Examination of Witnesses (Questions 60-79)
ROSIE WINTERTON
MP
26 JANUARY 2006
Q60 Mike Penning: Here we go, your
starter for 10: How many people in the United Kingdom under your
remit do not have an NHS dentist?
Ms Rosie Winterton: We think that
at the moment there are probably around two million people who
would like to have access to NHS dentistry but perhaps do not
at the moment.
Q61 Mike Penning: That is a staggeringly
high figure, Minister. Why?
Ms Rosie Winterton: There is a
whole variety of reasons.
Q62 Mike Penning: Remember, we have
a deal.
Ms Rosie Winterton: I should distinguish
between registration and people who can go to an NHS dentist—and
there are some very complicated reasons around NHS dentistry.
Q63 Mike Penning: I feel a long answer
coming on.
Ms Rosie Winterton: I know. I
am sorry. Registration was introduced fairly recently. It did
not exist before that. The highest level for NHS registration
itself was in 1993 and that was something like 57% for adults
and 60% for adults and children. There will always be a number
of people who do not, for whatever reason, register with an NHS
dentist. There is a certain number of people who feel that they
want to go to a dentist when there is something wrong with them;
there is a certain number of people who just do not register for
whatever reason; and there are some people who register privately
because they want private care. Certainly there is no doubt that
in a number of parts of the country at the moment we need to improve
on the number of people who can get access to an NHS dentist.
Q64 Mike Penning: We have around
two million people. If we move on from that, the predicted shortfall
for dentists for 2011 is over 5,000. Will the new contract address
that problem? If so, by how much?
Ms Rosie Winterton: Yes, I very
much hope that it will. We have worked with dentists over a number
of years. We have introduced pilot schemes to look at new ways
of working. Dentists have told us over a number of years that
the current system, whereby, if they give somebody a filling they
are paid, if they give somebody a crown they are paid, is what
they call the "drill and fill treadmill". They have
found that bureaucratic; they say it is not the best clinical
practice. They want to be able to have you in a chair—
Q65 Mike Penning: I am sure, Minister.
I am very sure.
Ms Rosie Winterton: And I have
noticed that an extraordinary number of MPs are currently having
check-ups or getting treatment.
Q66 Chairman: Saturday morning for
mine.
Ms Rosie Winterton: —so
that they can say to you, "These are your oral health needs
and this is what you can do in terms of preventative care."
They want more time to sit down with you, to talk to you about
how to do that. They want to remove what some perhaps might feel
has been a perverse incentive to over-treat. Through the new way
of working that we have introduced, we have found that it frees
up dentists' time, not only to be able to provide a higher quality
of care but also to be able to take on more people. That is why
I think the new way of working will address the problems. At the
moment, if a dentist leaves the NHS, all the money reverts back
to the centre. In future, that money will remain at local level.
The PCT will be able to say to dentists, "Okay, if you want
to leave the NHS, that is fine, but we now have the money that
we were paying to you to be able to secure dentistry from elsewhere."
As I am sure members know, we have recruited over 1,000 dentists;
there are 1,000 dentists who are at the moment awaiting the results
of the international qualifying examination; we are training more
dentists—we have started another 170 from this year and
we will be increasing that. I believe, therefore, that we will
have dentists who will be wanting to work in the NHS; existing
dentists who may want to expand their contracts with the NHS;
and the PCTs will have the ability to address shortages locally
from now on.
Q67 Mike Penning: The prediction
is 5,100 short by 2011. What is your prediction for the shortfall
with all these new things that are flowing through?
Ms Rosie Winterton: In a sense,
the 5,100 figure has come from quite a longstanding report.
Q68 Mike Penning: Give me a new one.
Ms Rosie Winterton: I can say
that we have addressed some of the problems so far: the 1,000
extra are already in place; the numbers that we believe we will
be able to make up because of the new ways of working. Remember,
in a sense, the previous figures that were looked at were based
on people continuing to work in the way they are. Because of things
like the new NICE guidelines, whereas at the moment people have
been used to going back to a dentist every six months, in future
the dentist will say, "Actually, you have quite good oral
health, you do not have to come back every six months, you can
come back in as much as up to two years," that frees up time,
It means that existing dentists will be able to increase their
capacity and the new dentists we take on board will likewise be
able to increase capacity. With the extra training, the extra
dentists we have been able to recruit and the changes in the contract,
we feel we will be able in the future to move towards a system
whereby more people—and of course we look to the figure
I have quoted—will have access to a dentist.
Q69 Mike Penning: That was a very
long answer to my very short question. What will the figure be?
You have said the figure is old. What is the new figure?
Ms Rosie Winterton: It is difficult
to give you an exact figure in terms of the numbers of dentists
compared to the shortfall. As we have said, if each individual
dentist, if we look at the figure of 1,000, generally has a list
of, let us say, 2,000, then—in terms of fulfilling our figure,
when you look at all the extra recruits we are bringing in and
the extra training that is going on and the extra capacity that
will come in—we can look at two million more people being
able to access a dentist. But you also have to remember the individual
negotiations that will carry on between a PCT and a dentist. If
a dentist is in an area of particularly bad oral health, they
may say, "We cannot take on 500 more patients. We will be
able to take on, say, 200 or 300 more patients," so I do
not want to say for every dentist that they can see x number
of patients because it will depend on the area they are serving.
Some will be in areas where there is good oral health and they
will be able to take on more. That is why it is difficult to say
that under the new system you could put an exact figure of dentists
with an exact figure of patients.
Mike Penning: To be fair, I am going
to give up now because I did not ask about patients, I asked about
how many the shortfall of dentists would be. I give up!
Q70 Chairman: Could I take over,
that last question begs the question of the freed-up capacity
that will be created. How easy will it be to get that to areas
where there is most need, where we do have bad dental health problems?
Ms Rosie Winterton: Curiously
enough, areas where there can be poor oral health are not necessarily
the areas where there is a shortage of dentists.
Q71 Chairman: I know.
Ms Rosie Winterton: We want to
see the PCTs, with the money they retain locally, looking at whether
there are other ways in which they can address some of that, perhaps
through public education in terms of oral health needs. I was
in Newham recently. It has one of the lowest registration percentages,
it does not have good oral health figures, but it is quite difficult
to get people to go to a dentist. They are looking at ways they
can go out into the community to persuade people to come forward
and at whether there is more they can do in terms of education
in schools about people looking after their teeth better. It is
a balance between saying, "How do you get people to register
in some areas?" and "How do you use some of the money
that people may have locally to improve overall the oral health
of the local population?"
Q72 Chairman: Where money is saved,
keeping it within the PCT is clearly an incentive, but then you
may get the imbalance that the PCTs which are holding money for
dental care do not need the dentists because they are not the
areas which have problems in terms of dental health. Presumably
you will be watching what is taking place with the changes in
this new system, will you?
Ms Rosie Winterton: Yes. Because
we want to take dentists with us, we have made it very clear that
they will be entitled, based on their earnings during a reference
period between October 2004 and September 2005, to have equivalent
earnings for a three-year period. Let me say that I think that
is quite a good offer for dentists. A dentist who gives fairly
good commitment to the NHS does have an earning power of about
£80,000 a year, plus about £80,000 towards practice
expenses. We have made that offer because we want to ensure that
the level of NHS dentistry that is provided at the moment is adhered
to within any area, but, above and beyond that, obviously the
PCTs will be sitting down with dentists and, if they say, "Look,
there is some spare capacity here," looking at how they can
address some of the other needs within the area. As I have said,
in places like Newham they are talking to the dentists about going
out into schools and talking to people about oral health needs.
That is the kind of discussion which, frankly, we have not been
able to have in terms of dental provision previously but which
we can look at much more closely now with the move towards local
commissioning.
Q73 Chairman: My dentist who is in
South Yorkshire has people from as far away as Nottingham on their
list. That may change in the next few months. Could I move on
to the issue of dental access centres. Is the opening of dental
access centres getting over the problem of the lack of NHS dentists?
Ms Rosie Winterton: There are
about 53 dental access centres now and they treat about 400,000
patients. They have provided a very effective way of delivering
care to people in urgent need of dental treatment. Obviously we
were very aware that there had been difficulties in terms of access
in certain parts of the country and they have been able to address
some of those access problems. That is not to say that there is
still not a long way to go in terms of access, but they have been
able to do that.
Q74 Chairman: Are they going to remain
in this new shape of dentistry?
Ms Rosie Winterton: Yes. It will
be, as I have said, up to local PCTs to decide what they feel
is the most effective way of delivering that dental care in the
future. But dental access centres have been a very important part
of ensuring that there is that immediate access. Some of them
provide routine treatment as well, but the emergency part of it
was the initial part. PCTs need to look at what they feel is most
effective. They may decide in future that they want to deliver
it in another way, but that will be up to them.
Q75 Chairman: Or, indeed, if a PCT
wanted to open a new access centre, that would be a matter for
them, as it were.
Ms Rosie Winterton: Absolutely,
yes.
Q76 Charlotte Atkins: The new contract
system is obviously intended to keep NHS dentists in the NHS and
prevent the leaking away of so many dentists who are deciding
to go private, but many dentists would say that the new contract
is just a new sort of treadmill and it will make absolutely no
difference to their resolve to go into the private sector.
Ms Rosie Winterton: I would hope
that is not the case. As I have said, we have worked out this
contract over a number of years with the dental profession, based
on certain principles, principles that you move away from the
drill and fill (where, as I have said, they are paid for every
intervention) onto a system whereby they have a patient on their
list and they deliver what in their clinical judgment is the best
care for the patient. That is giving the trust to them to be able
to deliver that. There is obviously a whole series of changes
which do come into effect: obviously the NICE guidelines, which
mean that people do not have to be recalled within the same period;
the charging system, which is much simpler for dentists, is much
simpler for patients as well. The whole system, the treadmill
that we are completely taking away, is not, I believe, being replaced
by another treadmill. We do have to be very clear that it is important
that we do monitor the work that is being carried out by dentists—otherwise
we would not be doing our job in terms of making sure that patients
are getting good care—but, where there is scope, at the
same time allowing dentists to do more preventative care. Remember
the deal we have made, in the sense of the offer of giving the
same amount of money for three years based on this reference period,
is actually for 5% less work anyway, but we are saying that within
that, if there is scope for taking on additional patients, that
is what we want to see. I think that is what Parliament would
expect us to be doing and what our constituents would be expecting
us to do.
Q77 Charlotte Atkins: One of the
big issues—and, as a constituency MP yourself, I am sure
you have had the letters—is children, where adults have
been told that they have to have a private Denplan type contract
otherwise their children will not be treated on the NHS. Your
Acting Chief Dental Officer told us last week—as I am sure
you have read—that under the new contract that would certainly
not be allowed. I am concerned, if these children are effectively
then going to be withdrawn from an NHS dentist, about how we can
ensure they are not left without a dentist and without the valuable
preventative work that those dentists can do, and also about the
PCT in their public health role making sure that that preventative
role is pursued in their particular area.
Ms Rosie Winterton: The new contract
prevents dentists from saying, "We will only take your children
on if you go privately". That was something which we received
endless complaints about.
Q78 Chairman: Absolutely.
Ms Rosie Winterton: Quite frankly,
it was scandalous that people were saying that. Many MPs complained
about it. We are saying in the new contract that they cannot do
that. That would be seen as discriminatory. However, if the PCT
says to a dentist, "We are quite happy for you only to take
on children under the NHS," then that is for agreement between
the local dentist and the PCT. So there is still the scope there,
but we are not having a situation whereby they could say, "We
will only take your children if you go privately".
Q79 Charlotte Atkins: Obviously dentists
are independent practitioners and many of them will say, "Forget
it, we are going to go down the private sector route and we are
not going to be dealing with these children." Has the Department
arrived at an estimate of the numbers of children in this position?
I am concerned at the capacity of PCTs to be able to pick up the
treatment of these children who are left without a dentist because
of this change. There will be a fall-out—there is bound
to be. What sort of numbers are we expecting the PCTs to pick
up, to find some sort of NHS dentist for these children?
Ms Rosie Winterton: Let us be
clear about what happens under the new system. If a dentist says,
"I'm going to leave the NHS," the PCT says, "Fine,
okay, I now have the money that was being paid to you and we will
find another dentist. If you do not want to work for the NHS,
okay, but we will—
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