Select Committee on Welsh Affairs Minutes of Evidence

Examination of Witnesses (Questions 100 - 106)



  Q100  Hywel Williams: This is a different topic in some ways. It is information on emergency treatment for dental problems. If I could refer to my own case, when I broke my tooth on a piece of treacle toffee at a Christmas Fair, I did phone NHS Direct when I was in England and asked them about services in Wales and they told me that they knew nothing at all about services in Wales apart from some stuff that they had on paper which was three years old. That was the only NHS Direct number that I could access. I am just thinking of people who live in Wales and work in England when they are trying to access that sort of information from NHS Direct. Do you have any knowledge or experience of this at all?

  Mr Geddes: There is an NHS Direct Wales and there is a number for that.

  Q101  Hywel Williams: But you cannot access it from England.

  Mr Geddes: That is because of the vagaries of the telephone system, is it not, that particular problem? The largest number of calls that NHS Direct currently gets is for dental problems but their difficulty is that they often have nowhere that they can send the patients to. Certainly in Gwent we have a very effective out-of-hours system which is run by a combination of general practitioners and the salaried primary dental care service. They provide the premises and the support staff and the dentists provide the service on Saturdays and Sundays to do that, and it is also providing out-of-hours telephone cover advice. There it is very effective. There are similar schemes in Cardiff but there, of course, you have significant numbers of dentists who are prepared to muck in and provide the service. The difficulties that the population in mid Wales have are different because there is a long way between practices and there are very few practices anyway, so out-of-hours in those areas is more of a problem. After 1 April that is something that the local health boards are going to have to address and we will be watching with interest to see how they do that.

  Q102  Mr Crabb: Currently Pembrokeshire has the lowest adult take-up of NHS dentistry in Wales and the second lowest anywhere in the United Kingdom, I understand. I am asking you to look into your crystal ball and look forward 10 years. Do you see anything that will improve that situation or as politicians should we just give up on the traditional model of NHS dentistry and understand that we cannot turn the clock back and that perhaps there will be parts of the country like Pembrokeshire in   west Wales where dental provision will be principally through the private sector?

  Dr Wills-Wood: Pembrokeshire has got a very good initiative to try and address adult dentistry there. One of the big problems with adult dentistry is the fact that there are long waiting lists for local dentists. Pembrokeshire LHB has in fact employed a dentist who goes around the general dental practices and carries out dental work there. It works very well because they go to the sites where the practices are in different parts of Pembrokeshire. I believe the only way in the long term for NHS dentistry—and this is my own personal view—will be through tailor-made contracts. I do not believe long term there will be a general dental service contract that everybody is used to at the moment. I do not believe there will ever be enough resources to fund a comprehensive dental service long term and a decision will have to be taken by the Welsh Assembly. Do they say in their guidance, "We only want essential dental services for Wales which would come with good access for those essential dental services"? It would be a great shame if NHS dentistry in Wales were to die after 1 April. Many of us are committed to the NHS service and we would like to see it continue but it will not be in the form it is in today.

  Q103  Mr Crabb: The changes that we have been discussing to NHS dentists' contracts are only going to affect a minority of adults in a place like Pembrokeshire with such a low outtake of NHS dentistry and the bulk of dental provision to adults in places like Pembrokeshire is in the private sector. Do you think folks will therefore need to adjust their expectations in the balance between private and public provision?

  Dr Wills-Wood: I think they have to accept that the health economy in Wales is a mixed economy and dental services are moving towards a mixed economy, yes.

  Q104  Chairman: Can I bring you back to this question of cross-border issues? Have you raised any of these issues with the Department of Health at all?

  Mr Geddes: We have raised them with the Assembly. We are told that there is a mechanism for discussing not just cross-border issues in relation to dentistry but the general provision of health care services anyway. We are told that they meet regularly to discuss these things and that dentistry has been on their agenda.

  Dr Wills-Wood: We have raised these issues with the Welsh Assembly because they seem to be increasing not only in north Wales but also in the south-east. As Stuart says, we are told that these regular meetings happen but we do not seem to get any movement on it in practical terms.

  Q105  Chairman: It seems that there is a lesson to be learned from the meeting that you had with the Department of Health and the Secretary of State for Wales only last month. Would you not agree that you need to build on that relationship in order to address the cross-border issue from both sides, so to speak, from the side of the Welsh Assembly Government and also the Department of Health and the Wales Office?

  Dr Wills-Wood: I would be happy with an approach like that. I think anything that could sort out these cross-border issues would be good because at the end of the day it is mainly the vulnerable parts of the population who have been affected the most. It is not the average fit, well person. It is the people who are housebound, the children and things like this.

  Mr Geddes: There are similarities as well not just with dentistry but other things, such as some of the other specialist services. Wales does not provide everything for everybody and some English patients come to centres of excellence in Wales.

  Q106  Chairman: In England you mean?

  Mr Geddes: They come both ways. We need to take the example of the specialist services and use them as centres of excellence. We have an example there already, so if it works for the provision of, for example, cleft palate treatment in dentistry then why can it not work for other things?

  Chairman: Thank you very much for your evidence. As I said at the beginning, thank you for the memorandum you sent us and if you feel that you wish to add to that then we would be very pleased to receive any further written evidence.

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