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3 July 2007 : Column 226WH—continued

which is to be applauded.

The Home Office has had reasonable settlements. Of course, it has enormous obligations, but it has the cash to avoid this lurching of cuts part-way through the year. I therefore ask that the in-year cuts be restored and that should changes be necessary in future, we do not adopt the across-the-board approach, but consider what works best. Clearly, the Safer Hastings partnership works well—I have given examples of its success—as do the schemes in Milton Keynes and Brighton, but schemes in other areas might work less well. Perhaps some objective assessment should be made as to where, if anywhere, reductions should be made.

If reductions are made in the constituencies that have been mentioned today, services will be affected. The Minister might say that funding could be filled from other sources or could be dealt with differently, but that is not possible because it is ring fenced, so a reduction in the funding for particular projects means a reduction in those programmes. I regret that it has been necessary to raise this issue, and I am grateful for the opportunity to do so. I hope that the Minister will reassure my colleagues and me that he will reconsider.

1.13 pm

The Minister for Security, Counter Terrorism and Police (Mr. Tony McNulty): I congratulate my hon. Friend the Member for Hastings and Rye (Michael Jabez Foster) on securing the debate. He spoke with passion about all that has gone on in Hastings with policing, community safety and Home Office matters, and about developments throughout the public sector to do with the Safer Hastings partnership. I do not doubt that the partnership has, as he described, had a significant impact on improving the quality of people’s lives in Hastings and St. Leonards.

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Let me give the detail of the main Home Office funding for the partnership’s work, although that funding is not paid directly to the partnership by the Department. Key elements for 2007-08 are the safer and stronger communities fund, the drug interventions programme grant and the basic command unit fund. The SSCF is a pooled budget comprising funding from the Home Office and the Department for Communities and Local Government, which is paid to upper-tier local authorities under the local area agreement process.

My hon. Friend will know that, for this year at least, the SSCF for East Sussex is £2,301,332 in revenue and £702,451 in capital, compared with £1.69 million in revenue and £190,000 in capital last year. That is an advertent point, which he did not seek to make, but the overall SSCF has not been cut; its pooled budget has grown. I shall come to his specific point about the Home Office, but people should not run away with the notion that the overall SSCF, and all that it does with such success throughout East Sussex, including Hastings, has been cut in the way that he described, because it has not.

Given the pressures that my hon. Friend described, which I understand are not priorities from his perspective, tough choices had to be made across the Home Office, both before and after its split from the Ministry of Justice, to enable us to live within our budgets and to meet our public protection obligations. As a result, the Home Office contribution to the SSCF is less than it was in the indicative figures that were offered in December, but that does not mean that we are any less committed to local delivery through LAAs—local area agreements—and partnerships, or to having a localised, neighbourhood focus on all that we do in policing and community safety. He will know that the overall pot for neighbourhood policing in England and Wales has increased by 41 per cent. this year, and he will be as committed as I am to ensuring that neighbourhood policing, in all its forms, works alongside crime and disorder reduction partnerships and other partnerships to bed in the success that he discussed.

The East Sussex upper-tier authority, in which Hastings sits, received over £3 million from the SSCF for 2007-08. Under its LAA, East Sussex and its partners enjoy greater freedom and flexibility to decide how best to use the SSCF grant to deliver an agreed range of outcomes. The intention is clearly that local areas should be able to prioritise pooled resources as they see fit to meet the needs of local communities. That flexibility is at the core of the new relationship between central and local government and is the basis of the LAA development that we want to see, not least in holding local police forces accountable more readily, particularly at BCU level.

Michael Jabez Foster: I acknowledge that local authority systems should determine priorities locally, but perhaps I did not make my point very well. How can a local authority do that if it has fixed its budget and made its decisions for this year, and then a reduction is made after that budget has been agreed and determined?

Mr. McNulty: In the strictest sense, it was not agreed. It was not until mid-May or June that Home Office contributions to LAA budgets were confirmed.
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That was quite wrong, and I assure my hon. Friend that that cannot and should not happen again. Previously, from December onwards, any figure about the Home Office contribution to LAAs was indicative, so the notion that the deal was done by December simply is not accurate. I understand why my hon. Friend is frustrated, and I accept, as I had to on a range of other issues last year, that it is not appropriate to wait until after the start of a financial year to wait for confirmation of decisions or subsequent reductions before making such decisions. I shall do all that I can to ensure that that does not happen again.

My hon. Friend will also know that Hastings is within the East Sussex BCU, which received £190,000 from the Home Office for 2007-08, as it has for the past four years. In any partnership, partners bring some of their own funding and resources to the table, and funding streams feed into the Safer Hastings partnership to meet local priorities. I was pleased to hear, for example, that it is being awarded funding from the neighbourhood renewal fund to progress its already considerable efforts in tackling town centre violence and disorder. If my hon. Friend could tell me how he unlocks NRF money, I would be enormously grateful, because my constituency has not received a penny from it in the past 10 years, despite containing significant pockets of deprivation.

The overall allocations of the SSCF grant were given to upper-tier areas, including East Sussex, and, given the nature of the pooled pot for LAAs, that allowed areas at that stage to plan their spend. I agree with the core element of my hon. Friend’s point: it is unfortunate that the detail of the Home Office element of SSCF allocations came later than usual. I fully understand that that may have caused some local planning difficulties, and the Home Office is committed to ensuring that it is not repeated in future years. The reasons for the delay were complex, but we will learn from this experience.

Collectively, £10 million accrued to the Home Office in terms of its contribution. Rather like the £27,000 lost in Hastings, that could, in the scheme of things, be conceived as being rather small beer in the Home Office’s budget of billions. I take with a gentle pinch of salt the letter that my hon. Friend received from the Treasury saying how wonderfully generous it has been and that everything is fine because it gave 2.7 per cent. None the less, I appreciate and would not deprecate the notion that £27,000 is huge in terms of Hastings’s funding. The loss of such a sum would have a potentially significant impact if forewarned and planned for; it would have even more impact if not planned for.

In the scheme of things, £10 million does not help matters much in the Home Office’s budget, but I have had to take £10 million from one place, £20 million from another and £10 million from another to get funding for the key priorities at the time— prisons and the counter-terrorism budget—and we in Government must take such decisions.

I also take my hon. Friend’s point about the notion of using needs-based assessment, rather than universality, if these things are reduced in future. It is no comfort to him, or to my hon. Friends the Members for Milton Keynes, South-West (Dr. Starkey) and for Brighton, Pavilion (David Lepper), that they have all been hit by 14 per cent. cuts. The fact that they share the pain does not make it all okay.

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My hon. Friend the Member for Hastings and Rye made the fair point that, if we were to recalibrate and lessen the moneys—I have no intention of doing this—that the Home Office puts into the LAA and SSCF pots as a matter of policy, it should be done more readily on either a success and performance-reward basis or a needs basis. I am entirely sympathetic to the challenges that the funding reduction causes and to the point that the Home Office elements were determined late and should have been done more readily—hopefully prior to the start of the financial year—so that people could have gone about their business.

Hon. Members would expect this, but I should say that we would still expect areas to meet their agreed target on reducing crime and disorder and the harm caused by drugs. I hope for the continuation of the substantive success that has occurred across East Sussex broadly and certainly in Hastings, as my hon. Friend outlined.

It is easy to talk about tough choices, appropriate priorities and targeting resources where they can have the most impact as things flatten out, rather than be reduced more generally, in terms of the Home Office. I am afraid that I cannot give my hon. Friend any satisfaction on restoring those elements that were reduced this year. However, I assure him that whatever the news, good or bad, for SSCF, LAAs, the BCU and all the key Home Office funding elements, it is incumbent on the Home Office to ensure that people know sooner rather than later what budgetary elements are coming from it. Such an approach would allow them to plan accordingly and to sustain—this is true in the case of Hastings—the good works that have been done through the partnership.

I applaud not only the commitment, but the innovations, substance and evidence of results of the Safer Hastings partnership. Although I might deprecate and decry the manner of the process, largely because I was involved in it, given that I know what the £10 million is being spent on elsewhere in the Home Office, I would defend the fact that cuts were made. My hon. Friend’s anger and frustration at it being mid-May or June—well after the start of the financial year—before the funding was finally announced is entirely fair.

I applaud what is happening in Hastings. East Sussex is wedded to the neighbourhood policing model that I see very much as the other part of the equation in terms of what people are achieving in partnerships such as Safer Hastings. I wish my hon. Friend and his colleagues in the partnership well in continuing the process, albeit, however temporarily, handicapped by the late confirmation of Home Office funding, for which I apologise. I shall seek to ensure, through him and my other colleagues, that that will not happen again. I therefore hope that we can maintain the good news and good success in crime and community safety, rather than discussing the unfortunate oversight of presenting the funding after the financial year has started.

1.25 pm

Sitting suspended.

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Dental Services (Sutton and Merton)

1.30 pm

Tom Brake (Carshalton and Wallington) (LD): I welcome the Minister to her new post. I am pleased to have been able to secure this debate. I am sure that it will be non-confrontational, so I hope that it will be a gentle easing into the process for her.

I welcome the opportunity for this debate. I highlighted my reason for seeking it in health questions last week, when I mentioned the responses I had received to a health survey in my constituency that is almost complete. We sent out 70,000 survey forms, one to every elector in the constituency, and so far we have received about 7,000 back, quite a representative sample of residents. A certain amount of self-selection may have gone on in the response—perhaps it is true that people who are happy generally tend not to respond to surveys, whereas those who are unhappy do—but 7,000 residents is still a significant proportion of my constituency.

The biggest issue that leapt out of the health survey responses was access to NHS dentists. No fewer than 71 per cent. of those who responded said that they had had problems registering with a dentist. That prompted me to launch a campaign called, snappily, “Desperate for Dentists”. I secured a skeleton—it was loaned by local Carshalton college—and arm-twisted my dentist into allowing us to set the skeleton in her chair to illustrate how long people were having to wait for access to an NHS dentist, although fortunately it is not normally quite as long as that.

The campaign addressed securing free check-ups, ensuring a contract renewal process engaging both patients and professionals properly so that contracts are drawn up with full co-operation by both parties, placing greater emphasis on preventive treatment and establishing individual dental plans tailored to patients’ needs. I understand that the National Institute for Health and Clinical Excellence supports the latter idea, as different patients might require more or less dental treatment. Some people whose teeth are in stable condition might not need a check-up every year, but some people clearly need much more frequent check-ups and different treatment.

I suppose that I should not have been surprised at the amount of concern expressed about access to NHS dentists. We know that the national picture is that a significant percentage of dentists are not taking NHS patients. Indeed, within three months of the introduction of the new contract, 1,500 dentists had opted out of the NHS, representing 8 per cent. of NHS dentists. That is a worrying position.

Although 28 million patients seen by NHS dentists in 24 months, according to national statistics, is a large figure, that figure had not changed since the previous period. Despite the new contract and the expectation that it would lead to more people being seen, in practice there has been relatively little movement during the 12 months between 31 March 2006 and 31 March 2007.

London also has issues, particularly for children. Only 65.3 per cent. of London children were seen in the past 24 months, compared with nearly three quarters of children in the south west strategic health authority. There are regional discrepancies. Unfortunately for my constituents, the local discrepancy within the London region points to particular issues in Sutton and Merton.

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Let us compare what has happened in London with what has happened in Sutton and Merton primary care trust. In London as a whole, the number of patients seen from 30 June 2006 to 31 March 2007 dropped from 51.7 per cent. to 51.2 per cent. That is a relatively small percentage, although a large number of people were affected, but in Sutton and Merton the number has dropped much more substantially, from 52 per cent. to 49.7 per cent., at a time when the average across England as a whole has not changed for the past four quarters. The same percentage of patients have been seen throughout those periods, whereas in London the number is beginning to drop and in Sutton and Merton it is dropping more substantially.

On the face of it, that is hard to understand. The number of dentists per 100,000 people is quite good in Sutton and Merton—it has 53, compared with 42 in other parts of England. Still, a smaller percentage of the population in Sutton and Merton are seen by dentists—only 45 per cent., compared with 51.5 per cent. in England as a whole. Clearly, there are local issues, highlighted by my survey and borne out by publicly available statistics.

I sought the view of a local dentist and met a couple of weeks ago with an orthodontist. His name is Tim Pollard, and he is happy to put on record his view of the new dental contract:

rather than improving

and for some practices,

The practices might have been starting up, or had maternity or sickness leave that made the year atypical.

The contract

so dentists cannot grow their practices. It may also mean that once the dentist has done all the work that he has contracted to do, he may end up with staff unable to work except in the private sector. Patients have the frustration of knowing that dentists and staff are available to do NHS work, but because the financial input from the PCT for that year has been spent and all the work has been done, the dentist cannot do any additional NHS work.

Importantly, dentists are at financial risk because they have lost control of their business. An interesting question, which I hope the Minister can clarify, is what position dentists who have built up their practices using private money will be in when they attempt to sell on those practices. My understanding is that given that there appear to be no funding guarantees from the PCT, dentists will be left with a practice in which perhaps half the work is not guaranteed—the other half, if it is private work, will be—and uncertainty about the practice’s future income will make it almost unsaleable. For dentists who have invested heavily in their practices, that is a huge problem.

3 July 2007 : Column 232WH

The biggest problem is what will happen after 2009 when the contracts come to an end. I raised that issue in health questions last week, so I hope that the Minister’s officials will have done their homework and perhaps secured a detailed response. It was interesting that, in response to the hon. Member for Chorley (Mr. Hoyle), the then Minister said that under the present contracts PCTs are not allowed to spend the money allocated to dentistry on anything else: they cannot switch it to other services. I understand, as do the orthodontists, that there will be no such guarantees after 2009, and that it will be for PCTs to determine what level of funding they want to put into dentistry. I understand that they will have to provide “reasonable services” and, if so, I hope that the Minister will explain precisely what that means.

If orthodontists and dentists are thinking about increasing their practices and want, for example, to extend their premises because they will be doing more business, they need to invest now. They need certainty now so that they can make planning applications, design extensions and put together investment plans for the future. However, because of uncertainty about what will happen beyond 2009, they are not in a position to do so.

Last week, I hoped to obtain an indication from the then Minister—perhaps the present Minister can provide it now—of the point at which PCTs should enter into discussions with dentists and orthodontists about what will happen beyond 2009. Clearly, if PCTs leave that until January 2009, dentists will not have made the necessary investment, and they are worried that big corporate organisations might come into the sector after 2009 and put them out of business, or that they might invest in anticipation of securing renewal of their contract but find that a big corporate takes over a block of work. Both dentists and, more significantly, patients need clarity on what will happen. We do not want patients turned away, which may, unfortunately, happen under the present contractual arrangements, and we certainly do not want services collapsing or investment not being made because dentists do not know what will be over the horizon in 2009.

I do not want to give a solely negative view of what is happening with my local primary care trusts. I am pleased that they have chosen to re-establish an oral health advisory group, and I hope that that group will be truly representative of patients and professionals. If it is not, the claims that are being made about PCTs being representative of the local community will simply not stack up. At the moment, I am afraid that the view of PCTs is that their democratic accountability is sorely lacking. Only through organisations such as the oral health advisory group, with real representatives, real power and a real say in local services, will the local community begin to believe that primary care trusts are genuinely accountable to local people in a way that I do not believe they are now, although they are working on it. The level of scrutiny that they are under is welcome, but democratic accountability has still not been achieved.

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