel Crisp: You are thinking
of 60% of 30% if you read those figures. A third of the dentists
responded and 60% of those who responded—
Q127 Mr Steinberg: We can assume that
the two-thirds who did not respond are probably in the same boat.
Sir Nigel Crisp: I do not know
about that. We have got 2,500 dentists and getting up to 20% who
are opting for the new arrangements.
Mr Steinberg: It is a bit like the government
saying if 50% do not vote that that is a vote for them. That does
not follow.
The Committee suspended from 5.31 pm to 5.40
pm for a division in the House
Q128 Chairman: Sir Nigel, can you complete
your answer please?
Sir Nigel Crisp: I have forgotten
the question. I beg your pardon: what I wanted to say was that
we said something earlier about bad debts which we do not think
is right. Can I send you a note on that?
Chairman: Of course you can.
Q129 Mr Steinberg: I brought up paragraph
2.30 on page 36 and we were having an argument about whether or
not it is two-thirds or a third. It is irrelevant really, is it
not? Regardless of what the statistics are, the fact of the matter
if that if that number of dentists are going to drop out of the
system you are going to be woefully short of dentists. As I said
before, we are almost in a meltdown situation and that seems to
substantiate it. You are hoping to recruit a thousand dentists
if I remember correctly, but a thousand is not even going to make
a difference to the ones who have dropped out, let alone add further
dentists to the system.
Sir Nigel Crisp: Can I draw your
attention to page 45 of the Report, which is the other side of
this argument, if I may put it like that, where you see a very
interesting curve on that graph. This is the number of dentists
who have not filled in a form on the questionnaire to their association.
This is the number of dentists who have voted with their feet
and signed up contracts. You can see the angle of that increase
there, and these figures are September 2004, and they are people
who have signed up. The figures I mentioned earlier were the people
who have expressed an interest in signing up. There is a considerable
body of opinion out there who are wanting to sign up to the new
arrangements.
Q130 Mr Steinberg: That is fine.
Sir Nigel Crisp: It is.
Q131 Mr Steinberg: But at the end of
the day the number who are wanting to sign up and the number who
will sign up are still going to be woefully short of the number
of dentists that you need. That is obvious.
Sir Nigel Crisp: No, I do not
think it is because the first one was a vote and that you can
take your view as to how likely you think the people in that survey
will follow that through with action. This is what dentists are
doing in practice. In addition to that I am happy to get in at
some point the description of how we are going to secure the thousand
more dentists we believe we need, because we believe we need a
thousand more.
Q132 Mr Steinberg: Somebody else can
answer that question because I want to move on. I think the whole
thing is summed up on page 13 in figure 3. You are making great
play on that thing that you have just shown me to take it as proof
of what is going to happen. I look at figure 3 and think to myself,
"No wonder national dentistry is in the state that it is
in today" because if you have a look at the spending that
has gone on since 1991, not just by this government but the previous
government, we are spending, according to this, less now than
we were in 1992, 12 years ago.
Sir Nigel Crisp: Yes.
Q133 Mr Steinberg: So how on earth can
the system manage and how can all the problems that most of us
have outlined that have taken place recently be solved when frankly
it is quite clear that it is just a matter of resources?
Sir Nigel Crisp: Two things. First,
as it says here somewhere, that figure from 2003 to 2005 goes
up very sharply by 19%. The next figure on the curve goes up 19%.
What you will know from the last 100 of these Committee hearings
on health is that there are a number of areas where we have put
in much more than the average: cancer, for example, and coronary
heart disease. There is a whole series of areas where we have
put in much more expenditure. Dentistry has stayed flat, I absolutely
agree with you, and that is a significant part of the problem,
but we are now coming to the point where we are going to invest
a lot more money in dentistry and in the next two years, again
as this report says, it goes up by 19% which is higher than the
increase in spending during that period.
Q134 Mr Steinberg: Sir Nigel, that is
all well and good, but really—
Sir Nigel Crisp: And true.
Q135 Mr Steinberg: It could well be true
and the Today programme will probably say that as well,
but the fact of the matter is that it has taken you and Professor
Bedi and Professor Halligan—I do not know how long you have
been in your jobs but if I had had this graph when I started my
job I would have looked at it and said, "It is quite obvious
why we have got no National Health dentistry because there is
no money going in". In fact, in 1996 it almost disappeared
off the graph. I am surprised we have any dentists at all.
Sir Nigel Crisp: I am sorry. You
are absolutely right that we have not increased the expenditure
in dentistry at the same pace as we have increased it in areas
that we have given higher priority to and that is why it is below
the average increase in spending, but we need to rectify that.
There are a number of other features that have happened over that
14-year period, including the discussion that was raised earlier
about—
Mr Steinberg: How much have a Permanent
Secretary's wages gone up in that time?
Chairman: I do not think that is a fair
question.
Q136 Mr Steinberg: I was being a little
bit facetious.
Professor Bedi: Can I make a comment,
Nigel? This graph is exactly why we are doing the reforms, because
the low level is because the dentists determine how much NHS dentistry
and how much activities they draw from the open-ended public expenditure,
so the commentary there is that we need these people because of
the present system and the way it works.
Q137 Mr Steinberg: Why has it taken 10
years, Professor, to work out that you need these reforms? If
you look at 1993-94, the expenditure had gone down considerably
and it has never really increased since, so it has taken 10 years
for somebody to come up with this magnificent view that something
needs to be done. In the meantime people cannot get a dentist.
Sir Nigel Crisp: Dentists are
very important and the ability to get dentists is fantastically
important. What has happened over this period is that in that
first ten years there was lack of clarity about what needed to
be done because oral health was improving very fast and it was
not clear how many dentists were needed. A lot of work has happened
since 1998. The other point worth making is that we have spent
the increased money in the NHS on things which have been seen
as a higher priority at the time, like cancer and coronary heart
disease. I do notice, for example, that this Committee has not
examined dentistry in its last 100 sittings. We have given it
the same—
Chairman: That is a bit of a mean shot.
Mr Steinberg: You just decided your fate
there.
The Committee suspended from 5.48 pm to 5.54
pm for a division in the House
Q138 Mr Bacon: Can I ask you to send
the Committee a detailed note which summarises the position for
dentists in the UK as to income and numbers? The note I would
like you to send would contain information on all the dentists
in the UK, let us know how many there are, how many of them work
purely in public practices, in the NHS, how many of them work
purely in private practice, that is, purely for themselves privately,
and how many operate what you call a mixed economy, and what the
income levels are for these different types of dentists, showing
also regional variations, so a public/private mix, showing also
the difference between income for the practice and the actual
income for a dentist. Can you do that?
Professor Bedi: I can certainly
go to the Dental Practice Board who have detailed information
about NHS commitments for people who undertake NHS activity. There
are some estimates from Inland Revenue figures, which we have,
that are two years old.
Q139 Mr Bacon: If the note comes from
a variety of sources I do not mind, but can you send us a note?
Professor Bedi: We will try to
get in all that information.[11]
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