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Session 2005 - 06 Publications on the internet Standing Committee Debates |
National Health Service (General Dental Services Contracts) Regulations 2005 |
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Column Number: 1 Fourth Standing Committee on Delegated LegislationThe Committee consisted of the following Members: Chairman: Mr. Greg Pope †Barlow, Ms Celia (Hove) (Lab)†Blunt, Mr. Crispin (Reigate) (Con) †Clarke, Mr. Tom (Coatbridge, Chryston and Bellshill) (Lab) †Crabb, Mr. Stephen (Preseli Pembrokeshire) (Con) †Creagh, Mary (Wakefield) (Lab) †Efford, Clive (Eltham) (Lab) †George, Mr. Bruce (Walsall, South) (Lab) †Goldsworthy, Julia (Falmouth and Camborne) (LD) †Hollobone, Mr. Philip (Kettering) (Con) †Laxton, Mr. Bob (Derby, North) (Lab) †Merron, Gillian (Lord Commissioner of Her Majesty’s Treasury) Miliband, Edward (Doncaster, North) (Lab) †Milton, Anne (Guildford) (Con) †Murrison, Dr. Andrew (Westbury) (Con) †Webb, Steve (Northavon) (LD) †Winterton, Ms Rosie (Minister of State, Department of Health) †Wright, Mr. Iain (Hartlepool) (Lab) Geoffrey Farrar, Eliot Wilson, Committee Clerks † attended the Committee Column Number: 3 Wednesday 8 February 2006[Mr. Greg Pope in the Chair]National Health Service (General Dental Services Contracts) Regulations 20052.30 pmDr. Andrew Murrison (Westbury) (Con): I beg to move,
The Chairman: With this we may take the National Health Service (Personal Dental Services Agreements) Regulations 2005. Members of the Committee may refer to both proposals. Dr. Murrison: It is a pleasure to serve under your chairmanship, Mr. Pope. Today’s debate touches on the lives of a large number of our constituents. I cannot remember an issue in the past five years or so that has prompted so much correspondence in my mailbag as NHS dentistry. It is therefore right and proper to give these measures adequate scrutiny, and it is right that they should be debated together because they are truly intertwined and linked with the National Health Service (Dental Charges) Regulations 2005, which we debated in December. We had a long and fruitful discussion about the vicissitudes of those regulations, and inevitably some material that we shall debate today touches on the substance of that discussion. However, I will do my best not to be repetitive. It is important to put on the record our objection to the Government’s direction of travel in respect of national health service dentistry. We all want the same thing—to improve dental health and dental public health, and, especially, to focus on preventive measures in oral health—but the question is how we get there. We would probably agree that where we are at the moment is not satisfactory. For some time, our emphasis has been on capitation, registration and, above all, ensuring that there is a long-term relationship between patient and dentist whenever possible. As with primary medical care, that is the best model for oral health. There is an extremely strong feeling in the profession, reflected in correspondence to us, that capitation and registration are the best model to deliver health outcomes. The Government’s path is contrary to that and runs the risk not only of not improving the situation, which we can agree is unsatisfactory, but of making it worse. On 1 April, which the profession has begun to call national deregistration day, we will see what the future holds.
What is proposed is a leap in the dark. The Minister must accept that there is a large element of risk in what she is embarking on, because she has not tried it out. She will say that we have had personal dental services pilots, which were introduced in March 1997 within the remit of the National Health Service (Primary Care) Act 1997. My hon. Friends can therefore take credit for the success of PDS, which is the model on which it is reasonable to build. However, units of dental activity, which we debated at length in December, have not been piloted. The two models cannot be balkanised, because UDAs are so bound up with the Government’s proposals for the future. If the Minister’s model for the future is to be properly trialled, the proposed mechanism for dental charges must also be trialled, which has not been done. That is what worries the profession. I hope that the Minister is not kept awake at night, but if anything does that, it should be this proposal. She cannot say, hand on heart, that she is certain that it will be okay come 1 April. The profession thinks that it will not be and we share that view. I do not want to waste time banging my political drum, but it is worth while putting the matter into context. Since 1998 the number of registrations in this country has dropped 3 million, and the adult registration rate is now 39 per cent. In my region, the south-west, it is about a quarter of the adult population, which is lamentable, yet the Prime Minister famously promised that everybody would have access to an NHS dentist by the end of 2001. I make no apology for repeating that. He said it clearly, and I think the meaning for most people in this country was clear: they would have easy access to a high street NHS dentist by the end of 2001. Manifestly, that has not happened. This matter will sink or swim on UDAs and on banding. Harry Caton’s report, which introduced UDAs, has been noted by the Government, but what we have today is not what Harry Caton proposed. The detail of UDAs and banding has been substantially revised since the report was delivered, so responsibility for it is in the Minister’s hands—it is her creature. It seems that more people will pay more under the regulations. The Minister will say that fewer will pay a lot—the top band of NHS charges—and she is right, but more will pay more for lower-grade treatment, and I defy her to suggest otherwise. Dentists will certainly leave; I know that from my constituency experience. Surely other hon. Members are in contact with dentists in their area who say that they will not sign the contract, and we are just days from the deadline at the end of the month. That seems to me to be guaranteed to make a bad situation a jolly sight worse. It is important to cite evidence from the British Dental Association. It is an excellent organisation in many ways, but traditionally it has probably done what it can to be as helpful as possible to Ministers, so
I know that Mr. Lester Ellman, chair of the BDA’s general dental practitioner committee, has, at the eleventh hour, asked the Minister for a meeting to discuss the contract. I am not sure whether he has been given a date and a time, but I urge her to see Mr. Ellman to discuss, even at this late stage, the profession’s concerns about her plans for the future. We are deeply concerned, as is the BDA and the General Dental Practitioners Association, about the lack of piloting. We are also concerned about the lack of consultation with the profession, which it has complained about, and in this place, where it would have been reasonable, as this is the biggest change to British dentistry in 50 years, to explore the matter more generally in Government time on the Floor of the House of Commons. We should know why the draft regulations were published for information only and not for consultation. Why did the BDA storm out of negotiations with Ministers early last year? Did it feel that it was being led down the garden path? It is hopeless that such a thing should have happened with the prime negotiating body for that element of health care. I am keen to know why the Minister thinks it happened. Anne Milton (Guildford) (Con): The Minister looks confused and bemused, but I do not think that the public in Guildford and Cranleigh are wrong. Judging by the expression on her face, she seems to dismiss their concerns, but many dentists in Guildford and Cranleigh are worried. They want to continue to give people NHS dentistry, but they will not be able to do so if they are not adequately rewarded. Dr. Murrison: My hon. Friend makes a good point. That is a cue for me to refer to some of the many letters e-mailed and posted to me by dentists the length and breadth of the country. Believe me, this is only a small sample of the correspondence that I have received on the subject. I shall quote some of those letters because they exemplify the profession’s concerns. The Minister of State, Department of Health (Ms Rosie Winterton): I am grateful to the hon. Gentleman for giving way because I want to make it clear that my slight surprise about the statement that the subject has not been debated is due to the fact that hon. Members had plenty of time to debate an entire Bill on the subject. It may have been before the hon. Member for Guildford (Anne Milton) entered the House, but the subject was debated on the Floor on a number of occasions during the passage of that legislation. Column Number: 6 Dr. Murrison: I am grateful to the Minister for that intervention. On reflection, over the past five years, the subject has been debated chiefly when my colleagues brought it to the Floor of the House, largely in Opposition time rather than Government. However, my memory may be somewhat partial. I shall deal with some comments made by dentists. One says:
The letter continues:
Another dentist writes to me from Bexley, saying:
I shall come back to that point later. A Birmingham dentist—many have written from there—writes:
That is a recurring theme. A dentist from Leicestershire writes:
I presume he means that they are making plans to leave. That reinforces what I said earlier—many dentists will sign up by the deadline, but will drift away as the weeks and months pass. A dentist from West Sussex writes:
I think he is right. A dentist from Doncaster wrote to the Minister about the new contract and the miscalculation of UDAs, and sent me a copy of the letter:
The letter concludes:
A dentist from Birmingham writes:
Column Number: 7 A little closer to my home, a dentist from Wiltshire—in fact, the secretary of the Wiltshire local dental committee—writes:
dentists—
Another dentist from Wiltshire, one of my constituents, writes that
A dentist from Chippenham writes:
Let us hope he is wrong. A dentist from Birmingham writes about registration rates:
the Minister—
Well, we have cottoned on to it and it is good of that dentist to write to us. The issue is how people are counted as being registered and the possible temptation to massage the registration rates, shall we say, given the difference between a 30-month and a 15-month period. We shall be on the lookout for that. Another dentist from Doncaster writes:
The Minister commented on that on 6 December and might wish to do so again. Another Doncaster dentist—my word, lots of Doncaster dentists have written to me—says:
A husband and wife dental team from the midlands writes:
That couple have been practising for 20-odd years. A dentist from Widnes, who is apparently a “lifetime labour supporter”, writes:
That is another illustration of my earlier point about dentists possibly being tempted to sign up now, but then drifting away as the months go by. Column Number: 8 A dentist from Stokesley, North Yorkshire, writes that
Another dentist from Birmingham writes:
My last dentist, from Birmingham, says:
I have some sympathy with that last case and certainly with the point about the dentists in south Birmingham. Although there is a recognised need to expand NHS dentistry—indeed, there is a willingness to do so on the part of many dentists—contractual issues at PCT level are preventing that from happening. In my area, I have been rather frustrated by the case of a dentist who, because he is altruistic, wishes to expand his NHS dental practice but is unable to do so because the PCT says it does not have the resources, or is at least waiting to see how many dentists will sign up to the new contract before it reallocates UDAs to those who feel able and willing to take them up. I hope the Minister has enjoyed those contributions, and it is important to read them out. It is all very well politicians going on and on about such things, but it is vital that we get feedback from across the country. I have been struck by the number of dentists from all over the country who have written to voice their concerns. In all candour, I have known nothing like it in my five years in the House, and that really ought to sound alarm bells. We all have an interest in ensuring that NHS dentistry works. Of course, we have an interest in scoring party political points off one another, but, beyond that, I hope that we are here to ensure that things work and to raise concerns with Ministers. I hope that they will genuinely listen to what we, our constituents and those who lobby have to say and that that will make a difference. They need to listen carefully to the concerns that I have articulated, and I hope, even at this late stage, that they will consider more carefully than they have to date the likely impact of the proposed arrangements on NHS dentistry. It would be nice to know why it has been left to this very late hour to discuss the regulations. I appreciate that the Minister is in the hands of the House
I would like to hear from the Minister about IT. Connecting for Health and the national programme for IT in the NHS are among the things that we have discussed at length, but we are not discussing NPfIT in the context of dentistry at the moment. What we must discuss is whether the software is in place and up and running to support the huge change in NHS dentistry. We are really talking about the software that is needed to support accounting in the new set-up, as well as the support required at the Dental Practice Board, at PCT level and in practices to ensure that information is correctly captured and recorded. I have already raised concerns about the software model that is used to calculate UDAs, but that is not what I am talking about in this context. I am concerned that practices and PCTs do not have the software necessary to support changes in how we account for NHS dentistry. The Minister has presumably considered the issue, and I hope that there will not be another public sector IT disaster and that things run smoothly. It would be good to have her assurance that that is the case. Several dentists have written to say that they are concerned that training packages in the new system have been discussed at length, but nothing has been delivered. That is part of their general concern that they have not been kept in the picture; they have not been adequately consulted or informed about the new arrangements. It is important to stress that we are talking about not a slight change to the arrangements, but the most fundamental change in NHS dentistry for half a century. It is remarkable that dentists are not being adequately informed, and that dentists and their staff are not being offered the training that they need to be happy and comfortable with what is happening. There is a look of incredulity on the Minister’s face. No doubt she will say why when she responds to the debate. The dentists have expressed their views to us and the litmus test is the correspondence we have received—not from a small group of disaffected dentists, but from dentists throughout the country who say, “We have not been kept informed. We do not know what is going on, we are panicking and we need more information.” The Minister needs to understand that, get to grips with it and do what she can to rectify matters at the eleventh hour. I am interested to know what the arrangements will be for out-of-hours cover, as the issue has been raised with me locally, where I live. Clearly, PCTs will have responsibility for that element of NHS dentistry. I lied ever so slightly when I said earlier that I had given my last quote from a dentist, but the following is short and it relates specifically to out-of-hours cover:
Column Number: 10 That implies that there will be no emergency cover in the area. The letter goes on:
That is what the dentists have been told. We covered the matter very briefly on 6 December when the Minister said that dental pain is an emergency, and I agree with that. In a previous incarnation, I was required to do a bit of dentistry in the absence of a dentist, although I am not trained specifically in dentistry. I consider dental pain an acute emergency, especially having experienced it myself. Will the Minister say what is to be regarded as an emergency by PCTs? I would include protection of the airways, bleeding and swelling, and dental pain, which is by far the most common dental emergency. The dentist I quoted is fearful that there will not be any dentists on the rota come April 1, so there will be no emergency service in primary dental care in his area. I suspect that the Minister will have looked specifically at that concern and will have some idea of how prevalent such a situation is likely to be after 1 April. Will the only out-of-hours emergency dental cover to which we have recourse be an accident and emergency department? That would be a serious deterioration in the service that we enjoy now. On 6 December, we briefly covered the tolerance limit for UDAs, and I am pleased that in the revised regulations it has gone up from 2 per cent. to 4, which is a move in the right direction. That limit is still rather fine, however, and dentists are worried that towards the end of the year there will be an overshoot. They will not want to go under their UDA allocation for the year because that involves penalties. I am worried about dental public health and oral health research, and so are a number of people who have written to me. Currently, 400-odd treatments that are listed for payment are recorded separately. That will obviously be reduced to three bands, plus a few other bits and bobs under the new regulations. What assessment has the Minister made of the impact of that on dental epidemiology? It may seem quite a small point, and I suppose that in the great scheme of things it is, but advances in dentistry, as elsewhere in health care, are informed by research, often epidemiological research. Unless there is an alternative means for capturing individual items, as we can currently with the recording mechanism available to us, that recourse to dental epidemiology will be lost, or at least severely damaged. It would be nice to know what thoughts the Minister has had on that and whether she intends to do anything to remedy it. What does the Minister have in her regulations that will incentivise preventive oral health? In December, she went some way to convince us that preventive oral health would be encompassed within band 1. The hope is that dentists will use band 1 to practise prevention. Other than that, it is difficult to see what effort has gone into focusing on preventive oral health within these regulations and, other than allowing dentists to charge for preventive oral health within band 1, it is
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