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Mr. Geoffrey Cox (Torridge and West Devon) (Con): Is my hon. Friend aware that the problem in his constituency, which is contiguous with mine, is in fact Devon-wide? I have just been sent an e-mail from a Devonshire dentist who tells me that in north Devon
"2 practices have already deregistered for adult patients. 3 practices are now on the brink of refusing to sign the new contract."
In my constituency, no dentist is accepting national health service patients. The situation is the same across the entire county.
Mr. Steen : People will clearly be able to tell which constituents come from Devon; they will all have black teeth and swollen cheeks. They will all be suffering from bad teeth because Devon does not have NHS dentists. This is not just about Totnes; my constituency covers parts of five local authorities—the Dartmoor national park, Devon county council, Teignbridge district council, South Hams district council and the Torbay unitary authority. They all have the same problem.
I understand why the Minister is no longer in her place; she can no longer face us. What are we to say to people in Torridge and West Devon and in Totnes? From what the hon. Member for North-East Derbyshire (Natascha Engel) said, if she had visited only NHS dentists she would probably have no teeth left—perhaps she does not. We cannot tell a nation of 60 million people, including children and the elderly, that the NHS is free at the point of delivery and then produce the wicked joke that there are no dentists.
What do I say to my constituents? The Minister knows about my concerns, because I have written to her over and over again about one person after another. I am embarrassed to represent an area in the world's fifth-largest economy and tell my constituents that they cannot have free dental health provision.
Natascha Engel: Has the hon. Gentleman discussed the matter with his PCT? What was its response about NHS provision for dentistry?
Mr. Steen:
I am impressed by my PCTs, which are responsible and highly committed organisations. The snag is that they cannot find dentists. I do not know whether something is wrong with the contract. In any case, I am not concerned about the machinery, but about every person I see in the street who is in pain. I represent them, so I say to the Minister that she must do something about the contract so that people can receive free dental care. She must provide the dentists. I do not mind if she brings in busloads of Bulgarians or Romanians. She can bring them in from any country in Europe. She misunderstood my earlier question—I do not object. The Prime Minister misunderstood me too, but he regularly misunderstands my questions. The point is: what are we going to do about the situation? I cannot represent a constituency when I know that people will continue to be in pain and will have to find money that they do not have to pay for private dentistry.
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John McDonnell (Hayes and Harlington) (Lab): I apologise to the House as I shall have to be discourteous and leave soon after speaking. I have a ministerial meeting at 3 o'clock on a pressing constituency matter, but I shall try to return for the wind-ups so that I can hear the ministerial response.
Over the past six months, I have convened meetings of London dentists. We have held two meetings at the House of Commons, as well as meetings with individual groups of dentists elsewhere. One of the meetings in the House was in November and the other in February, and I am grateful to the Minister for the access that she gave to civil servants, who attended one of the meetings, and also for the correspondence she provided that enabled us to share information about the new contract procedures with the dentists.
Like many dentists, I welcome the Government's policies with regard to the additional resources and their commitment to dentistry. I was impressed by the parliamentary Labour party briefing and can understand why on this occasion it was circulated more widely than usual, given the additional resources it described, including the £368 million for improving dental services in July 2004, the 19 per cent. increase since 2003–04 and the nearly 1,500 new dentists. I welcome all that, but I want to raise issues about the method of introduction of the new contract, especially the timing, some of which relate to London and others specifically to my constituency.
My colleague, the hon. Member for Ruislip-Northwood (Mr. Hurd), has pointed out that the contract is being introduced in our area at a time when Hillingdon primary care trust is struggling with a deficit of £25 million. It looks as though the amount may be nearer £30 million—it varies week by week. That has resulted in an inability to manage change generally and impedes the introduction of the new contract. We are on our third chief executive in less than four months—and counting. The PCT's struggles with its deficit have led to problems in the introduction of the contract.
I welcome the Minister's statement about the implementation group and the review mechanism, which is a real breakthrough and was one of my recommendations. However, the Department may need to intervene in some instances—such as Hillingdon and other parts of London—where there has been a failure to manage the introduction of the contract effectively. I have two brief examples of the impact on my constituency.
The first relates to the Hayes dental practice in Station road, Hayes, where Dr. Stern has encountered a problem to which the Minister referred earlier, although it was not addressed locally in the way that she described. Last year, during the reference period, two of Dr. Stern's colleagues left and he was unable to recruit for some time. As a result, the PCT's assessment of his activity and income levels was not an accurate reflection. In December, he thought that he had held a co-operative meeting with the PCT. He contacted it regularly after that but heard nothing about the contract. On Thursday 23 February, he received a package containing two copies of the new 135-page contract, with an accompanying letter that stated:
"You will be aware that you need to have signed the contract and confirmed this to us by no later than midday on Friday 24th."
So he was given only 24 hours. Furthermore, when he read the contract he discovered that it did not take into account the representations that he made about staffing and activity levels during the reference period, so his income will not be as before and he will have to lay off staff, including not only his dentist colleagues but also support staff.
I accept what the Minister said about appeal procedures, but that dentist thought that he had gone through that process during his negotiations with the PCT. The Department may have to intervene in such cases, where the PCT is clearly struggling to manage the introduction of the new contract.
The second example affects colleagues in Hillingdon and Ealing and relates to the orthodontics centre in Northolt opened by Sarinda Kumar over the past 12 months. We all welcomed the centre, to which the dentists involved committed significant personal outlay, raising capital of about £450,000. However, because the centre opened mid-year, the contract value is not sufficient to reflect the new service it provides. As far as I am aware, there has not been much response from local PCTs in terms of recognising those needs.
The orthodontics service at Hillingdon hospital has also suffered due to the PCT cuts, which relates to a general point about the priority accorded to dental services in several PCTs. There seems to be a lack of sufficient specialist advice from local dentists in the PCT and a failure to acknowledge the need to involve them fully in discussions about the roll-out of services generally and in consultations about the implementation of the contract.
Other general matters were raised that were not specific to my constituency or London overall. There is a concern that the units of dental activity do not fully reflect the importance of prevention. There may well be a need in the review process to find out whether a specific, separate UDA is necessary for prevention and dental health promotion.
Mr. Cox: Does the hon. Gentleman agree that, if a charge of £183 is levied for a single crown and precisely the same charge is levied for doing six crowns, the incentive for those whose teeth are becoming bad will be to wait until they are sufficiently bad to maximise the value for money that they get from the charge that they pay?
John McDonnell: Such issues may well arise during the review process, because the one thing that neither the Government nor any of us want to do is to provide any disincentive to people turning up for health treatments.
Another concern was raised by the London dentists. PCTs obviously set their own targets and the budgets are allocated and then capped. The concern is that, particularly in areas such as mine and in London, PCTs will put pressure on individual practices to increase their income to a certain level from charging. In other words, that is a perverse incentive in the system, thus undermining NHS work as well.
There are concerns about children and exempt patient contracts, which will be determined by PCTs. Given the lack of local engagement with adequate dentistry advice and support, the decision-making process on how such contracts are allocated needs to be closely reviewed by the Department in the first year of operation.
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A number of dentists have said that they must introduce new computer systems at considerable cost. The information that we received from yesterday's meeting is that those costs range from about £10,000—with one practice, it was £35,000—and that the allocation that they receive goes nowhere near recovering those costs. In fact, less than 10 per cent. is recovered in some instances and a lot less than that in many others. That will impact on the overall delivery of service.
I believe that the Government have exceptionally good intentions. There is real commitment, and it has been backed by resources. I congratulate the Minister on her personal commitment to the development of dentistry policy. We would not have come this far in the allocation and investment of resources and the priority for dentistry without her personal commitment, but those intentions are being frustrated in many constituencies, particularly mine, because of the financial crisis in the PCTs themselves.
I accept that an element of ring-fencing has gone on for three years, but the concern—it was raised by the hon. Member for Ruislip-Northwood—is that beyond those three years, no matter what statutory duties are placed on PCTs, dentistry will be a soft option when prioritising expenditure. The Government will need to monitor the situation closely over the next six to 12 months in particular. In special circumstances, such as mine, direct intervention by the Department may be needed if the system is seen to be failing and we are losing NHS dentists.
I welcome the implementation group review and the structure that has been announced today, but I suggest that, first, the review should report in six months and then in 12 months, and that that information comes before the House. We could then have another debate—not on an Opposition day, which sometimes degenerate into knockabout rather than real debate—on that report to find out what adjustments need to be made to the system. There is a commitment on both sides of the House: we want dentistry to improve in this country, but we want it to do so in a way that brings people with us. I do not think that dentists are convinced about the system. If we introduce the appropriate adjustments as we learn from experience, we will be able to retain people in the NHS and to work together to improve the system overall for all our constituents.
2.53 pm
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