The Secretary of State for Health (Alan Johnson): Some 27.9 million people in England saw an NHS dentist during the two years ending on 30 June 2007. We are committed to improving further access to NHS services. We have increased central funding by 11 per cent. for 2008-09 and are requiring the NHS, through the operating framework, to increase the number of patients able to access NHS dentistry year on year. Given that prevention is better than cure, today we are launching guidance to strategic health authorities on consulting with their local populations on water fluoridation, which is known to reduce tooth decay. A central budget totalling £42 million over the next three years has been established to meet the capital costs of fluoridation.
Mr. Fraser: Under the current contract, dentists are paid the same for fitting one filling as they are for fitting 10. Some are refusing to treat patients with the poorest teeth. Does the Secretary of State think the arrangement the best way to improve NHS dentistry, particularly for high-needs patients?
Alan Johnson: The new contract was the best way forward. In fact, an NHS dentist is not allowed to refuse to treat patients with the poorest health. Under the old system, there was an absolute incentive to drill and fill. If a dentist moved away from the locality, the local patient population lost out. The famous queues in Scarborough happened under the old system, not the new. Although the new contract has taken time to settle down and although it was not popular with the professionsometimes we have to do things not popular with the profession if they are necessary to help patient carewe have made improvements in dental care.
Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): Despite the fact that the local population is growing rapidly, Milton Keynes primary care trust has successfully used the new funding formula to fund the opening of new NHS surgeries. Today on the NHS Choices website it is possible to find access to at least half a dozen NHS surgeries in Milton Keynes. Is the Secretary of State rolling that example out across the country, given that it appears that some other PCTs seem not to know how to use the new system effectively?
Alan Johnson: My hon. Friend has seen huge advances in Milton Keynes, and we have also seen those around the country. Every PCT now has a free helpline for people to ring if they want to access dental treatment. There has been a 20 per cent. increase in the number of dentists since 1997 and there is a 25 per cent. increase in the number of training places at not only the existing dental schools, but the two new ones that we are building. Access to NHS dentistry is getting better all the time.
Sir Paul Beresford (Mole Valley) (Con): I doubt whether the Minister will agree with me completely[Hon. Members: Hear, hear.] There is an impression that I have a small interest in this subject. The Secretary of State may not agree, but I personally believe that access should be measured according to the numbers of dentists prepared to offer national health service treatment, regardless of whether the patients accept such treatment or choose to go private. Regardless of what the Secretary of State has said about the contract, it has hurt a lot of dentists, particularly the experienced ones. Many have moved out. What could and will the Secretary of State be prepared to do to the contract to attract those highly experienced professionals back into offering national health service treatment?
I pay tribute to the hon. Gentleman, not least for his work on fluoridation over the years. In response to his question, yes, there was an initial dropthis was a very controversial change; Governments have to do things that are controversial if they believe that that is in the interests of patient care. Of the disputes around the country, only 14 remain to be resolved. As regards the new dentists coming through, I find, without any inference as to the hon. Gentlemans agehe looks to
me like one of the younger cropthat there is a difference between the younger dentists and their enthusiasm for the brave new world under this contract and some of the older dentists. I would like those who have left to come back, but it is a decreasing problem given the number of new dentists coming through.
Charlotte Atkins (Staffordshire, Moorlands) (Lab): Does the Secretary of State recognise, though, that some PCTs have been slow and have given insufficient priority to commissioning dental care services? Having said that, does he agree that the single most effective way of reducing inequalities in oral health is to fluoridate the tap water in selected areas?
Alan Johnson: On the first point, my hon. Friend is right about some sluggishness in PCTs in commissioning these services. That is why we have made it a tier 2 issue in the operating framework this year and increased funding by 11 per cent. On the second point, I pay tribute to the work that she too has done on fluoridation over the years. I entirely agree, as do the British Medical Association, the British Dental Association and every reputable scientist who has considered it, that extending fluoridation is the best way to close health inequalities.
Paul Rowen (Rochdale) (LD): Following the comprehensive spending review, the Secretary of State announced targeted funding for additional GPs in areas where there was a shortage. Has he any proposals to do the same to recruit dentists, because in places such as Rochdale and the north-west there is a real shortage and they are not reaching people at the moment?
Alan Johnson: As I mentioned, we have a 25 per cent. increase in the number of undergraduate students coming through. We have built two new dental schools, one in Plymouth and one in Preston, which will open this year. That will do an awful lot to resolve the problems. However, I am interested in looking at any possible solutions if we have the equivalent of under-doctored areas, so I would not rule out considering such ideas.
Mr. Kevan Jones (North Durham) (Lab): Will my right hon. Friend join me in congratulating Durham PCT and Associated Dental Practices, which has opened the new Pelton Lane Ends surgery in my constituency, bringing dental health care to 3,600 patients, in some cases for the very first time?
Alan Johnson: I am pleased to join my hon. Friend in congratulating the new dental practice. Following the comments of my hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey), that once again shows that progress is being made right around the country.
Mike Penning (Hemel Hempstead) (Con): The 3 million residents of this country who do not have access to an NHS dentist will be astonished by this complacency. The report by Citizens Advice is much more interesting than some of the comments coming out from the Ministers office. With £2.6 billion of taxpayers money being spent on NHS dentistry and people pulling their teeth out with pliers and using superglue to put their caps back on, why is the Secretary of State so complacent?
Alan Johnson: Anybody pulling their teeth out with pliers needs more medical care than a dentist can provide. The hon. Gentleman may have seen the splendid letter from the Under-Secretary, my hon. Friend the Member for Brentford and Isleworth (Ann Keen), which was sent to all Members of the House to counter this ridiculous nonsense going around about dental servicesridiculous nonsense that unfortunately Conservative Front Benchers have taken to parroting.
2. Mr. Graham Allen (Nottingham, North) (Lab): What assessment he has made of the potential contribution of nurse-family partnerships to the development of Nottingham as an early intervention city. 
The Parliamentary Under-Secretary of State for Health (Ann Keen): The family-nurse partnership early intervention pilots target support towards the most vulnerable first-time mothers, primarily under the age of 20. For the very first time, we are starting early in pregnancy and continuing until the child is two years of age. We would be very happy to receive a good-quality bid from Nottingham and any other bidders for the next wave of pilots. We will assess the quality of all bids against the published criteria.
Mr. Allen: The health partnership and the PCT in Nottingham are well aware of this issue and are doing excellent work on intensive health visiting. OneNottingham, the local strategic partnership, regards that as key to breaking the intergenerational nature of deprivation in our city and the underachievement that goes with it. Does the Minister agree that this Government should have a long-term ambition that every young mother and child should get the level of intensive health visiting that they need as a way of breaking that cycle and reducing the massive bills of social failure that come as a consequence of not being properly parented in those first couple of years?
Ann Keen: I welcome my hon. Friends support for the family-nurse partnership programme, and I congratulate him on his work to develop early intervention and prevention in Nottingham. I am aware of the interest that he has shown over the years, and he is a strong advocate. Health visiting and universal care for children, with qualified clinical nurses, is critical. I welcome the interest shown by all PCTs and local authorities in the intervention that family-nurse partnerships can offer. However, my hon. Friend will understand that as the bidding process is under way it would not be right for me to support any particular area.
The Parliamentary Under-Secretary of State for Health (Ann Keen):
The national health service has seen unprecedented increases in funding for cancer services.
Such spending has increased from £3.4 billion in 2003-04 to £4.35 billion in 2006-07. In 2006-07, Bedfordshire primary care trust spent £17.9 million on cancer services. As the hon. Gentleman will know, it is for individual primary care trusts to decide the level of funding that they allocate locally for the diagnosis and treatment of cancer patients in their local population.
Andrew Selous: More than three times as much is spent per cancer patient in the constituency of the hon. Member for Nottingham, North (Mr. Allen) than is made available for my constituents. When will the Government bring in a truly fair funding formula that will mean we are no longer two Englandsa phrase that independent academics recently referred to in the Health Committeewhen it comes to health care?
Ann Keen: On spending, it has been agreed by Members of all parties that local primary care trusts know the needs of their area best. We have already extended breast screening to all women between the ages of 50 and 70; we have introduced bowel cancer screening programmes, which are the first in Europe to target both men and women; and we have seen major reductions in waiting lists.
Patrick Hall (Bedford) (Lab): I can tell my hon. Friend that none of my constituents has complained about access to cancer services in Bedfordshire, although there is always a wish to see improved services. Does she agree that one of the drivers that helps to underpin improvements in cancer services is an effective system of patient and public involvement? Therefore, does she share my concern that on 1 April the Bedfordshire PPI forum will be abolished with no likely replacement LINk system in place?
Ann Keen: My hon. Friend would have a serious point if local involvement networksLINkswere not in place. LINks will only strengthen the patients voice, not only in the health service but for social services. I always agree with the idea of involving patients and the public. That is why our cancer reform strategy has been so successful; all stakeholders including all the cancer charities were involved and it has been welcomed by those charities.
Alistair Burt (North-East Bedfordshire) (Con): The Minister is right to say that decisions must be taken locally, but is she not able to see that a PCT can take decisions on spending only according to the money it is given? The issue raised by my hon. Friend the Member for South-West Bedfordshire (Andrew Selous) is that the variables and differentials in certain areas have widened so much that it is not possible for an area such as Bedfordshire to compete or to give necessary treatment to its patients. That distinction in the variables in the formula has now stretched so far that is affecting access to care. This is a matter of justice.
Ann Keen: The hon. Gentlemans point concerns me, because there has been an increase of over 5.5 per cent. for all PCTs. I encourage him to engage more fully with his PCT to look at how certain areas are operating the very best practice. I know that results within the hon. Gentlemans area for the incidence of cancer and its outcomes are still very good indeed.
Kelvin Hopkins (Luton, North) (Lab): My hon. Friend will be aware that Luton has serious health inequalities, which have persisted over many years, while at the same time receiving funding well below its fair funding target. Things are starting to improve, but will my hon. Friend ensure that Luton gets its fair funding target at least, and that its health inequalities are properly addressed?
Ann Keen: It is my belief that no one is more than 2.5 per cent. away from their target. I urge my hon. Friend to work closely with his PCT and to keep discussing the issue. It is critical to all hon. Members to have the equity that we all want for our constituents.
Mark Simmonds (Boston and Skegness) (Con): Expenditure on cancer services in the UK now matches that of many other European countries. Yet despite the significant investment by British taxpayers in cancer servicesan extra £693 million over three yearsUK five-year survival rates have not accelerated and are among the worst in Europe. If the UK achieved the European best cancer survival rates, more than 34,000 lives would be saved every year. Why has the extra expenditure not improved survival rates?
Ann Keen: I cannot be clear that that information is the most up to date and I urge the hon. Gentleman to check the figures. There is an increase in survival rates and improvements throughout the cancer sector, as all experts and charities have recognised. We still have some difficulty in this country with people being aware of what to look for, so that when they present at their general practice the GP can diagnose quickly. More work is being done on raising awareness. However, I urge the hon. Gentleman to check the facts.
The Minister of State, Department of Health (Dawn Primarolo): The Department of Health is reviewing options for the regulation of tanning salons with stakeholders, including the Health and Safety Executive and Cancer Research UK. It is important to consider ways in which to strike the balance between consumer safety and choice. We will focus initially on the harm to young people who use sunbeds.
Mr. Sarwar: The Minister will be aware that recent research suggests that sunbeds may be responsible for 100 deaths every year from skin cancer. Is not it time that, perhaps with the support of the Health and Safety Executive, a full review is conducted of commercial salons, with a view to drawing up legally enforceable guidelines for their management and operation?
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