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House of Commons
Tuesday 22 November 2005
The House met at half-past Two o'clock
PRAYERS
[Mr. Speaker in the Chair]
Oral Answers to Questions
HEALTH
The Secretary of State was asked—
NHS Dentistry
1. Mr. Andrew Robathan (Blaby) (Con): What percentage of the residents of the South Leicestershire primary care trust area is registered with an NHS dentist. [30509]
The Minister of State, Department of Health (Ms Rosie Winterton): Registration details are not collected on the basis of residency. However, the number of patients registered with dental practices in south Leicestershire is equivalent to 51 per cent. of the local population, a 3.1 per cent. increase since October 2004. Fifteen practices are currently accepting NHS patients.
Mr. Robathan: The other 49 per cent., including my family and myself and my constituents in the Lutterworth area, would like to register with an NHS dentist but, believe me, it is impossible to find one. Can the Minister explain how it was that in September 1999 the Prime Minister said to the Labour party conference:
Was the Prime Minister mistaken then, or was he not entirely correct when he told the Labour party conference that?
Ms Winterton: As the hon. Gentleman knows, we are reforming the system whereby NHS dentistry is delivered. With regard to the first part of his question, there is a dental access centre in his area. There are 15 practices currently registering NHS patients in his area, so I suggest he contacts the PCT to see whether he can be registered.
David Taylor (North-West Leicestershire)
(Lab/Co-op): The position in south Leicestershire has a knock-on effect on the nearby PCT of Charnwood and North-West Leicestershire, in which my constituency is located. There are therefore shortages there, apart from the western end of the constituency. The soon-to-be amalgamated PCT
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has done a reasonable job introducing the new contracts. Can the Minister confirm that as recently as 1992, less than 10 per cent. of UK dentist income came from private practice, whereas now it is more than half? When will the new measures start to redress that balance, so that we can get even coverage throughout our county?
Ms Winterton: As the hon. Gentleman rightly said—[Hon. Members: "Friend!"] the difficulty is not necessarily that there is a shortage—
Mr. Speaker: Order. Let me say to those on the Opposition Front Bench and others, but mainly those on the Front Bench, that if they want to get to the Government Dispatch Box, they should not shout at a Minister. That is the last way that they will manage to get there.
Ms Winterton: Thank you, Mr. Speaker. The changes that we will bring in next year will address some of the problems related to the fact that NHS dentists have increasingly been undertaking private work. The offer that we are making to dentists is a fair one. Allowing them more time to do preventive work, and other measures, such as increasing the number of dentists in training and bringing in international recruits, will help to ease the current problem. We know that it is by no means solved, but we are taking firm measures to deal with the crisis that we inherited from the Conservatives.
2. Mr. Stewart Jackson (Peterborough) (Con): If she will make a statement on her plans to reform NHS dentistry. [30510]
The Minister of State, Department of Health (Ms Rosie Winterton): From April 2006, commissioning of NHS dentistry will be the responsibility of primary care trusts. A new dental contract will be introduced alongside a much simpler system of patient charges. The reforms will improve access, encourage more preventive dentistry and provide a stable income for dentists.
Mr. Jackson: I have corresponded with the Minister and received a delightful letter back from her. Will she come to my constituency, visit the PCT and acknowledge the crisis in NHS dentistry in Peterborough? In the meantime, will she ask her civil servants to undertake an urgent review of the deregistration of NHS dental patients across the country and the massive impact that that is having, particularly on preventive dentistry?
Ms Winterton:
I am aware of the hon. Gentleman's correspondence and the situation in his constituency, where I understand that a dentist has threatened to leave the NHS, which would deregister about 30,000 patients. However, I also know that the PCT has been in discussions with other local dentists and is confident that if that dentist deregisters, it can offer those patients places with NHS dentists. I am aware of the problem, and the PCT is dealing with it. I hope that the hon. Gentleman will join me in encouraging the dentist to stay with the NHS and in thanking the PCT, which is working extremely hard to ensure that NHS dentistry is improved in the area and that those 30,000 people are found places, if it is necessary to do so.
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Jim Dobbin (Heywood and Middleton) (Lab/Co-op): My hon. Friend has visited my constituency to meet Mr. Tariq Drabu, who has a dental practice in Middleton. Since her visit, he has invested some £50,000 of his own money and, with the help of the PCT, increased his NHS patients by 1,000, and he is also about to take on a new partner. Does she think that his commitment to the NHS sets a good example to other dentists and will she consider visiting Middleton in the new year to see the progress made?
Ms Winterton: I remember visiting my hon. Friend's constituency, where I was particularly impressed by the fact that the dentist to whom he has referred was working under a personal dental services contract. I thank the dentists who have taken that approach, because they have shown how the new contract will work. The system allows more preventive treatment and greater clinical judgment by dentists on how to look after their patients, which benefits not only dentists, but patients, too. That is how we will approach the new contract in April 2006, and my hon. Friend is right that how his PCT has worked locally is an extremely good example of how NHS dentistry can be turned round in a local area.
Paul Rowen (Rochdale) (LD): Will the Minister explain how dental registrations in Rochdale have fallen from 58 per cent. in 1997 to 38 per cent. this year? Is that progress?
Ms Winterton: Of course that is not progress, and it is not good that the number of NHS places has fallen. One reason why the decrease has occurred is that more dentists have turned to private work. We have tried to turn the situation around by working with dentists to introduce a new contract that reflects how they say that they want to work and by introducing a simpler system of patient charges to reduce bureaucracy, about which dentists have complained. We are bringing dentists back into the NHS, using international recruits and training more new dentists, which started in October. I know that the situation is far from perfect, particularly in Rochdale, where I have visited the dental access centre, and we are taking steps to turn the situation around.
Mr. John Grogan (Selby) (Lab): Will my hon. Friend confirm that the average dentist currently gets about £80,000 from the NHS plus access to capital grants and that that payment is likely to be maintained under the new system? When dentists deregister, despite the excellent remuneration under the new system, will she encourage PCTs to commission other dental services or directly employ salaried dentists?
Ms Winterton:
My hon. Friend is right to point out that if a dentist makes a reasonable commitment to the NHS, they can expect to receive about £80,000 in pay plus another £60,000 in business expenses, which is not an unreasonable salary. Because the power and the money will be devolved to the local level, if an NHS dentist decides to leave the NHS despite those generous terms, the PCT will have money available locally to commission dentistry from a dentist who is interested in the NHS.
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Sir Paul Beresford (Mole Valley) (Con): As you know, Mr. Speaker, I have a slight interest in the subject, so I might be able to help. The Minister knows that dentists are trained to use new methods, materials and techniques that patients demand and which are, I think correctly, available only outside the NHS. Will she re-examine the contract to see whether it can be tweaked to encourage mixed NHS and private dentistry, which would allow dentists to stay with the NHS, at least in part?
Ms Winterton: Nothing in the new contract will prevent the continuing mix of NHS and private dentistry. The hon. Gentleman is right to say that new materials are available as well as so-called cosmetic dentistry, which is not allowed on the NHS at the moment. He and I have discussed several of those issues, and I can assure him that nothing in the new contract prevents dentists from undertaking private work if that is what patients demand.
Chris Mole (Ipswich) (Lab): The mix to which my hon. Friend refers causes confusion for some patients. What are the Government doing to clarify for patients the information about which services are charged for and which are provided on the NHS?
Ms Winterton: My hon. Friend is right that there has been confusion; I am sure that other hon. Members will have had experience of that. People say to me, "I've just paid £1,500 for NHS dental treatment", and I say, "No, you haven't, because the maximum you could pay was £383." The Office of Fair Trading looked into this very thoroughly and said in its report that there is some confusion. As a result of the changes that we are making, we want dentists to make the prices for private work absolutely clear in their surgeries and to tell patients what they can expect to pay under the NHS. The simplified banding system will also make it clearer to patients what they can expect to pay on the NHS. I accept that there has been a problem, but we are taking steps to put it right.
Dr. Andrew Murrison (Westbury) (Con): Is it not the case that the Minister's plans will result in more patients paying more, perverse incentives for dentists to offer cheaper treatments within each of the charging bands, and little help from units of dental activity to encourage preventive work of the sort that my hon. Friend the Member for Mole Valley (Sir Paul Beresford) mentioned?
Ms Winterton:
No, they will not. We should be absolutely clear about what we are offering dentists under the new contract. If they give a reasonable level of commitment to the NHS, they can expect to take home about £80,000 a year. On top of that, about £60,000 is given in expenses to help run practices. That will be guaranteed for three years to encourage the same level of commitment to NHS dentistry as at present. However, in terms of units of dental activity, there will be a reduction to allow for preventive care. The hon. Gentleman is wrong to say that this militates against
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NHS dentistry; in fact, it is a very good offer to NHS dentists. I hope that Opposition Members would join me in encouraging dentists to stay with the NHS and not to go private.
3. Natascha Engel (North-East Derbyshire) (Lab): If she will make a statement on progress towards recruiting extra dentists into the NHS. [30511]
The Minister of State, Department of Health (Ms Rosie Winterton): Some 1,453 dentists were recruited by the end of October 2005, contributing to a 1,100 net increase in the number of NHS dentists in England between September 2004 and September 2005. This recruitment drive improved access to dentistry in many parts of the country. During the past 12 months, registrations increased by 700,000.
Natascha Engel: As a result of that work, NHS patient registration in north-east Derbyshire has increased by nearly 5,000. What steps will my hon. Friend take if a critical mass of dentists opt out of the NHS contract and choose instead to provide private treatment only?
Ms Winterton: I am very pleased to hear that there has been an increase in the number of NHS patients in my hon. Friend's area. That is due in no large part to the work of local primary care trusts—
John Bercow (Buckingham) (Con): No small part.
Ms Winterton: Quite right. It is due in no small part to PCTs and local dentists working to rectify the situation.
As regards what will happen if dentists do choose to leave the NHS, the whole idea of commissioning at local level is that instead of the money reverting to the centre, as it used to, it remains at local level. That means that the PCT can use that money to purchase dentistry from other dentists or to recruit from other areas if necessary.
Julia Goldsworthy (Falmouth and Camborne) (LD): Does the Minister agree that headcount NHS dentist figures do not give a full picture of the extent of shortages? I recently spoke to a dentist who has only three NHS patients—his wife and two children—but still counts as an NHS headcount dentist. Does the Minister agree that, to overcome the problem, the Department must undertake to measure NHS dentists on a full-time equivalent basis?
Ms Winterton:
One of the advantages of the new contract and the new system of commissioning dentistry is that the local PCT will be required to consider local health needs for dentistry and then examine the number of dentists who provide it. If necessary, in the instance that the hon. Lady has highlighted, it would be possible to ask dentists whether they would like to take on more than three patients so that the PCT got the advantage of the money being devolved locally and NHS dentists could expand their practices if others were not willing to offer NHS dentistry.
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Joan Walley (Stoke-on-Trent, North) (Lab): Is it not the case that, if the Government are to be truly successful in recruiting more dentists, they will have to increase the number of training places available? Will my hon. Friend look closely at the proposal to build a dental school in Stoke-on-Trent as part of the new provision that is planned for the west midlands?
Ms Winterton: My hon. Friend knows that we will increase the number of training places by 25 per cent. We set a target this year for 170 extra places and we have made 189 available. As she also knows, we are considering proposals for a new dental school and we will examine them in the new year. Let me remind hon. Members that we are considering a new dental school because the Conservative party closed two when it was in power.
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