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3 July 2007 : Column 232WH—continued
I hope that the Minister will clarify whether, before the present round of contracts, there was a requirement for primary care trusts to have an oral health advisory group. I understand that under the new contractual arrangements there is now such a requirement. I am confused as to why my local primary care trust disbanded
its oral health advisory group. There was a period of abeyance and inactivity with no such organisation, but it has now been re-established. That is welcome, but I wonder why it was abolished and why there was an interim period without such a group.
I hope that the Minister will tell me, in writing if not now, whether the advisory bodies, such as the oral health advisory groups, have any statutory powers or responsibilities, or whether the Government expect them simply to be advisory groups to help the PCT, but with the PCT ultimately able to decide to go forward in whatever way it chooses.
I hope that the Minister will give me the important news that there will be an improvement in access to dentistry in Sutton and Merton, because there seems to be a gentle decline at the moment. In London, the decline may be even gentler, but there is a deterioration in access to services, and I would like confirmation that that will improve. Finally and most importantly, I would like clarification from the Minister as to what will happen beyond 2009 so that dentists can make the necessary investment and patients know that NHS dentists will be available to treat them.
1.46 pm
The Parliamentary Under-Secretary of State for Health (Ann Keen): I congratulate the hon. Member for Carshalton and Wallington (Tom Brake) on securing this debate on dental services, and I thank him for his kind and supportive comments at the beginning of his speech. I also congratulate him on the imaginative use of his website, the pictures with his local dentist, and his survey of his constituents. It is certainly the way forward to consult all stakeholders and the PCT.
I want to respond to the specific issues raised by the hon. Gentleman, but I want to begin by describing the main steps taken by the Government in the past two years to help to expand access to NHS dental services.
For some 15 years, following problems that arose from a new contract in 1990, dentists had been drifting away from the NHS. Under that old system, dentists could set up practice where they wished and choose how much NHS work they wanted to do. That was an inherently unstable system. In April 2006, the Government took decisive steps to bring the situation under control. They devolved more than £1.7 billion of resources to primary care trusts, which now use that money to agree with local dentists the services that they will provide for the NHS. If a dentist stops providing those services for any reason, the local NHS now keeps the funding and can use it to agree new services with other dentists.
Those changes build on a major programme of Government investment in dental services. Overall expenditure this year, including revenue raised from patient charges, is likely to be at least £2.4 billion, a real terms increase of more than £400 million since 2003-04. Another key change introduced last year was to abolish an outdated system of dentists' pay, which had created a drill-and-fill treadmill. The new remuneration system supports dentists in carrying out less complex courses of treatment in line with modern clinical practice.
I ask the hon. Gentleman to remember that we are only just over a year into the new arrangements and, inevitably, some aspects are still bedding down and need further discussion, but there are already excellent examples
of how PCTs have worked with their dental services—for example, in Leicester and Norfolk, an inner city and a more rural area.
The hon. Gentleman’s concern today is his constituency. Sutton and Merton PCT is now commissioning more services than in April 2006, and its primary care support service can place patients with NHS dental practices in the area. I am sure that the hon. Gentleman’s consultation work, and the active interest that he takes in his PCT, are helping with that.
The volume of dentistry now being commissioned by primary care trusts is greater than it was before last year’s reforms. Primary care trusts are finding also that, when they commission new services, significant numbers of dentists are interested in taking on more NHS patients. That follows a major recruitment programme in the two years leading up to the reforms, in which more than 1,400 new whole-time dentists joined the workforce. The Government have also provided £100 million of capital funds to allow NHS dentists to invest in premises and equipment. That all takes place against the background of dramatic improvements in oral health, with 12-year-old children in England now having the best oral health in Europe.
I agree that more progress needs to be made. There are still difficulties in obtaining access to services in some areas of the country, and the hon. Gentleman has drawn attention to problems in his constituency. I will be talking to patient groups, dentists and the NHS to consider how we can achieve further progress. However, primary care trusts are now in a much stronger position to develop dental services in ways that improve access and reflect the needs of their local populations.
The first factor is financial investment. The Government have increased investment by over £400 million in the past four years. In 2009, which the hon. Gentleman mentioned, those resources are due to become part of primary care trusts’ overall health budgets. That will strengthen still further the responsibility of the local NHS for dental services in its area. In making decisions on investment, PCTs will have to take into account the new statutory duty given to them last year, which requires them to provide dental services in their area that reflect local needs. Primary care trusts will need to continue to build up investment where it is necessary to meet those local needs.
The second issue is the work force. In 2005, the Government increased the number of dental undergraduate places by 25 per cent., which means that 170 extra students now enter training each year. The first students from the expanded training programme will graduate in 2009, and new dental schools are opening in the south-west peninsula and in Preston later this year. Another positive development is that dental therapists, hygienists, technicians and nurses are increasingly playing an enhanced role within the dental team. That is much to be welcomed.
The third factor is how primary care trusts and dental practices use the £2 billion or so that is invested in NHS dental services in ways that deliver the best outcomes for patients. Local responsibility for dental services forces primary care trusts to focus not just on how much they are spending, but on what that investment is delivering in relation to patient care, such as the number of patients who are able to access services, as well as clinical quality, patient experience and health
outcomes. The Department of Health works closely with the NHS to help drive improvements in all those areas.
The final factors that I will touch on are professional and public engagement, to which the hon. Gentleman has already shown his commitment. If NHS dental services are to prosper, there has to be a strong local relationship between PCTs and dentists. It is important in that context to debunk the myth that general dental services contracts, which the hon. Gentleman mentioned, will expire in 2009. That is simply not the case; the contracts are ongoing. There are greater flexibilities for PCTs and for dentists to review the precise terms of contracts after 2009. However, if a local practice is delivering high-quality services that are valued by local NHS patients, it is hard to see why the PCT or the practice would want to propose any significant changes. There is a smaller category of contracts that have fixed terms. It is good practice for PCTs and practices to review and, where appropriate, extend those contracts on a rolling basis to promote continuity.
PCTs are also increasingly engaging the local public in helping to review how services should develop. For instance, some PCTs have used their new powers to establish dental services in areas of historically poor access—both in response to local public demand and to recognise the greater oral health needs of those areas. I am sure that the hon. Gentleman would agree that it is important to the future oral health of our constituents that there be close co-operation with PCTs in areas where people have not always had access to dental treatment. The Department is working with the NHS to spread that good practice, and the hon. Gentleman might wish to encourage constituents who have experienced difficulty in obtaining access to services to get involved via the patient advice and liaison service.
Tom Brake: I want to press the Minister on one issue before she finishes. She has clarified that there is a statutory duty to provide local dental services and to reflect local needs, and she has also said that the dental budget will be incorporated in the overall PCT budget. That gives rise to the concern that, when the dental budget competes with cancer services budgets, it might lose out. What guarantee, if any, can she therefore give that PCTs will maintain broadly the same spending profile for dental services?
Ann Keen: My experience is that when a contract is working well in the NHS, and when we are building on a good relationship with PCTs and dental services, it is obviously wrong to go back on it. We should build on the success of NHS dentistry and PCT involvement. The system of the 1990s and before did not work but, since 2006, the new contract has led to proven improvements in oral health and in NHS services to patients. PCTs would do well to consider that and to continue the progress that has been made.
There have been solid achievements in the first year of the new system. There is, of course, still much work to do, including building up trust in the contracts and in working relationships. Nevertheless, investment is growing, the local NHS is commissioning a steadily increasing volume of dentistry, and the numbers of NHS dentists are back on an upward track. The Government are committed to working with the NHS and the profession to build further on that progress. I am confident that there will be co-operation, and I will always welcome the opinion and comments of the hon. Gentleman on what is an important issue.
Adjourned accordingly at three minutes to Two o’clock.
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