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Mr. Webb was one of the pioneers of working with qualified Polish dentists to help plug the gaps in NHS dentists that we experienced, both in 2006 and before. He has pointed out to me—normally when I have had my mouth wide open so I could not respond—that the training that those Polish dentists have received does
not fully equip them for the different culture and tasks that they face in the UK. It is not that they are not properly qualified; it is that things are a bit different in the UK. Mr. Webb needed to put in extra work with those dentists, but the new contract did not compensate him for his efforts—efforts that PCTs should recognise as essential to ensuring that dentists are delivering high-quality dental care in an NHS service that is of the appropriate standard.
In October this year—some 10 years on—in Biddulph, on the other side of my constituency, I was delighted to perform yet another official opening ceremony of an NHS dental surgery. It took me three years to persuade my local primary care trust of the urgent need for such a surgery, because it did not figure as a high priority for the PCT. I believe that that is a problem countrywide. Once it was established that the need was there, however, the PCT was very supportive of the dentists, Mr. and Mrs. Keen—who, as far as I know, are not related to the Under-Secretary of State for Health, my hon. Friend the Member for Brentford and Isleworth (Ann Keen).
The PCT helped to secure the right building for Mr. and Mrs. Keen—just behind the high street—and the right contract, so that Biddulph people, who had been denied access to NHS dentistry for so long, would be prioritised as patients in that surgery. We avoided the long queues around the block by directing applications through the PCT, but that has not halted the expansion of the practice. Although it has been open for just three months, it is already recruiting an additional dentist, and has the capacity to develop three more surgeries.
This is a young dental team who have enthusiastically embraced NHS dentistry and have the passion that will allow them to take on the challenge of huge inequalities in oral health in the town of Biddulph, which is an old mining town. That is not to say, however, that there are not significant issues relating to the NHS dental contract that must be addressed. It is widely recognised that PCTs are not renowned for their commissioning skills. In general, they seem to lack the necessary analytical and planning skills to carry out that role effectively.
With the commissioning of dentistry coming at a time of PCT mergers, dentistry clearly did not receive the priority that it deserved. As a result, access to NHS dentistry has deteriorated rather than improving with the new contract. But at least, through the GDS contract, we can now address the uneven and inequitable distribution of NHS general dental services. In the past, there was no mechanism to allow that. The people of Biddulph either had to travel out of the town, or had to sign up for private dental treatment through Denplan. Most of them—unlike the hon. Member for North Norfolk (Norman Lamb)—could not afford that. They were at the mercy of the decisions made by their local dental practitioners, who could decide for themselves how much NHS and how much private treatment they provided.
That all changed when the PCT awarded the NHS contract to Mr. and Mrs. Keen. Not surprisingly, many Biddulph people are choosing to move to NHS treatment in their state-of-the-art surgery, because they are now empowered to do so. I am pleased that the Department of Health is belatedly offering a programme of work to PCTs to encourage them to commission more effectively, and is reviewing its dental public health work force so that it has the skills to assess the need for better NHS facilities. That should help PCTs to get their act together.
As for the NHS dental contract itself, there is a real need for a review of aspects of the reforms. It should be established, for instance, whether the units of dental activity so hated by dentists can allow a proper focus on preventive care and cosmetic treatment. Now that the dental health of our young people is so much better, there is clearly much less need for the drill-and-fill approach. They demand much better cosmetic and orthodontic treatment, and we should focus on that. We must also look again at the payment bands to ensure that patients are not encouraged to delay visits to their dentists and store up dental problems in order to save money under the new charging system. We must ensure that the UDA system is used flexibly enough to allow dentists to get off the drill-and-fill treadmill and to address the wider public health agenda. That is what primary care trusts were set up to do, and they must do it in the area of dentistry as well as in other areas of public health.
PCTs must make more use of specialists and consultants in dental public health and carry out more effective oral health needs assessments. They must work more closely with their dentists to ensure that they are addressing the real oral health needs of their populations. They have to address the other health needs of their populations; why are they not doing it in relation to oral health? And where are the strategic health authorities in all this? They seem to have completely reneged on their responsibility to manage the dentistry performance of PCTs. The Department of Health needs to investigate with the profession whether the quality and outcomes framework-style system that GPs have would help to improve the dental health of patients.
I welcome the closer working relationship that appears to be emerging between the Department and dentists. I also welcome the top priority that the Government are giving to improving access to dentistry, the increased £2 billion funding for dentistry and the announcement of further action in the new year to improve access. I am sure that the Committee will look carefully at those new measures.
I want to finish by thanking the Health Secretary for the £14 million a year for local health authorities to support fluoridation schemes in areas of poor dental health. That is the single most effective measure to reduce oral health inequalities, and this provision demonstrates that we have a Government who are committed to doing that. I would also like to congratulate the South Central strategic health authority on being the first SHA to undertake a fluoridation consultation under the Water Act 2003. I wish it every success in its initiative, and I hope that the Government will give it all the support that it needs. Dental health in the United Kingdom is improving, but far more needs to be done through fluoridation and through working with the profession to ensure that we make the best of the health professionals working in dentistry.
Sandra Gidley: I am interested that the hon. Lady mentioned fluoridation. Is she aware that most of the evidence is showing a case for fluoride relates to its use in a topical sense, and that the evidence base for adding fluoride to the water supply is very limited? Some countries have actually removed fluoride from the water. I think that her enthusiasm is slightly misplaced, because the improvements in dental health in areas where fluoride has been added to the water have not been as great as had been expected.
Charlotte Atkins: That is absolute rubbish, I am afraid. That is not the case at all. I benefited greatly from being brought up in an area where there was a huge amount of fluoride in the water; it made a huge difference to our oral health. If we compare the situation in fluoridated Birmingham with that of Manchester, we see that the evidence demonstrates the benefits of adding fluoride to the water.
9.18 pm
Sir Paul Beresford (Mole Valley) (Con): I am going to try to rush through my speech, and to add to, rather than repeat, the points that have already been made. In his introduction, the Chairman of the Committee said that there were three drivers or criteria in the original contract and that, from the point of view of the dental patient and of the profession, it had certainly failed. We do not have a more preventive approach now, dentists are on a treadmill as they have never been before, and there has been a transformation, in that many dentists have moved out and many thousands more wish to do so. We really need to find a system that will encourage many of those dentists who have gone totally private to come back, at least in part. The difficulty with that, of course, is the treadmill I mentioned and the avalanche hanging over every dentist with UDAs—units of dental activity—and the UDA contract.
The difficulties of the UDA system—for example, the issue of whether to do root canal treatments or extractions—have already been touched on. A root canal on a molar tooth will take about 90 minutes, if the dentist is practised at it and if they use very expensive nickel-titanium reamers, which must be thrown away. In contrast, an extraction generally takes 15 minutes and the forceps are retained, which provides quite an incentive to the dentist, sadly.
What really worries me is that according to NHS information centres, in excess of 1.2 million people are no longer able to access the national health service. That applies to about a million adults and, even more appallingly, about 200,000 children. That has got to be overcome. The hon. Member for North Norfolk (Norman Lamb) mentioned that it is anticipated that many dentists will leave next year. The only benefit of the credit crunch that I can see is that they might be tempted to stay.
Let me move on to two other issues: the development of dentistry and the patient, who has not really been mentioned so far. Over the last 10 or perhaps 12 years, there have been dramatic changes in dentistry, mostly positive and with most gains predominantly experienced in the western world, by which I mean the United States, Canada, Australia, New Zealand, parts of Europe and to some degree in the UK, but outside the national health service.
Mention was made of fluoridation, and I would like to re-emphasise the point made by the hon. Member for Staffordshire, Moorlands (Charlotte Atkins) and to contradict the intervention from the hon. Member for Romsey (Sandra Gidley). Fluoridation is heavy in many of the countries I mentioned. It has made a huge improvement to the diminution of dental decay and without the detrimental health side-effects that were predicted by a few and were proclaimed by scaremongering detractors. Let me take a few moments to explain more fully.
When I was a kid in New Zealand, dental schools provided dental nurses to work in state schools—New Zealand’s schools are almost entirely state schools—and there were three dental schools. With fluoride in 60, 70 or 80 per cent. of the country’s water supplies, those dental schools have been diminished to one. There are more schools, more children and more teeth, but there is less work. Instead of having three dental schools, as I said, New Zealand now has one, and the girls who come out of it who go to treat the children spend 50 per cent. of their time teaching prevention and 50 per cent. on actual treatment. Only a sixth of the number of children need treatment now, yet the effect of fluoride in the water supply has a lesser effect on children than on adults.
Let me come back to the changes in dentistry. Progress on dental materials and techniques has been dramatic. Dentistry provides very successful implants, new composite fillings, new all-porcelain crowns, porcelain inlays, protective porcelain inlays/overlays and new materials for dentures, many of which can be and often are retained and stabilised by implants. There are beautiful, natural-looking veneers, protective overlay veneers, successful dental bleaching methods, dramatic new orthodontic techniques producing quite superb results and improved oral surgery techniques. Protection against cancer is also better if patients go to the dentist.
We need to recognise that dentists are taught all those techniques in dental schools, but they are not available on the national health. I do not think that they should all be available on the national health. NHS dentistry should be driven predominantly as a health service for oral conditions. I am sorry to disagree somewhat with the hon. Member for Staffordshire, Moorlands, but although cosmetics are vital, the NHS should have no role in paying for them, except in exceptional circumstances, which do arise. A young girl who comes in with stained upper and lower anterior teeth should have bleaching available to her on the national health service. As the system works now, however, she will get six or 12 veneers where the teeth are stripped down via a high-speed burr and damaged for ever. The bleaching, however, would leave her with her natural teeth and make a dramatic change. We need to think about that.
One negative, which I touched on during Question Time earlier and which the hon. Member for Staffordshire, Moorlands also mentioned, is oral cancer. It is distressing to see that the incidence of oral cancer has got much worse. There are more deaths, and the cure and detection rates are diminishing. A large degree of that relates to the fact that patients are no longer being seen.
The chief dental officer was reported in the press as claiming that dentists were milking the system by asking patients to return for annual examinations. I hope that that is wrong, because the prevalence of oral cancer, particularly in deprived areas, means that it is vital that patients are seen and checked for that cancer regularly. I am referring to young people as well as those whom we normally expect to get cancer as they get on. Another point needs to be made: if a decayed molar, for example, needs to be restored, it can be restored by amalgam, composite, gold, porcelain bonded to gold or porcelain bonded to porcelain, but whatever is used, that is one fewer decayed tooth among the national population.
We need to work to a system that introduces the private sector working alongside the NHS. I am a great supporter of NHS dentistry. I spent a lot of my career, in the early days, working in east London. We need NHS dentistry, but we need the dentists to be there for it. Taking away the drive to force them out, which the UDA targets system has introduced, might give us the chance to persuade some of those dentists to come back.
I have a few more points to make. I hope that the Minister will think carefully when she looks at the new review. I shall cut out most of what I wanted to say and put a few basic points to her. We need to move on fluoridation. I have touched on that. Australia, New Zealand, Canada, a number of European countries and most of the states of the United States have dramatically better dental health than the UK, and that is entirely down to fluoride.
May I suggest to the Minister that she needs to recognise a few basics? Patients need choice and they need that choice presented to them by well-trained dentists. The dentists need the appropriate equipment and materials. They need the time to produce quality work, including prevention, which the UDA targets system does not allow them. The measure of success should be the number of dentists prepared to offer core dental health treatment on the national health, not necessarily the number of people using the NHS, because that choice must be the patient’s choice.
9.28 pm
Mr. David Drew (Stroud) (Lab/Co-op): I am delighted to take part in the debate. My remarks will be brief, because they have to be brief. I do not want to have a coughing fit. Like most Members who are present, I wish to keep my sanity and my health for the Christmas period.
As always, it is a delight to follow the hon. Member for Mole Valley (Sir Paul Beresford), who knows much more about dentistry than I could ever want to know about it. My impression of dentistry is one of a profession going through quite dramatic change—structural change, changes to training and changes in how the profession is funded.
My views have been formed in two particular ways. First, I have two quite close friends who are former dentists and are horrified at some of the changes that have taken place in the profession. They see themselves as good, old-fashioned NHS dentists and not in their wildest imagination could they think that, once they had left the profession, it would go from being almost comprehensively NHS to being much more dependent on the private sector.
My second point of impact was a meeting with dentists in the Stroud area some years ago. It is the only meeting that I have had with dentists collectively because it was such a shocking experience; it is seared on my memory. This meeting pre-empted the new contract, and virtually to a person, the dentists made it absolutely clear that whatever was in the new contract introduced by the Government, it would be the baseline, and that they would negotiate on top of it. They did not see the British Dental Association as representing them; they saw themselves, more or less, as private contractors in a marketplace who would charge whatever the patient would be prepared to spend.
That was a pretty depressing experience, because I went to the meeting to try to bring those people back into the NHS, and I learned very quickly that they were not very interested in coming back to the NHS, whatever was in the contract. This is why my constituency is so unusual, as I said when I intervened on my right hon. Friend the Member for Rother Valley (Mr. Barron) earlier. In the south of my constituency, all the dentists are NHS dentists. I have to explain to my constituents that if they live in the Stroud area, they ain’t going to get an NHS dentist, but if they live in the south of the constituency, they will—unless they choose to cross over. It is a bizarre situation, and it is just like having the Berlin wall. I wish we could overcome that problem.
It is grossly unfair that those in the north of my constituency do not have access to NHS dentistry, and dentists who operate in the south, such as Steve Clarke, who runs a big training practice, are able to make money out of the NHS. He is supportive of the NHS, and provides quality care on the NHS. I know that because I send to his practice a lot of constituents who moan to me about not being able to access an NHS dentists. Something peculiar is going on, perhaps because of the wider changes in dentistry.
The problem with the PCT is that it measures access to NHS dentistry across my whole area, so the picture looks quite good. Of course, it depends which part of the area people live in, and those in the northern part of my constituency are strongly disadvantaged. I had that argument with the PCT, which is now putting resources into Cheltenham, Tewkesbury and the Forest of Dean, having previously put resources into Gloucester. I keep asking for resources to be put into Stroud, and it looks at the figures and says, “You’ve got a good number of NHS dentists in Stroud”. However, that is the case only on a locational basis.
I shall end on the issue of fairness and equity. I hope that the Government will consider that issue in the investigation that they have launched. I could go into all sorts of questions of fairness and equity with regard to orthodontistry, where those who seem to be in the right place at the right time get free treatment and other people do not. I also feel strongly about the question of what people get for what they pay. We have all dealt with difficult constituency issues where people have felt that they paid money when they were not sure what treatment they would receive. That is one of the problems of not underpinning dentistry more widely. I could speak about fluoridation, but I am clearly not among friends because I am a long-time opponent of fluoridation of the water supply, so I will say no more about it.
In conclusion, I hope that there is a comprehensive investigation of dentistry in this country. I accept that we have not got it right, but that has been true for a long time, and we owe it to people in those deserts where there is no NHS treatment to provide greater fairness and equity. If this investigation can do that, it will have come not a second too early; too many people have lost out, and continue to lose out, which is completely unfair in this day and age.
9.34 pm
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