Select Committee on Health Minutes of Evidence


Examination of Witnesses (Questions 80-99)

ROSIE WINTERTON MP

26 JANUARY 2006

  Q80  Charlotte Atkins: If you live in a rural area, as I do, picking up another dentist could mean having to travel 20 miles.

  Ms Rosie Winterton: That is exactly the point I have been making, in terms of the numbers of dentists who are coming through the system. We will work very closely with them to make sure, and have discussions with PCTs—as we did in the past with the thousand extra dentists that we brought in. We were able to work with them and direct them to where there were shortages, which is why a lot of the numbers have built up. Many of the thousand extra dentists have gone, for obvious reasons, to areas where there were shortages. We will do that. I am confident that PCTs, because they now retain the money locally, will be able to go to other NHS practices within an area, or they will be able to take new recruits on, bring them into the area, and look at other issues like the salaried dental service or the dental access centres as to how to deal with those problems. But I think we have to be absolutely clear that our very strong message to PCTs if dentists leave—and they have a duty, remember, to provide for the needs of local people—will be that that money will be used to bring in other dentists. I would be quite surprised if many feel, particularly in the case of children, that they want to walk away completely.

  Q81  Charlotte Atkins: If the Department is really keen to see preventative health measures, particularly in the dental health area, why is the Department not doing more on the issue of fluoridation? Last week, your Acting Chief Dental Officer said that fluoridation has probably been the most significant factor in the improvement of oral health across the board (which obviously includes in toothpaste). Why is the Department not doing more on that, given that the PCTs are now going to have responsibility for overseeing dental care?

  Ms Rosie Winterton: As I understand it, the guidelines in terms of consultation on fluoridation have now gone out, and it is up to local areas to decide how they want to do the consultation in terms of whether they bring it in. We have made very clear, and so has Parliament, that this is to be done with local decision-making.

  Q82  Charlotte Atkins: But, if you really want to improve dental care, why is the Department not taking more of a lead on this issue?

  Ms Rosie Winterton: We have provided evidence, we have provided guidelines, but, as I have said, it has also been a decision endorsed obviously by Parliament that this should be something which is led at local level.

  Q83  Charlotte Atkins: Lastly, the issue of new contracts for dentists. We do not want them to go down the same route as contracts for doctors, where doctors now are the best paid doctors in Europe. Clearly on the dental side we have seen NHS spending overall go up 75% and the expenditure on dentistry has only gone up 9%. In that situation we do not want to see scarce dental resources jut going into stuffing dentists mouths with gold.

  Ms Rosie Winterton: You cannot get those on the NHS!

  Q84  Charlotte Atkins: White fillings, of course, are the issue in terms of cosmetic dentistry. We do not want to see important resources which should be improving the dental health of our children and our adults, just going into increasing the salaries for dentists. Yes, we must have incentives for dentists to stay in the NHS—but not just to pay them over the odds for a service which they should be providing and making available to all our constituents, not just children.

  Ms Rosie Winterton: The way funding for this is working means that the contracts that are being offered to dentists reflect their earnings between October 2004 and September 2005, so they are based on historic earnings. We have guaranteed those for three years, as I have said, for 5% less work, but we do believe that within that there will be scope for them to see more people. It is certainly based, as I have said, on the current situation in terms of expenditure, allowing, of course, for some inflation in the doctors and dentists review body. If, for example, a dentist wanted to leave the NHS, the PCT could negotiate with another dentist an increase in the amount that they were being paid, but that would be in return for increased patient care. The overall pot, if you like, is decided or is out there with the PCTs. Because it is based on historic earnings, it would be quite surprising behaviour for a PCT suddenly to say, "But for doing nothing else we are going to give you more money." That is not the way it would work. If they were going to give them more money, it would have to be in return for increased activity.

  Charlotte Atkins: Thank you.

  Q85  Jim Dowd: Could I say that I am not against having the best paid doctors in Europe as long as they are both the most highly skilled and the most productive at the same time. I presume the objective of the Department in this is to ensure that everybody who wants access to an NHS dentist has it, even though a lot of people will not want it. Does the Department calculate the volume of total activity undertaken by dentists, both NHS and private? If you do that—and if you do not, there is no point in me asking the rest of the question—is there any indication of how that proportion is moving?

  Ms Rosie Winterton: In terms of what are called "courses of treatment", there has been an increase during the period, curiously enough, when registrations have fallen.

  Q86  Jim Dowd: An increase in the NHS proportion?

  Ms Rosie Winterton: In the courses of treatment. That means that if you go to a dentist and you have your check-up, scale and polish and your filling—and that is considered to be a course of treatment—there have been increases in that. The fall in registrations, to a certain extent, has been complicated by the fact that at one stage the registration period was reduced to 15 months. A lot of people went back to the dentist and were told, "No, you are not registered here any more." They asked, "Why is that then?" and were told, "Because you have not been for 15 months." In a sense, a lot of people fell off there. In terms of registrations, at the moment, under the PDS system it is more patient lists—because of the fact that the way of working changes, so you do not have to go back within that 15 month period—and, because a lot of patients have changed to PDS, again, there are differences in the registration figures. It is quite complicated to explain how all those things fit together, but overall, in terms of courses of treatment—because sometimes things have been provided in a different way, whether through dental access centres or some dentists doing emergency out-of-hours treatment—courses of treatment have gone up. In the future, in terms of how we measure that, there is a system within the banding system—

  Q87  Jim Dowd: Sure, but that is the overall volume that has gone up.

  Ms Rosie Winterton: Yes.

  Q88  Jim Dowd: I was wondering if there is any way of differentiating between the courses of treatment. Within the total increase in the volume, do you know which proportion is done under the NHS regime and which is done privately?

  Ms Rosie Winterton: We certainly know that dentists have increased their private work. We do not measure their private work, so it is quite difficult for us to put an exact figure on. We can only, in a sense, measure NHS work.

  Q89  Jim Dowd: Does the Department not have a general idea of the volume of dental work done in the United Kingdom?

  Ms Rosie Winterton: On the NHS, yes.

  Q90  Jim Dowd: No, overall.

  Ms Rosie Winterton: Not privately.

  Q91  Jim Dowd: It has no idea of an overall level of picture.

  Ms Rosie Winterton: We know the number of dentists is something like 21,000. We know that the vast majority of those do some NHS work. I think the figures show that it is only something like 5% or 10% who do purely private work, but we do not know the proportion of time that some of the others spend doing private work as opposed to NHS work. They may be doing NHS work and doing something completely different, but we do not have records from them of the work that they are doing privately.

  Q92  Dr Naysmith: Minister, you are saying that all this time when there has been all this fuss about dentists shedding their National Health Service patients and so on, at the same time the amount of work being done under the National Health Service has been increasing. That is a very interesting statistic.

  Ms Rosie Winterton: Two things have been happening. I should qualify what is considered to be activity and what is considered to be courses of treatment. There was a time when the courses of treatment rose even though the number of registrations was falling. Registrations at the moment are moving slightly upwards but the new way of working means that what we would traditionally regard as activity has slightly fallen. Under the PDS system, people are not going back as often as they used to; there are not so many direct interventions; there is more emphasis on oral preventative health advice—so it is a mixture.

  Q93  Dr Naysmith: That is only just coming in now.

  Ms Rosie Winterton: No, remember the PDS pilots have been going on for really quite some time. There are now 30% of dentists working in that new way. From that it has been very quickly shown that the levels of direct intervention, which is how we used to measure activity, go down—which is why we know that, in terms of the future, there is scope for extra within the system to look at treating more patients.

  Q94  Dr Stoate: I would like to clarify one or two small points on this issue because I am now slightly confused. You are saying the number of registrations has increased. Could you say what percentage of the British population is currently registered with the NHS?

  Ms Rosie Winterton: I think it is around 46% of adults, 60% of children. At its height it was something like . . . I think I said 57%.

  Q95  Dr Stoate: You did say that. Whether it was right or not, I do not know.

  Ms Rosie Winterton: Registrations are up slightly over last year.

  Q96  Dr Stoate: So 46% of the adult population in this country is registered and roughly 60% of the children's population is registered. If you take as an average that just over 50% of the population overall is registered, that means there must be something like 30 million people who are not registered. Now I am really confused, because you said there are two million people who could benefit from being with an NHS dentist, but now we are saying that only half the population is registered, which means that 30 million people are not. Does that mean those 30 million people are doing something completely different? That is a very, very high figure.

  Ms Rosie Winterton: At the height of registration there were something like 57% registered. There are some people who do not register.

  Q97  Dr Stoate: But 30 million?

  Ms Rosie Winterton: I can only say that is a fact. In some parts of the country at the moment there are areas where they are going out trying to get people to register, because, for whatever reason, sometimes people are deterred because they do not like going to the dentist, I am afraid.

  Q98  Dr Stoate: We either are saying that 30 million are registered privately somewhere, which seems—

  Ms Rosie Winterton: No, I am not saying they are necessarily registered privately.

  Q99  Dr Stoate: No, I am not saying that either. I am saying that there must be a huge number of people who effectively have no dental health care whatsoever. We are talking about a huge number.

  Ms Rosie Winterton: But some of them may go, for example, to dental access centres.


 
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