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Sir Paul Beresford (Mole Valley) (Con): As dentists have been gently attacked, it is rather appropriate to get an opportunity to return that gently. I clearly have an interest, although my dentistry aspect is such that my income does not reach anywhere near that suggested by the hon. Member for Selby (Mr. Grogan)—would that it did.
I want to touch in particular on the point that was raised during the Liberal Democrat presentation—if we can call it that—and I refer to the fact that dentists feel that they are highly trained for five or six years. They have a broad spectrum of facilities that they wish for and a broad spectrum of opportunities to provide a wide range of treatments, but the NHS does not allow them to do that if they keep strictly to the NHS. The key thing—the Minister seems to be moving in this direction and it will be interesting to find out whether it happens—is that the NHS must work in partnership with the dentists providing a mixed service. Using that method, we can attract dentists back into the NHS, as well as providing an opportunity for those who leave the dental schools, move straight into the NHS and suddenly realise that they cannot do much of the work for which they have been trained. We hope that that method will thus prevent them from moving into the private sector, with the consequent loss to the NHS.
It is vital that we have NHS dentistry. One need only walk into an old people's home to see a lady with a broken denture to recognise that that is her means of eating and that she has no opportunity of having her denture repaired, particularly in the south and south-east, as she does not have an NHS dentist, and especially not one who would provide dentures or who would come out to provide dentures because she cannot travel to him. What does she do—live through a straw? We must consider those patients.
There is a crisis, but it is possibly not quite as bad as the Liberal Democrats say, and I do not intend to go through the figures. When I first came to this country, dentistry in Britain was seen by much of the western
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world as being absolutely appalling and, to a fair degree, the NHS was the cause. The hon. Member for Selby touched on that fact, calling it "drill-and-fill". The Australians used to call it "bash the gnash". They used to come here and fill anything and everything. I remember taking on two Australian dentists from Queensland—they will remain nameless—and the figures that they produced at the end of the week for the NHS work that they had done stunned me. I asked them how they had managed it and they said that they got the patients in the chair, filled them with local anaesthetics until they were grey with the stuff, turned up the air rotor and drove round. I saw one or two of their patients and I was absolutely appalled by what I saw. We sacked those dentists, but it took weeks to put right what they had done.
There have been dramatic changes since them. The first change is the addition of fluoride to the water supply, which must be the cheapest, simplest and most sensible way of dealing with dental decay. That is done in many other western nations such as Australia, New Zealand, Canada and the United States and it has got to come here. Fluoride in toothpaste has also made a dramatic difference. My recently deceased father was a dentist in New Zealand and he said that until fluoride in the toothpaste and in the water supply came along, trying to deal with dental decay was like trying to fill the bath with the plug out. He said that the changes it produced were dramatic. We will see that here—indeed, we are already seeing it to some degree.
The second issue that changed the system in the NHS was the introduction of patient charges. To a fair degree, that stopped the Australian-type practice that I have just described. I am not being particularly anti-Australian, because dentists of many nationalities, including English ones, engaged in "bash the gnash". However, when charges were introduced patients started to look at what they were paying for and they used to ask why work was being done again. They did not want the work done again, so they moved to other dentists and a few dentists actually went bankrupt as a result.
When patients realised that they had to pay, they started to ask whether they could pay for something different—whether they could have white fillings, crowns or whatever was available at the time. I know that dentists complained when the fees were cut, but that made them concentrate on what they were providing and look at whether they could provide a better and fuller service. Some of the bad dentists who I know—again, I mention no names—went bankrupt. The technicians carrying out crown and bridge work and making dentures often commented that the standard of dentistry demanded by patients went up as dentists moved into the private service. The standards of NHS dentistry then went up as well. The technicians were stunned because the change happened so quickly.
In the past 10 or 15 years, there have been dramatic changes in dental techniques. The changes have made different approaches available to patients, but they have also brought with them enormous costs. We now have new restorative materials, tooth-coloured composites,
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techniques of bonding, new ceramic to metal crowns and bridges, new all-porcelain crowns and bridges, inlays, inlay overlays, overlays, veneers and bleaching.
The Minister said that the NHS should not provide bleaching and, in many circumstances, that is right. However, the NHS needs to think again. If a teenager has badly stained teeth—perhaps as a result of tetracycline, which may, by then, have gone—the NHS's answer is for the dentist to pick up a high-powered drill, scream round and take all the enamel off and put on crowns that will have to be replaced again and again. Bleaching will stop that. Patients will have their own teeth that are properly bleached and looking right, and the process can be topped up every three to five years. This brings me to what I am after—a radical rethink.
Techniques have changed. We now have the new nickel titanium endodontic root canal instruments, digital x-rays, various hot seal endodontic filling materials—and many dentists use loupes and microscopes as well as new impression materials. We also have new and reliable dental implants, and orthodontics and oral surgery have also leapt ahead. I deliberately ignore those dentists who use Botox.
Those and many other improvements have meant that the dental treatment available offers the cosmetic approach to dental health care that is wanted by patients. That does not mean that patients are not being looked after, but that they are being looked after differently and that they are choosing, when they can, to pay. Over the past few years, the reactions of patients have been dramatic. It might be basic in some cases as in when they ask for a white filling rather than a black one, but it goes right through to requests in the full American style for a Hollywood smile makeover. The effect of television and magazines on demand over the past few years has been dramatic. Patients have started to get a better understanding of what they want. Sometimes that makes it difficult for the dentist. I remember a 5 ft 2 in lady coming in with a picture of Farrah Fawcett-Majors and asking whether she could have a smile just like that. I suggested to her that she would be more likely to win the Derby if I could manage it. [Interruption.] Sweetness and light.
The NHS has not kept up with the treatments that are available, and I do not think that it should. That is not its realm. However, I was a little surprised when, I think, the first Labour Secretary of State for Health said something along the lines that the NHS could compete with the private sector. It should not. According to a recent estimate, that would cost about £6 billion. There are better things that we can do with the money. The NHS's target should be health, although there are variations on that—I referred to bleaching a moment ago.
The new contract offers an opportunity to look at the issue again. Before the contract is set in stone, I hope that the close discussions with the dental profession will bring some changes. I have spoken about endodontics and root canal treatment, but such work is poorly paid in an item-based payments system. However, it is vital for many patients.
To give another silly dental example, an elderly patient with a few teeth left may have a tooth that is heavily filled and that has suddenly blown up because there is an abscess underneath it. The patient suffers the
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pain that my hon. Friend the Member for Westbury (Dr. Murrison) mentioned, and the dentist has several options. The first is to take the tooth out, and that is quick and cheap, but the patient's denture will not work anywhere near as well as it did. The other option is root canal treatment, but that is exceptionally difficult for a molar in an elderly patient. It takes one, two, three or possibly four hours and requires loupes, microscopes, nickel titanium reamers and so on. That is just the endodontics but, after that, the tooth then needs to be built up. The recompense for the capital outlay for the equipment—I have not touched on digital x-rays, for example—is pitiful. It should be possible to rethink our approach to try to slant the money towards such preventive treatment as well as towards the prevention involved in teaching children how to look after their teeth better, in improving their diet and in adding fluoride to toothpaste and to the water supply.
I am not attacking the Minister, but I am ignoring much of what the Liberal party has said in its classic approach of attacking everyone but not coming forward with solutions. We have an opportunity to move forward and my hon. Friend the Member for Westbury has described some of the options. The only part of the Liberal motion that has any credibility is the request for Ministers to discuss the issue with the profession. Let us take this opportunity, but without setting things in stone.
We must bear in mind two key issues: the fact that the nature of dentistry has changed dramatically, even though we often look at it in a stone-age way; and the fact that dentists must be encouraged to return to the NHS to provide a basic core service, but be allowed to offer private dentistry because patients demand that. I hope that the opportunity is taken.
2.28 pm
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