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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