Examination of Witnesses (Questions 100-119)
ROSIE WINTERTON
MP
26 JANUARY 2006
Q100 Dr Stoate: But you would know
if it were that number.
Ms Rosie Winterton: I know not
30 million are. We also have to remember that dental registration
is time limited, so there will be some people who inadvertently
fall off the system. It is not like GP registration: you can register
with a dentist where you work, where you live. It is completely
open. I am saying that, for whatever reason, at the height of
registration it was still only 57%. There will be some people,
frankly, who just do not register; some people who go privately;
some people who will go to a dentist when there is something wrong
with them and that is the way they operate.
Q101 Jim Dowd: Are you saying that
if you do not attend for 15 months you automatically drop off?
Ms Rosie Winterton: That was the
previous system, yes.
Q102 Jim Dowd: But is it now?
Ms Rosie Winterton: It changed.
Under the new system there will be patient lists. It is not registration
in the same way as it used to be. Under the previous system, you
registered with a dentist. This is one of the problems that happened:
when the registration was changed to 15 months a lot of people
did not realise that, and, when they want back to their dentist,
they said, "You are no longer registered, you have fallen
off." Because under the new system it is up to the dentist
to say, "You do not need to come back every six months,"
the NICE guidelines have changed and they say it is no longer
necessary for people to have that constant attention. You now
come back when the dentist says you need to. Some of them may
say, "You need to come back in three months because you are
in a right state," but some of them may say, "You don't
really need to come back for 18 months." You are on that
person's list but it is not registration as we perhaps knew it.
Q103 Jim Dowd: That is the new system.
The answer to how it is missing 30 million could easily be that
that 57% at its height, or 46% as it is now, is only a record
of the number of people who have been to a dentist in the last
15 months.
Ms Rosie Winterton: That could
well be. I am saying that there is a host of reasons why people
are not on it.
Q104 Jim Dowd: I am surprised it
is as high as that, actually.
Ms Rosie Winterton: Many people
did not know until they went back to a dentist that they were
no longer registered. I am sure colleagues had a lot of letters
from people saying, "I've just gone back and been told that
I'm no longer registered."
Q105 Chairman: Earlier, Minister,
in response to Mike Penning's question, you said that your belief
is that there are two million people who would like to register
with the NHS at the moment.
Ms Rosie Winterton: They would
like to have access, yes.
Q106 Chairman: So that is the only
identification out of the 30 million missing people here who are
demanding or wanting access to NHS dentistry.
Ms Rosie Winterton: Yes.
Q107 Mike Penning: If I could clarify
one matter, you said there are 21,000 registered dentists, private
and within the NHS.
Ms Rosie Winterton: 21,000 overall
on the GDC list.
Q108 Mike Penning: We have a population
of around about 70 million.
Ms Rosie Winterton: Yes.
Mike Penning: So the calculation works
out at
Dr Stoate: 3,000 per dentist.
Mike Penning: No, it is more like—
Q109 Chairman: We will have that
debate, but we need to move on. This is a very interesting area.
Does the Department hold figures for how many have dropped off
the old system in the last 15 months? Do you have a measure of
people who did not present themselves to a dentist and therefore
were off again? Do you keep those figures centrally?
Ms Rosie Winterton: No, we do
not. We tend to know when a dentist is de-registering whole sections
of people.
Q110 Chairman: But not the individuals.
Ms Rosie Winterton: They do not
report an individual.
Q111 Chairman: They could reflect
in your two million demandees, as it were: they have dropped off
and they may come back again. I really need to move on, but my
colleague asked you about the issue of fluoridation and whether
you were doing anything about it. My understanding of how it woks
is that it is a public health measure.
Ms Rosie Winterton: It is, yes.
Q112 Chairman: We have the wrong
Minister here. Perhaps you could make the inquiry for us and see
whether the Department has done anything in that particular area.
I have an interest in and support the fluoridation of public water
supply; other people may not here, but it would be useful if the
question could be answered by the Minister responsible.
Ms Rosie Winterton: Of course.
As I say, I am pretty confident that the guidelines did go out
on how the consultations should be carried out, but I will certainly
come back on that.[5]
Q113 Mr Burstow: Could we possibly have
a note that covers two issues? One is to do with the issues around
workforce planning and what data the Department holds. The other
is concerning this question we have been asking you now about
what information the Department and PCTs hold that enable them
to make commissioning decisions on behalf of populations in respect
of dentistry. We do not seem to have a complete picture. From
the questions that have been asked, there seem to be large gaps
in the picture.
Ms Rosie Winterton: A lot of PCTs
have had systems whereby they record numbers of people who have
made inquiries about NHS dentistry, so that as more come on stream
they are able to direct people towards that.
Q114 Mr Burstow: Would it be possible
to have the note, because we need to move on. It would be very
helpful to have the picture in terms of what data there is on
both those issues.
Ms Rosie Winterton: Sure.
Q115 Mr Campbell: How do you respond
to the criticism that has been made by dentists that the new system
will have a negative impact on treatment and it will lead to under-treatment?
Ms Rosie Winterton: I would hope
that dentists, who, after all, are professionals, would not ignore
the health needs of their patients. One of the things they have
said to us is the drill and fill method of treatment that they
have at the moment—the treadmill, as they call it—is
that they are only paid when they do treatment. It has been perhaps
indicated in the past that that is a kind of perverse incentive
for over-treatment. We are doing what dentists have asked us to
do: "Allow us to make the decisions and pay us on that basis."
That is what this system does. I would hope that would not mean
that dentists would somehow ignore a patient's medical needs—because,
quite frankly, they would be had up for it if they did.
Q116 Mr Campbell: What evidence do
you have that the new system of prevention will help the patient?
Ms Rosie Winterton: I think everybody
agrees that prevention is a very important part of any medical
treatment, of any public health approach, if you like, and health
approach. If a dentist does have time to talk to somebody, more
time to sit down and say that there are some problems here and
to talk a little bit about lifestyle or—
Q117 Mr Campbell: Stop smoking? Stop
drinking?
Ms Rosie Winterton: —brushing
habits or whatever, that is going to help. We certainly know from
the PDS pilots that we have spent some five years doing, that
patients like the system more and dentists themselves feel that
it allows them greater discretion.
Q118 Mr Campbell: So that is going
to be a plus.
Ms Rosie Winterton: I hope it
will. As I have said, I would hope that we can all trust dentists
to give the proper care and not to somehow skimp on it, because
that would be a very sad reflection if that were the case.
Q119 Dr Taylor: I was a captive in
my dentist's chair last Saturday morning.
Ms Rosie Winterton: You see, I
knew everyone would have had visits!
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