Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 380 - 399)



  Q380  Dr Taylor: The Birmingham Local Dental Committee is convinced that the BDA has really given up and is really trying to persuade local dental committees to make the best of a bad job, even actively advising members to convert to private dentistry. Does that accord with what you have heard?

  Dr Ellman: Yes, indeed. I am aware of what Birmingham LDC has done.

  Q381  Dr Taylor: We went to Wales yesterday and we were told by the minister that they had made distinct changes to the dental contract in Wales which made it more acceptable to the Welsh dentists. Do you know about that?

  Dr Ellman: I am not familiar with the details of the changes in Wales. I am aware that they are making differences between England and Wales, but I am not entirely sure that I understand all the nuances of it so I cannot comment.[6]

  Q382  Dr Taylor: Let us come on now to help and information that is available to patients. Firstly, Dr Ellman, in your written evidence you have said, "as with many co-payments in the NHS exemptions are absolute. Consequently there will be a large proportion of the population on the cusp of exemption criteria." Have you any idea what could be done to help these sorts of people?

  Dr Ellman: It is really a matter for government. It is possible to work on the basis of a partial subsidy in relation to the income level that is there and therefore in a way means tested. You could support it in stages.

  Q383  Dr Taylor: Would you like us to put that sort of suggestion forward?

  Dr Ellman: I have no reason not to. It would be very helpful for many who are on the lower economic scale but not supported by benefits of any sort.

  Q384  Dr Taylor: Can I just clarify some detail about the actual charging. Have I got it right that you pay £42 for one filling and, if you have 10 fillings, you pay exactly the same?

  Dr Ellman: Yes, £42.40 is the current—

  Q385  Dr Taylor: So one filling is exactly the same?

  Dr Ellman: Yes, it will be. That is exactly how it works.

  Q386  Dr Taylor: Surely, if patients know about that, as we have rather been hinting before, they are going to delay and have a few fillings to get their money's worth rather than just pay the 42 quid for one and then go back and pay another 42 quid for another?

  Dr Ellman: Yes, that is a possibility. I have no idea. I suppose, to some extent, it depends on how difficult the problem is. If it is causing you acute distress, then you are obviously going to seek help straightaway.

  Q387  Dr Taylor: Before I come to the others, how are you setting about letting people know, and really it is supposed to be a simple banding system, but, if one crown costs you the same as several crowns, one tooth on a denture the same as a whole denture, how are you setting about explaining it to people? Is it your job to explain to the person in the chair how much it is going to cost? How do you set about that?

  Dr Ellman: We put out some advice leaflets for dentists to help them explain the charges and the changes to the patients, so we have gone in that direction. That has only recently been published and it is actually on the BDA's website now, together with a poster that they can download and put in the waiting room, which explains as simply as we can what the changes will mean for patients, so we have done that. Dentists are aware of what is going on and most of them do explain to their patients what is involved.[7]

  Q388  Dr Taylor: Again, in your evidence, you draw attention to the document Help With Health Costs, and, as other people have told us, and I forget how many pages it is, but it is terribly complex.

  Dr Ellman: Yes.

  Q389  Dr Taylor: You say here that you want to go out with your own paper. Is this what you have actually done already?

  Dr Ellman: No, we are not allowed to. Sorry, are you referring to that form that you can claim on?[8]

  Q390  Dr Taylor: I am referring to HC11, Help With Health Costs.

  Dr Ellman: That is a big form that is published by the Department of Health, I think, which means that, if you are on a low income, but not on Jobseekers Allowance or one of these benefits, it will allow you to claim the money or the support from the relevant authority. That is a big, complex document, as you rightly say. We would like that simplified because it makes it very difficult for patients to deal with and some, I am sure, are deterred by the fact that it is a big jargony form.

  Q391  Dr Taylor: So, and this is really to everybody, should we be suggesting that that document is sort of fragmented into separate documents for each particular service? Obviously the dentists would say yes.

  Dr Ellman: I think it is the same document for every service, is it not, that applies? I am not sure.

  Q392  Dr Taylor: I rather imagined, although, I have to admit, I have not seen it, that it actually explained details of the charges.

  Dr Ellman: No, it does not. It is a form that is used for you to claim repayments or payments of the dental charges in this particular instance.

  Q393  Dr Taylor: So how are you and the others trying to draw patients' attention to the range of costs? Is it your job to tell them what it is going to cost?

  Mr Cartwright: If I could pick this up for optics, many practices have this sort of leaflet which is a guide to NHS entitlements because we are slightly different in that we do not have charges, we have entitlements. Practices would also have posters, saying what the entitlements are and on the PCT, primary care trust, visit, the ophthalmic advisor will pick that up if there is not one there and say, "Well, you should have one. You should have leaflets", and staff would be aware of that as well.

  Q394  Dr Taylor: So you would accept that it is a part of your role to hand out the information?

  Mr Cartwright: Certainly, and we do so, yes.

  Dr Ellman: We do likewise.

  Dr Baker: Anyone who has been to a GP surgery will know there are racks and racks of leaflets and there are normally leaflets explaining prescription charges available for people to pick up.

  Q395  Mr Campbell: Back to the opticians again, I have a thing about opticians! Scotland and Wales have introduced a new eye test examination. Basically can it come here? Can it come to England and how much will it cost?

  Mr Cartwright: We would certainly be delighted if it were to come here or a very similar sort of system and I think it can come here. That would be part of what the general ophthalmic services review should be about. We would need to look at the cost and I think certainly it would cost more, but I think, if that was looked at in terms of the value of the longer-term savings, that would clearly make the case for that sort of system coming here.

  Mrs Hansford: Someone has just whispered in my ear that, if the Scottish scheme were introduced in England, it would cost £92 million according to the Department of Health.

  Q396  Mr Campbell: So that is a lot of money.

  Mrs Hansford: In NHS terms, it is a drop in the ocean.

  Q397  Mr Campbell: A drop in the ocean of course, yes.

  Mr Cartwright: If we were saying that the current expenditure is £350 million and that includes vouchers and eye examinations, and I think we had a figure of nearly £2 billion earlier, you can replace teeth, but not eyes.

  Q398  Mr Campbell: Are you getting more money for better tests?

  Mr Cartwright: There is a wider range of services, yes.

  Q399  Mr Campbell: And of course available to all?

  Mr Cartwright: Yes.

  Mrs Hansford: I wanted to interject when we were talking about patients travelling to hospital and paying car parking fees. Of course the beauty of an optometrist delivering services in the community is that there are no car parking fees, there are no hospital trips, there is no transport because they can get on the bus, they can walk round the corner and the optometrist is there. That is one of the benefits of delivering more optometric services in optometric practices. It is an under-used resource.

  Mr Campbell: I will have to get on my bike then!

6   See Ev 137. Back

7   Note by witness: As part of the National Health Service (General Dental Services contract) Regulations 2005, dentists must display an NHS-sponsored poster in their waiting rooms explaining the new dental charges regime. Back

8   Note by witness: The BDA has produced leaflets and posters for dentists to display in their surgeries explaining the new dental charging regime and which patients are exempt from dental charges. The Department of Health have produced their own patients leaflets which build on the HC11 form. Back

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