Mr. Walker: The hon. Lady makes a valid point. Does she think that more education needs to be targeted at parents of young children about the importance of providing dental care for young people in her constituency and mine?
Meg Hillier: The Government's excellent Sure Start programme could embrace education in that regard, as well as the many other excellent things that it delivers in my constituency and elsewhere. Parents have an important role, as do nurseries and schools. We cannot provide the necessary education top-down from Government and I would not suggest that. There needs to be an awareness that dental health in children is a good indicator of general health and well-being. I thank the hon. Gentleman for his helpful intervention.
The Labour Government are making a difference in a positive way. Before I finish, I wish to pick up on a point made from the Opposition Benches. The hon. Member for North Southwark and Bermondsey (Simon Hughes) expressed concern about foreign-born dentists. It is a shame that the hon. Member for Mole Valley (Sir Paul Beresford) has already left. I am delighted to have foreign-born dentists working in London and in my constituency, and I was rather shocked that a London Member should raise that as an issue of concern. Clearly, we also need to secure places at home to train dentists, wherever they were born, which the Government are doing.
I hope that my hon. Friend the Minister will address some of the points that I have raised and that we can look forward to a greater emphasis on dental health care, for children particularly, in east London.
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Mr. Jamie Reed (Copeland) (Lab): I have listened with interest to the contributions from both sides of the House. Like many other hon. Members, I am disappointed by the way in which the Cheadle by-election seems to have hung over so much of the debate. That has done the subject a grave disservice. Every time the Liberal Democrats have been asked to provide details of their policy with regard to dental provision, they have offered nothing but evasion and dissemblance.
Dental provision in my constituency, Copeland, is a problem, but there can no doubt that the Government's approach to tackling the problem is the right one. I am grateful for that. The West Cumbria primary care trust, within which Copeland falls, has seen some 2,600 new registrations in the past year alone. That is to be welcomed. In addition, the number of children being registered is 64 per cent. throughout the primary care trust, which is excellent.
In my experience, many dentists in my constituency are committed to the principles of the health service and everything that goes with that. However, it is clear that comprehensive dental provision, not only in my constituency but throughout the UK, cannot rely on the unique professionalism and philanthropy found by my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) in his constituency. There needs to be some kind of compulsion in any new contract for dentists with regard to NHS provision. Would the Minister consider a golden handcuffs clause in any new contract, such as that commonly found in business, whereby a large investment in training individuals requires them to repay the organisation that provides that training?
Mr. Walker: Is the hon. Gentleman suggesting that, when dentists graduate from dental school, they should be required to spend perhaps five years providing dental services in the NHS before they start taking on private patients?
Mr. Reed: An element of compulsion should be considered. It is reasonable and realistic to expect that any organisation which invests so much time and taxpayers' money in the provision of a public service should expect some recognition and repayment of that service when it is required.
Mr. Martin Horwood (Cheltenham) (LD): I should like to tell the House about one family in my constituency who contacted me during the general election campaign. The son had had persistent toothache for months. The family was on a relatively low income, although not on benefit, so they found the typical charges of a private dentist unaffordable. The son's toothache persisted and eventually they were able to get NHS treatment by being referred for emergency dental treatment. By that stage, and after months of discomfort and pain, the son was recommended to have three teeth removed. That is the state of NHS dentistry for some people in my constituency.
The hon. Member for South Swindon (Anne Snelgrove) said that, a few years ago, one could not get an NHS dentist for love nor money in South Swindon.
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That is still the case in Cheltenham. This morning, I looked at the primary care trust website, which lists all the dental practices not only in my constituency, but in the whole PCT area. There is page after page of dental practices not accepting any new NHS patients for treatment. Out of 30 practices in the PCT area, 27 are not accepting any new NHS patients at all, two are registering only children up to the age of 18, and only one is also accepting some adults, but only charge-exempt adults.
Susan Kramer (Richmond Park) (LD): Has my hon. Friend had the same experience as I have had in my constituency? Although there are a few NHS dentists who will accept adult patients, there are virtually none who will do the more sophisticated treatments, such as dentures, porcelain veneers, bridges and crowns. That is an aspect of the failure of dentistry that is seldom discussed but is an acute problem for my constituents.
Mr. Horwood: I thank my hon. Friend for highlighting that additional complication. In Cheltenham, apart from charge-exempt adults who qualify for that single dental practice, there are no NHS dental practices that will accept adult patients.
Mr. Andrew Turner (Isle of Wight) (Con): Does the hon. Gentleman recall that in questions on the subject on 14 June, my hon. Friend the Member for North-East Milton Keynes (Mr. Lancaster) referred to children being accepted on NHS lists only on condition that their parents agreed to go private with the same dentist? Has he had that experience in Cheltenham?
Mr. Horwood: I have not had that specific experience but I am alarmed to hear about it. It shows the extent to which NHS dentistry has collapsed, although as my hon. Friends pointed out, it was the last Conservative Government who were at the root of the problem when they changed the NHS contract in the first place.
The primary care trust is struggling hard to redress the situation. It increased funding for the number of dental chairs and the St. Paul's dental practice will consequently have more chairs. It has recruited two Polish dentists to start work in Cheltenham.
The problem is not the number of dentists. A recent study in The International Journal of Health Geographics revealed that Cheltenham and Tewkesbury primary care trust had one of the highest densities of dentists per head of the population in the country. The problem is the NHS contract. Unless those two Polish dentists are bad either at dentistry or economics, they will find the same position as in all other dental practices: if they try to pursue the NHS contract, they will ultimately face overdrafts and insolvency. That happened to dental practices in the early 1990s, when the previous Conservative Government first made the changes. The problem was not dentists being greedy, inefficient or trying to charge too much, but the increasingly large overdrafts that they built up as businesses. They simply could not sustain themselves.
Ms Rosie Winterton:
If the hon. Gentleman is considering the international recruits that the primary care trust has brought in, I suspect that they will work under the new system of contracts rather than the old
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one. I cannot understand his contention that they will be in the same position as they would have been in the early 1990s.
Mr. Horwood: It would be nice to know when the new contract will be introduced. This morning, I spoke to the chair of my local dental committee, who has waited for eight years under a Labour Government for something to be done about the NHS contract. It was promised two years ago.
Ms Winterton: If the new dentists are being brought in by the primary care trust through international recruitment, I suspect that they will work under the new personal dental services pilot contract, not the traditional general dental services contract. I hope that they find it reassuring that they are likely to work in that new way and will not therefore face the problems that the hon. Gentleman mentioned.
We have one of the highest densities of dentists per head in the country. The hon. Member for Hackney, South and Shoreditch (Meg Hillier) said that we should accentuate the positive, but there is little positive to be found. NHS registrations in the Cheltenham and Tewkesbury PCT have fallen below 40 per cent. That is a fall of some 30 per cent. since 1992, when the Conservative Government made the changes. The position under the Labour Government has got increasingly worse.
Moreover, according to the chair of my local dental committee this morning, the situation is set to deteriorate because Gloucestershire dentists are threatening to start deregistering NHS patients. Even if the two Polish dentists provide some NHS registrations, the increase is likely to be offset by other dentists in Gloucestershire deregistering NHS patients. The overview and scrutiny committee in Gloucestershire recently said that there was a genuine risk of NHS registrations deceasing even more unless something is done about the fundamental problem of the NHS contract. It was introduced by the Conservatives, but the Labour Government have done nothing about it for eight years. We have waited two years for a new NHS contract but it has not been provided. The time has come for something to be done.