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Helen Goodman (Bishop Auckland) (Lab): The hon. Gentleman has repeatedly mentioned inequalities. He is probably not aware that last week, in my constituency's most deprived ward of Coundon, a new health centre was opened with provision for two dental chairs, where there has never been a dentist before. His point is not borne out across the country as a whole.

Mr. Lansley: I received an e-mail from a dentist in north-west London—I think that he was in the constituency of the right hon. Member for Holborn and St. Pancras (Frank Dobson)—who was abandoning NHS dentistry and was deeply depressed about the Government's implementing of the new contracts. I am afraid that wherever one goes, including in north London, there are dentists who are going to do that. This morning the Minister and I discussed on the radio what is happening in Barnsley. I do not know whether any Members from Barnsley are here. That is not a wealthy area, but patients there have been queuing for private dentistry because their dentist has abandoned the NHS.

It is time for a new system. We know where the Government are heading because the Minister has made it perfectly clear in previous discussions. She is threatening dentists by saying that if they do not choose to do NHS work, she will find other dentists who will. There will be dentists coming in from Poland.

Mr. Stewart Jackson (Peterborough) (Con): Perhaps, like me, my hon. Friend would like to disabuse the hon. Member for Bishop Auckland (Helen Goodman) of the notion that everything is rosy in NHS dentistry. In my constituency, 34,000 patients have been deregistered, with a huge impact on lower income groups, older people and young families. What is worse is that the primary care trust has been forced into political posturing by operating a hotline that patients have to phone secretly to be told where the new NHS registrations are. That is spin under the NHS.

Mr. Lansley: As my constituency is nearby, I have seen that that is indeed what is happening in my hon. Friend's constituency, where the enormous loss of NHS dentistry is affecting a large proportion of his constituents. I sympathise with him and agree with the support that he is giving to NHS dentistry in his constituency.

Mike Penning (Hemel Hempstead) (Con): It is not only certain constituencies that are in crisis, but the
 
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whole country. When the Select Committee on Health looked into this, the Minister eventually admitted that 30 million people in this country do not have an NHS dentist.

Mr. Lansley: That is right. Only about 40 per cent. of non-exempt adults have access to NHS dentistry. Of course, the Government are going to abolish registration and manipulate the figures. They will say that increased numbers of people see an NHS dentist, but that does not mean that they are necessarily registered with them or have access as they did in the past on the basis of a long-term relationship.

It is deeply worrying that fewer children are getting access to NHS dentistry. This morning's Which? report said that 82 per cent. of the public think it extremely important that children get free dental treatment, but that too is being lost. The inequalities are dramatic. In some places, a quarter of adults have access to NHS dentistry, while in other places it is 60 per cent. That is deeply unacceptable in a national health service.

The Minister always used to say that we need a new way of working; well, we do. We need a new way of working that is not about dentists on a treadmill, particularly a new treadmill that is governed by primary care trusts, which, as the National Audit Office made clear, have none of the expertise necessary to put this new system in place. We cannot move towards the system that the Government seem to be proposing whereby patients have perverse incentives to delay treatment or present as urgent cases with pain because it will be cheaper than if they have the work done while not being in pain. We must have a system whereby the patient's relationship with their dentist is geared around preventive work and good oral health, patients know that they have security of access to NHS dentistry, and dentists are incentivised to offer NHS dentistry and to increase their commitment to NHS dentistry instead of reducing it.

John Hemming (Birmingham, Yardley) (LD): The hon. Gentleman almost certainly knows that the deadline for the first return of contracts was yesterday. If people have not returned their contracts by yesterday, payments will be delayed by a month. The secretary of the Birmingham dental committee told me that 75 per cent. of NHS dentists had not returned their contracts by the deadline. Some may be returned this month but the figures show a massive reduction in the number of NHS dentists in Birmingham.

Mr. Lansley: I understand the hon. Gentleman's point. We held discussions with the Birmingham dental committee, as he doubtless has. Dentists in Birmingham are rightly anxious and angry.

Richard Burden (Birmingham, Northfield) (Lab): Will the hon. Gentleman give way?

Mr. Lansley: No.

As I explained, we need a new way of working. However, we have made it clear that it is most important not only to commit ourselves to improving the
 
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NHS    overall but to trusting NHS professionals. Happily, in this instance, the desires of the patients and the profession are exactly the same. Patients want a relationship with a dentist in which they have security of access and certainty that what is in their interests—good oral health—is being pursued, with their making a reasonable rather than an excessive contribution through charges. That is what we need. The motion calls for that, even at the last minute.

Two weeks ago, the Minister met representatives of the British Dental Association, who left the meeting deeply disappointed with its results. It is not too late for the Government to withdraw the contract, suspend the use of units of dental activity and work through a piloted system that is based on capitation. That is the way forward. I urge the Government to do that even now, and I urge the House to support the motion.

1.11 pm

The Minister of State, Department of Health (Ms Rosie Winterton): I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:

Although the motion is flawed, it gives us the opportunity to debate NHS dentistry as we approach the implementation of the most significant reforms to dental services in the history of the NHS. It is worth reminding the House why we are making those changes to NHS dentistry. The current system provides no real stability for patients or the NHS. Under the traditional general dental services system, dentists can set up in practice where and when they wish and decide how much or how little NHS dentistry they wish to undertake. There have traditionally been no local budgets for dentistry. When dentists decide to reduce or abandon their NHS work, the NHS locally has no power to commission replacement services. I know that that has affected hon. Members of all parties and caused immense problems. That volatile system has not served patients well.

On top of that, the contract under which dentists have worked has been extremely unpopular with them, especially following changes that were introduced in the
 
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1990s and the subsequent fee cuts. Let me remind hon. Members that the traditional way of paying dentists is based on payments for 400 individual items of service, for example, a filling, a crown or having a tooth out. That put the emphasis on invasive work rather than preventive treatment. As hon. Members have said in the House previously, it has been confusing for patients, who often did not understand what they were paying for on the NHS and what they were paying for privately. I am sure that many hon. Members have experienced constituents saying, "I've just paid £1,000 for treatment on the NHS." When they have come to me, I have told them that they could not have paid that amount because the maximum that they can currently pay on the NHS is £384. However, confusion between NHS and private treatment has occurred.

The dental profession, especially the British Dental Association, complained for many years about the treadmill effect of how dentists were paid. As I said, that put the emphasis on invasive rather than preventive treatment and was an incredibly bureaucratic system for dentists. Two dental schools were closed under the previous Administration. Again, that significantly reduced the numbers of dentists in training.

To tackle the genuine shortages in access to NHS dentistry, we have taken some immediate action.


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