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Steve Webb: I heard the hon. Gentleman use the word "finally", having devoted 19 of his 20 or so minutes to not saying what should be done. He obviously had the opportunity to table an amendment to our motion to say what should be done, and yet we have a blank sheet of paper from the Conservatives. What actually does he propose, other than saying that child oral health is a good thing, which we knew?
Dr. Murrison: I have just been explaining what we would do. It was contained in our manifesto. I am sorry if the hon. Gentleman feels that child oral health is not important; as the father of five children, I can tell him that it is fundamental. If we establish good dental practice early on—that means regular check-ups early on, and if the hon. Gentleman had taken the trouble to read our manifesto he would have seen how we were going to do that—we stand a good chance of ensuring that the next generation has far better oral health than this one does.
2.7 pm
Mr. John Grogan (Selby) (Lab): I have never been to Cheadle in my life, so I cannot contribute to that aspect of our discussions, but I will try to convey a flavour of the situation across the Pennines, in Yorkshire, on this issue. It is a pleasure to follow the hon. Member for Westbury (Dr. Murrison) and I listened to both his speech and that of the hon. Member for Northavon (Steve Webb) with great care.
The hon. Member for Westbury made some interesting points. He said that Governments make decisions on the basis of the best available evidence. They certainly should, but that seems to me to be a rather technocratic approach to government. Decision making must be guided by a political will, a political vision and a political strategy. In response to some of the criticisms by the hon. Member for Northavon, I honestly do not think that as a Government we focused on dentistry soon enough, and it took a while to put the political strategy and the vision into place. But I think that we are there now, and the next year will be crucial. If I have one criticism of the hon. Gentleman's speech, it would be that he was a little bit easy on some of the practices of dentists down the years. At times he
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sounded like a spokesman for the British Dental Association, which has a long and proud record and many members who are committed to the NHS, but dentists, like Governments of all colours, have lessons to learn from the past 20 years. I intend to reflect on that in some of my remarks.
I promised to impart a little bit of the flavour of the situation in Yorkshire. To be very parochial for a minute if the House will allow me, I think that in Selby and York, my local primary care trust, the commissioning that the Government have brought in is making a difference and is working. That is one thing that has improved in the past seven or eight years. It does give a very local focus. It enables MPs, councillors and others to speak to the decision makers, to get down to the detail of where NHS dentists are, where there are gaps and where improvements could be made.
In Selby and York, for example, 15,000 extra places have been approved under personal dental schemes for the next three years. It appears that they will be delivered within the next year, and I understand that we will be up to about 56 per cent. coverage in Selby and York. We want to get a little higher than that, but that will not be bad in comparison with a lot of other areas in the country.
One dentist, Mr. Kelsey, made it on to the front page of the Yorkshire Post. The Minister and I discussed his case over tea and biscuits for no less than 45 minutes, and I bring her good news. He wants to retire. He could not find someone to buy his practice. He tells me that he is committed to that practice transferring to the NHS. A buyer has now been found, with two dentists in that practice, and the local PCT will propose a personal dental scheme to the Department that, I hope, will be approved, so that the 5,000 places that would have been lost in Selby can be replaced, possibly on a like-for-like basis.
If I have one criticism of some PCTs, it is that the local delivery of dentistry is important. It is not acceptable to have to take long journeys, perhaps on two or three buses, to get to a dentist. In rural areas, it is important that NHS dentistry is available in market towns, such as Selby, Sherburn and Tadcaster in my area.
I want to make two suggestions for improving the situation in Yorkshire. We have heard a lot about queues forming outside dentists' surgeries when they open up for additional NHS places. In some areas, PCTs have introduced waiting lists—Doncaster may be one of them, but there are certainly other examples throughout the country—whereby people who want an NHS dentist go on to a waiting list. Instead of having to queue or ring up every two or three weeks as the situation changes, those people will be informed—in a short period, we hope—when extra NHS places become available in the locality. I urge my own PCT in Selby and York to consider that development, which makes the system much more civilised and efficient. It allows a certain degree of preference to be given to local people to gain access to dentists in their own areas.
Clearly, the expansion of training places in dental schools is important. In both Leeds and Sheffield, expansion is occurring by a factor of about a third in the coming year. It would be remiss of me not to put in a plug for the merits of the very successful medical school at York and Hull. Indeed, one of the bids for a new
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dental school comes from York and Hull. I know that other hon. Members would advocate different areas, but that is a particularly good bid from God's own county.
I want to make a few comments about the nature of dentistry and dentists themselves. We are coming into an absolutely crucial period for the negotiations during the next few months. I remind the House that, despite the problems of the past few years, NHS dentists earn, on average, £75,000 or £76,000—considerably more than MPs—and most of them also do private work. We are talking about relatively highly paid people, many of whom are very much committed to the NHS, but it takes two to tango in negotiations, and there is a high expectation among Labour Back Benchers that if the Minister puts a reasonable offer to dentists, as I am sure she will, they should respond in kind. That will involve changes in working practices.
If we look back over the past eight years, another thing that has become apparent, for whatever reason, is drill-and-fill—I think that was the phrase mentioned by the Minister. Numerous reports, dating back to one in 2000 in the NHS prepared by Aubrey Sheiham, professor of public health at University college London, refer to practices such as dentists
and an economic model encouraged them to do so. The report states:
"Studies show that dentists replace fillings far more than necessary, and that if they suffer a drop in income, they will replace their patients' fillings more frequently."
There were economic incentives for dentists to adopt such an approach, but that will not happen under the new contract, and nor should it. Perhaps some patients will be seen less frequently. If there is less dental need for them to be seen every six months, perhaps a check-up every year or so will be sufficient, and a lot of dentists who are committed to the NHS realise that.
It is interesting that perhaps one of the better puns that has been coined in this respect appeared in the Yorkshire Post headline "Dentists set to bare their teeth". The Yorkshire Post has been running quite an effective campaign called stop the rot—a rather more hackneyed phrase—but nevertheless it has been pointing out some of the things that hon. Members on both sides of the House have mentioned today: the expansion of dental places, the need for a new contract and so on.
A few weeks ago, the front page of that paper commented on an attempt by the leadership of the British Dental Association to get its members to go on strike for a day and not to do routine NHS treatment. Rather less prominently, it reported the following day that that attempt had been rejected by two to one. The dentists themselves decided that a much better approach would be to lobby Members of Parliament, and they will do so in July.
The Yorkshire Post and, indeed, most people in Yorkshire would agree that we want value for money, that it is not a question of writing a blank cheque to dentists, as I am sure the hon. Member for Northavon would agree, and that those negotiations depend on a responsible attitude on both sides. Where that responsible attitude is not shown—I hope that that will
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not be countrywide, but there may be PCTs with particular problems—it is well worth reminding dentists that there is another model: a directly salaried model.
Many dentists from overseas are coming in on that model and are directly salaried by the PCT. If that is what is takes to fill the gaps in NHS provision, that approach will receive a great deal of support among Labour Members. Dentists cannot have the NHS over a barrel. They have earned reasonable amounts of money from the NHS in previous years, and I think that they will be offered that in the future. Many of them are committed to the values of the NHS. However, if it is a question of taking on local dentists in certain areas and ensuring that NHS dental provision is maintained and expanded, that is what Ministers must do.
Incidentally, we have an almost all-female team in the Department of Health, with a solitary male Minister. We have a number of strong female Ministers and I am sure that my hon. Friend the Member for Doncaster, Central (Ms Rosie Winterton) will, if necessary, show a good deal of Yorkshire grit and determination in those negotiations and ensure that, by the next election, we have a very good story to tell on NHS dentistry.
2.17 pm
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