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House of Lords

Thursday, 3 July 2008.

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

Prayers—Read by the Lord Bishop of Southwell and Nottingham.

NHS: Dentistry

Baroness Afshar asked Her Majesty’s Government:

Baroness Thornton: My Lords, PCTs are reporting that plenty of dentists come forward when they tender new services. Although there was a fall in numbers in 2006, we still have 4,000 more NHS dentists than 10 years ago. We have made increasing access to dentistry a national priority for the NHS and we have increased this year’s funding by £209 million, taking our total spend to £2,081 million.

Lord Colwyn: My Lords—

Baroness Afshar: My Lords, I thank the noble Baroness for that reply. Does she acknowledge the difficulties that arise when, according to a recent health survey in York, 45 per cent of people in the city of York who wish to see a dentist when they need one cannot do so?

Baroness Thornton: My Lords, in 2006 we introduced a legal duty on PCTs to provide dental services for those who need them. I know that access has been a problem in some areas and I am sorry that there has been a problem locally in York. However, as I have said, the extra £209 million put into dentistry this year should ease the situation. Indeed, we know that commissioning activity generally is up. Specifically, four new NHS dental practices have recently opened across North Yorkshire, and a total of 70,575 patients have been assigned to NHS dentists across the area. The PCT is working hard to solve the problem. But perhaps as fellow Yorkshire women, we might go back to the primary care trust to ask how it is progressing and what plans it has to solve this problem.

Lord Colwyn: My Lords, I apologise to the House for my keenness in trying to get in, having failed to speak on a Statement last week. I hope that the noble Baroness is not implying that NHS dentists are not working to the highest possible standards. In view of the pledge of the Minister, the noble Lord, Lord Darzi, to provide high quality preventive care and his recognition that target-driven systems are not the way forward, will the noble Baroness re-examine the present system whereby all NHS dentists spend all of their time working to achieve treatment targets?

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Baroness Thornton: My Lords, my noble friend is, as ever, enthusiastic on behalf of dentists, and has put the emphasis on quality and prevention. For example, 12 year-old children in the UK have the best oral health in Europe. Although we are not reviewing the contractual system now in place, as part of the review being undertaken at the moment we will re-evaluate the new system to work out what is the best way forward, whether the system is working, and what steps are needed to ensure that local commissioning is taking us in the right direction for the future.

Baroness Tonge: My Lords, does the noble Baroness agree that many dental conditions are more damaging to a patient’s health than many disorders now being treated at no cost in other parts of the health service? How long will we have to wait for the Government to sort out this muddle and ensure that crucial dental treatment is available to all under the health service?

Baroness Thornton: My Lords, the noble Baroness is right to point out that preventive treatment is vital. The whole point of the new system is that we are, as it were, putting our money where our mouth is and giving the NHS an 11 per cent uplift. I apologise. I do not know whether it was a witty civil servant or an accident that put that in my brief. Putting budgets for the first time into the hands of the local NHS will help to bring forward the prevention that we all want.

Lord Tomlinson: My Lords, does my noble friend agree that in many respects concerning dentistry, prevention is better than cure? Will she clearly recommit the Government to the programme that is necessary for the fluoridation of water supplies in this country so that our dental health may be protected from birth and the demand for dental services will not be as great in the future as it is as present? I remind the House of my interest as president of the British Fluoridation Society.

Baroness Thornton: My Lords, in the UK about 6 million people—10 per cent of the population—drink water that is either artificially fluoridated or has a natural level of fluoridation. This is an issue that local communities need to consider but, by way of illustration of the benefits, children in Sandwell, which has fluoridated water, have two and a half times fewer fillings than children in Bolton, an area of a similar social profile.

Baroness Gardner of Parkes: My Lords, have we not had this week a devastatingly condemning report on the state of dentistry in the National Health Service? This talk about prevention is all very well, but is it not clear that the report from the Commons states that people are not doing the repair work because the existing contract is a disincentive to do so? Can dentists be blamed because they are being forced to turn into private practitioners? When will the 2006 contract be reviewed to make it more practical in delivering dentistry to patients?

Baroness Thornton: My Lords, the review is taking place at the moment and we will carefully consider the Health Select Committee report on dentistry in due course. We welcome the Select Committee’s support for the key elements of our dentistry reforms which

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are now being given to local primary care trusts for the first time. We are pleased that the committee agrees that this localised system is the way forward. The report of my noble friend Lord Darzi, High Quality Care for All, emphasised the importance of effective local commissioning in improving access to high-quality services across the NHS, including dentistry.

Lord Patel: My Lords, recently there have been several questions about dentistry, including questions on the House of Commons report, all of which point to one issue: do we have a national shortage of dentists? If we have, who is responsible for maintaining the supply of dentists to the country?

Baroness Thornton: My Lords, NHS dentistry is expanding and we are seeing a steady rise in the amount of services that are being commissioned. We are also increasing the number of dentists for the long term. We have increased the number of undergraduate training places by 25 per cent and have established two dental schools—one in Plymouth and one in Preston—which will open this autumn.

Baroness Whitaker: My Lords, is my noble friend aware that there are at least four dentists within an easy walk of where I stay in north London and that several of them have repaired my teeth extremely satisfactorily?

Baroness Thornton: My Lords, I am extremely pleased to hear that.

Baroness Byford: My Lords, will the Minister answer the previous question? Do we have a sufficient number of dentists at the moment or not?

Baroness Thornton: My Lords, we made a fundamental and essential reform to the NHS dental contracts in 2006 and dentists have lost their ability to restrict the supply of NHS dental services. Much of the opposition comes from dentists and organisations in the private sector.

Health: Bone Marrow Transplants

11.14 am

Lord Harrison asked Her Majesty’s Government:

Baroness Thornton: My Lords, there are 300,000 donors registered on the British bone marrow register and a further 350,000 on the Anthony Nolan register. The NHS Blood and Transplant service’s current strategy is to maintain the BBMR at its current size and to target its recruitment activity towards underrepresented ethnic-minority groups to increase the diversity of the

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register, and, with the long-term perspective in view, to educate young people about the importance of becoming donors in the future.

Lord Harrison: My Lords, given the bravery of Adrian Sudbury who, even in his dying days, campaigned vigorously to improve the opportunities to find life-saving donors for bone marrow transplants, will my noble friend build on the need to talk to our young people in schools and colleges and impress upon them the ease and importance of giving blood, in order to find donors? Will she also build upon the excellent work of the national blood register and the Anthony Nolan Trust to ensure that we produce a comprehensive register, equal in effectiveness to that in Germany in providing matches for such blood donor transplants?

Baroness Thornton: My Lords, my noble friend raises an important point. The promotion of the donation of blood, bone marrow and organs in schools is important. The NHS Blood and Transplant service has developed a set of teaching materials called Give and Let Live and a website to help provide students between 14 and 16 the knowledge and understanding of key issues related to donating. That pack is available to all schools. The Secretary of State met Adrian Sudbury; indeed, he also met the Prime Minister and Ed Balls, who have committed themselves to promoting blood and bone marrow donation in schools. It is planned that a letter will be sent to all schools in September to coincide with the relaunch of the Give and Let Live resource.

Lord Jenkin of Roding: My Lords, will the Minister join me in congratulating the Anthony Nolan Trust on the splendid work it has done over the years in this field? Will the Government now support the trust’s ambitious new programme to establish a cord blood donor base to provide material both for therapeutic care and for research?

Baroness Thornton: My Lords, I am happy to join the noble Lord in congratulating and commending the Anthony Nolan Trust as the pioneer in this area. The Government support and are developing a properly funded strategy with the NHS cord blood bank, which already exists. We will be in discussion with the Anthony Nolan Trust about how we make sure that we co-ordinate, although I want to put on the record that with regard to finding donors of bone marrow, the trust and the NHS bank work together seamlessly and in a completely co-ordinated fashion.

Baroness Tonge: My Lords, the Minister will be aware that the collection sites for cord blood, which is so valuable in treating leukaemia and not just providing an alternative to stem cell research, are in London only. Will she give us an assurance that she will help the Anthony Nolan Trust to ensure that collection sites are spread throughout the United Kingdom?

Baroness Thornton: My Lords, the proposals for the policy and expansion in this area are under discussion. It is an important area because approximately 40 per cent of the donations to the NHS cord blood bank

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derive from ethnic-minority mothers, therefore greatly improving the chances of finding a match that could lead to transplant. The Royal College of Obstetricians and Gynaecologists and the Department of Health are fully engaged with that discussion, and we hope that we will have some announcements to make fairly soon.

Baroness Howarth of Breckland: My Lords, in the light of the Minister’s comments on hard-to-reach groups, particularly those from black and ethnic-minority communities, what are the Government doing to encourage those groups to come forward? This is a problem right across not only bone marrow but organ transplant issues.

Baroness Thornton: My Lords, I thank the noble Baroness for that question, because she is absolutely right. Over 90 per cent of Caucasian patients can find a match on bone marrow or cord blood registers which could lead to transplantation. That figure falls to 30 to 40 per cent for ethnic-minority groups. The NBS has introduced the one blood campaign to attract more people from BME backgrounds to become blood donors and join the bone marrow transplant register. We have endorsement from the International Islamic Propagation Center, reassuring Muslims that it is acceptable to donate blood. We have partnerships with a number of organisations to work with communities at a local level. A series of short films has been screened on Channel 4 and, under Section 64, we are giving funding to the Afro-Caribbean Leukaemia Trust with the purpose of raising the number of black and ethnic-minority communities donating to the register.

Lord Walton of Detchant: My Lords, does the Minister accept that not only does the Anthony Nolan Trust deserve warm congratulation but so do the Medical Research Council and the Wellcome Trust, because they are collaborating in this tripartite arrangement for establishing the cord blood bank, which leads the world in work relating to transplantation and stem cell use in such processes?

Baroness Thornton: My Lords, as ever, the noble Lord tells your Lordships more than I could possibly do. He is completely correct.

Baroness Masham of Ilton: My Lords, is the Minister aware that the Anthony Nolan Trust searches for tissue worldwide and is the hub of Europe? Does she agree that it is an excellent example of a charity working with the National Health Service?

Baroness Thornton: My Lords, the noble Baroness is completely correct. All three separate registries in the UK—the Anthony Nolan Trust, the national registry and the Welsh registry—are linked to a worldwide bone marrow registry. All three have reciprocal arrangements for seeking matches. We have the third largest number of bone marrow donors in the world behind the USA and Germany, and we are helping to lead the world on these issues.

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11.21 am

The Earl of Sandwich asked Her Majesty’s Government:

Lord Tunnicliffe: My Lords, DfID has provided £60 million of humanitarian assistance to northern Uganda since 2006. In 2008, we provided a further £5.1 million to address humanitarian needs. DfID is working with the Government of Uganda and other donors to review what more needs to be done to support recovery in the north. Support for recovery work will be a priority for DfID in Uganda as humanitarian needs give way to recovery assistance.

The Earl of Sandwich: My Lords, noble Lords will not need reminding of the atrocities committed by the Lord’s Resistance Army in Uganda against families and young children over many years, during which 90 per cent of the Acholi people were displaced from their homes. We are only a few years from that now, with a fragile peace. Four out of 10 people are still homeless. Poverty is twice as bad in the north as it is in the south. Uganda is a favoured country. I acknowledge that the Minister is explaining on behalf of his Government what we are doing for the general government recovery plan, but what can we do to help the communities, voluntary organisations and the churches that have struggled so hard to achieve this peace?

Lord Tunnicliffe: My Lords, we agree that the reconstruction effort in the north should be given priority and we continue to press the Government in Uganda to give priority to solving the problems in the north. The Ugandan Government have allocated additional resources through their budget for the peace, recovery and development plan and have clearly indicated that recovery is a priority. We are working with international donors to consider joint ways of funding the plan and its implementation. Further work is needed to clarify details of the plan so that donors can agree medium-term funding. Discussions with the Government are under way to clarify that.

Lord Howarth of Newport: My Lords, given all the evidence that it has suited President Museveni politically over many years that conflict, suffering and political disablement should persist in northern Uganda, how confident can my noble friend be that the Government of Uganda are now genuinely committed to peace, reconciliation and reconstruction and that it is appropriate that our Government should provide humanitarian assistance by way of budget support to the Ugandan Government?

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