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Mr. Lansley: I am grateful to my right hon. and learned Friend, but I am not going to make that pledge. My
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objective, and the objective of the Conservative party, is to secure access to NHS dentistry for people in this country on an equitable basis. Inequalities of access have given rise to the need for a new contract. The purpose of the motion is to make the Government realise that it is the eleventh hour—it is one month to the day before the new dental contract comes into force. The profession are against the contract, and it profoundly disagreed with it in earlier discussions. The Government, however, refused to listen. In December last year, the British Dental Association literally walked away from the negotiations, and said that talking to the Government was akin to a one-way street. It talked to the Government, but the Government did not respond.

Mark Pritchard (The Wrekin) (Con) rose—

Mr. Lansley: I shall give way to my hon. Friend, as I know that he is anxious to contribute.

Mark Pritchard: I am always anxious to contribute to debates secured by my hon. Friend. Does he agree that there is concern about oral health because of the lack of access to dentists, and that cancers of the mouth may increase and orthodontic provisions could be affected?

Mr. Lansley: That is absolutely right. A central reason why dentists as a profession want to spend more time with patients is that they want to undertake proper preventive work and good oral health work. In the mechanics of the contracts, the Government have not taken proper account of the time that it takes for new orthodontic practices to establish their work. Practices across the country, including one in my own constituency, have written to me,    because they have been offered a contract that dramatically underestimates the amount of work that they need to do. The base year or target year did not include their work because they had established themselves more recently.

The dentists walked away from negotiations with the Government, so the Government proceeded on the wrong basis. They did not introduce proposals based on registration or a capitation system. Their proposals did not encourage preventive work or promote good oral health. They should work with the profession, rather than against it. Not only is the profession against the Government, but this morning, Which? published a survey in which 79 per cent. of the public said that they do not trust the Government to improve dentistry in the next year. The profession and the public are saying the same thing, so the Government must think again. The motion is designed to make sure that they do so. The contract is a shambles, and it is not based on the primary dental services pilots. It does not include a UDA system. I apologise to the House. There are no Northern Ireland Members in the Chamber, but by "UDA" I mean "units of dental activity". The personal dental services contracts were not established on that basis, although the UDA system allows dentists to spend more time with patients and takes account of the size of patient lists. The Government would not proceed with such proposals, which is tragic.

Ann Winterton (Congleton) (Con): Is it not irresponsible of the Government to introduce an untried
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and untested system, which is causing chaos throughout the United Kingdom, and will not achieve their aim of improving the quality of care for patients, securing access to dentistry and improving the nation's oral health?

Mr. Lansley: My hon. Friend is right, and has captured the profession's view. I have already cited the British Dental Association, which has said:

Those are the things that we are supposed to target, but the Government are not setting out to achieve them. The contract is seriously flawed.

David Tredinnick (Bosworth) (Con): Leicestershire primary care trusts have a £6 million shortfall, so it will be impossible to deliver even the care that is available this year. That is on top of the complaints by the Leicestershire local dental committee, which is almost unanimously against the proposals, particularly the decision to charge on a treatment basis rather than per visit.

Mr. Lansley: My hon. Friend is quite right. The pictures of people queuing for a dentist in the Leicester Mercury are testament to the difficulties that they are facing in the light of the withdrawal of services. The Secretary of State has not bothered to stay in the Chamber to discuss dentistry, but there are dental practices in her own constituency that have written to    my hon. Friend the Member for Westbury (Dr. Murrison) to say that they have ceased to provide NHS dentistry. We need a new contract. Not only do practices find it impossible to secure contracts that will enable them to continue to look after their patients—90 per cent. have experienced difficulties with contract values—but, as I have said, they have lost the ability to charge for missed appointments. They can no longer offer services to exempt adults and children.

The Minister of State, Department of Health (Ms Rosie Winterton): Absolutely.

Mr. Lansley: Well, there is a problem with which we must deal, as some dental practices say that adults can only register their children for NHS work if they enter into a private contract themselves. PCTs, however, have told practices that they cannot offer a contract to treat children and exempt adults on the NHS, whether or not the practice has made that condition. Children have therefore been thrown off NHS lists, even though their dentist is willing to offer NHS dentistry.

Ms Winterton: As the hon. Gentleman knows, because of demands in this House dentists were following exactly the practice that he outlined by saying, "We'll take your children on the NHS if you as parents go privately." There can still be children-only lists under the new system. I am sure that he agrees that if primary care trusts believe that it is better for dentists to offer services to children and parents at the same time, it is absolutely right that they have the discretion to do that.
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Mr. Lansley: As the BBC survey said this morning, 5 per cent. of primary care trusts are saying that one cannot have exempt adult and children-only lists. I know why they are resisting it—because then there is no patient income.

That brings me on to another essential point—charges. The British Dental Association has accused the Government of using the new contract as a revenue-raising measure contrary to the principles of the national health service, yet this is a Government who talk about a free NHS. In 2004–05, dental charge income was £465 million; in 2006–07, it will be £623 million. Those are the Government's own figures. I only received the latest figures this morning, having asked the question in November—we can only get information out of the Government by bringing this debate to the Floor of the House. That is a 28 per cent. real-terms increase in dental charge income. The Government's contribution to dentistry over those same two years is rising by just 9 per cent.

That is completely contrary to the Government's previous claim that the contribution made by patients towards the cost of dentistry would remain the same. In fact, it is rising—I have just stated the figures. There are three bands of charges. That is simpler, but not necessarily fairer. For example, a check-up will cost £15.50 instead of £5. Lord Warner, the Minister in the other place, said that 42 per cent. of patients get their treatment in band 2 and, of those, three quarters will pay more under the new system. That is what is going on—more charging and more costs for patients. Of course, the Government will parade the fact that £2.7 billion is being spent on dentistry, neglecting to say that the cost of dentistry to patients has increased by one third, on the Government's figures, in the space of two years.

Steve McCabe (Birmingham, Hall Green) (Lab) rose—

Mr. Lansley: Perhaps the hon. Gentleman would like to explain that.

Steve McCabe: Given the hon. Gentleman's concern about charges, does he agree that there is something unethical—indeed, perhaps involving a breach of data protection legislation—in dentists who are voluntarily opting out of the NHS writing to patients to advise them of private insurance arrangements without disclosing the benefits that they themselves stand to make? Is that appropriate?

Mr. Lansley: I can understand that the hon. Gentleman is embarrassed that dentists are leaving the NHS and writing to their patients, but that is, regrettably, what is happening. They have a relationship with patients and are contacting them to give them details of what they are proposing to do. Instead of the hon. Gentleman criticising dentists, it would be better if he and his hon. Friends tried to work with them. The dentists we have talked to who are leaving NHS dentistry or reducing their commitment to it deeply regret having to do so.

The way forward is clear. Many dentists who sign up to the contract will do so reluctantly. They will be very unhappy with the straitjacket of activity targets that
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they are being put into. If they start to move beyond the 4 per cent. tolerances, they will find that they have no confidence that contract values will be honoured in future. They may well find that penalties are imposed on them. As time goes on, particularly as the income protection period expires, many will say that they are going to give up and go outside the NHS. A third of the dentists who got together in Birmingham at the local dental committee said that they would not sign the contract, and dentists in many other parts of the country are saying the same.

Instead of dentists reducing their commitment, we must go in the opposite direction. Their commitment to the NHS must be increased if we are to avoid recurring inequalities in access to dental care.

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