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Mr. Crabb: My memory may fail me, but I do not recall people queuing from 5 o'clock in the morning to sign up with a dentist under a Conservative Government. The truth is that NHS dentistry has all but collapsed in parts of the country under the present Government. Labour Members ought to be extremely concerned about the trends in my constituency developing in constituencies that they represent. My constituency had a Labour majority of 9,000 at the end of the 1990s, but as NHS dentistry unravelled so did that majority.
Few issues galvanise so many people from so many different backgrounds as the NHS. The Labour party should understand that better than anyone, as it claims to be the party of the NHS. The NHS serves everyone, and people are attached to it, so they are rightly angry when they wake up one day and find that their NHS dental service, for which they helped to pay, no longer exists and they are required to sign up for a private sector service.
In conclusion, the new contract represents a massive missed opportunity to reinvigorate NHS dentistry. Not one dentist to whom I have spoken in Wales or England believes that the clock can be turned back, and they are very pessimistic indeed about the future of NHS dentistry in this country. The truth is that the NHS dental service is dying under the Labour Government.
3.31 pm
Dr. Andrew Murrison (Westbury) (Con): We have had an instructive debate this afternoon, with a total of 11 Back-Bench speeches, all of high quality. I have received reams of correspondence from dentists about the new contract—none of it is complimentary. Ministers will be particularly interested in messages I have received from Leicester, Doncaster, Liverpool and Birmingham. Most of them use parliamentary language, but some do not. I should like to begin by sharing one that I have just received from Doncaster, as I know that the hon. Member for Doncaster, Central (Ms Winterton) will be interested in it:
"As of 1020 hours Doncaster time, we have not received a contract . . . I can state with a fair degree of confidence 100 per cent. of dentists in Doncaster have not agreed to the new contract."
The Minister made great play of apparent demands from patients for a simplified, more transparent charging mechanism, but I can honestly say that I have not met a single constituent who is exercised about the complexities of the charging system. However, like my hon. Friends the Members for Totnes (Mr. Steen), for North-East Milton Keynes (Mr. Lancaster) and for The Wrekin (Mark Pritchard), as well as the hon. Member for Rochdale (Paul Rowen), I have received shedloads of letters about deteriorating access to NHS dentistry. That is not surprising, because in the strategic health authority area serving my constituents only 25 per cent. of people are registered with an NHS dentist. I am horrified to hear that in the constituency of my hon. Friend the Member for Preseli Pembrokeshire (Mr. Crabb) the figure is even lower at 15 per cent.
As constituency MPs, we know—and Citizens Advice recently confirmed it—that access to NHS dentistry is of overwhelming concern to dental patients, despite the Prime Minister's famous pledge in 1991, which, I note,
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is not reiterated in the Government amendment to our motion. The contract is set to make matters much worse. Community Dental Centres is a group of nine major dental practices in the west country that cares for 100,000 patients. It announced yesterday that unless there are changes to the contract it is likely to pull out of NHS dentistry. It points out, as did the London local dental committees that I met last night with the hon. Member for Hayes and Harlington (John McDonnell) and my hon. Friend the Member for Ruislip-Northwood (Mr. Hurd), that payments will be based on dental activity, which is not the same as dental care. Activity implies the treadmill, which is precisely what we thought Ministers were keen to remove. Dentists want to offer care to patients, not activity, and the Minister ought to know the difference between the two.
The consumer organisation, Which?, and the National Audit Office appear united in their belief that primary care trusts are simply not up to managing the new contract. Which? has asked for a clear audit framework to measure the impact of the changes. That would at least allow us to draw breath and reconsider after a few months or a year. I am pleased to hear that the Minister is going to put in place a review group and implementation team. I hope that it meets in six months' time and in 12 months' time and that at each of those points, as the hon. Member for Hayes and Harlington suggested, there is a report that is debated in this place.
What is the Minister doing about contractual arrangements for practices that have grown in the test year? Yesterday, I met a full-time NHS dentist from south-west London who is preparing to sack three members of staff on 1 April because his practice growth has outstripped his allocation of units of dental activity. That problem, which was well described by my hon. Friend the Member for Enfield, Southgate (Mr. Burrowes), is particularly severe for young orthodontic practices, because they are paid eighteen months in arrears. An orthodontist from Bristol wrote to the Minister, with a helpful copy to me, to say:
"The financial disaster we are facing is due to the methodology adopted by the Department of Health for deriving contract values for orthodontic practices."
On the same theme, a Birmingham dentist writes:
"One Dentist in South Birmingham extended his practice to 6 Dentists last year from 3 to accommodate the extra patients seeking NHS treatment, he has been told his budget is such that the 6 dentists must work part time or 3 must leave, as his funding is based on the period when he had 3 dentists. This will leave about 4000 patients without a Dentist."
Clearly, at this late stage there is considerable confusion about how the anomalies that the test year will introduce are to be resolved. This is the eleventh hour.
I am assuming that moneys released from the many dentists who opt out will be reallocated to the few who are expanding their services or to the Government's massively expensive dental access centres. However, practices willing to expand have not been told that that is the case. Can the Minister offer us a time scale? Why are we getting reports that the few high street dentists still willing to take NHS patients are being turned down if there is a dental access centre nearby, despite the big cost disparity? I suspect that it is because dental access centres are a Government pet project that must be supported at all costs.
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More concerns emerge from Birmingham on the subject of out-of-hours cover. It appears that the contract, taken with PCT deficits, will mean that post-1 April cover will be basic, to say the least. Birmingham dentists have been told that haemorrhage and swelling that compromises the airway are the only items to be regarded as dental emergencies, which means that dental pain is not. Dental pain is the most common form of dental emergency, and for those of us who have suffered it in the middle of the night it truly is an emergency. Are we really to have a contract that will allow people in this country, in the 21st century, to struggle through the night with acute dental pain?
I have had a raft of messages from dentists over the past six weeks or so. I will read just a few of them. They would fill two box files and, sadly, time does not permit me to read them all. A dentist from Coventry writes to me with more than a hint of desperation:
"Three of my best friends with over 80 years of NHS experience between them have sent out their conversion letters."
That is, conversion to private practice. He continues:
"These are dentists who have stuck with the system until now. There are many hanging on there by their finger tips hoping this disaster will be stopped on Wednesday. They are torn because of feeling for their patients."
A dentist from Yorkshire says, typically more briefly:
"if these reforms come in I doubt there will be an NHS dental service worthy of the name in 3 years."
A general dental practitioner from Colchester writes:
"We will reduce our NHS commitment. Accordingly, letters will go out to my NHS kids/exempts shortly, and my associate will keep what little NHS funding remains, prior to a move to private practice within 12 months. It's the only solution that I can come up with that allows me to keep people in a job. The alternative is to make everybody redundant!"
That raises an important point because, in Committee, the Minister said that primary care trusts could provide children-only contracts. However, since children and exempt adults do not pay the 80 per cent. contribution, how will PCTs that operate with massive deficits manage to provide such targeted contracts? The contracts that they let will depend heavily on the 80 per cent. co-payment.
The contract is clearly too rigid. The British Dental Association rightly believes that dentists will overdo their UDAs for safety, yet there is no way to claim for them. If they undershoot, they will face penalties. Despite the assurances in Committee, the contracts that have emerged appear to allow for the tailing off of services towards the end of a year and for some jockeying to approximate as closely as possible the target number of UDAs. There is a parallel in the way in which PCTs finesse hospital treatment when funds run out at the end of the financial year. That is no way to manage patients.
Ministers claim that the new contract will encourage a more preventive, health-promotion focus. How will that happen when the cost of the band 1 episode on which Ministers rely for health promotion will be at least twice the current cost? Nothing in the contract rewards the use of dental hygienists, whose services may become the
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preserve of private patients. I am sure that that was not the Minister's intention last year when she opened the school for complementary professions to dentistry in Portsmouth, which I had the pleasure of visiting last week.
Several dentists have written about the perversities that the Government's interpretation of the Cayton report introduced. Earlier, we heard the Minister's explanation of the difference between the Cayton report and what we are now offered, and the extraordinary 40 per cent. uplift. Perhaps the Under-Secretary will expand on precisely what the Minister meant in her justification of the difference.
We know that the cost of a basic filling will increase substantially and that a mouthful of fillings will cost the same as one. Clearly, the articulate and well-briefed patient will be able to obtain several items at once from band 2 while those who are less adept at using the system may lose out. There will be a tendency for dentists to offer simpler and quicker treatments in band 2 and only the guileful patient will be capable of pushing for more. Inevitably, that will widen oral health inequalities.
Doubtless the Government will continue to blame previous Governments, local health care managers and practically anyone else they can think of for the chaos over which they preside. An insightful dentist wrote to me earlier this year. He said:
"I believe you are after information about how the government are making a complete shambles of this new NHS dental contract."
That is quite right. The writer continues:
"What tickles me is, after 7 years, they are still trying to blame the previous Tory government. That's a bit like blaming potholes in the roads on the Romans."
The hon. Member for Carlisle (Mr. Martlew) might like to note that point.
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