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Mike Penning (Hemel Hempstead) (Con):
It has been a short, but excellent debate, and I apologise to hon. Members who have not had the time that they deserved—
perhaps having three statements at the start of the day did not help. I know that the Chairman of the Select Committee raised that during a point of order earlier.
I shall try to touch on some of the points raised by hon. Members this evening, starting with the Chairman of the Select Committee. I was a very proud member of the Select Committee, and we heard earlier that there were calls for an inquiry into dentistry some time ago. I agree that there were such calls, and I praise Committee members for calling for that. I also praise the Committee for the quality of the recent report, which was very fair. It is scathing in places, but it also offers forward-thinking and innovative ideas on how the contract could be progressed. I do not agree with parts of the report, however, and Her Majesty’s Opposition also have some ideas on how we could make progress, to which I will return shortly.
I was interested to hear the Chairman of the Select Committee, the right hon. Member for Rother Valley (Mr. Barron), refer to his dentist, because unless he is having treatment at the moment, he has not got a dentist as this contract does not involve registration. Therefore, unless someone is undergoing treatment, they do not have a dentist. I would have liked that to have been made clear in the report; I do not think it is generally known by the public, but it is a fundamental point of the contract, which was imposed on dentists in 2006, that people are not registered unless they are actually having treatment. That is a very important issue, because if we were to go out on to the high streets of this country and ask members of the public who rely on NHS dentistry whether or not they are registered with a dentist, the vast majority would still say they were even though they are not. They might turn up at the dentist and say, “I need treatment”, but that dentist might have already run out of UDAs; that dentist might already have said, “I can’t treat any more patients this year.” Those are the circumstances when some of the problems are occurring.
Dr. Murrison: Does my hon. Friend not agree that one of the most powerful ways of incentivising dentists is to register patients, as they would then have an incentive to build up a list of people with good oral health, which would ultimately reduce their work load? That aspect of incentivisation has been completely missed in this new contract.
Mike Penning: I completely agree with my hon. Friend and I will come on to that point later. I do not see how we can have preventive dentistry without having some form of capitation and registration. I think the right hon. Member for Rother Valley alluded to that in his speech.
The report digs deeply into what NHS dentistry is capable of doing in this country today. Should we actually give up on parts of the country that rely on NHS dentistry? There is a postcode lottery; it is a fact that in some parts of the country that I have visited there is a plethora of NHS dentistry. In Newcastle and the north-east there is almost no private dentistry, whereas in other parts of this country—I am referring to England now—there is almost no NHS dentistry. This is a national health service, however, and that is partly—although not completely—why this contract was created. It was already in difficulties before, which is why the Government, in good faith, tried to bring in a contract that would help, but instead it has made the situation worse.
When the Select Committee took its evidence, about 900,000 people who had had NHS dentistry had lost it. The latest figure is 1.2 million. That means there are now 3 million people in this country who need to rely on NHS dentistry but cannot access it. As the economic climate becomes increasingly difficult, more people will need to rely on NHS dentistry. I listened carefully to the comments of the hon. Member for North Norfolk (Norman Lamb) when he said he is in Denplan. A lot of people who are in Denplan will not be able to continue to afford to make those monthly payments should they lose or change their job. The demands on NHS dentistry will, therefore, increase.
We must look at what the Government might propose in the review. My personal view is that this contract is a damaged brand, with its language of UDAs. From meeting dentists around the country, it is clear that they are not confident that the contract can provide for the British people the sort of dentistry we expect in the 21st century. I therefore look forward to the review with a degree of scepticism in terms of where the contract can go.
Sandra Gidley: The panel undertaking the review has been welcomed, but I note that it contains no community dentist and so some dentists will be wondering about its composition. It seems to be made up of a couple of academics, somebody who apparently wants to be the chief dental officer one day and a failed commissioner who commissioned dental services without doing a needs assessment. Does that augur well for the future?
Mike Penning: No, it does not. In fact, it resembles something similar to what happened when this contract was imposed in 2006.
Lots of hon. Members have discussed the importance of proper continuity and discussion with the professionals in the dentistry profession. As has been mentioned, no one body represents the whole of dentistry and the dentistry profession—perhaps it would be better for the dentists if they did have one body that could stand up and fight their corner. I am very concerned that there appears to be a lack of engagement between Ministers and the professionals.
I did not intend to upset the Minister at Health questions earlier today, but I clearly did so. Let me therefore go back for a second to where we were. I asked why no Minister went to the British Dental Association conference in Manchester this year to speak on behalf of the Government, given that the contract is so controversial within the profession. The Liberal Democrat spokesman was there, I was there and so, too, was the chief dental officer. He is a civil servant—he is not a Minister of the Crown and he is not elected; he is appointed by the Secretary of State for Health—and it is fundamentally unfair that a civil servant is there to represent the mistakes and problems that the Government have got themselves into on dentistry. Both the Liberal Democrat spokesman and I refused to debate with him in public, although I would have been more than happy to have debated with a Minister.
I understand that the Minister was busy that day, but I was with a Health Minister on the train to Manchester—the hon. Member for Bury, South (Mr. Lewis) was a
Health Minister at the time. I said to him, “Fantastic, you are obviously coming to the BDA conference to represent the Government.” He replied, “No, I am going home.” The only person who was representing the Government was the chief dental officer, and that was fundamentally unfair on him, because he was put in a position that only an elected Minister should be put in.
As the process goes on and as this contract is reviewed, I am very concerned about whether the Government will have the courage to admit how much of the contract they have got wrong and how much of it has affected people in this country. We see reports in the press of people extracting their teeth with pliers and people going to the pharmacists to get do-it-yourself fillings, which are available in most pharmacists in this country, because of the lack of NHS dentistry. That might be down to fear; it may not be fact, but the perception of a lack of such dentistry exists.
We have discussed the UDAs at length today. It cannot be right that in band 2 up to six fillings or one root canal or an extraction can be carried out. The obvious situation to consider is that of a dentist who is under pressure. What is such a dentist going to do? I hope that all dentists do what is right for the patient, but given that they are looking at the UDA rather than at the outcomes, it is obvious that, at times, real problems will arise. Many dentists have said that they are not willing to work under this contract and they have walked away, and we have to encourage them to come back.
One area of the report that concerned me—this issue came up when I was on the Select Committee and we were examining charging—was the bit dealing with dentists who say “I will keep your children on only if you take me on as a private dentist.” Such an approach is fundamentally wrong, because it is blackmailing people by saying that they can have NHS dentistry only if they pay for a private insurance plan or they pay as they go. I think that we have to accept the fact that, there is nothing because so few dentists have been working in some parts of this country, at this stage wrong with a dentist who is willing to take on a child, with no strings attached, under an NHS contract. That is better than nothing, and we need to examine such an approach. I know that the Select Committee was concerned about people being pressurised into certain things. That is fundamentally wrong, but if we can encourage private dentists to come back into NHS dentistry and take children on without any strings attached, that has to be good. On average, children have 1.5 fillings or extractions by the age of five, so the oral hygiene of our youngsters is going in the wrong direction. If we do not address children’s oral health problems, that will have an effect as they get older. It is therefore vital to address the issue of oral health in the young.
We have to encourage more dentists to come back into NHS dentistry. We have to look seriously at the court case earlier this week, which the Government lost on appeal when a dentist objected to the fact that, whether he had performed well or poorly, the PCT could remove his contract at any time. The courts ruled that that was wrong. We should extend the length of contracts, so that dentists can invest in their practices. PCTs do not pay for surgeries or equipment: the investment has to be made by the dentists themselves. There must also be a presumption that should a dentist want to move on or retire, they have the right to sell on the
goodwill in their contract. If we want dentists to come back into the NHS, or young dentists coming out of training schools—I have visited them and they are fantastic—to come into the NHS, we must give them the confidence to do so, especially in this difficult economic climate.
I agree completely with the Committee: if we want to understand what is happening to dental hygiene in this country, we have to have registration and a per capita system; otherwise, we will not have a national health service. Instead, we will have the postcode lottery that has put NHS dentistry into crisis today. I welcome the report and I congratulate the Committee on it.
9.46 pm
The Parliamentary Under-Secretary of State for Health (Ann Keen): I welcome the opportunity to speak on the important subject of dental services. I will do my best in the time available to respond to the points made in the debate. I start with my right hon. Friend the Member for Rother Valley (Mr. Barron), who made his contribution as Chairman of the Committee. He mentioned training and how it affects dentists in practice. The review by Professor Jimmy Steele, which we welcome, will cover those areas.
My hon. Friend the Member for Staffordshire, Moorlands (Charlotte Atkins) was an absolute trouper during her speech, and we certainly witnessed her commitment to dentistry this evening. I congratulate TLC 4 Smiles, which obviously gave her the courage and commitment to continue. I thank her for her contribution and the work that she and other hon. Members have done to push dentistry to the forefront.
Many hon. Members talked about the importance of oral health care, and the hon. Member for Mole Valley (Sir Paul Beresford) raised the important issue of oral cancer. I am sure that he would agree that the Government’s approach to children and the purchase of tobacco, and the discouragement of cigarette smoking, is important, because reducing smoking is one of the most important elements of addressing oral cancer.
Mike Penning: With that in mind, will the Minister consider whether dentists should be allowed to prescribe nicotine replacement therapy?
Ann Keen: We should consider all aspects of smoking cessation.
People’s oral health has changed, and dentistry needed to change to reflect that. Dentists themselves recognised that the old contract was a so-called “drill and fill treadmill”. Under that contract, dentists themselves chose where to set up in practice, they chose how much NHS work to do, and if they chose to leave the NHS, there was nothing that the local NHS could do to protect local access. As the Committee and many Members have pointed out, it is access that is important. Our new contracts give local primary care trusts the power to decide what services they need. Local PCTs contract with dentists to provide those services.
Mr. Bone: The Minister describes the problem in great detail, but the fact is that it has got worse. Since 1997, 15 per cent. fewer adults are being seen by an NHS dentist. The Government’s policy has totally failed.
Ann Keen: If the hon. Gentleman will let me proceed with the points that I want to make, he will see that some aspects of the contract have without question improved things for patients. There are difficulties, which we have recognised.
If a dentist decides to leave the NHS, the PCT can commission new services to maintain and grow NHS access. The fundamental principles of the new dental contract are right. It allows prevention as well as traditional dental treatment and allows the local NHS to commission local services to meet local needs.
Sandra Gidley: Will the Minister explain why it takes so long to commission new services? It takes more than a year to do so locally. At the beginning of the process, the commissioners did not even know how many dentists the UDAs would commission. The level of knowledge was that low. What is being done to address that and to speed up the process so that people do not lose out?
Ann Keen: The hon. Lady will be aware that those on her Front Bench have said how good the situation is in certain parts of the country, and particularly in Birmingham. There are many good practices that can be considered and we want to encourage the commissioners to do that.
The new contract was a radical change. In its report, the Health Committee identified concerns about the way in which it works. That is why we have asked an independent team, led by Professor Jimmy Steele of Newcastle university, to carry out the review. The review will help us to determine how we can use local commissioning to increase access to NHS dentists and improve the quality of services.
Sir Paul Beresford: Let me take the Minister back to the previous intervention. Does she not agree that many PCTs are using the extra commissioning money to cover the loss of fees from patients?
Ann Keen: If the hon. Gentleman would like to give me information about where that is happening, I would be very happy to look at it. PCTs have the money ring-fenced until 2011 and they are encouraged. We have to congratulate many dentists and PCTs on the work that they have done to see that the contract works to the benefit of all our constituents and all patients who require dental services.
The review will help us to determine how we can use local commissioning to increase access to NHS dentists and to improve the quality of services. It will investigate whether the decline in complex treatment is consistent with the needs of patients. It will help us to understand what more we can do to encourage prevention and reduce inequalities in oral health. The review will look forward to help us begin to plan the dental services we will need to meet peoples’ needs in the future.
Greg Mulholland (Leeds, North-West) (LD): Will the Minister consider putting a dentist on the review panel? May I also briefly bring her back to the key issue of access, which I am not sure that she has quite covered? I remind her that, in 2007, the Department said that the key test of its reforms would be
“their ability to support improved patient access”.
Despite that, 20,000 fewer patients are accessing NHS dentistry in Leeds, and 900,000 fewer have done so across the country in the past two years. How can the Minister possibly defend the contract in terms of access? When will she accept that it has failed in that aim and that the review must fundamentally address that point?
Ann Keen: I will not accept that at all. Many Members have said to me, both inside and outside the Chamber, that dental care has improved. In fairness, hon. Members need to recognise that the problems of dental access date back to the early 1990s. The problem had been growing for many years and culminated in the famous queue in Scarborough. That was probably the first time that the nation’s attention was focused on a system that was badly in need of reform.
I ask the House to remember that the queue in Scarborough occurred in January 2004, more than two years before we introduced our contract reforms. Indeed, it demonstrated the need for them. On top of the problems with the old contract that I have already described, we had a shortage of dentists. We have now opened two new dental schools and increased the total number of dental undergraduates in training by 25 per cent. The first of those new graduates will leave dental school next year, and the recurring increase in dental graduates will transform the availability of dentists. I hope that hon. Members of all parties will listen to what I am saying and be honest enough to accept that, although a decision was taken under the previous Administration to close two dental schools, we have now put that right. Does the hon. Member for Hemel Hempstead (Mike Penning) want to intervene to accept that the Conservatives closed the schools, and that we have put that right?
Dr. Murrison: Does the Minister accept that those closures were predicated on projections about the reduction in dental care made by the profession at the time? I am sure that she likes to adhere to the evidence base, so she will know that many dentists, because of the changes to dentistry, have been drawn to cosmetic dental surgery. That was not expected, and she should acknowledge that both those factors are part of the problem that we face today. Will she acknowledge that it is wrong of her to lay into previous Governments for adhering to the evidence base that underpinned those closures?
Ann Keen: The fact remains that two dental schools were closed under the previous Administration, and that they have been opened by the present Government.
As I said, the new contract is based on dental services locally commissioned by PCTs to meet the needs of people seeking care in their areas. We have shown our commitment to increasing access to NHS dental services by increased investment of 11 per cent. in the current year. Next year, we will invest a further 8.5 per cent., for a total increase of £385 million over the two years.
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