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House of Lords

Thursday, 19 April 2007.

The House met at eleven o’clock: the LORD SPEAKER on the Woolsack.

Prayers—Read by the Lord Bishop of Worcester.

Health: NHS Dentistry

Baroness Gardner of Parkes asked Her Majesty’s Government:

The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, there were 20,887 dentists listed on NHS contracts at the end of December 2006. This is 1,500 more than in March 2005. Data on NHS dental expenditure and patient charge income for 2006-07 will be available later in the year.

Baroness Gardner of Parkes: My Lords, I thank the Minister for that reply. He may not be aware that I asked him an almost identical question almost exactly a year ago. Has he seen the Which? report which states that although there has been a slight improvement since 2005, the situation,

In particular, there is concern about the lack of access to emergency treatment, which leaves people in pain.

Lord Hunt of Kings Heath: My Lords, I have seen the Which? survey, which does not give the whole picture since it does not show the patients already receiving treatment; it is concerned with patients looking for NHS dentistry. Clearly, there are still challenges in ensuring that all patients who require NHS dentistry receive it, but the new contract, which gives far more responsibility to local primary care trusts, is the best way to have a much more proactive approach to providing that. There are good examples. For instance, the local PCT in Cumbria has now commissioned 50,000 new places for NHS patients. This is the first year of the contract; we have just moved into the second year. We expect PCTs to learn the lessons and enhance patient services in the future.

Earl Howe: My Lords, is the Minister aware of evidence that primary care trusts, which as he will know were very short of cash towards the end of the previous financial year, were diverting money away from dentistry into other services and therefore

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leaving patients untreated? Is he aware that that has been a widespread problem? I have had several reports of it.

Lord Hunt of Kings Heath: No, my Lords, I am not aware that it is a widespread problem. The noble Earl is right to suggest that we have made it clear to the health service that deficits needed to be cleared by the end of the previous financial year, and that has been done. That has involved primary care trusts making some tough decisions. I reassure the noble Earl that the PCTs entered into contracts with individual dentists to provide services for the whole of that financial year, and PCTs must remain committed to such contracts and pay up those contracts that were agreed at the beginning of the financial year.

Lord Colwyn: My Lords, does the Minister not agree that, despite all that he has said, the general public and the dental profession do not believe that the new contract is working? Will he undertake to initiate further discussions with the British Dental Association, the Dental Practitioners Association and other dental organisations to agree changes to the contract to finalise the new system, which dentists and patients hoped would provide NHS treatment for all who need it?

Lord Hunt of Kings Heath: My Lords, of course my department will continue to meet the BDA and other dental organisations. A review group is also meeting on a regular basis to look at aspects of the contract. The contract is about moving away from the treadmill of the drill and fill procedures that dentists did not want to be so involved in; it is about providing incentives for more preventive work. We have just reached the end of the first year. It is early days, and it will take time to bed down, but I am encouraged that in many parts of the country it has worked well and particularly that primary care trusts now have the ability to deal with the access problems.

Baroness Neuberger: My Lords, the Minister will be well aware that the latest survey by the British Association for the Study of Community Dentistry has shown huge disparities in the standards of oral health across the country. The highest instance of decay was seen in Merthyr Tydfil, where 76 per cent of five year-old children have decayed, missing or filled teeth. How does the Minister think that a dental contract that thus far seems to have involved some 69 per cent fewer patients seeing an NHS dentist, including 11,000 children, will tackle that inequality?

Lord Hunt of Kings Heath: My Lords, overall we see the figures for dentistry as being stable in terms of the number of patients receiving NHS dental treatment. We expect that to improve as the contract beds down. Regarding public health measures on oral health, I have always believed that water fluoridation is one of the most effective measures. I would refer to my own city of Birmingham in the West Midlands, where the city council many years ago—a Labour council—took the far-sighted decision to fluoridate

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the water supplies. The result is that in Birmingham we have half the level of dental decay among children living in similar demographic areas, such as Manchester, Liverpool and Yorkshire. I think that fluoridation really is the answer here.

Lord Elton: My Lords, the noble Baroness said that the numbers treated were going down. The Minister said that they were stable—and the population is going up. Where actually are we in all of this?

Lord Hunt of Kings Heath: My Lords, the figures I have suggest that 55.7 per cent of the population visited NHS dentists at least once in the two-year period ending December 2006, which includes a part period of the new contract. That is pretty stable—it was 55.8 per cent for the two years ending March 2006, when the contract started. So far there has been very little difference, but we think that we have a good foundation for improving access in the future.

The Countess of Mar: My Lords, the noble Lord mentioned fluoridation. Dentists look after not only teeth but gums as well. In order to keep your teeth in your mouth, you have to have healthy gums. I am particularly concerned about the reports on children’s oral health. Is the Minister sure that any child in any part of the country who needs to see a National Health Service dentist can do so?

Lord Hunt of Kings Heath: My Lords, of course the noble Countess is right; fluoridation is not the only answer, but it is a very important foundation. There are many other aspects of good oral health promotion, including sensible eating advice for children and adults. If patients, whether adults or children, have difficulty in gaining access to an NHS dentist, they should contact their local primary care trust, NHS Direct or access the NHS UK website. The NHS stands ready to help people who cannot gain access.

Royal National Orthopaedic Hospital

11.13 am

Lord Laming asked Her Majesty’s Government:

The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, a revised outline business case for the redevelopment of the Royal National Orthopaedic Hospital site has been submitted to the NHS London strategic health authority. The SHA is working with the hospital and my department to ensure that an affordable business case is put forward. The SHA hopes to make an announcement in the next few months, once it has considered the business case.

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Lord Laming: My Lords, I am grateful to the Minister for that reply. Will he confirm that this hospital, a national centre of excellence, is located in buildings that were built with a life expectancy of 15 years during World War II? Will he confirm that during the past 10 years there have been a number of strategic reviews, the most recent of which described the hospital as the jewel in the crown of the NHS? Will the Minister do everything in his power to ensure that a decision is made in the very near future?

Lord Hunt of Kings Heath: Yes, my Lords, I recognise the excellence of the work undertaken at the RNOH and the inadequacy of the facilities. I can assure the noble Lord that I will press the London SHA to come to a decision as soon as possible. The problem with the previous bids is that they were deemed unaffordable. The hospital trust has now put forward a more modest, scaled-down proposal, which is being seriously considered.

Lord Dykes: My Lords, I support the noble Lord, Lord Laming. I declare an historical interest as the former Member in another place for the constituency in which the Royal National Orthopaedic Hospital is based and attest to its superb achievements over many years. Is the Minister aware of the need to maintain its functions and the way in which it is supported not just emotionally but practically by many people in the area and elsewhere? This hospital is indispensable.

Lord Hunt of Kings Heath: My Lords, that message is very clear.

Lord Wedderburn of Charlton: My Lords, I speak as someone with an interest in this splendid hospital, having received expert treatment from its wonderful staff. Will the Minister visit the huts in which those staff now work and have worked since the 1950s? This is supposed to be a jewel in the crown of the National Health Service, but the huts of the Stanmore hospital, in which miracles are performed, are a disgrace and should be ended as soon as possible. Will he see that that is done as a matter of urgency?

Lord Hunt of Kings Heath: My Lords, I have already said that I will ensure that the London SHA comes to a decision as quickly as possible about this hospital. I am well aware that it has taken time and that unsuccessful bids have been put forward. It will set a terrible precedent if I say that I will visit the hospital, but I assure the noble Lord that I know the work of the RNOH and am aware of the inadequacy of its facilities. As I said, we have to come to a decision which is affordable for the NHS, but I will ensure that the SHA is pressed to come to a decision as soon as possible.

Baroness Neuberger: My Lords, I declare an interest as another patient of the Royal National Orthopaedic Hospital and sing its praises. Perhaps I may widen the debate somewhat. Given what has happened with regard to decision-making over the hospital and the disaster relating to the Paddington

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site, at what stage will we see some kind of strategic plan from the London strategic health authority for the renewal of buildings on the London estate that are impossible to work in?

Lord Hunt of Kings Heath: My Lords, it is worth remarking that the NHS is in the middle of the biggest capital expansion that it has ever seen, with well over 100 new hospitals either having been built or in the process of being built. With regard to the London strategic issue, I commend a report by Professor Darzi, who has been asked to give advice and leadership to the London SHA in this area. London presents a very mixed picture. It has within it some of the highest-quality health provision in the world, of which we should all be very proud, and, in other parts, inadequate services and facilities. For far too long—20 or 30 years—decisions have not been taken. It is essential that we have the leadership and vision to ensure that all Londoners benefit from the quality of services now available in some parts of London. We think that the Darzi review, which is essentially about a clinically led understanding of the best service provision, is the foundation on which to deal with the issues raised by the noble Baroness.

Lord Lawson of Blaby: My Lords, can the Minister explain the meaning of his answer to the previous question, when he said that a visit to this hospital would set a dangerous precedent? Is he saying that he will not visit any hospital because it might set a precedent or just that he will not visit this one; and, if not, why not?

Lord Hunt of Kings Heath: My Lords, of course I frequently visit hospitals, but if all noble Lords were to get up at Question Time and ask me to visit particular hospitals, that would set a dangerous precedent. I made it clear that I well understand the issues facing the RNOH. I know of the excellent work being undertaken and I should have thought that noble Lords would recognise that I take a close interest in the progress being made.

Lord Patel: My Lords, in the Minister’s conversations with the SHA, will he ensure that it recognises that the replacement for this hospital should provide not only the best possible care but also the facilities that will be required for training and education? The RNOH currently trains 10 to 15 per cent of all future consultants in orthopaedic surgery.

Lord Hunt of Kings Heath: My Lords, of course that is right. I am sure that the noble Lord would acknowledge the Government’s efforts to increase the number of consultants and the drastic reduction in waiting times for orthopaedic treatment apparent in the RNOH and orthopaedic services generally. I assure him that this hospital’s commitment to teaching and research will be fully taken into account by the London SHA.

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Israel: Hand in Hand Schools

11.20 am

Lord Turnberg asked Her Majesty’s Government:

Baroness Royall of Blaisdon: My Lords, we support work that aims to improve mutual understanding between young people to promote dialogue, respect and tolerance between different cultures. Between 2005 and 2006 the Foreign and Commonwealth Office provided £98,300 in support of Hand in Hand. We also support a number of other projects in the occupied Palestinian territories through other FCO funding mechanisms.

Lord Turnberg: My Lords, I am grateful to my noble friend for her response. I picked those schools because they are such an obvious and excellent example of the way in which it is possible to bring together Arab and Jewish children to encourage co-operation and co-ordination. As the Minister knows, the teachers are mixed Arab and Jew, and the head teachers are Arab and Jew and share responsibilities for the schools. That is just a small example of the large number of efforts that are being made to improve relations between Arab and Jew, Palestinian and Israeli.

Is my noble friend aware that the Israeli 100 shekel note, for example, has a picture of a village called Piki’in where Jews, Christians and Druze live in a close harmonious relationship? Does she agree that organisations such as One Voice, with its 250,000 young Palestinian and Israeli members, and hospitals such as Hadassah, where Arab and Jewish doctors and nurses work closely together, are the sorts of grassroots activities that we in the UK should be publicising and building on as we try to encourage the peace process?

Baroness Royall of Blaisdon: My Lords, I was aware of all the examples cited by my noble friend. They are all extraordinary examples of the way in which mutual understanding must be, and is being, fostered between Israel and Palestine, thus providing a strong basis for peace when it is attained in the Middle East. It is only through efforts at these grassroot levels that peace will truly be attained.

Baroness Williams of Crosby: My Lords, Hand in Hand and similar experiments are very welcome but we should be realistic and recognise that there are 750 children in Hand in Hand schools, and that the great bulk of children in Israel and Palestine are still educated in schools that are effectively segregated. Given that, can the Foreign Office, or possibly DfID, help both Israel and the Palestinian areas by looking at the curriculum by which schools work in the separate countries, and which are fundamentally

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very inclined towards separatism and stressing fundamental differences rather than similarities? Is that not one of the keys to spreading more widely the excellent work to which the noble Lord, Lord Turnberg, referred?

Baroness Royall of Blaisdon: My Lords, it is indeed, and I am grateful to the noble Baroness for bringing to my attention the importance of the curriculum and ensuring that the curriculum in both Israel and Palestine is properly balanced and tolerant. I shall certainly take that back to the FCO and DfID.

While Hand in Hand is small, organisations such as One Voice are big and expanding, and we must continue to support their work, as well as looking at things like the curriculum.

Lord Clarke of Hampstead: My Lords, is my noble friend aware of other initiatives, such as those of the Trade Union Friends of Israel and the Trades Union Congress? Both organisations have sent delegations to the occupied area of Palestine and to Israel, and their fundamental message is to bring people together. If children, through the wonderful idea of Hand in Hand, are to get the benefit, their parents should be able to talk about the co-operation between the communities that exists through the trade union movement. I cite the constant trade union involvement in Northern Ireland through those difficult years, where the unions’ objective was a better economic and social life for all people.

Baroness Royall of Blaisdon: My Lords, trade unions have an extraordinarily important job in improving the quality of life of their members, as well as their work in other countries, in promoting tolerance, understanding and bringing people together. I pay tribute to the trade union movement, both in this country and Israel and Palestine.

Baroness Deech: My Lords, is the Minister aware that the Japanese Government are providing considerable financial assistance for an agro-industrial park near Jericho that combines Palestinian work with Israeli technical expertise? These peaceful and promising ventures would flourish even more with some additional UK Government help, in particular in science fellowships and scholarships to bring Palestinian and Israeli scientists over here. A couple of the ventures are Sesame, which is to do with a radiation source in the Middle East being built in Jordan, and One Voice, which is working on campus collaboration. Additional UK Government help would go a long way towards peace.

Baroness Royall of Blaisdon: My Lords, I was not aware of the examples cited by the noble Baroness or of the support of the Japanese Government. However, it is clearly incredibly important that scientists are able to exchange views. Bringing them together from all the countries of the Middle East not only enables them to do better research and work together but also fosters understanding and is an important way forward. I will take this back to the

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Foreign and Commonwealth Office; the more that we can promote exchanges between scientists, as well as supporting their work in the region, the better.

Lord Steinberg: My Lords, does the Minister agree that in Israel there are already Arab players in the football team and Arabs in Israeli orchestras and that there was an Arab in the Israeli Olympic team? All of these things, which are not actually organised, are good for the future. Is the Minister aware, however, that hatred of Israel and Jews is being taught in Arab and Palestinian schools to children who are as young as four or five? We should protest about that very much indeed.

Baroness Royall of Blaisdon: My Lords, I was not aware of the extent of the participation of Arabs in the Israeli football team, for example. I warmly welcome that.

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