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House of Lords

Tuesday, 14th May 2002.

The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers—Read by the Lord Bishop of Rochester.

Dental Care

Lord Colwyn asked Her Majesty's Government:

    What they are doing to improve access to regular dental care within a service that also encourages prevention and the continuing maintenance of good oral health.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, arrangements are now in place to ensure that patients can gain access to NHS dental services by calling NHS Direct. The working group, Options for Change, has proposed new methods of service delivery that would allow the NHS locally to place a greater emphasis upon preventive care and reducing oral health inequalities.

Lord Colwyn: My Lords, I declare an interest as a practising dental surgeon. I thank the Minister for that Answer. As ever, he is very helpful about dentistry. However, does he not agree that the fee structure of the General Dental Service remuneration scheme encourages dentists to leave the health service? Despite continual reviews and the development of alternative systems, the situation remains fundamentally unchanged. Will the Minister ensure that the Options for Change demonstration sites consider schemes which focus primarily on oral health gain and prevention with dentists being paid for maintaining oral health rather than for individual items of service?

This is "National Smile Week". I shall be interested to know whether the Minister has any official appointments during National Smile Week—his assurances will bring a smile to both patients and dental surgeons.

Lord Hunt of Kings Heath: My Lords, I have not, as yet, been given ministerial responsibility for smiling, but one is ever hopeful. As to remuneration, the noble Lord is right to suggest that the discussions around Options for Change are very much concerned with changing some of the incentives for dentists so that they are rewarded more for work in relation to prevention and oral health in general and less in terms of the treatment they give to patients. The average remuneration generally for a dentist wholly committed to the NHS, after costs, is between £55,000 and £60,000 per year.

Lord Tomlinson: My Lords, does my noble friend the Minister agree that he has a great deal to smile

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about this week following the success of Birmingham City football club? Will he encourage the remainder of the country to be as fortunate as Birmingham in terms of having adequate access to fluoridated water as a sensible preventive measure? I declare a non-remunerative interest as president of the British Fluoride Society.

Lord Hunt of Kings Heath: My Lords, I am grateful to my noble friend for his reference to Birmingham City's remarkable achievement on Sunday. As to fluoridation, I have long been convinced that for those areas of the country where there is severe dentistry disease fluoridation is one of the ways in which that problem can be tackled. It is significant that a large number of boroughs in the West Midlands, when compared to places such as Manchester, which has very poor dental health, do very much better than the national average.

We commissioned a review of the research available on the efficacy of fluoridation from the University of York. It suggested that, overall, fluoridation is beneficial. However, it was felt that the amount of research available was not sufficiently robust. We have asked the Medical Research Council to report to us on the question of further research in the area.

Baroness Northover: My Lords, is the Minister aware that my family are smiling even more because they are Arsenal supporters? On a more sober note, does the Minister remember that at the Labour Party conference in 1999 the Prime Minister promised that within two years everyone would have access to an NHS dentist? When the Government came to power in 1997, 54 per cent of people had access to an NHS dentist. That has now fallen by 7 per cent. Is it not time for dental health to be regarded as part of general health with free dental checks and delivery by the Government of the Prime Minister's pledge?

Lord Hunt of Kings Heath: My Lords, the noble Baroness is right to suggest that the Prime Minister has focused attention on improving access to NHS dentistry. That is why he made the pledge and why we have put in place a system whereby patients who have difficulty finding an NHS dentist can ring NHS Direct, which will refer them to the nearest NHS dentist. In many parts of the country that is having a very beneficial impact.

The noble Baroness also raised the issue of the willingness of the public to come forward for dental treatment. Again, there is a large variation up and down the country, with an average overall of only 43 per cent of the adult population receiving regular dental treatment. We need to improve our oral health promotion. That will be the benefit of the discussions that are taking place with the dental profession at the moment about a potential new contract.

Baroness Gardner of Parkes: My Lords, perhaps the Minister will tell the House about access centres. As I understand it from an Answer that he gave me recently, people are referred by NHS Direct either to a

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local NHS dentist or to an access centre. Can the Minister confirm that setting up the 50 access centres in the country cost £50 million? What are the running costs of those centres—as I understand it, dentists work on a salaried basis—and what is their productivity in terms of how many patients are treated and how successfully?

Lord Hunt of Kings Heath: My Lords, dental access centres are one of the ways in which we have been able to increase NHS dentistry for members of the public who have found it difficult to obtain such treatment from general dental practitioners. At present, 49 centres are being funded. Forty-seven are currently open, operating from over 120 sites. According to the figures for March 2002, some 300,000 patients receive treatment at the centres annually. A capital investment of £12 million took place in 2001–02. Those assets remain NHS assets. The revenue cost of the service in 2001–02 was £29.9 million. That is a good use of money to extend NHS dental care to many people.

Lord Monson: My Lords, is the Minister aware that most continental European countries, although every bit as keen on dental health as Her Majesty's Government, positively shun fluoridation? Indeed, some have banned it on the basis that the risks outweigh the possible benefits.

Lord Hunt of Kings Heath: My Lords, we commissioned the University of York to review evidence on fluoridation. The findings indicated that the fluoridation of water helps to reduce tooth decay. The review found no clear evidence of adverse effects on general health other than an increased risk of the mottling of the teeth.

Lord Hooson: My Lords, in regard to the concern about preventive medicine, have the Government any plans to recruit and train an increased number of dental hygienists?

Lord Hunt of Kings Heath: My Lords, I am convinced that expanding the workforce in terms of the professions supplementary to dentistry—increasing not only the number of hygienists but also the number of therapists—could be of enormous help. Orders will be laid before this House this evening in relation to dental auxiliaries. Yes, the whole dental team has a role to play.


2.44 p.m.

Lord Waddington asked Her Majesty's Government:

    Whether, before entering into the present negotiations with Spain about Gibraltar, they sought an undertaking from the Spanish Government that the ban on access to Gibraltar from Spain by air or ferry will cease.

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The Minister for Trade (Baroness Symons of Vernham Dean): My Lords, we did not seek such prior undertakings because, as the Brussels communiqué of 1984 makes clear, such matters should be settled in the context of the Brussels Process talks. These talks continue. Our aim throughout has been for greater stability, greater freedom and greater prosperity for Gibraltarians.

Lord Waddington: My Lords, I am grateful to the Minister for her reply, and that she has taken the trouble to come to the House to give it. However, I have to ask her this important question. What is the point in proceeding further with these talks when the British Government and the Spanish Government between them seem to have made it absolutely certain that any deal will be rejected by Gibraltar? The Spanish Government have made no promise to lift their illegal blockade; and the British Government have as good as indicated that they will concede the principle of joint sovereignty. Will anything be left other than disillusionment? Would it not be better to break off the talks now? There is a very good reason for doing so in view of Spanish intransigence as regards the base.

Baroness Symons of Vernham Dean: My Lords, the point of the talks that we are undertaking is what it always was: to attempt to achieve a settlement in regard to a matter which has caused a great deal of difficulty between ourselves and one of our major allies in the European Union—a country for which we have great regard—in order to try to ensure that the standard of life of the people of Gibraltar is improved. What we are trying to achieve is the free flow of people, goods and services from Gibraltar to the Spanish mainland. We are trying to achieve a financial services hub for Andalucia and the wider region; to bring jobs and prosperity to people in Gibraltar; and to improve the communications—the airport and the ferry—in the way suggested by the noble Lord. I remind him that Mr Caruana himself said that there is no harm in proposals being put to Gibraltar to accept or reject, provided that the exercise is genuinely democratic. That is what we are engaged in.

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