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Steve McCabe : The hon. Member for North-East Milton Keynes (Mr. Lancaster) said a moment ago that a three-year contract was not sufficient, although these days most people would be happy with a three-year contract. However, the hon. Member for Enfield, Southgate (Mr. Burrowes) seems to be saying that the contract should have no obligations and that there should be no mechanism to resolve disputes. Is he seriously saying that we should simply pay the money and give no further attention to what happens? Does he think that that would be credible?
Mr. Burrowes: The debate is about the proposals that the Government have put in place. I hope that the hon. Gentleman agrees that there has been discrimination against a young dentist who has been on maternity leave. She has been left with a bureaucratic and centralised resolution process. She effectively must choose between not continuing to provide NHS care, or meeting the needs of her 2,000 NHS patients.
I want the Minister to hear the words of Mrs. Surabaskaran loud and clear. She says:
"If the dispute is not resolved speedily with due consideration for my maternity leave I will be forced to seek a job in the private sector."
However, she does not wish to do that.
Ms Rosie Winterton: In the circumstances that the hon. Gentleman describes, I believe that his constituent could sign the contract with a note to say that there is a dispute about some aspects of it.
Mr. Burrowes: I am grateful to the Minister for that point, but my constituent has no guarantee that she will receive her due reward. She runs the risk of being given a contract with a value that is half what it should be. Neither she, nor any other NHS dentist, has an individual contract guarantee.
We must also consider the situation facing graduates. We have to welcome the fact that 100 extra dental school places were announced on 26 January, but is that the only way to secure the future of NHS dentistry? The Dental Practitioners Association says:
the concern is not so much about salaries or training places, but NHS access—
"is caused by the large gap between the terms and conditions offered by the NHS and those in the private sector. This has led to an outflow of dentists from the NHS which has been exacerbated by the prospect of an inflexible and inefficient new NHS contract in April 2006 which is generally expected to make working in the NHS less desirable to most dentists."
That is the case, particularly for vocational dental practitioners. How do they fare with this contract? If one looks at the detail of the contract, one sees that all
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revenue associated with vocational training will be put on hold during the relevant period and will be removed from the contract value. The employment of vocational dental practitioners will essentially be at the behest of the primary care trust. We have heard already of deficits among PCTs, and the situation is the same in my constituency. It is fair to suggest that the first to feel the squeeze in the PCTs' capacity to deliver NHS dentistry will be vocational dental practitioners, who will be unable to find a place to pursue their training. Many a dental practice is not receiving, in its units of dental activity, any recognition of vocational dental practice. The PCTs do not have to provide that recognition. They have been asked by the Government to do so, but there is no specific requirement to take any account of the vocational route that we would wish many people to follow.
Finally, I turn to the care given to patients. It is at the heart of the motion, which refers to support for preventive work and the achievement of good oral health. The Minister says that it is all about preventive care, but what is the reality? As dentists in my constituency tell me, no real value is given to preventive treatment in the UDA system. Root canal treatment is worth three points, as is extraction. Root canal treatment usually takes three 45-minute visits, while extraction takes half an hour, so there will be an incentive to take out a tooth rather than give root canal treatment, despite their having the same UDA value of three points. Dental repairs too, will come straight out of the dentist's salary, so there will be an incentive to fit fewer crowns and more fillings. The contract looks more to points than to patients.
I should conclude because I have gone way over the time—eight minutes—that dental practitioners will be allowed by the contract for an examination, X-ray, and scale and polish. The question is not so much whether there will be time for NHS dentists to give quality care but whether there will be any access at all to NHS dentists.
3.12 pm
Paul Rowen (Rochdale) (LD): I am grateful to Her Majesty's official Opposition for initiating this debate, the second on this subject. The first was last October and was initiated by the Liberal Democrats. We were told then by the Minister that we should wait until the new contracts had come out to see what would happen. I have to tell her that in my constituency it is no longer a case of saying that NHS dentistry is in crisis; NHS dentistry simply does not exist. In 1997, 58 per cent. of the population was registered with an NHS dentist. Last year, that figure had dropped to 35 per cent. The Minister herself admitted, when I questioned her, that that is not progress. I have asked on numerous occasions, both verbally and in writing, what she will do to improve the situation.
Since Christmas, the situation in Rochdale has got worse. Last December, residents received letters from the last remaining full-time NHS practice informing them that from 1 April this year it was pulling out of NHS dentistry completely. I asked the practitioner why, and he replied that he simply did not believe that the new contract, with its emphasis on dental units, would do anything to improve what was already a hard-pressed and desperate situation. From 1 April, there will be no full-time NHS dentist working in my constituency.
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I listened very carefully to the Minister to see what the new contract could offer us. She talked about what it will mean to existing dentists, particularly with regard to the reference year. How does that create new money to enable Rochdale PCT to employ more dentists? It does nothing in that regard. The dentists have to be in the system already, receiving NHS money; no NHS money will be transferred to non-existent "ghost" dentists.
Stephen Hammond: We have heard a lot about access, which is the key point. The hon. Gentleman has described what is happening in his constituency, and that has been the tale throughout the House. One question that the Minister has to answer today is how many dentists who had previously resigned from the NHS will come back to the NHS under this contract. Surely the answer is zero, and that is a failure of access.
Paul Rowen: I agree entirely. The situation in the borough of Rochdale will get worse because dentists in the Heywood and Middleton constituency—I think that there are eight—have said that they, too, have no intention of signing the new contract. A borough that already has a very poor record of dental health will be left with virtually no NHS dentists. Yes, we have a walk-in centre, and it is fully committed, but it is doing nothing in the way of preventive work. It simply cannot cope with that on top of the emergencies that it deals with.
In the past 12 months, we have seen new dental practices open in neighbouring areas, such as Radcliffe and Bury. People in my constituency have queued from 5 o'clock in the morning to get themselves on the list at those practices. A dentist from Zimbabwe recently opened a practice in the neighbouring constituency of Oldham, East and Saddleworth, and within four days his list was full. Rochdale needs 10 dentists to treat those people who cannot afford to go to a private dentist.
When the Balderstone surgery announced that it was pulling out of the NHS, a constituent came to see me. He said that he had been told bluntly that if he wanted to stay with the practice he had to be prepared to pay £15 a month. There is no way that that gentleman could afford that sort of money. I wrote to the PCT, pointing out the situation with the last remaining NHS practice and asking what it was going to do and what advice it could give me to pass on to my constituent. The advice was laughable; it was to look at the website. When one looks at the website—not everyone has access to the web—one asks, "Where are the dentists for Rochdale?" They simply do not exist. I really am sick of hearing talk about this new contract and what it is supposed to deliver, when the few dentists left in the NHS are being driven out as a result of the obsession with targets.
We need to hear concrete proposals from the Government to address real shortages. I have been asking since May, when I was elected, what the Minister will do to deal with the crisis in my constituency. Everything that she has done so far has made the situation worse. In the next few years, we will see a dramatic rise in dental ill-health; we will see more expensive treatment having to be carried out; and we will see people's general dental health deteriorating greatly. That is not why the NHS was created. It is not what the Prime Minister promised us back in 1999, when he said that everyone who wanted an NHS dentist
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would have one within two years. The reality is that fewer and fewer people in my constituency have access to a dentist.
I have asked for a meeting with the Minister. I invite her to come to Rochdale and explain to people why we cannot get NHS dentists in the constituency. They deserve answers and we ought to have them now.
3.19 pm
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