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Natascha Engel (North-East Derbyshire) (Lab): Oh!

Sir Paul Beresford: I am sorry to upset the hon. Lady. My voice is not pitched high enough to make what I am saying even more emphatic. The process that I am describing would secure lots of UDAs, and the dentist would have to do it all again after a few years, when the gingiva had moved. Once more, he would achieve lots more UDAs, but what that dentist would want ideally is to be able to offer the patient an opportunity to go for private treatment as well. The best treatment would be to spend hours carefully bleaching her teeth. That would leave her with a broad and beautiful smile, intact teeth, and no need to repeat the treatment.

However, Dr. Kinnear-King says that he feels that he cannot undertake the bleaching treatment, because he is looking over his shoulder at the avalanche that is the monthly UDA total. Somehow, the Government have to change the position that dentists find themselves in.

In his letter, Dr. Kinnear-King says that he is a solid socialist, but that he is seriously considering not signing the contract. He intends to go private, but says that he will keep the fees down so that he can offer his patients
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the service that they need. As I remember from my own experience as a full-time dentist, the problem is that some people cannot afford even low fees.

The Minister's implementation team will have to look very carefully at how the mixture of NHS and private treatment can be introduced. It must also find a way to ease the treadmill, or dentists will continue to walk away from the NHS. We have enough dentists, and will soon have more than enough, but they must be encouraged to stay with the NHS. The present contract, and the way that it has been implemented, is achieving the exact opposite of that.

2.28 pm

Natascha Engel (North-East Derbyshire) (Lab): I am pleased to be able to contribute to this very important debate, although the description of treatment given by the hon. Member for Mole Valley (Sir Paul Beresford) was really quite disgusting. Dentistry affects us all in different ways—

Ms Rosie Winterton: It touches a raw nerve.

Natascha Engel: That is right, it does touch a very raw nerve.

Sir Paul Beresford: I hope that I can help the hon. Lady. Many dentists are moving into the private sector, but I assure her that most patients feel more pain from the white envelope containing their bill than they do from the treatment that they receive.

Natascha Engel: I am grateful to the hon. Gentleman for that, although my recent personal experience with a dentist from Bulgaria does not quite fit with what he describes.

I want to thank the Tories for devoting one of their Opposition days to dentistry—

Ann Winterton : Her Majesty's official Opposition.

Natascha Engel: I thank the hon. Lady for that.

The problems associated with getting dental treatment cause more people to come to my surgeries, write to me and send me e-mails than just about any other issue. Their concern is mainly generated by letters that they have received from their dentists explaining that they are no longer taking on NHS patients or are opting out of the NHS. It is important, therefore, to consider why we are introducing these reforms to dentistry.

Everyone, even the Tories, would agree that there are not enough dentists, that provision is unequal, that access is difficult and that the Government are trying to respond to the concerns of both the public and dentists. Everyone, even the Tories, wants better access to treatment and to promote good oral health. We have heard a lot today about the difficulties that people have experienced, but we have heard almost nothing from the Opposition on proposals for changes that they readily admit are very necessary.

I do not deny that we are in a difficult situation. Almost all the dentists in my constituency have already decided not to sign the NHS contract and I agree that we
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need to do more to attract dentists to stay in the NHS. However, would not our time be better spent today discussing some constructive proposals and ideas on how to do that?

The Government have always worked on the principle that prevention is better than cure. We want to ensure that dental recall periods are based on clinical need, rather than on automatic six-month check-ups. We want to free up dentists' time to see a range of patients and provide additional NHS services, such as promoting oral health.

I have terrible teeth and have been to many dentists, so I have met far more dentists in a professional capacity than I would want to. All of them, without exception, are committed to providing oral health care and preventive medicine to the highest standard. However, preventive measures are increasingly being hampered by sweets in supermarkets and it is surprising that that has not been mentioned yet today. It was not until recently, when I took my two-year-old shopping, that I noticed a whole bank of sweets, at adult knee-level, lining the channel to the supermarket check-out. Everyone knows that sugar and sweets cause tooth decay, so why is that still happening?

Julia Goldsworthy: I understand that there was a private Member's Bill on children's food, which the Government did not support. Would the measures in that Bill have helped to alleviate the problem that the hon. Lady describes?

Natascha Engel: I understand that we are adopting similar measures. What I would really like to know is why the Opposition have not made any mention of the link between sweets in supermarkets and reforms in dentistry. It sounds a trivial matter, but it is very important when we are discussing preventive medicine. Our oral health plan at least takes a more holistic approach to prevention by aiming to improve oral health and to reduce health inequalities. We propose to do that by increasing the use of fluoride to help to prevent tooth decay, improving diets and reducing sugar intake. I hope that my hon. Friend the Minister will meet the parents jury of the Chuck Snacks Off the Checkout! Campaign, which I intend to join. We will also encourage preventive dental care; aim to reduce smoking to tackle oral cancer—the ban on smoking in public places will go a long way to achieving that—increase early detection of mouth cancer; and reduce dental injuries such as those caused by contact sports. I have heard no positive or constructive proposals from the Opposition to match those ambitious plans.

I do not claim that everything in dentistry is fine, but I would rather look for ways to improve the situation. I will meet the chief executive of my primary care trust in north-east Derbyshire and dentists in my constituency to find a local solution. These reforms coincide with the reorganisation of primary care trusts. Let us ensure that the outcome of our reforms will enable PCTs to place with an NHS dentist anyone who wants one.

Poor people are more likely to have poor oral health. Poor people are not in a position to pay for private dental care. We do not want to exacerbate inequalities but to ensure that everyone has access to an NHS dentist. Oral health is too important to be used for political point-scoring, so let us hear some good ideas.
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2.34 pm

Mr. Anthony Steen (Totnes) (Con): I shall make a short speech, because I have one simple point to make. I have some 78,000 people in my constituency and, on the whole, no NHS dentists, so those people have nowhere to go. It is not a question of the NHS being free at the point of delivery: it is failing at the point of delivery. There are no NHS dentists. The Minister knows that we have had busloads of Polish dentists coming to set up in south Devon, and we now have a few of those, but on the whole there are no NHS dentists. That is the first problem that the Minister must address.

The issue is not about having high-powered discussions about drilling people's teeth out. There are no NHS dentists to drill people's teeth out. I must declare an interest, in that my hon. Friend the Member for Mole Valley (Sir Paul Beresford) is my dentist. He is an experienced and very skilled dentist. I hope that the House will excuse the slight lisp with which I speak, which is because of a slight problem we have had. My hon. Friend's concern is the care of patients and the access that they have to treatment. What do I say to a garage forecourt man who, when I spoke to him the other day, had a very swollen cheek? I asked him what was wrong and he said that he had an abscess. He said that he could not afford to go to the dentist, because they are all private in our area. He said that he had gone to the doctor—that service is free at the point of delivery—and got some antibiotics to try to reduce the swelling. I know how painful an abscess is and the necessity of immediate treatment, so it is criminal that the NHS system does not work in our area.

What should small children and elderly people do? I have the ninth oldest constituency in the country—not the Member of Parliament, but the constituents—and they are one of the groups of people that need quick access to dentists. Because I have a large rural constituency—it runs 30 or so miles one way and 40 or so the other—we have no adequate public transport. What do we say to such people? We are supposed to be the fourth or fifth—I think that the Chinese have just overtaken us—richest country in the world.

I do not wish to get into the detail of the contracts, but I wish to ask the Minister whether dentists will end up like opticians, who are now outside the NHS. Everybody applauds the Minister's frankness and her integrity, but is it really the Government's intention to get rid of NHS dentistry that is free at the point of delivery? If not, why do we make it so complicated? What are these units of dental activity? Does it depend on the dentists themselves being very active? It is another example of weasel words—the Government are wonderful at using them. Does it mean that if the dentist rushes around his consulting room, he gets an extra point? Or is it based on something more that he does for the patient?

Can the Minister tell me why one dental practice in Plymouth is being offered £22 per unit of dental activity, when the next-door dental practice—I know them both, although I have not used them both—is offered only £14 per UDA? What is wrong with the £14 UDA dentist? Will people who go to the £22 UDA dentist get better dentistry? The Minister is trying to marry two
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services that are irreconcilable—a salaried service and an individual, private service. The result is that few people will be offered free services by their dentist.

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