Examination of Witnesses (Questions 380
- 399)
THURSDAY 9 FEBRUARY 2006
DR LESTER
ELLMAN, DR
MAUREEN BAKER,
MRS LYNN
HANSFORD AND
MR DAVID
CARTWRIGHT
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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