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Ms Rosie Winterton: Does the hon. Lady accept that we should be able to monitor and measure dental activity, given the amount that we spend on it locally? How would she monitor dental activity?

Julia Goldsworthy: I would like the Department to monitor dentists on a full-time equivalent basis, rather than on a head-count basis. I have used this example before: I have spoken to a dentist who is on the NHS list and who has three NHS patients—his wife and two children.

Paul Holmes (Chesterfield) (LD): Does my hon. Friend agree that the Minister's speech was strong on
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wishful thinking and weak on reality? The reality for my constituents in Chesterfield is that the wonderful new contract has driven dentists to leave the NHS. In recent weeks, a wave of my constituents have come to me to say that they have been given the choice between taking out expensive private medical insurance and looking for another dentist. However, when they look for another dentist, it is almost impossible to find any slack in the system that enables new NHS patients to be taken on.

Julia Goldsworthy: That has been the experience in many other places. Of course, it is outcomes that are most important, rather than the treadmill of units of dental activity.

As we have heard, local dental committees report real concerns about the test year. The new UDA targets are based on the test year, but do not account for variances during the year, which could result in contract values that do not represent the NHS work that is undertaken. The system has not been piloted. I am pleased to hear that a review is to be conducted, but what will the Government do to implement the review group's recommendations? When will it be set up? Will it be in time for the introduction of the new contract on 1 April?

Will we know whether more patients are accessing NHS treatment if it is courses of treatment, rather than registrations, that will be measured? What will happen to waiting lists at NHS dentists if people stay on the register permanently? Will we see a massive increase in registrations, with many patients struggling to get a check-up on the NHS within two, three or four years? Will there be any measurement of how long the average time is between check-ups for the average patient?

Ms Rosie Winterton: Will the hon. Lady give way?

Julia Goldsworthy: I will if the Minister will allow me to make some progress.

If that means that people will go longer between check-ups, how can that be squared with the Government's stated aim to shift their focus to preventive work? Under the new system, people will go to a dentist only if there is a problem.

Ms Winterton: Again, I do not think that the hon. Lady quite understands the system. The NICE guidelines have changed. It is up to the dentist to decide when a patient should come back. Some patients will have to come back within six months, but the point about the flexibility in the new way of working is that, if the dentist believes that the patient has good oral health and does not need to be seen for two years, that is when the patient would come back.

Julia Goldsworthy: Of course, if there are not enough dentists, how will those patients be able to access the regular check-ups that they need?

That leads me on to the final changes, those to pricing structures—changes that, ultimately, the patients will notice. The price of a check-up will increase, surely deterring people from having regular check-ups, where not just caries but problems such as mouth cancers are detected, and where the preventive work that the Government claim is so important is performed.
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The new pricing structure means that the median price will increase, even though the charges for the most expensive treatments will reduce. According to the BDA, three quarters of the 42 per cent. of patients who fall into the middle band will end up paying more than they did previously. That will lead to perverse incentives, where problems will be stored up, so that the treatment is more affordable and represents better value for money for the patient. I have raised that issue with the Minister in previous debates and she has refused to accept it, but I quote one of my constituents to emphasise the point:

People are coming to me saying, "If I understand the new charging system correctly, it makes better sense for me to wait until I need two or three fillings and I can pay for them under one band, through one course of treatment, rather than having them one at a time, and paying three times for the same treatment."

Primary care trusts are also concerned that the new charges and the new contracts will lead to even greater pressures being placed on emergency treatment centres. Previously, emergency treatment centres would accept only patients who were not registered with an NHS dentist. Now they will have to accept everyone. With emergency treatment cheaper than a band 2 course of treatment, there are concerns that people will wait until their problem is an emergency.

It is also unclear how many and how well people understand what the new charging structures are and how they will be affected by them. I understand that the new information leaflets have been sent to primary care trusts and are sitting in NHS dental surgeries. Have the Government estimated the penetration of those leaflets and what the level of understanding is now about the new charges, given that they will be put in place on 1 April? Has the Minister's Department undertaken an evaluation report and, if so, will she be prepared to publish it? Will patients see the leaflet only when they go for a check-up? Will some patients know nothing about the new charging structure because they went for a check-up before Christmas and were told to come back in a year? They will not know that the price of their check-up will increase significantly the next time they go for a check-up. Does she think that that is fair and proper?

Ms Rosie Winterton: I hope that the hon. Lady realises that, under the new system, it is not just an ordinary check-up that is undertaken. It is an examination, plus preventive health advice, plus a scale and polish if necessary, plus any diagnostics, for example, X-rays. That all comes within the £15 range.

Julia Goldsworthy: Of course, all the patients will know is that it is more expensive than last time. I would be interested to know how many leaflets have been produced, and how many have been sent to NHS and private dental surgeries, in case patients wish to switch to the NHS if they can. At what cost have they been produced? I understand that an evaluation report has been produced and I hope that the Minister will undertake to place it in the Library of the House.
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The theme that sadly emerges is one of a series of unknowns. A series of fundamental changes are being introduced but there has not been adequate testing and piloting to determine the changes' knock-on effects individually, let alone in combination. For those reasons, it is hardly surprising that patients, dentists and primary care trusts are still unclear about what the new contract will represent and what impact it will have. Since the Government did not spend the time in advance of the changes assessing their impact, I am glad to hear that a review group will be set up, but will the Minister undertake to implement its recommendations?

The new contract and charging system has not produced the circumstances or incentives for patients to take a preventive approach to their health care. The cost of a basic check-up will increase, dentists will not have the time that they want to spend on preventive work, and it does not appear that more people will necessarily have access to NHS dentistry as a result of the changes. Ultimately, people will go for regular check-ups only if they can afford them, if they understand how the new system works, and if they can find an NHS dentist. It seems that many of the problems still remain essentially unresolved.

2.8 pm

Mr. Eric Martlew (Carlisle) (Lab): Before I get into my speech, I should like to thank all the hard-working dentists in my constituency and throughout the country who work well with the NHS. Sometimes, in my local skirmishes with some of my dentists, I have perhaps forgotten that.

Did not the hon. Member for Falmouth and Camborne (Julia Goldsworthy) think it odd that the dentist whom she mentioned treated only his family on the NHS? Did she not think that that was a bit of sharp practice? Perhaps I am naive. Perhaps she can put his name on the record so we can all know who it is.

I have sat and watched the Opposition—the major Opposition, because there is no one here from Lloyd George's party. One of the Conservative Members who attended the debate was a Minister in the previous Government and a practising dentist. The right hon. Member for Wokingham (Mr. Redwood) has just left, but he was in the Cabinet when the Conservative Government closed two dental schools. It is no good Conservative Members putting up their hands up and saying that that was 10 years ago. They did it and they also cut fees by 7 per cent. So do not imagine that dentists, even though they are angry with us, believe the Conservatives. They remember what being a dentist was like under the Conservatives. The haemorrhage of dentists away from the NHS started during their time in office, whether by accident or design; I leave Members to figure out which it was for themselves.

There was a severe problem in Carlisle when four dental practices decided to resign from the NHS. They resigned before they saw the contract, so that was not their reason for doing so. The hon. Member for South Cambridgeshire (Mr. Lansley) mentioned people queuing to sign up for private treatment, and that did indeed happen at a particular practice in my constituency. The dentist in charge of it sent out a letter saying, "If you don't queue up and sign up, bringing your bank details with you, you won't be able to get a
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place." That resulted in hundreds of my constituents queuing from 5.30 in the morning, waiting to sign up. [Interruption.] If the hon. Member for South Cambridgeshire will contain himself, I will get to the point. That dentist was even handing out raffle tickets in another part of Cumbria. He said that he was going to cut the list, and that those who did not sign up early would be unable to get on it.

A lady came to my constituency office on Friday and told me that she phoned that dentist four months later. The receptionist was over the moon that someone had actually phoned to ask whether they could sign up. In fact, the dentist had plenty of places left. Some dentists who have gone private will have a problem when—

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