Examination of Witnesses (Questions 400
- 405)
THURSDAY 9 FEBRUARY 2006
DR LESTER
ELLMAN, DR
MAUREEN BAKER,
MRS LYNN
HANSFORD AND
MR DAVID
CARTWRIGHT
Q400 Chairman: I have just one more
question to you about the issue of domiciliary eye tests when
we were talking earlier about elderly people falling and everything
else and sort of the added cost to the NHS for that. What is the
current position with domiciliary eye tests?
Mr Cartwright: Domiciliary eye
examinations are available, and there are many practices who do
them and some companies which specialise in domiciliary eye care.
I believe that one of the issues there is that there is a fee
for the first patient and then a lower fee for subsequent patients.
There should be a higher fee for the first and second patients
and then perhaps a tail-off, whereas it happens at the moment
after just one patient.
Q401 Chairman: If you had this National
Service Framework which was mentioned earlier, obviously issues
like that would be in there and hopefully would be accepted throughout
the UK. Could I move on to Dr Ellman. You advocate an automatic,
free oral health risk assessment programme which I would have
thought, in terms of last week's White Paper, was something that
the Government would be interested in looking at. What are actually
the costs and benefits of such an initiative like that? Has it
been costed in any way?
Dr Ellman: Not as far as I am
aware, but it has not been developed properly yet either.[9]
There is an outline being developed, but there is no IT system
to support it currently. A full oral health assessment has been
used by other people in private plans, for instance, to give guidance
to get a full picture of somebody's oral health, not just the
fillings, but the whole picture. That would be beneficial because
you could see and again you could do the one thing we have never
really done much of in dentistry and that is to measure the health
gain, the effects in terms of what we do. We know what the immediate
effects are, but we do not know the long-term effects. It would
also enable patients to be encouraged along the prevention route
by doing oral health scores, so you would know exactly where you
were in terms of relationship. This has been trialled outside
the NHS by Denplan actually who did it as part of one of their
schemes with a fair degree of success, so I think we are not reinventing
the wheel from that viewpoint.
Q402 Chairman: Have you got reports
from Denplan on that which perhaps the Committee could look at?
Dr Ellman: I can try and ask them
if they could supply us with some for you. I have not any.
Q403 Chairman: The other thing I
would just like to ask you, Dr Ellman, was not really about NHS
charges, but it does come into what you have just said there to
some extent. It is this issue of fluoridation of the public water
supply. What is the BDA's position on that?
Dr Ellman: Absolutely solidly
in favour. We ran a massive campaign here at Parliament for that
some 18 months ago and that was very successful. The BDA is very
much in favour of that and the science is very much in favour
of that. There are entrenched views in the different directions,
but there we are.[10]
Q404 Chairman: We have heard them
over the years, but, with our new regulations in situ now, we
do not know when or who is going to operate them. Could I just
move back to the opticians. How do you see the new general
ophthalmic services contract developing in the future, not in
terms of you would like it set in the National Service Framework
and everything else, as I am sure you would, but in terms of charges?
Do you think there is going to be any great change?
Mr Cartwright: I think, in the
ideal situation, there would be eligibility, so an eye examination
would be something that everybody could access. I think we have
to be realistic and say that there are certain groups that are
more at risk than others, such as children, elderly people, sufferers
of medical conditions and those on low income, so that is absolutely
right. Personally, I would then put more effort into extending
the role of the optometrist to be able to deal with specific situations
that would free up resource elsewhere. We have talked about where,
if somebody has red eye or conjunctivitis, that would go into
the optometric practice and, perhaps rather than extend eye examination
eligibility to absolutely everybody, I would put some money into
that side.
Q405 Chairman: Well, could I thank
all of you for coming along this morning. It has been quite an
enjoyable session with the little bit of entertainment in the
middle of it all! Thank you very much indeed and hopefully it
will not be too long before we are actually reporting to Parliament
in relation to this. Any further papers you have on these issues
we will be more than happy to look at before we come to any firm
conclusions.
Mrs Hansford: Would you like us
to send copies of these documents to the Committee?
Chairman: Yes, indeed we would. I think
David would in particular. Thank you.
9 In 2003, the BDA produced a report, Oral Healthcare
for Older People: 2020 Vision, which made a number of recommendations
in this area. See Ev 137. Back
10
Note by witness: Water fluoridation is the most effective
public health measure in reducing dental decay and for tackling
oral health inequalities. Tooth decay is a significant problem
in the UK and the dental health inequalities are widening. In
socially deprived communities as many as one in three children
under the age of five will have one or more decayed teeth extracted.
As part of the Water Act 2004, MPs voted in favour of local communities
being offered the change to decide whether they wanted targeted
water fluoridation schemes in their locality. Back
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