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Sir Paul Beresford: The Minister will have noted the points made earlier about the spectrum of NHS dentistry available for dentists to offer their patients. Are there any plans to broaden that spectrum, or are we going to stay with the core?
Sir Paul Beresford: Earlier, there was a suggestion that one of the difficulties faced by dentists was that the broad spectrum of equipment, services, treatment and materials was not all available on the NHS. Is what the NHS offers going to be broadened or will the NHS stick to offering only a core service?
Ms Winterton: The NHS will continue to offer what is considered clinically necessary. The hon. Gentleman rightly distinguishes between the core service and some of the cosmetic treatments that are available, such as white fillings, teeth whitening and so on. We firmly believe that the NHS should continue to provide what is clinically necessary for good oral health, but it will not extend into cosmetic surgery, as that is for individuals to decide. Those services are available in the private sector, but we do not believe that they are suitable for NHS provision.
Chris Huhne: Earlier, I asked for a reassurance that the reforms would take account of the problems faced in different regions of the country, especially in respect of costs. I am told that the costs of dental provision are substantially higher in some parts of the country than in others. Will the Minister give the House the benefit of her analysis of those differences? Will they be taken into account in the reforms, and especially in the new contract? In my constituency, registration for NHS dentistry is very poor. The local newspaper found that not one dentist was prepared to take on any new NHS patients.
Ms Winterton: The hon. Gentleman needs to remember that, under the new system, commissioning is done at local level. There are always variations: for example, some dentists will be fully committed to the NHS, some will be 50 per cent. committed, while the commitment of some dentists will be lower still. The PDS system has involved negotiations with local PCTs to determine the historic amount paid to NHS dentists in that PCT area. In that sense, therefore, the new system reflects the income that dentists received previously, and we have guaranteed that that amount will continue to be paid for three years. In many cases, however, new ways of working mean that dentists' time can be freed up and that new patients can be taken on as a result.
The Government's proposed amendment makes clear our intention to improve the delivery of NHS dentistry. There is no doubt that access problems remain in parts of the country. I hope that the House will recognise that the drift away from NHS dentistry began some years ago under the previous Administration and that this
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Government have embarked on a programme of radical reform and modernisation backed by significant new investment.
Changes are taking place already. I am confident that, when the programme of reform is complete in April next year, we will have a service that promotes oral public health and tackles inequalities. The service will be better for both patients and dentists, and I urge the House to support the Government's amendment.
Dr. Andrew Murrison (Westbury) (Con): I begin by congratulating the Minister on her usual polished performance. [Hon. Members: "Oh!"] I assure the House that I have lots more like that. Unfortunately, I have to condemn the hon. Member for Northavon (Steve Webb) for scaling new heights in by-election opportunism.
In the debate, I have counted phrases such as "holes in the argument", "crowning moments", "bridging the gap" and "getting to the root" of problems. One I liked particularly, which I made up earlier on account of my recent root canal work, was "touching a raw nerve". If I may say so, that is particularly good.
Linda Gilroy (Plymouth, Sutton) (Lab/Co-op): I take it that the hon. Gentleman is referring to the raw nerves on the Opposition Benches. Will he apologise for his party being the root cause of the problem in the beginning?
Reference has been made to what most Opposition Members regard as ancient history. Reports were produced in the 1970s suggesting that dental caries would decline dramatically for a number of reasons, including the fluoridation of various products, notably toothpaste. At that time, Governments of all parties had to base their plans on what the best available evidence suggested. It could not have been predicted that the incidence of dental caries would not improve as had been suggested, nor that the take-up of cosmetic surgery would increase to the point that it has characterised dentistry over the past 30 years.
David Wright: The hon. Gentleman mentioned the planning that went on in the 1970s and 1980s. Two dental schools were closed just before the 1997 general election: what planning went into that? What about the 7 per cent. cut in dentists' fees?
The fees were cut in the early 1990s, so the hon. Gentleman needs to get his facts right. The closure of the two dental schools was predicated on the predicted fall in the incidence of dental caries. I hope that when Labour Members are in opposition and looking back at the record of this Labour Government, they will be happy to say that decisions were based on the best evidence available at the time. It beggars belief that anybody would think that any party in government
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would be mendacious enough to close something down without evidence to support doing so. We all have to make decisions based on the finite resources available to us and in the best interests of patients. That was what was done at the time.
David Wright: Does the hon. Gentleman accept that the wrong decision was taken at the time by the Conservatives? Is he willing to apologise for that decision, given the trend in the demand for dental care?
Dr. Murrison: Governments must make decisions based on the best available evidence, and it would be extraordinary if they did not. At the time, that was precisely what was done. I hope that the Minister makes her decisions based on the best available evidence and advice from professionals and others.
I have spent some time cantering around the history of the issue, and I turn now to the history contained in the motion, because it consists largely of an attack on the Conservative record. That is extraordinary for a party that considers itself an effective Opposition, because any Opposition must examine the Government of the day. That is our job. I wondered why the Liberal Democrats should attack the Conservatives in that wayperish the thought that it might be due to the by-election that will sadly be held in Cheadle.
The hon. Member for Northavon did himself no credit by using a large chunk of time in illustrating his remarks with reference to Cheadle. As he did so, I think that I am at liberty to say that earlier today I spoke to our candidate there, Mr. Stephen Day. The difference between Stephen and Mr. Hunter, of course, is that Stephen lives in the constituency. He is living there and winning there, and therefore he knows well the needs of the local community, especially their dental needs. When I spoke to him this afternoon, he confirmed that NHS dentistry is practically non-existent in Cheadle, despite eight years of a Labour Government.
Mr. Francois: I listened carefully to the speech by the hon. Member for Northavon (Steve Webb). He spoke for more than half an hour in the parliamentary equivalent of a Liberal Democrat "Focus" leaflet. He criticised everybody else, but said barely a word about what the Liberal Democrats would do differently
This is a serious matter and it deserves serious consideration. It is an issue that is raised weekly by our constituents. It is also raised with the citizens advice bureaux, which tell us that it is one of the most frequently raised issues. This morning, I met representatives of Which? magazine. I commend the magazine and its stop the rot campaign to the Minister. The hon. Member for Northavon mentioned that campaign, and it is extraordinary that half of England's
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dentists are unable to offer an emergency appointment to people in dental pain. I have had dental painI suspect that most hon. Members haveand it is a truly dreadful experience. The thought of having to put up with it for any length of time is frightful. The lack of emergency appointments also puts pressure on other parts of the health care system, such as accident and emergency departments and doctors. I have in the past been required to treat people in dental pain in an emergency because there was no access to a dentistalthough admittedly that was in unusual circumstances.
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