Select Committee on Health Minutes of Evidence


Supplementary memoranda from the Minister

  1.  I am writing to follow up some of the points that we discussed in relation to NHS dentistry at your hearing on 26 January.

ORAL HEALTH AND FLUORIDATION

  2.  The Committee asked if I could set out in writing the Department's position on the use of fluoride and fluoridation.

  3.  Experience of oral health promotion initiatives shows that interventions to put fluoride on people's teeth are more effective than campaigns to change behaviour in respect of diet or oral hygiene practice. There have been major improvements in oral health since the introduction of fluoride toothpaste in the 1970s. However, there remain inequalities in oral health, which are strongly associated with economic and social deprivation. This is likely to be linked to toothbrushing regimes with fluoride toothpaste.

  4.  In October 2005, we issued a new oral health plan for England, setting out a range of actions that the NHS, dentists and other stakeholders can take to build on improvements in oral health and further reduce inequalities. This includes action to encourage the use of fluoride toothpastes, especially for young children in disadvantaged areas, and action to promote water fluoridation where local communities support this action.

  5.  The Government has reformed the legislative framework governing fluoridation to give communities with high levels of tooth decay a real option of having their water fluoridated. In September 2005, the Department issued guidance to Strategic Health Authorities on the consultations they would need to undertake to assess the feasibility of a fluoridation scheme and assess public opinion towards fluoridation. The feasibility of schemes depends largely on the organisation of the water distribution system of the area. We are therefore encouraging SHAs to consult the water companies which serve their areas before deciding whether they should proceed with a public consultation.

NUMBERS OF DENTISTS AND RELATIONSHIP BETWEEN NHS AND PRIVATE WORK

  6.  The Committee asked for information about the ratio of dentists to population. The position on this is that:

    —  the total number of primary care dentists practising in England is about 21,000; and

    —  there are about 2,400 persons per primary care dentist (based on an England population of around 50 million).

  7.  In terms of the split between NHS and private work, the Office of Fair Trading's 2003 report, The private dentistry market in the UK, included an estimate that about 2% of dental practices offer exclusively private care. The report also contained estimates that NHS patients make up around 94% of all child patients and around 67% of adult patients.

  8.  We do not have data on the comparative number of courses of treatment in the NHS and private sectors. However, information collected in a 2000 workforce survey found that, on average, dentists spent about three-quarters of their time on NHS work. Almost 60% of dentists spent 90% or more of their time on NHS work, and 70% of dentists spent 70% or more of their time on NHS work.

  9.  In terms of the value of NHS and private work, we estimate that in 2003-04 dentists working in the NHS derived on average about 54% of their gross earnings from the NHS and 46% from private work. About a third of dentists had an NHS commitment of a third or less (measured by comparative earnings); about 20% had an NHS commitment of about a half; and about a half of dentists had an NHS commitment of two-thirds or more.

NHS REGISTRATIONS

  10.  I indicated at the hearing that around 46% of adults and around 60% of children are currently registered with an NHS dentist. "Registration" in this context measures (for adults) the number of patients who have seen their dentist at least once in the last 15 months.

  11.  The concept of NHS dental registration was only officially introduced in 1990. The highest recorded level of NHS registration in 1993 was 57% for adults and 60% for adults and children, at a time when the adult registration period was two years as opposed to 15 months now and when the figures were inflated by some duplicate registrations. (In other words, these figures would now be lower if measured against the 15-month period.) Registration numbers and rates have been relatively stable since 1998 when the figures first reflected the new 15-month registration period.

  12.  The Committee expressed surprise that these figures were not higher—and asked for further information about the Department's estimate that around two million patients were unable to access regular NHS dental care.

  13.  The first point to emphasise is that NHS dental registration is (unlike GP registration) a time-limited measure. The figures exclude a number of patients who attend less regularly than every 15 months. Under the new NICE guidelines, recommended recall intervals range from three months to two years, depending on a patient's oral health. The figures also exclude patients who do not seek routine dental care, but who are nonetheless likely to receive urgent NHS treatment when they need it.

  14.  The figures also of course exclude patients who do not wish to attend a dentist, or who have chosen to attend privately. In 2003, the Commission for Health Improvement report on access and NHS dental patients found that, for those patients who had not been to an NHS dentist in the past year, the two most common reasons given were that they did not think they needed to go (because their teeth were all right) or because they preferred to have a private dentist.

  15.  The Department's estimate (in September 2000) of two million people being unable to register with an NHS dentist was based on extrapolating from the position in 1993, when (two-year) registration levels were at 60% but there were no significant problems of access to NHS dentistry. We therefore calculated:

    —  the fall since 1993 in the number of adults registered with a dentist (adjusted for changes in the measurement of registration) (1 million);

    —  an allowance for increases in demand arising from the increase since 1993 in the number of adults with natural teeth (0.75 million, or half of this increase);

    —  an allowance for additional demand for NHS services by virtue of measures to improve access and promote better oral health (0.25 million).

  16.  We will of course continue to monitor the number of patients who see primary care dentists, so that we can assess the impact of the forthcoming reforms in improving access to NHS dentistry.

COMMISSIONING DATA

  17.  The Committee asked what information will in future be available to the Department (to influence decisions about resource allocation) and to Primary Care Trusts (to inform decisions on local commissioning of primary care dental services).

  18.  Both we and the NHS will have access to data on:

    —  the numbers of patients seeing an NHS dentist (within a specified period);

    —  the numbers of courses of treatment carried out, broken down between the three main bands under the new system (examination/diagnosis, treatment, and advanced treatment), between adults and children, and between charge-exempt and charge-paying patients;

    —  measures of oral health.

  19.  In terms of oral health, the Department commissions decennial surveys of adult and child dental health. The most recent adult survey was conducted in 1998 and the most recent children's survey in 2003. In addition, the British Association for the Study of Community Dentistry, which includes many dentists working in schools among its membership, conducts more frequent surveys of children's dental health. These surveys provide figures on levels of tooth decay by Primary Care Trust.

TRENDS IN REGISTRATIONS AND ACTIVITY

  20.  It may also be helpful if I clarify some of the information I gave on trends in registrations and activity.

  21.  In terms of adult courses of treatment, there has been a steady increase over the last 10 years. In 1996-97, there were around 24.6 million courses of treatment; in 2004-05, there were some 26.6 million.

  22.  In order to allow more time for preventative work, General Dental Services (GDS) dentists transferring to the new contract will have a 5% reduction in the courses of treatment they are required to carry out (after weighting for the relative complexity of the three new bands).

  23.  For registrations, there has been an increase between November 2004 and November 2005 of 1.8%. For a number of PDS schemes (which do not use a formal registration system), these figures are based on the number of patients seen in the previous 15 months). As set out above (para 11), registrations have been relatively stable since 1998.

  24.  I hope that this further information is helpful.

Rosie Winterton MP

Minister of State for Health Services

3 February 2006


 
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