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Ms Rosie Winterton: I have not been invited to the reception and I would hate to gatecrash it. In his discussions, the hon. Gentleman might raise with Which? the fact that we have opened 53 dental access centres across the country to address the problem of providing emergency treatment.
Dr. Murrison: Well, the Minister has received an invitation, but has failed to reply to it. Which? also mentioned to me that 4.1 million people have had difficulty in registering with an NHS dentist in the past two years in England, according to its survey, which is full of useful information. I recommend to the Minister that she attends the reception.
Unfortunately, the Minister did not attend the British Dental Association conference in Glasgow earlier this year, which was a serious omission given the state of negotiations between the BDA and the Government. I hope that the Government will repair the bruised relationship with the BDA, because that is essential if we are to achieve the sensible contract to which we all aspire.
I am pleased that the motion includes primary health care. I am not sure whether it was done by design or default—it was probably by default, as it is a Liberal Democrat motion. In either case, it was very sensible, because dentistry should be considered as part of the mainstream national health service. I fear that that concept may be withering on the vine, but I was encouraged by much of what I heard from the hon. Member for Northavon and the Minister. I hope that the Minister will not allow it to wither away, because dentistry is a fundamental part of the mainstream national health service and it certainly is not a bolt-on extra. I welcome in particular the Minister's commitment to oral public health.
I was interested in what the Minister said to my hon. Friend the Member for Mole Valley (Sir Paul Beresford) in connection with what might be on the list of appropriate treatment under the NHS, because that is important. What dentists say to us is that they want to do national health work, but it would mean working with inferior materials or doing procedures that are possible if done privately but not under the NHS. The Minister looks confused, but that is the case. I am surprised by her perplexity, because if she has been discussing the issue with the BDA and dentists that concern will have been raised. It is important that whatever we provide is of adequate quality, for the sake of patients and the professionals who are keen to
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provide the best possible service they can, within reason. Nobody would promise—we would not, and I imagine that the Liberal Democrats would not—to provide everybody with a perfect smile on the NHS. We cannot do that, but serious attention needs to be given to the quality of NHS dentistry that we can allow dentists to provide. I hope that the Minister will give that some thought, perhaps in connection with her report on Cayton.
Mr. Ian Austin: I am disappointed that the hon. Gentleman did not start by congratulating the Government on the record investment delivered for the NHS and dentistry. It is up by 19 per cent. or £250 million more a year and some 3,500 more dentists are now working in the NHS. It is no use trying to explain away the mistakes of the past as based on the advice given at the time, because Labour Members told the then Government what the effect of the new contracts would be and the consequences of closing the two dental schools. If the hon. Gentleman accepts that the Conservatives were wrong then, why does he expect anybody to believe what he says about the NHS dental service now?
Dr. Murrison: When the hon. Gentleman reads those remarks in Hansard, I suspect that he will be less than thrilled with his contribution, which sounded as if it were drafted by the Whips Office. It is all very well to say anything one likes in opposition, as the Liberal Democrats know full well. They are perpetually in opposition and can say whatever they like in the sure and certain knowledge that they will never be called on to carry out their promises, with one exception. That of course is in Scotland, where they are the coalition partners with the Labour party.
It would be interesting to know the situation north of the border. I am told that it is not 1,000 miles from where we are, despite the fact that Scotland has a far more generous settlement than this country. The hon. Member for Northavon did not mention that. Of course it is a devolved issue, but it would be interesting to hear from him how his party has managed dentistry where it is in a position to make a difference.
Mr. Alan Beith (Berwick-upon-Tweed) (LD): The hon. Gentleman seems to be failing to notice that the Scottish Executive has to live with the same contract, and that the closure of the same two dental schools is now denying the supply of dentists to the Scottish Executive.
Dr. Murrison:
I am very grateful to the right hon. Gentleman for that intervention. He is right that it is the same contract and that we all operate from the same pool of dentists, but I think it is reasonable to accept that dentistry is now focused around primary care trusts, or the equivalent thereof in Scotland presumably, so his party in coalition has some way of making an impact on dentistry. He must appreciate that it is not all down to the number of dental schools, or the contract; there is more to it than that. Nothing in the speech by the hon. Member for Northavon gave me any confidence that his party in office is able to make the difference that it constantly tells us it would make. I am sorry if I have missed something; I would be more than happy to allow an intervention from the hon. Gentleman.
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I am concerned about the commodification of health care across the board, both in primary health care and in dental care; I would not want to make a distinction between the two. In recent weeks and months there have been announcements about dental access centres, walk-in centres and megasurgeries. We know about falling dental registration rates. We know about the threat to registration with GPs. We have heard about the 48-hours-in-advance conundrum that faces many practices, which are not permitted, apparently because of their fiscal settlement, to allow patients to book surgery appointments a long way in advance. All these things, and more, mean that there is far less personal one-to-one contact between practitioner and patient than there used to be.
The unique thing about health care in this country has always been that personal contact, be it in terms of general practice or general dental practice, and nothing in the Government's actions in the recent past has given me any confidence that they fully appreciate the importance of that personal service—that one to one. Arguably, it is far more important in general medical practice because one is dealing with long-term chronic disease, very often with life-threatening disease, and very often with elderly people who need that contact. I fully accept that very often in general dental practice contact tends to be a little more one-off, but most of our constituents would say that they value an ongoing relationship with an identifiable practitioner, and I fear very much that both in medical care and dental care the Government are moving away from that important model of registration and an ongoing relationship. I hope very much that the Minister will give us some idea in her remarks whether she associates with that and if not, why not, because it seems to me very much that we are indulging in the commodification of health care, in that less personal model, rather than the personal model that is so important for most of our patients.
The Minister is about to embark on a consultation exercise on health outside hospitals, and it will be interesting to learn to what extent that will involve dentistry. I have said that I very much welcome her enthusiasm for associating dental care with mainstream NHS care, so I assume that the consultation exercise will fully involve dentistry, because it really must do so. It is hailed as a major public engagement exercise. Being a bit of a cynic, I am concerned that this might be yet another tick-box exercise. I hope that that is not the case and I very much hope that the Minister will give some thought to the results. Recently we have had the results of referendums in France and the Netherlands in relation to the constitution, and it would appear that the results of those referendums are largely going to be finessed by the EU and by the countries involved. I hope very much that the Minister does not agree with such a model, and that she will truly reflect on the outcome of the consultation exercise, because I know full well that some of the messages that she will receive have to do with the value that people place on personal contact between practitioner and patient.
In terms of what needs to be done—[Interruption.] I hear the hon. Member for Northavon huffing and puffing, but as my hon. Friend the Member for Rayleigh (Mr. Francois) pointed out, we heard precious little about what the Liberal Democrats would do, and we have heard very little about what they are doing in
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Scotland. All I can do is refer to our discussions with the British Dental Association, which have been carried out in an extremely warm atmosphere. Our proposals are broadly welcomed by both the General Dental Practitioners Association and the BDA, and they appeared in our manifesto for the election just past.
We have proposals on capitation. We have proposals on the use of dental hygienists and nurses—which, incidentally, the Minister has not mentioned yet; I hope that she will. We have proposals on registration. Registration is a recurring theme and I am very pleased that there appears to be cross-party unity on its importance.
Finally—I know that the Minister did not mention this—we need to place an emphasis on child oral health because we know that good dental practice is established very early indeed.
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