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Dr. Murrison: I am delighted that the hon. Gentleman rose to that cue. Does he seriously suggest that a decision that the university grants committee made 19 years ago is germane to the argument today? I do not think solet us knock that one on the head. The debate is not only about the number of dentiststhe hon. Gentleman knows that full wellbut about how they are employed. The contract will make the position substantially worse and that is the reason for the debate.
"We are now . . . having to accept a contract that has not been fully piloted in its present form contrary to what the DOH keeps indicating. I could go into details but suffice to say I have never met so many colleagues that are disenchanted with the proposed contract and are considering cutting back or leaving the NHS in all the years since qualifying."
The accounts that we are receiving suggest that many dentists will sign up at the last minute as a stop-gap to allow them time to make plans, which will probably involve leaving the service. Concern about the systematic miscalculation of UDAs is a recurring theme of the correspondence that I received. The perception that the proposals will establish a new treadmill is one of the principal causes of dissatisfaction among NHS dentists. Sadly, that could have been ironed out if the new arrangements had been adequately piloted.
In my five years as a Member of Parliament, I have never received so much correspondence or attended so many meetings about a single issue. One has to be pretty dedicated to the service to be an NHS dentist, given the attractions of more lucrative private work, yet the Government appear to have alienated them all. That is quite an achievement.
The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne): This has been a rich debate, and if a single theme has emerged from it, it is that there is a need for reform. So this debate, on the eve of the most significant reforms to dental services in the history of the NHS, is indeed timely.
Important progress has been made in the provision of NHS dentistry since 1997. For example, there has been a 22 per cent. increase in the number of dentists in the system since then, from just over 16,000 in 1997 to about 20,000 in 2005. That is good news, but it is obviously not enough because many of them will not be working full-time in the NHS. Many of them will extend their private sector commitments rather than their NHS commitments, so we must take registrations into account as well. The number of registrations has gone up by 305,000 since 1998; it has increased in four of the six years for which we have records. The number of dental interventions has also gone up.
None of the increases that I mentioned has happened by accident. They have occurred because investment in NHS dentistry has risen substantially over the past few years. Indeed, it has gone up by 20 per cent., or £250 million, in the past couple of years. The Government have also recognised, however, that there are parts of the country in which an enormous amount more needs to be done. We therefore commissioned a report into the viability of the future work force, which in turn prompted our announcement of unprecedented investment.
We have heard today that there is still an enormous amount to do, and the Minister of State set out a programme of reform that rests on three foundations. The first involves a new role for local health professionals working in primary care trusts to take a lead in commissioning services, and new arrangements to ensure that, when dentists leave the NHS, the money
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is recycled back into the NHS. From April this year, those health professionals will have the freedom to run budgets of about £1.7 billion. The second involves the big increase in the number of dentists being trained and recruited. The third is that we are seeking to change the relationship between the NHS and dentists with a new contract that will end the treadmill and encourage prevention. It will also encourage more dentists up and down the country to serve the NHS.
The hon. Member for Mole Valley (Sir Paul Beresford) spoke with great insight and intelligence, as he always does on these matters, and I welcome his congratulations on some of the proposals that my hon. Friend set out. He said that the present system was not a treadmill. That was the opinion of one of his friends, but I think that the hon. Gentleman secretly believes that it is a treadmill. We must ask ourselves whether it is unreasonable for the NHS to agree to a certain amount of activity in return for writing cheques for £80,000 a year. Looking at the national picture, we shall be writing cheques for £2.3 billion worth of dental services, and it is not unreasonable to ask for a few specifics in return.
The hon. Gentleman asked a number of important questions about whether there would be monthly targets and whether the PCT would be breathing down his friend's neck. There will not be monthly targets, and it is important to remember that the contract has been set in such a way as to ensure that dentists undertake 5 per cent. less work. It therefore represents a decisive move against the treadmill. We would, however, like to know the name of the hon. Gentleman's socialist dentist friend. Given what is happening, it will be important to ensure that his party membership is being paid by direct debit.
The hon. Gentleman underlined the importance of the monitoring group that my hon. Friend the Minister of State announced, and I welcome his congratulations on that move. More broadly, NHS dentists, no matter who is in their chair, have to offer what is clinically necessary.
The hon. Member for Totnes (Mr. Steen), who is not in his place, is an excellent advert for the hon. Member for Mole Valley. The hon. Member for Totnes did not say whether the treatment he received from his colleague was on the NHS, but in a thoroughly reasonable speech he highlighted concerns that underline the need for the reforms we are makingmore investment, more recruitment and putting more people in training.
The hon. Gentleman called for free care, but NHS care has not been completely free for some years, not even in Devon. The important point for him to pick up in Hansard is that the budget for NHS services next year will be ring-fenced. I think his PCT is Torbay, where there is a ring-fenced budget of £6.3 million for commissioning dental services next year.
The hon. Member for North-East Milton Keynes (Mr. Lancaster) underlined the need for more dentists, which is an argument on which we would agree, but he should do more to challenge dentists locally who are refusing to register children. He questioned the number who might sign up to their contract by the end of the month. We shall see, as my hon. Friend the Minister of State said.
We expect the vast majority of dentists to sign the new contract, and the point I would make to the hon. Gentleman about contract length is that contracts are a
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two-way deal. Many dentists do not want a contract of more than three years. Of course, the new general dental services contracts are an open-ended commitment, but the work that local health professionals will be doing in his area will be made substantially easier by the £8.2 million they will have to commission dental services next year.
My hon. Friend the Minister of State was able helpfully to highlight a number of aspects of the contract, in particular the issue of the abnormal reference year, which was referred to by the hon. Member for Enfield, Southgate (Mr. Burrowes). He mentioned the example of a dentist who had taken maternity leave. She must take up the dispute resolution procedure with her PCT; it is important that she do so.
I hope the hon. Gentleman accepts that it is not possible for my hon. Friend, formidable though she is, to negotiate every single contract personally. That is why she has to set a framework and rely to some extent on local professionals to operate within it. I should also say, if it is helpful to the hon. Gentleman, that my hon. Friend can sign and earmark the disputed clauses for later resolution.
The hon. Member for The Wrekin (Mark Pritchard) made a number of points about listening to professionals. That is an important aspect that was highlighted in a document published yesterday, to which I shall refer in a moment, but, far from dentists not being listened to, the new system is virtually identical to that developed with the BDA two years ago. Far from blaming PCTs, we are putting more power in the hands of local professionals to negotiate local arrangements. What is more, they are doing a good job.
In the hon. Gentleman's area, my hon. Friend tells me, there are new dentists arriving. He mentioned the centre that is opening just across the constituency border, where about 40,000 registrations will be available. That is part, I am glad to say, of a national pattern, and about 1,100 new dentists were recruited between April 2004 and April 2005.
The hon. Gentleman made an interesting point. If I might be permitted a detour through the registration statistics under the last Conservative Government, he said that he is proud of that record, but I remind him that in the last four years under that Government registrations fell by 2.1 million.
The hon. Member for Rochdale (Paul Rowen) highlighted the shortage of local dentists in his constituencyan issue that I think has been acknowledged. He made a number of points about the contract, the number of dentists in training and PCT responsibilities, all of which are incredibly important in taking things forward in his constituency. Rochdale's PCT has not one, but 20 NHS contracts and £4.3 million to commission services next year. He also criticised targets, but when we are writing cheques to a dentist for £80,000 it is not unreasonable to ask for a few things in return.
My hon. Friend the Member for Carlisle (Mr. Martlew) spoke with great experience of health services. Usefully, he reminded us about our inheritance. He also reminded us helpfully of the struggles of living on £80,000. I extend my congratulations to his PCT, which is doing a good job
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locally. The fact that he has eight new dentists and 20,000 new registrations locally shows that progress is beginning to be seen in many parts of the country.
My hon. Friend the Member for North-East Derbyshire (Natascha Engel) echoed the point about the need for reform and the lack of constructive criticism this afternoon. She was right to highlight the problems of shopping with toddlers, especially as one gets closer to the checkout. I have three children under the age of five, and I find that the only secure way of getting through a checkout is to put them in the trolley, where their little hands cannot reach through the bars. She made the important point that the reforms that we have introduced dovetail with a broader public health strategy.
My hon. Friend the Member for Hayes and Harlington (John McDonnell), who, I am glad to see, has returned to his place, raised a number of important issues in an intelligent and thought-provoking speech. Where PCTs are wrestling with important issues, it will be of some comfort to know that money is ring-fenced for dentistry. He also raised the issue of the abnormal reference year. His PCT has the flexibility to discuss that in review with local dentists. As my hon. Friend the Minister of State said in reply to some interventions, dentists can sign contracts but mark disputed terms, which can be resolved later in dispute resolution. He was right to underline the importance of the implementation group
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