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Paul Rowen (Rochdale) (LD):
I am grateful for the opportunity to take part in the debate and thank my hon. Friend the Member for Northavon (Steve Webb) for giving us a timely breakdown of the serious crisis in the dental health service. Had I listened to the Minister's speech without knowing about some of the realities in my constituency, I would have thought that everything in the garden was rosy, but unfortunately that is not the case. Over the past eight years, the situation in Rochdale has got worse. Fewer people in Rochdale are now registered with an NHS dentist and there are fewer NHS dentists. Although palliatives have been put in place, the walk-in centre is no longer a walk-in centre because people have a two-day wait before they can be seen there.
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The Minister spoke about some of the issues that must be addressed. I agree with the hon. Member for Mole Valley (Sir Paul Beresford) about fluoridation. Yet another debate is going on in the north-west about whether we should have water fluoridation and I have met one of the officers employed by the regional primary care trust who is involved in that. I believe that fluoridation should happen, so it would help if the Government gave clear advice and instructions so that it is not left up to individual areas and authorities to decide whether such a simple and cost-effective way of improving dental health could be implemented.
Ms Rosie Winterton: Just for clarification, guidance will be issued in the summer on the processes that should be followed when engaging in public consultation.
I shall use an example from my constituency to demonstrate the problem with dentist numbers. I have received figures from my primary care trust showing that Rochdale needed 65 registered NHS dentists. We actually have 38, which is why the number of people registered with an NHS dentist has gone down. One of my constituents told me the other week that if people do not regularly attend for check ups, they get dropped off the list, which made my constituent less than happy. We need to change some working practices, such as drill and fill and the requirement for people to attend their dentist every three months if that is not necessary. I welcomed the comments made by the hon. Member for Mole Valley about that matter, of which he has a lot of experience.
There is also a problem with conditions of service and the contracts under which people work. A report appeared recently in the local paper about three young Rochdale-born dentists who wished to establish a new surgery in the town. They could get a grant if they joined an existing practice, but they could not get a grant to open their own surgery. As a result, the three dentists moved 10 miles down the road and now provide a service in Radcliffe in Bury, rather than in Rochdale, which was where they wanted to work.
Many dentists have moved out of the NHS because of the contracts under which they have worked. The Minister will face a big problem when trying to convince them that they will benefit both financially and in terms of their working practice by returning to the NHS. They are currently able to provide services at a cost that they would be unable to offer under the NHS. When the hon. Lady enters into the new contract discussions, she will need fresh thinking about what NHS dentists can offer, otherwise dentists who have got used to private practice and different working conditions will not move back to the NHS. We all want a viable NHS dentistry service, so we want the negotiations brought to fruition in a meaningful way, as the motion makes clear. I look forward to the Minister's statement next week and hope that she will think about what she can do to improve the situation in the north in general, and in Rochdale in particular.
2.47 pm
Anne Snelgrove (South Swindon) (Lab):
Thank you, Madam Deputy Speaker, for calling me to speak. I have enjoyed the contributions made by hon. Members on
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both sides of the House. I pay tribute to the hon. Member for Mole Valley (Sir Paul Beresford), who has sadly left the Chamber, because his speech was extremely eloquent and interesting.
I am pleased to have the opportunity to describe to the House the successes of NHS dentistry in South Swindon and to inform my hon. Friend the Minister of the challenges that we still face. Happily, those challenges are by no means the mountains that they were in 1997 and I am sure that they will be resolved simply by her plans for NHS dentistry.
In 1997, one could not get an NHS dentist for love nor money in Swindon, but the Labour Government's commitment to, and investment in, dentistry, and especially their commitment to training more dentists, has dramatically changed the situation. Our financial investment would be stymied without an increase in the number of dentists, but of course it takes time to train people. It is easy to pass judgment when in opposition. If the training programme were circumvented, the Opposition would accuse the Government of endangering people's dental health. However, because the training programme takes time, Opposition Members complain that the Government are not acting fast enough. They are having their cake and eating it, and they might find that that leads to dental caries, if they are not careful.
I am pleased to say that Wiltshire is involved in the Government's initiative to train overseas dentists. Earlier this year, the primary care trust, the community dental service and the personal dental service investigated training overseas dentists who already lived nearby, but could not practise because they did not have the IQE—the international qualifying exam. The training will allow them to gain clinical experience here in the UK while they study for the IQE. Individuals on the programme fund themselves, but all the partners involved are seeking innovative ways to fund the training—for example, by getting those involved to practise as dental nurses first.
The Government's initiative to increase the number of places for undergraduates is also being supported in the south-west. Bristol dentistry school is, I am pleased to say, developing outreach teaching. The consultant dental manager at our PCT—a difficult phrase to say; I am glad that I still have my own teeth—met with Swindon medical academy and Bristol dentistry school earlier this year to discuss the possibility of outreach teaching at the medical academy. All the parties are keen, but, as always, resources are an issue. I hope that my hon. Friend the Minister of State will be able to reassure me that the enthusiasm of Swindon practitioners will be matched by the funding needed to realise their plans.
Swindon has already benefited from dental access grants to the tune of £170,000. Six applications for funding were made, five of which were successful. The PCT has allocated £95,500 to the successful applicants, which translates into 10,000 new registrations. The money is enabling the five existing services to expand and modernise by providing new equipment and, crucially, four more dental chairs. The PCT is using the remaining money to set up two new dental chairs at one of Swindon's medical centres. By the end of 2005, therefore, Swindon will have a total of six new dental chairs.
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Dr. Murrison: I am fascinated by the dental chairs and I wonder who will fill them, given that we have lost 100 dental academics since 2000 and that the research assessment exercise appears to be sounding the death knell of dental academia.
Anne Snelgrove: I thank the hon. Gentleman for enabling me to take my maiden intervention. I think that the Government's plans to increase the number of dentists by increasing the number of undergraduates and by employing people from overseas under strict licensing controls are the right way to proceed. I am sure that we will be able to fill the places.
I was pleased to visit one of the NHS dentists in my constituency a few weeks ago. Ambience dental practice opened in 1998 as a direct result of Government funding, and it has seen 32,000 patients since then. Ambience is one of the pilots in the Government's personal dental services scheme, which began in January 2005. The practice is strongly in favour of the scheme, because it releases capacity and gives the practice a steady monthly income, which helps financial planning.
Under the old general dental services scheme, which is still running in many practices and in many Conservative Members' constituencies, Ambience's maximum capacity was 13,500 patients. If a patient did not attend within a fifteen-month period, that patient dropped off the list—a problem described by the hon. Member for Rochdale (Paul Rowen). If a patient who had once been on the list rang up in pain for emergency 24-hour treatment, Ambience was normally unable to help them and directed them to our local access centre, which we are lucky to have. Under the new scheme, the period in which patients may remain on the list without attending the practice is 30 months, the effect of which is to increase Ambience's capacity to 17,500 patients. That is one of the reasons why I welcome the new contract: the Minister is right to say that it points the way ahead. Because of the new contract, instead of turning patients away, Ambience is taking on an average of 10 new patients a week, which is extremely good news for my constituents.
Under the old budgeting system, a dental practice's income was based on the earnings of the practice in the previous year; in addition, fluctuating payments were made based on how much work was achieved by the practice each month, so when a dentist was on holiday, income fell. Under the pilot scheme, Ambience is given approximately £13,000 per treatment room—it has five—of which 50 per cent. represents salary and 50 per cent. costs. That gives Ambience a stable income and helps it to cater for the ebbs and flows of the dental practice.
With extra Government funding, Ambience could increase the number of treatment rooms available: it has the space to do so in the building in which the practice is located. The building is in the centre of town and would make an excellent extended practice. Each treatment room has the capacity for 2,000 to 2,300 patients per annum, so with two new treatment rooms Ambience could increase practice capacity by 4,600, which would greatly help South Swindon. Ambience dental practice is just one example of successful development by dental practices in Swindon: there are other NHS dental practices which I am sure are equally successful, and I look forward to visiting them.
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In addition to the increase in capacity and in the number of patients being treated that I have described, Swindon has a dental access centre for emergency treatment. Sadly, I have had to use it myself, but I cannot speak highly enough of the prompt, efficient service that I received. As the hon. Member for Westbury (Dr. Murrison) has reminded us, toothache is a dreadful thing. It was a relief to me to be seen within 24 hours—something that most NHS patients could only dream of before the Labour Government's investment in dental services.
I am pleased to inform the Minister that, earlier this year, I registered with an NHS dentist in Swindon. It was not difficult, as some would have us believe. I have received excellent service from my NHS dentist, including treatment for an abscess at 9 am on 6 May, which was not how I anticipated celebrating my election, especially given that the course of antibiotics prescribed forbad the consumption of alcohol.
There are two issues to which I wish to draw the Minister's attention. First, not enough of my constituents are aware of the availability of NHS dentists and they sometimes make erroneous value judgments about the quality of treatment. For example, a constituent attending my advice surgery last week—she did not come to discuss NHS dentistry, but she said, "Oh, and another thing," and launched in on the subject—complained that she and her husband had paid approximately £1,000 for private dental treatment, including root canal treatment. Not only did she think that there were no NHS dentists with open lists in Swindon, which is not the case, but she believed that complex treatment could be offered only by private practices. Nothing could be further from the truth. Expert root canal treatment is offered on the NHS—I paid approximately £60 for mine. Incidentally, I was cheered by the comment of the hon. Member for Mole Valley that root canal treatment on elderly patients takes three to four hours: given that mine took less than half an hour, the hon. Gentleman has knocked a few years off me, which alone makes getting elected worth while. We clearly need to publicise the treatments available to an excellent standard on the NHS.
Secondly, I am sad to say that some dentists are charging an initial registration fee before taking on NHS patients. Initial charges can be as much as £40 to £50 and apply to children as well as adults. For those on low incomes, that is a daunting sum to find, so I ask my hon. Friend the Minister of State to look into the issue. One of my constituents recently contacted me about her 10-year-old son, who had severe toothache. He was treated at the dental access centre, but could not be given follow-up treatment there. When my constituent, who is on income support, tried to register her son with a local NHS dentist, she was asked to pay £45, which she could not afford. I understand that there is some dispute about whether that charging practice is allowable within NHS dentists' terms of reference; in my opinion, it should not be, because it places an unacceptable barrier in the way of many who are most in need of treatment. Such charges might explain why the registration of children in Swindon as a whole has decreased slightly, whereas adult registration has increased. Despite that, 69 per cent. of children are registered, which is 6 per cent. above the national average. I do not want Opposition Members to run away with the idea that the situation is dreadful.
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As I said at the start of my speech, the issues I have described are ones that the Minister can easily help us to overcome. We in Swindon have seen great investment in dental services and we look forward to it continuing. In addition, I look forward with great interest to hearing about my hon. Friend's plans for the continuing development of dentistry. There is more to be done, as she has acknowledged, but we have made great progress in this important area of health.
2.59 pm
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