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On the flipside, I heard the noble Lords, Lord Colwyn and Lord James, describing practitioners with the reverse problem of delivering all their contracted activity before the end of the year. The only reason that they would have to shut up shop early and head for the golf course, as the media have recently reported, and which the noble Lord, Lord James, mentioned, would be if they were spending less time with their patients than they had done previously. PCTs have the flexibility to increase contracts where this is appropriate and have guidance on providing alternative care to any patients affected by a dentist meeting his contract too early. While we are not content when even a single patient remains affected, we are pleased to say that anecdotal reports suggest that this has been far less of an issue this year than it was last year. PCTs have used the support I have just outlined greatly to improve the provision of services across the country.
For example, the community dental access project set up by Tower Hamlets PCT in 2003 brings the dentists to the community through a range of dental services. Tower Hamlets has historically been an area of poor oral health and low uptake of dental care. The project, which has been developed at every step with the local community, uses a fleet of mobile dental surgeries to travel out into the heart of the community to locations selected by the local community. Both screening and treatment services are offered and the project uses link workers to help local people understand their dental treatment and how to access care.
The project has brought dentistry much closer to patients and the mobile services are very popular, with sometimes 100 people being screened in a day at a community event. However, I can assure noble Lords that the Government are not looking through rose-tinted spectacles, and we know that we still have work to do to ensure that everyone in this country who wants to see an NHS dentist can do so quickly and easily.
Several noble Lords said that the number of patients accessing NHS dental care has dropped by 0.5 million in the 24-month period ending September 2007 compared to the 24 months ending March 2006. I need to make it clear that these figures do not reflect the current situation. The noble Earl referred to the figures. The most recently published figures cover September 2005 to September 2007. Around 4 per cent of services had
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I am pleased to say that the current picture is far healthier with access improving as new services open across the country. We know that PCTs across the country are commissioning new and expanded services and that there is no shortage of dentists putting themselves forward for these new contracts. Furthermore, the majority of PCTs now run dental access helplines quickly to match up patients seeking NHS care with the services available. However, because the data available are retrospective and look back over the previous two years, it will take a little more time for the current growth in access to work its way into the figures for the loss of service immediately after the 2006 introduction of the new system.
Several noble Lords mentioned surveys that show a bleak picture. Without going into too much detail, there are surveys and surveys; it is a mixed picture. The Citizens Advice/MORI survey indeed showed a need to improve access, but in publishing the survey, Citizens Advice also welcomed the extra investment that we are making precisely to that end.
The Greater London Authority survey published in November concluded that London is well served by NHS dentists and found that, although the majority of dentists said that they were willing and able to take on new NHS patients, there was a problem in persuading some groups in society to come forward for treatment, which is why I so warmly commended the Tower Hamlets outreach service. In other surveys, the Commission for Patient and Public Involvement in Health survey was based on a self-selecting sample. As a result, those findings must be open to question. For example, the claim that six per cent of the population has resorted to self-treatment would mean that 3 million people had done so, making DIY dentistry marginally more popular as a pastime than freshwater angling. I suggest that that is probably not the case.
My key point is that primary health care trusts are commissioning new services now. We are starting to see reports in local newspapers that reflect that from places as far afield as Gainsborough, Wantage, Newquay, Plymouth, Norwich and west Essex—the sort of places where access problems have been most acute.
The noble Baroness, Lady Finlay, and others, raised the issue of hospital admissions for dental problems. I will not repeat myself by talking about the new services being commissioned, but I am sure that noble Lords will be interested to hear that the proportion of all dental admissions that were emergency admissions has dropped from 8.1 per cent in 2005-06 to 7.4 per cent in 2006-07. The article used the overall rise in emergency admissions, while omitting the fact that, as a proportion, dental admissions were down.
However, dealing with access is only one part of reforming the NHS. We need a quality service. The noble Lord, Lord Colwyn, raised the issue of the NHS next stage review and how dentistry fits into it. In 2007, my noble friend Lord Darzi invited stakeholders,
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The noble Lord, Lord Colwyn, also asked why the Patients Association poll of MPs showed that dentistry topped the concerns in correspondence. I acknowledge that there are concerns about access to dentistry; that is what this debate is about. In fairness, there are some long-running problems. As I said, our increased spending on dentistry and the inclusion of dentistry in the NHS operating framework is starting to address that issue.
The noble Lord, Lord Roberts, raised the issue for Wales. As he will be well aware, dentistry in Wales is a matter devolved to the Welsh Assembly, so I have confined myself to issues concerned with English dentistry. The noble Baronesses, Lady Finlay and Lady Gardner, and the noble Lord, Lord Roberts, raised the issue of the proportion of adults and children who have no access. There has never been a time when more than 60 per cent of the population was in regular touch with an NHS dentist. My noble friend Lord Desai explained why that may be the case. That is almost certainly not a satisfactory position, but back in 1993, when there was no access problem, 40 per cent of the population chose either to go private or to go less regularly than every two years. We are determined to increase access: that is now an NHS priority. We need to be clear about the number of people who are using NHS dentistry.
The noble Lord, Lord Roberts, talked about charges and whether they should be scrapped. We think that it is better to have a system that exempts people in hardship from payment while charging those who can afford to pay. I should make it clear that half of all NHS patients in England are exempt from charges.
The noble Lord, Lord Roberts, and the noble Baroness, Lady Gardner, raised the issue of dentists needing to be adequately compensated for NHS work. The figures from specialist dentists’ accountants show that NHS dentists’ earnings have increased since 2005-06. Single-handed dentists now earn more than £100,000 a year. Indeed, dentists’ expenses have fallen because the proportion of complex treatments has fallen, as we expected, under the new contract.
The noble Lord, Lord Colwyn, and the noble Baroness, Lady Gardner, raised the issue of income guarantee for dentists. Existing dentists’ gross income was guaranteed for the first three years of the new system, but where practice has changed and dentists’ costs have gone down, it is right that the PCT can renegotiate. The extension of the budget ring-fence shows the Government’s commitment. Within this, the NHS is entitled to expect a fair price for a quality service.
The noble Baroness, Lady Gardner, raised the issue of the claw-back of funds because of the income guarantee. Dentists were guaranteed no less income than they earned under the old system. Activity is set at a level delivered under the old system, so if they do less work now—in other words, if they do not do the work that they have agreed to do—the NHS rightly reserves the right to ask for funds to be given back.
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The noble Baroness, Lady Gardner, also raised the issue of dental products and lead in imported fillings. I recognise her concern, but I should add that dentists are responsible for the quality of the materials that they use and, as she will know, they must satisfy themselves that the products they use are of the required standard.
My noble friend Lord Desai was the one person who mentioned school dentists. In 2006, the National Screening Committee considered research into school dentistry and discovered, unsurprisingly, that middle class children were generally registered with a dentist, and that the parents of children in more deprived circumstances often failed to act on the advice that had been sent from schools and those children remained untreated. On the basis of this advice, we believe that the most effective method of improving the oral health of children is not the re-establishment of the school dental service but a combination of population-based inventions, such as water fluoridation—I am pleased that no one mentioned that today, although I have two pages on it—toothpaste schemes that build on the Brushing for Life initiative, improving access to NHS dentistry generally, and running campaigns that encourage families with children to visit their dentist regularly.
The noble Baroness, Lady Finlay of Llandaff, in her usual erudite and informed contribution to the debate, raised a number of important clinical matters, including patients with muscular dystrophy and cancer and the detection of oral cancer. With her permission, I will explore those and come back to her.
The noble Earl, Lord Howe, talked about the number of dentists and the fact that not enough are coming forward to do NHS work. In fact, PCTs at present report no shortage of dentists seeking to expand their NHS activity. For the first time in decades, dentists are competing to provide NHS care. It will take time for the new money to feed through to the new services, but it is not true that recruiting is the problem. The noble Earl highlighted the need to ensure that the money is effective, that it is going to the right places and that we are monitoring it in the right way. We all need to watch that.
The noble Lord, Lord Teverson, said that he felt fear coming into the Chamber, given that two dentists are present. I did not, because I have always had very good experiences with my dentist. The hygienist is a different matter, but it is probably better that we do not go there at this point.
I conclude our discussion today by reinforcing the point that the dental reforms of 2006 were an essential step towards solving the problems created by a previous treatment-focused, provider-led scheme. The reforms for the first time put the power into the hands of the local NHS to plan and to provide dental services to meet the local needs of the population. I reiterate our commitment to improving access to NHS dentistry. I thank the noble Lord, Lord Colwyn, again for bringing this subject to our attention and I thank all noble Lords for contributing to today’s debate.
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4.19 pm
Lord Colwyn: My Lords, it remains for me to thank all noble Lords who have taken part in this debate. I am grateful for their input. It has been an interesting afternoon. I have written one or two witty remarks about each speech, but in view of the two items of business we have yet to do, I will not say them, except to say to the noble Lord, Lord Roberts, that I regularly used Super Glue when I was in practice and if you want to pull your own teeth out, a screwdriver is far more effective than a pair of pliers.
I thank the noble Lord, Lord James, for mentioning laboratory bills. The problem that technicians have is something the Government have also got to keep a very careful eye on. Finally, the noble Lord, Lord Teverson, talked about dental tourism, which is fine as long as nothing goes wrong. I thank the noble Baroness, Lady Thornton, who covered all the items beautifully and I look forward to reading her speech in Hansard. She commented briefly, I think, on The NHS in England: The Operating Framework for 2008/9, published in December 2007, and the document, Commissioning NHS Primary Care Dental Services: Meeting the NHS Operating Framework Objectives, published in January 2008. I hope that the introduction of those documents will be thoroughly discussed with the profession and its leaders before being imposed.
Many dentists think that the contracts are unfair and unworkable. The shift towards private practice is not to earn more money. It is to create a stable, long-term environment to enable adequate investment in premises and modern equipment, and to spend greater time providing prevention-based care for patients. I beg leave to withdraw the Motion for Papers.
Motion for Papers, by leave, withdrawn.
Fuel Supply: Grangemouth Refinery
4.21 pm
The Parliamentary Under-Secretary of State, Department for Business, Enterprise and Regulatory Reform (Baroness Vadera): My Lords, with the leave of the House, I shall repeat a Statement made in another place by my right honourable friend the Secretary of State for Business, Enterprise and Regulatory Reform. The Statement is as follows:
“With permission, Mr Speaker, I would like to make a Statement on the implications of the industrial action at the Grangemouth refinery, which, I regret to report, is scheduled to begin on Sunday and to last 48 hours.
“Throughout the last few days, we have kept in close contact with Scottish Ministers, both parties to the dispute and with the industry as a whole. I am grateful in particular to ACAS for the effort it has made to resolve matters between the parties. Our first priority now is to ensure the maintenance of sufficient fuel supplies during the period of industrial action.
“Over the past few days significant additional supplies of imported fuel have been made available in Scotland. I have been advised by the industry
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“We are already working under our established Memorandum of Understanding with industry to develop a jointly managed approach which allows fuel suppliers to work together to maximise available fuel. We also have available, if necessary, the National Emergency Plan for Fuel which can be used to ensure fuel is available for priority groups such as the emergency services. Our best assessment is that, at present, there is no need for the Government to take action under its emergency powers. We are working closely with the Scottish Executive, and with the regional forums in Scotland, to prepare for further action should that become necessary. We will not hesitate to use these emergency powers if this becomes necessary.
“The oil companies have reported significant increases in fuel up-take this week in response to concerns about shortages of fuel. While this response is perfectly understandable, I want to emphasise that industry has made it clear that there is sufficient fuel available via imports and that any localised shortages will be re-supplied quickly.
“It is also essential to prevent the industrial action at Grangemouth from disrupting the flow of North Sea oil and gas associated with the Forties Pipeline System and the Kinneil processing plant at Grangemouth. I believe that there can be no justification whatever for action that adversely affects production of oil and gas from the North Sea. Continuing production depends on power, steam and cooling water being delivered by or through the Grangemouth site. Discussions are continuing this morning on ensuring the continuance of these vital utilities and of course it is essential that they are maintained.
“Finally, there is a need to protect critical equipment to allow a rapid return to normal operation following the period of industrial action. This will require the provision of safety cover for the INEOS refinery and petrochemical plants. It will also require maintaining the steam supply throughout the plant to ensure the integrity of steam lines, pipes and production units.
“This is a dispute for INEOS and Unite to resolve as a matter of urgency. The Government’s view is that both of them have a responsibility to minimise the impacts of their dispute on the public and on the wider economy. I would urge both sides to get back to the negotiating table as quickly as possible and to resolve this dispute without any further harm being done to the public and to the economy. We will continue to monitor the situation closely, working with the Scottish Executive and emergency services, local authorities and other key agencies”.
My Lords, that concludes the Statement.
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4.25 pm
Baroness Wilcox: My Lords, I thank the Minister for repeating the Statement and I strongly agree with her that it should be a priority to persuade the unions and INEOS to reopen negotiations at the earliest opportunity. I urge both sides to lay aside their own immediate interests and give thought to the serious consequences that this dispute could have for the general public and the economy.
The Minister will be aware that there has been much speculation about the impact of this shutdown. Does she agree that we need to maintain a sense of proportion in relation to these events? That is the only way to reassure the public and avoid the scenes of panic buying of petrol or stockpiling of supplies that we have seen in the past. Can she confirm that, as the situation does not as yet represent a widespread shortage, she does not expect there to be any impact on petrol prices on the garage forecourt and that she will monitor what happens to petrol prices to ensure that no one tries to take advantage of the situation and push their prices up unfairly? Fuel prices in general, and oil in particular, are already sky high, so we cannot afford to take this threat lightly.
The Minister will be aware that the industry believes that a two-day strike is damaging but manageable. However, there is deep concern about the implications of a longer dispute, which would undoubtedly increase the risk of serious shortages throughout the United Kingdom. How are the Government monitoring the situation, and will they make a commitment to keep Parliament informed?
Can the noble Baroness give us an indication of what action the Government will take if the unions and INEOS do not see it to be in their own interest to come to an agreement and restart production after two days? On current plans, the Forties oil field will be forced to cease production for a number of weeks. Can the Minister tell us whether any long-term damage will be done to North Sea fields, where there are only limited facilities to store oil and gas in situ? What effect will that have not only on UK oil prices, in the future?
What is the Minister’s understanding of the impact of the strike on plans to invest in the future of the Grangemouth facility? What impact does she think a strike will have on INEOS’s ability to fund the £750 million investment programme necessary to modernise the plant, and in this respect, does she agree that a strike will actually put jobs at risk and damage the interests of those working at Grangemouth and in a vital British industry?
Finally, while these discussions are ongoing, can the Minister give us more details about how her department is working with the industry to secure fuel from other sources to make up the shortfall while Grangemouth is out of action? To what extent does she understand that fuel has been stockpiled to minimise the effect of the strike on the public?
4.28 pm
Lord Redesdale: My Lords, I thank the Minister for repeating the Statement. The short-term damage that this strike could have would mirror the effects of the
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I understand some of the concerns of those working at Grangemouth. The closure of final salary pension schemes is affecting many businesses across the country. But they are in a situation where they hold so many of us over a barrel that their demands are slightly more pressing. Someone had to say that at some point and I thought I might as well get in there.
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