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10. Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): If she will make a statement on dental services in Milton Keynes. [3678]

The Minister of State, Department of Health (Ms Rosie Winterton): Milton Keynes primary care trust has been working with local dentists to improve access to NHS dentistry. It has secured eight new dentists through local international recruitment initiatives, which should lead to at least 16,000 extra registrations.
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Dr. Starkey: I thank the Minister for that announcement. Sixteen thousand is a particularly appropriate number, as the problem in Milton Keynes was exacerbated three to four months ago, when a group    of dental practices deregistered all of their 16,000 patients in one fell swoop. I am therefore pleased at the extra capacity announced by my hon. Friend. One surgery near central Milton Keynes railway station is about to open. However, will she keep a watching brief, and make sure that everyone in Milton Keynes who wants to sign up with an NHS dentist can do so, and that Milton Keynes PCT receives advice and support from her Department so that, if necessary, it can take extra measures to meet the need?

Ms Winterton: I am pleased that my hon. Friend's PCT is working proactively with local dentists. It has set up a helpline, which 4,000 people have used so far. That is the right approach, because we must establish a good relationship between PCTs and the people in charge of local dental commissioning. Those people should work with local dentists, so that if dentists deregister or, as happened recently, retire, they can warn the PCT, which can replace the registrations. The key point about the system that we are implementing is that the money that was being spent on a dentist remains with the local PCT rather than returning to the centre as it did in the past; the PCT can then create additional capacity.

Mr. Mark Lancaster (North-East Milton Keynes) (Con): Is the Minister aware that only last week negotiations between a dentist and the Milton Keynes PCT broke down? Is she further aware that there is a growing trend in Milton Keynes for parents to be told that their child will be granted access to a dentist only if the parents go private? Will the Minister reassure the people of Milton Keynes that the Government's stated policy of access for all to a dentist has not been replaced by a policy of "Buy two, get one free"?

Ms Winterton: I have to say to the hon. Gentleman that I think it is wrong for dentists to do that. I hope that he makes it clear to them, as I do, that he believes it to be unacceptable. I understand his point about what the dentist in that situation has done. There are times when dentists want to move to the new contracts because they like the new way of working, but it is important that the PCT ensures that there is proper value for money for the local taxpayer. If it did not feel that there was value for money, it would not pursue the move, and the Department would not allow it to do so.

I agree with the hon. Gentleman that it is wrong for dentists to adopt that attitude towards children, but the system that we are introducing, including local commissioning, new investment and the recruitment of 1,000 extra dentists, will lead to an overall improvement in the situation. I think that we are seeing some of the fruits of that at the moment.

Ambulance Service

11. Mr. Geoffrey Clifton-Brown (Cotswold) (Con): If she will make a statement on the merger of ambulance trusts. [3679]
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The Minister of State, Department of Health (Jane Kennedy): As the hon. Gentleman knows, the Department of Health commissioned Peter Bradley, chief executive of the London Ambulance Service NHS trust and national ambulance adviser to the Department, to lead a strategic review of ambulance services in England. The review is considering the future organisation of ambulance services and how resources can be used more efficiently. We hope to publish it shortly.

Mr. Clifton-Brown: I thank the Minister for her reply. She will be aware that Gloucestershire ambulance trust is one of the most innovative and efficient in the country; yet the strategic health authority launched a consultants' report with a predetermined view that it should be fully merged with Avon and Wiltshire. That is overwhelmingly unpopular in my constituency and in Gloucestershire. It is believed that a decision has already been made to conduct the merger in September, so the patients forums are seen as a complete sham. This should be a Government for the people, not a Government against the people's wishes.

Jane Kennedy: I hear what the hon. Gentleman says, and I know that he has been pursuing these concerns and has raised them many times, including not least, most recently, in an Adjournment debate in April. His points are valid. The purpose of the review is to get an overall picture of how ambulance services should now be developed, following the massive investment that has gone into them. There will always be a need to give interested parties, such as the hon. Gentleman's constituents, the opportunity to shape their local health services, and they will have an opportunity to comment on the detail of the review when it is published.

Mr. David Drew (Stroud) (Lab/Co-op): The hon. Member for Cotswold (Mr. Clifton-Brown) will know that I share a great deal of his concern about the way the plans are, apparently, being rushed through. I welcome what my right hon. Friend says, but will she make it clear that there will be a full opportunity to scrutinise the proposals and to look at how we can link the ambulance service with the fire service and the police locally as an alternative to what some see as back-door regionalisation?

Jane Kennedy: This is a comprehensive and wide-ranging review looking at every aspect of emergency ambulance services. Of course, it would be sensible to take into account precisely the point that my hon. Friend makes. I reassure the House that there will be consultation prior to the implementation of any proposed changes in the organisation of ambulance services.

Robert Key (Salisbury) (Con): I am sure that my hon. Friend the Member for Cotswold (Mr. Clifton-Brown)
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will forgive me for pointing out that the review is warmly welcomed at the southern end of our strategic health authority area. We think that it is a very sensible solution to over-management in ambulance trusts. Furthermore, when the consultation is complete—I believe that my constituents are in favour—will she consider also conducting a review of NHS trusts? We have 2.5 million people in our strategic health authority and 22 trusts trying to administer the NHS. Will she see whether the NHS hospital trust in Salisbury can merge with our local primary care trust? That would save an   awful lot of administration and deliver a better service.

Jane Kennedy: I am grateful to the hon. Gentleman for his comments, and I shall look into his suggestion. Clearly, the Government will not be able to please all the people all the time on this occasion, but this detailed review will be offered up for full consultation when we have the findings of Peter Bradley.

Alzheimer's Disease

12. Mr. David Kidney (Stafford) (Lab): What drugs are available on prescription for patients with Alzheimer's disease. [3680]

The Minister of State, Department of Health (Jane Kennedy): Four drugs are licensed for the treatment of the effects of Alzheimer's disease: rivastig—I knew that I would fall at the first hurdle. They are: rivastigmine, galantamine, donepezil and memantine. Forgive my pronunciation, Mr. Speaker.

Mr. Kidney: I thank my right hon. Friend for her answer. Does she agree that those drugs, however difficult to pronounce, are clinically effective? Has she witnessed, as many of us have, the vast improvements in the quality of life of patients who take those drugs, as well as of their carers? Can it really be that, at a cost of about £2.50 a day, she can allow the National Institute for Clinical Excellence to prevent those drugs from being prescribed on grounds of cost-effectiveness?

Jane Kennedy: The National Institute for Clinical Excellence has an international reputation for its work on clinical and cost-effectiveness, and its methodologies have been commended by the World Health Organisation. It will take a decision on the shape of its final guidance, taking account of all views expressed as part of the consultation. This is such an important and sensitive subject that we in Government want to be sure that every aspect has been fully considered. We must give the National Institute for Clinical Excellence the opportunity to carry out its work and present us with its findings.

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