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Mr. Neil Turner (Wigan) (Lab): Does the hon. Gentleman accept that the vast majority of deprived areas are in central London, the west midlands and the north? The resources were shifted to recognise the deprivation in those areas.
Mr. Francois: I am grateful to the hon. Gentleman for admitting that the switch took place. I am pleased that a Labour Back Bencher has been honest enough to put that on the record in the House of Commons.
The hon. Gentleman would be fairer if he acknowledged that the level of grant to Essex has increased in line with inflation or above it in every year since 1997. He can hardly say, therefore, that the increase in council tax was the result of taking away funding. He says that the Government were accused of having an underlying political motivation. That implies
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that all the areas that lost out on some of the funding changes, relative to what they would have received, were controlled by his party, which is not the case.
Mr. Francois: The Minister is well aware of what happened, as am I and all Members of this House. The public reaction to the change was reflected in the subsequent local elections, when the Labour party was slaughtered in Essex. I confidently predict that it will get another hiding in May.
Sir Paul Beresford: Perhaps part of the answer is that even if the Minister is right that Essex got more in percentage terms, its proportion of the total sum available dropped, while many of the northern councils, especially in urban areas, received more money through the change to the SSA, particularly as many of the indices were subjective rather than objective and therefore able to be manipulated.
We heard several good speeches on Report. My right hon. Friend the Member for Suffolk, Coastal (Mr. Gummer) made a thoughtful speech in which he raised the possibility of voluntary revaluation in certain limited geographical areas if residents wanted to be revalued for some pressing local reason. He did not give his argument a name, but I would characterise it as revaluation by consent.
During the debate on the amendment tabled by my hon. Friend the Member for Mole Valley (Sir Paul Beresford), we discussed whether, if we do eventually revalue at some point in the future, there would be any merit in running pilot revaluations in a few parts of the country to test the effects. I cannot imagine that many areas would rush forward to volunteer for that. Nevertheless, I suggest to the Minister that there might be some merit in doing it, not least to try to persuade people that the system is not bent. Whatever the Government were trying to do, a lot of the resistance arose because, given what had happened in Wales and with the grant shift, many people genuinely felt that the revaluation would not be fair. I think that the Minister would privately concede that. I make this as an entirely non-partisan suggestion.
Local government finance is the 21st century equivalent of the Schleswig-Holstein question. We have to come up with a grant formula that everyone can agree is equitable. Some people liked SSA and did not like FSS; some liked FSS and did not like SSA. It has been argued that some authorities needed more help with the process. I hope that the Lyons review will come up with an equitable formula, but if it is unable to do so, I hope and trust that an incoming Conservative Government will solve the problem.
Dr. Roberta Blackman-Woods (City of Durham) (Lab): I am grateful to have obtained the Adjournment debate for which I asked because I am concerned about the present and future availability of national health service dental services in Durham.
Twenty dentists in Durham provide NHS care but some of them do so only for the under-18s and other exempt cases under a personal dental services contract. All practices in my City of Durham constituency have currently closed their lists to new NHS patients. I understand that the nearest open list is at Chester-le-Street community hospital.
Problems with the availability of NHS dental care in Durham are unfortunately not new. In response to previous representations from me and my predecessor, the primary care trust agreed to employ a salaried dentist directly. That appointment was made but that NHS list is also closed, albeit temporarily.
The PCT intended to take on another salaried dentist and confirmed that in a meeting with me in the summer. In the event, that did not happen for a variety of practical reasons and the PCT does not currently have the financial resources to support it. Discussions with dentists about expanding their NHS provision are currently being held up until further details of the new general dental services contact are known.
Durham, like many commuter towns, faces a problem of the demand for dental services being higher than the size of its population base would suggest was necessary because many people who work in the city but do not live there register with a dentist. The PCT argues that that makes planning for the correct amount of dental services difficult. It also has the effect of pricing local, low-income people out of dental care because many of those who come into the city for employment can afford to be private patients.
The problem of "privatisation" has been happening for some years, with several dentists "encouraging" or forcing their NHS patients to become private ones. Sometimes lists are completely closed to NHS patients.
Mr. Peter Bone (Wellingborough) (Con): I am glad that the hon. Lady has secured such an important debate. When I listen to her speaking about Durham, I realise that her comments apply to Wellingborough, which suffers from exactly the same problem of dentists opting to go private. My constituents have to leave the constituency to find an NHS dentist.
As I said, several patients are forced to register as private patients. There was an unfortunate example in the summer, when a dentist gave two weeks' notice to his
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patients, did not inform the PCT, and told his patients that if they wished to re-register with him, they would have to do that on a private basis.
I would like the Minister of State for Health, my hon. Friend the Member for Doncaster, Central (Ms Winterton), to make some comments about how we can encourage dentists to take their social responsibilities to provide NHS care more seriously, especially as they are trained and supported by the NHS. I know that that applies only to some dentists, but I would welcome her comments on that.
I can see that the Government have taken action to try to address the problem of a shortage of NHS dentists by employing more dentists, setting and recently achieving a target of 1,000 new dentists, and I know that there are 170 extra training places this year in dental schoolsa 25 per cent. increase on 200405. I also understand that additional capital money is being made available, and discussions are taking place about a new dental school. But those measures, welcome though they are, are not delivering on the ground for the people in Durham.
In addition to the extra resources now being put into NHS dental services, I understand that the Government are placing a great deal of faith in the general dental services contract being introduced from April 2006, which they say is a large part of the solution to current problems. Feedback from the Durham and Chester-le-Street PCT, however, does not fill me with optimism. Already the PCT has received one letter of resignation giving the reason as the introduction of the new contact. The primary care development manager has stated that she has had many discussions with dentists over the past few months and she has yet to hear a positive view of the contract.
Orthodontists are also very unhappy with the proposals relating to them. Incidentally, Durham has only one orthodontist practice, and the waiting time for treatment is currently 20 months, which is also very unsatisfactory. Anecdotal evidence suggests that once dentists receive their contract values and activity levels from the Dental Practice Board, which I understand is happening soon, most will not wish to renegotiate their NHS contracts. The majority are unwilling to commit themselves without that information.
Obviously, I find this information very worrying. Faced with a potential sudden large reduction in the amount of dental capacity available on the NHS, the PCT will need to provide a direct PCT service, but currently the PCT does not have the capacity either in terms of dentists or surgeries to be able to re-provide that service.
Patients involved in a PCT consultation exercise also had some difficulties with the new contracts. They seemed to be concerned that dentists would no longer hold lists of registered patients as there would be no long-term responsibility for the quality of care provided. They were concerned that patients might not be able to receive continuity of care.
Patients also feel that the way that charges are structured in the new contractwith a fixed price for fillings, for example, no matter how many they havewould encourage people to wait until they require a large number of fillings before visiting the dentist. That
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would probably apply more to those on lower incomes, creating inequality in dental care. That sentiment was also reflected in consultations with the professionals.
The PCT and the British Dental Association acknowledge that the new charging system is simpler, and that there will be winners and losers in terms of costthose requiring one-off, more intensive treatment are likely to be the winners, and those needing regular lower-level treatment are likely to be the losers. The British Dental Association maintains that we shall need to train yet more dentists and other dental team members. It notes that demand for dentists is outstripping supply, which is why dentists are closing their books.
According to the BDA, in 2005, 15 per cent. of general dental practitioners were not taking on new child patients, 37 per cent. were not taking on new exempt adults, and 15 per cent. were not taking on new paying adultsa significant rise since 2000. It is also concerned that additional funding might not reach front-line dental services when PCTs become responsible for commissioning from April 2006.
The BDA acknowledges that the value of the private market has grown rapidly over the past 10 years and that NHS care still outstrips private practice, but it suggests that the move towards private care is prompted by a lack of investment in NHS dentistry. Evidence shows that dentists do not typically earn more in private practice than in the NHS, but that they can earn similar amounts of money while being able to spend longer with patients.
I think that it is fair to say that reaction to the new general dental services and personal dental services contracts has been mixed. More than anything, dentists appear to want a break from the treadmill so that the link is broken between treatments provided and remuneration received. The view being expressed by the BDA, however, is that under the new contracts dentists will lose the flexibility to work at their own pace but will be unable to get off the treadmill. The basis of the new system is that the contractor will complete a number of units of dental activity, set by the local PCT, in return for a set monthly payment.
Dentists are also concerned because the new proposals do not encourage disease prevention or the maintenance of good oral hygiene, as preventive care does not specifically attract units of dental activity. They are also of the view that the new system has not been sufficiently piloted before being rolled out across the country. They note that although one or two aspects of the new GDS contract proposals have been tested in the PDS agreements, the UDA output system is, they contend, as yet entirely untested. The BDA maintains that the shortage of dentists is likely to continue for some time.
I raised those more general points about the contract and work force planning matters because I should like reassurance from the Minister about the likely impact of the new contracts in terms of improving access to NHS dental services in Durham. I should like her to comment on the steps that she might take to alleviate the current unacceptable problem in Durhamthat no NHS facility is available to new patients. What support will be given to PCTs directly to employ dentists if the mixed economy of dental care does not deliver enough NHS capacity post-April 2006 and they need to employ salaried dentists to achieve NHS output?
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