---

Chris Huhne (Eastleigh) (LD): Can the Minister assure those of us in the southern part of the country, in particular, that regional circumstances are being taken into account, especially in areas where costs are clearly higher? Given the affecting story that we heard from the hon. Member for Telford (David Wright) about the impact of the Minister's recent visit to his constituency, perhaps I might invite her to visit mine, so that she can see for herself the substantial problems in registration for NHS dentistry. According to a recent survey by my local newspaper, the Southern Daily Echo, not a single dentist in my constituency was prepared to take on NHS patients. Will she put in her diary the need for an urgent visit, so that we, too, can benefit from the effects that appear to have been visited on the hon. Member for Telford?

Ms Winterton: Perhaps the hon. Gentleman would like to encourage his PCT to follow the example of that of my hon. Friend the Member for Telford (David Wright), with which my hon. Friend has clearly worked very closely. The hon. Gentleman could then invite me to visit his constituency, so that we can see what his PCT has learned from another area.

As a result of extra funding, recruitment initiatives and PCT activity, a quarter of dentists—5,800 in 2,100 practices—have moved to the new personal dental services contract. That shows that dentists are attracted to ending the treatment and paperwork treadmill. Patients are benefiting from a more preventive approach and, as new PDS dentists build up their patient base, access is increasing.

Andrew Gwynne (Denton and Reddish) (Lab): My hon. Friend is correct: the PDS is making a huge difference to the provision of, and the approaches taken
 
29 Jun 2005 : Column 1316
 
by, NHS dentists. It has certainly given them the confidence to invest in the future. As a result of the PDS, Roman Melnyk of the Silverdale medical practice, in Dukinfield in my constituency, is investing £80,000 of his own money, together with funding from Tameside and Glossop primary care trust. He intends to take on two extra dentists and one orthodontist, which is surely good news for the people of Dukinfield. Is my hon. Friend aware, however, that there are some delays in getting the agreements in place to take on these extra staff? Will she do all that she can to ensure that in Roman Melnyk's case—I will pass on the details—we can secure the two extra dentists and the orthodontist?

Ms Winterton: I certainly will. I am sure that the people of Dukinfield are benefiting greatly from the changes that my hon. Friend outlined, and it is good to see local PCTs taking that sort of initiative. All PDS applications are processed through the Department. Sometimes there are delays if the Department wishes to get further information in order to ensure that good quality services and value for money are being offered. There may be some delays and I shall look carefully into the points that he raised. As I said earlier, from October this year, 170 extra undergraduates are starting their dental degree and we are considering applications for a new dental school.

Since last April, the equivalent of approximately 830 additional dentists are treating NHS patients through a mixture of domestic returners, international recruits and additional NHS commitment from existing dentists. Another 117 Polish recruits are due to take up posts in England between now and the end of October, so we are well on the way to meeting the 1,000 target.

Mr. Heath: May I raise a matter peripheral to the training of dentists, but nevertheless important for the dental profession—the training and regulation of dental technicians? Will she tell us more about her thoughts on ensuring quality among dental technicians, which is crucial to providing a good dental service?

Ms Winterton: The hon. Gentleman raises an important point and we want to look further into extending the roles of the whole dental team. He may be aware that, through the section 60 order laid before the House, we are seeking ways of ensuring high-quality standards. Over and above that, we want to increase training for all members of the dental team and ensure that there is greater provision as a result of the new roles.

As I have said to many hon. Members, primary care trusts have been asked to put together action plans to deal with any particular problems. Some have experienced success stories in their constituencies. For example, in Blackburn, five German dentists started work in April looking after 10,000 extra patients and in Newhaven, Sussex, a Polish dentist started work in April on a three-year PDS contract, providing NHS care to an area where access was particularly difficult. Indeed, I understand that the hon. Member for Lewes (Norman Baker) was photographed with the new recruit. I am sorry that he is not in his place today, as we have a nice picture of him with the new dentist. My hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey) mentioned domestic recruitment and the importance of getting NHS dentists back to ensure increased access for NHS patients.
 
29 Jun 2005 : Column 1317
 

As well as recruiting from Europe, we have looked into how to speed the process for people waiting to take the international qualifying exam that enables dentists from non-EU countries to practise in England. We have been working with the General Dental Council to reduce waiting times and it now takes only 12 months, instead of two years as previously, to complete all stages of the exam.

As I said earlier, we have laid before the House a section 60 order that will allow reform of the dental team so that dental therapists, hygienists and nurses can take on new roles and, in some cases, undertake some routine dental work currently carried out by dentists, thereby freeing up their time for more complicated interventions. The order will also make it easier for patients to distinguish between what work a dentist has done on the NHS and what work has been charged for privately. I am sure that many right hon. and hon. Members will have heard complaints from their constituents about failures in respect of being properly informed beforehand about what work was done on the NHS and what was done privately.

Paul Rowen (Rochdale) (LD): Will the Minister give way?

Ms Winterton: I want to move on, if the hon. Gentleman will forgive me.

I hope that the history and context that I have outlined make it clear that we recognise that there are problems, but that we have in place fundamental reforms to improve the system.

My hon. Friend the Member for Telford—and many   hon. Members previously—asked about the Government response to Harry Cayton's report and about the details of the new contract. I shall announce next week our response to the Cayton report on patient charging and outline aspects of the new contract that we are introducing from April 2006. I hope that the House will understand that I cannot share all the details today, but I thought that it might help Members if I set out some of the principles underpinning the proposals that we will announce.

On the new dental contract to be introduced from next April, we want to encapsulate the new ways of working that are already apparent in personal dental services contracts—an end to the treatment and paperwork treadmill, more time with patients and creating the capacity for dentists to take on more NHS patients. We want to make dentistry more attractive to dentists, building on the success of PDS, which has already been enthusiastically taken up by about 29 per cent. of existing dentists. We also want to reform the system of monitoring NHS dentistry to ensure value for money, detailed information on the level of activity and high-quality service provision.

Dentists are already working with PCTs locally in many areas to make the reforms work and I certainly want that to continue. To make the contract work, we need a partnership between PCTs, local dentists and their representatives—locally and nationally—and the Department of Health. Other agencies, such as local authorities, are also relevant. I believe that the success of PDS last year shows the way forward and I am confident that the new contract will be successful.
 
29 Jun 2005 : Column 1318
 

On patient charges, the original remit of Harry Cayton's working group was to devise an improved system that would raise the same proportion of revenue and no more—approximately a third of the total expenditure—on primary care dentistry. Our response will enshrine a number of key principles. We want a system that is simpler and more transparent to both to dentists and, critically, their patients. There are currently more than 400 different items of service with associated charges, which is obviously not a straightforward system. Patients, their representatives and others tell us that dental charges are bureaucratic—a charge commonly made by dentists themselves—and not easy for patients to understand. It is often difficult to distinguish between private and NHS care.

We also want a system that reflects the new ways of working in respect of how dentists spend their time and that takes into account the National Institute for Health and Clinical Excellence guidelines on recall intervals, which recommend fewer visits for regular recall and scale and polish. Dentists take the decision as to whether the patient needs to come back within three months, if the dentists are worried, extending up to 18 months if they feel that a recall is unnecessary. That represents a much more effective use of dentists' and patients' time. We also want a system that encourages preventive treatment to improve oral public health.

I am sure that many hon. Members will say, as did the hon. Member for Northavon, that it has taken a long time for the Government to respond to the report. However, it has been vital to reflect on the findings of this important report in the light of the changed patterns of treatment and ways of working that have emerged in many of the PDS pilot sites. We learned a lot from that and it has been extremely useful in shaping our response. We will discuss our proposals with the British Dental Association, as has happened in the past, and we will publish our final contractual regulations in the new few weeks. We are determined to get this right, and I believe that we will.

The principles that we will follow in the new system will make charges more transparent for patients and less bureaucratic for dentists. They will reflect new ways of working and, in particular, they will emphasise long-term oral health promotion.

The hon. Member for Northavon talked about the fundamental review. We are considering the terms of that review at present and will pay special attention to the changes that are in hand. We want to see how they are bedding down and whether they are succeeding in drawing dentists back into the NHS. Other aspects that we need to look at include increasing the commitment of dentists to the NHS during their training. We will announce other matters to be considered in due course, but we want to make sure that the reforms are welcomed by dentists and that they are attracting dentists back into the NHS. Given that the reforms have been the subject of long discussions with the dental profession, I am confident that they will be welcomed.

---