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Figures released two weeks ago by the NHS Information Centre showed that not only had access to NHS dentistry not improved, but a million fewer adults and more than 200,000 fewer children have been able to access an NHS dentist in England since the contracts’ introduction—that figure being on top of the 2 million who wanted, but were unable, to access treatment before the new contract started. That leaves the Government even further away from their 1999 election promise of full access to an NHS dentist by September 2001.
In July, the Commons Health Select Committee concluded that, as measured by the department’s own success criteria, the new contract had failed to improve access to dental services or to create a more preventive service. It concluded that it was extraordinary that the unit of dental activity payment system was neither piloted nor tested. The report also noted the variable quality of commissioning of dental services by PCTs, and criticised some of the UDA targets as unrealistic and in need of urgent review. It also commented that an improvement in financial forecasting of dental charge revenue was needed to address their 2006-07 overestimate of £159 million, which resulted in PCTs having to cut dental services or divert money from other areas to make up the shortfall.
The British Dental Association, which represents some 20,000 dentists, has explained that the new contract is too target-driven, with a focus on treatment rather
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A report in the Times on 25 November highlighted the possibility that NHS dentists will be required to pay back some £120 million to the health service because they were unsuccessful in reaching the targets set by commissioners. Nearly half of dental practices fell short of their targets, and individual practices are likely to have to repay tens of thousands of pounds. This exerts a destabilising influence on dental businesses, whose partners will rely on their NHS revenue to invest in the equipment or resources necessary to treat their patients. It must be remembered that all capital, consumable and staff costs are funded within those UDA targets.
PCTs must provide more flexible contract arrangements and be supported by SHAs in the development of dental health strategies, the collection of local oral health data and improvement of performance management. Dental commissioning should not be viewed as low priority, and I support the Health Select Committee’s recommendation that the department and SHAs should clarify how they intend to improve this performance management.
The noble Lord, Lord Darzi, in his review High Quality Care for All, recognised the importance of dentistry in primary care and noted that access to NHS dentistry is still a problem. He stressed the importance of the delivery of preventive, high-quality care and recognised that target-driven systems are not the way forward. I hope that the noble Lord will be able to address the profession’s great concern over the report’s aspirations and the general concern over the reality of NHS dentistry under the current contract. The Minister set out a commitment to continuous improvement in the quality of care received by patients, noting the recent consultation on the role of the Care Quality Commission in regulating the safety and quality of medical and dental practices, and pledged to spread the Quality and Outcomes Framework approach, noting that some PCTs were already developing “quality scorecards” for dental services.
I welcome the Government’s support for fluoridating water supplies in conjunction with a general oral health strategy, but regret that proposed new legislative options for strengthening tobacco control may now only apply to display rather than use. I am sure that the noble Lord will let me know if that is incorrect. Tobacco use is the leading cause of oral cancer in the UK and, despite improvements in survival rates for many cancers, continues to kill some 50 per cent of those who develop the disease within five years of its detection. As well as the well publicised issues of making tobacco less appealing and less available, dentists must be provided with the time to build trusting relationships with their patients so that they can offer preventive health advice and support—time to explain the importance of not smoking, not drinking to excess,
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Looking forward to 2009, I hope that dentists will see a more constructive dialogue with the Department of Health. Progress must be made in the development of new models of effective and innovative commissioning of dental services with a more flexible contract, which, as I have said, should be amended to make way for the more preventive dental health service that I have explained. It is also important in 2009 that steps are taken to guarantee the future of dentistry—the future of aspiring dentists currently studying in, or contemplating application to, dental school. Expansion of dental education in recent years, whether it be the increasing number of students or the opening of new institutions, means that the already stretched pool of dental academics has come under further pressure. The number of dentists opting for academic careers will need to be carefully monitored to ensure that the pool does not diminish to the extent that the quality of dental research and teaching are jeopardised.
In conclusion, I am sure that the Minister will join me in welcoming the formation earlier this week of an All-Party Group on Dentistry, to be chaired by Charlotte Atkins. It is the group’s intention to monitor the progress of the Health Select Committee’s recommendations for NHS dental services while investigating and raising awareness of oral health issues in general.
3.05 pm
Baroness Howe of Idlicote: My Lords, it is a pleasure to take part in the diverse range of debates on the gracious Speech. I shall be concentrating on the children, skills and learning Bill. I want first to emphasise the importance of ensuring that, whatever resources are spent, they benefit all our children, especially the most deprived, and develop the full range of talents that we need in our country.
This Government, with their number one priority of “education, education, education”, have already achieved considerable progress for children from deprived or chaotic backgrounds, with initiatives such as Sure Start, children's centres and so on. The Government certainly also deserve congratulations for their Children and Young Persons Act. That will ensure that a far higher priority is given to the education and well-being of looked-after children, whose lack of educational achievement has, frankly, been a disgrace under successive Governments.
However, on the preventive side, there is certainly more that can still be achieved by early help and support for families. UNICEF’s report today, mentioned by the noble Baronesses, Lady Massey and Lady Walmsley, is critical of the UK’s low standing among developed nations—a view which, I know, the Government reject. Nevertheless, the report makes some telling points. Above all, we need to prevent the still cascading waste of young people's talents. All too often this can develop into a spiral of underachievement and end in a churning life of crime. I will return to that issue later.
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The Leitch report has rightly been seen as pivotal in convincing the Government of the need for significant additional educational action and, in particular, the need to raise the school leaving age compulsorily to 18. Leitch demonstrated, beyond argument, the huge gap that has already opened up between the education and skills levels achieved in the UK and those of competing countries such as the USA and Germany. Leitch showed that, for the UK to improve its competitive position, it would require an increase in the percentage of people with level 4 skills to at least 40 per cent by 2020, compared with our fairly appalling 29 per cent reached in 2005. But with a number of countries on track to achieve well beyond 40 per cent by 2020, and another, the USA, already at 40 per cent, reaching that level 12 years from now will still leave the UK well behind. Indeed, just to be competitive with other countries we need to be committed to achieving a minimum of 45 per cent at that level.
Those who reach back to the war years may remember the school year beginning with the confident singing of “There'll always be an England”; equally, we might sing with even greater confidence, as our parliamentary year begins, “There'll always be an education Bill”. There certainly has been one ever since I joined your Lordships’ House. Indeed, as has been said from these Benches, the Education and Skills Bill that we have just enacted would not make sense without the Bill for children, skills and learning foreshadowed in the gracious Speech.
Your Lordships will be delighted to see that my noble friend Lord Dearing, who has so much to give to this whole field, will be speaking shortly. As noble Lords may recall, he and I have a continuing concern that far more adequate provision should be made to remedy the underinvestment of the past, which has resulted in the serious skills deficits of people already at work.
Consistent with that, I particularly welcome action in the proposed Bill to respond to the needs of all our children and young people, and to see them set as learners for life early on. Full details of the new Bill are not yet published. The noble Lord, Lord Darzi, told us part of the story and I hope that we will hear a little more when the noble Lord, Lord McKenzie, replies.
To that end—I hope that this is the Government’s intention—I want to see that children’s trusts are able to deliver the Every Child Matters agenda by putting the children’s trust boards on a statutory footing so that they are able to provide a closely integrated and effective service which draws all the relevant players together.
I should also like to know more about what the Government have in mind for children’s Sure Start centres. I think it has already been said that they are to have a statutory basis, and perhaps that can be confirmed. Will the duties of local authorities include ensuring there is a sufficient number of these centres to meet local needs—again, I stress, especially in the most deprived areas?
Then there is nursery provision—the entitlement of free education for the nought to five year-olds. Will statutory funding now be available for the private,
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I move on to the young people who are heading for trouble or who are, sadly, already in trouble. I start from the position of fully supporting, as have several noble Lords, the local authority’s role in securing relevant education for all those in juvenile custody, of whom there are far too many. However, there must be no doubt that ultimate responsibility for securing effective delivery of that education lies with the local authority, and in future it must have the priority that we have sometimes seen lacking in the minds of prisoners, prison staff and even prison governors. In future, there must be no question of working in the prison kitchen and getting paid for it, when acquiring basic literacy and numeracy skills and/or beginning an apprenticeship are far more essential if there is to be any hope of post-prison rehabilitation.
Of course, that will not happen without clear lines of accountability and real motivation in prisons and in partnerships with local employers and the third sector. Equally, all this must be backed by a duty on local authorities to promote the individual young person’s educational attainment. As I mentioned earlier, we must be no less concerned with effective intervention before a youngster gets into trouble, and we must provide better arrangements to get them back on track. However, above all, we need to address the problem effectively in the parent schools, drawing on what I hope will be statutory behaviour and attendance improvement partnerships with the full support and active involvement of the head teachers. There must be committed ownership of this kind if they are to deliver their potential, and it must include the constructive involvement of parents. We must see that they, too, get support and encouragement in engaging in, and sharing ownership of, the problem.
I agree with both Leitch and the Government that we need a demand-led education and skills system for the post-19 group. However, once an individual who has clearly been failed by our education system realises the importance of acquiring the skills that are necessary for today’s employment, we owe it to that individual to provide them either free or at the lowest possible price that we can afford, whenever they wake up to the need for those skills. With the current chaotic economic situation and rising unemployment, when the vast majority will be unable to find unskilled work, the Government should put far more resources into this kind of upskilling.
In the longer term, I hope, too, that we will be able to provide the many academic or practical courses that are being cut back for everyone but which particularly benefit older, often semi-retired people. An older generation encouraged to enjoy their retirement by either upskilling for pleasure or acquiring the necessary
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3.16 pm
Baroness Warwick of Undercliffe: My Lords, it is a pleasure to speak in the debate on the loyal Address covering education, health and culture. In doing so, I declare my interest as chief executive of Universities UK.
The loyal Address mentioned three Bills that will have some impact on higher education, and it is on this that I want to focus my contribution to the debate. I shall remark briefly on each of them but I should like to set those remarks in context. This House needs no reminding of either the economic challenges that we face in this country or the role that our universities can play, with the right support, in ensuring the UK’s prosperity in the long term. Universities are the engines of the knowledge economy and creators of cultural wealth and social capital. The central role that they play in meeting some of the grand challenges of the 21st century means that ensuring their continued strength must, and should, be a national priority.
The Government have made a substantial investment in supporting universities in science and research, and as this investment has flowed, the UK has continued to improve its research performance; for example, increasing its share of the world’s most influential papers from 12.9 per cent to 13.4 per cent in two years.
Since 2001 income from business through consultancy contracts has increased by 128 per cent and the total turnover of all active university spin-outs by 240 per cent. All of this shows that UK universities are a unique national resource. We must ensure that this resource can be properly utilised to help the country in the current economic downturn.
The noble Lord, Lord Baker, referred colourfully to the range of issues we are debating today. I want to extend his net a little and draw in some of the comments made by noble Lords on business and the economy on the third day of the debate on the Queen’s Speech. So much of what my noble friend the Minister referred to in his opening speech today is linked to the emphasis on Monday on the maintenance of a highly skilled, highly productive workforce prepared for the future. This is the inspiration driving the noble Lords, Lord Baker and Lord Dearing, in their academies initiative. I, too, am delighted to see the noble Lord, Lord Dearing, who will speak today, looking so well.
It is this imperative that drives the Government in the education legislation to which we are referring today. For example, the Government wish to ensure that professionals made redundant as a result of the current economic circumstances should have opportunities to enter, or in many cases re-enter, higher education. The commitment to supporting people to re-enter education lies at the heart of the children, skills and learning Bill, which seeks to introduce an entitlement to an apprenticeship to all suitably qualified young
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However, it would be remiss of me not to point out that this commitment would be most effectively supported by reconsidering the current policy on equivalent and lower level qualifications, known as ELQs. It seems odd that at the same time as arguing the need for more higher education, particularly for those faced with redundancy—the noble Baroness, Lady Howe of Idlicote, referred to this—the Government have effectively frozen additional student numbers on which that expansion is likely to depend, although I acknowledge that that will not affect provision that is co-funded by employers.
With reference to the children, skills and learning Bill, will the Minister expand on that definition of “suitably qualified”? Will the apprenticeships scheme include progression to higher education so that apprentices could achieve foundation degree status or even go on to obtain higher degrees? Also on this subject, will the Minister clarify the Government’s intentions to offer workers the right to take time off to train? Will this entitlement also include higher-level qualifications?
I mentioned earlier the role that universities could play in assisting the economy. I am pleased to inform the House that universities have responded with a will to offer help to small and medium-sized businesses suffering in the downturn. Universities UK, the Higher Education Funding Council for England, and GuildHE have produce Standing Together, which highlights the central role of universities in supporting businesses and individuals with skills, advice, knowledge transfer and know-how. The leaflet offers practical support by giving the contact details of what is known as the front door for business at every higher education institution that is a member of either GuildHE or Universities UK. Of course, many universities are adding to the health and wealth of the economy through their own spin-out companies, to which I referred earlier.
The second Bill I wish to refer to briefly is the borders, immigration and citizenship Bill. International students and researchers contribute extensively to the academic, cultural and economic health of our country. While universities are as committed as any other sector to ensuring the security of our country, they are also trying to balance this with the need to remain competitive with other countries in attracting the best brains—the best students and researchers—to this country. It is vital, therefore, that when any immigration measures are introduced, the impact on higher education as an attractive and welcoming place to study and indeed as an export earner is not compromised.
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My final remarks relate to higher education and the health service. The health Bill sets out to highlight patients’ rights and the quality of care they can expect to receive. Central to delivering that is the training and education of medical, dental and nursing staff and those in allied health professions. Most universities are involved in providing training or conducting research for the NHS in some way. However, it is clear that in the synergy between the health service and higher education, particularly in relation to workforce planning and commissioning and the multiprofessional education and training levy, known as MPET, there needs to be better communication between the Department of Health and the Department for Innovation, Universities and Skills. I hope that the Minister who opened the debate, who has feet in the academic and the government camps, will be able to take these points back to his department.
Universities already play a crucial role in the development of our workforce nationally and internationally and are key to helping the country through this economic downturn. I look forward to the debates that will take place on the Bills within the loyal Address and hope that noble Lords will join me in recognising the importance of our universities and the necessity to ensure that they have the right public support to meet the challenges that face us.
3.25 pm
Lord Lucas: My Lords, I start by picking up on something that the noble Earl, Lord Listowel, talked about. Much of what he said about children’s homes applies equally to prisons, and given what was said by the noble Baroness, Lady Howe, and by the right reverend Prelate the Bishop of Ripon and Leeds, I can promise the noble Baroness, Lady Morgan, an interesting time on that part of the Bill when it comes before us.
The particular remark I want to pick up on is what the noble Earl said about practice in children’s homes. He said, in effect, that when a child is crying in the night the continentals reach for the child and the English reach for the form to fill in. That is something that I see in schools, and it is immensely destructive. We have done a lot in our quiet way—I am sure that it was totally unintentional—to undermine the courage of institutions and individuals involved in education. The most shattering example of that was when the Royal Society sacked Professor Michael Reiss, who had done nothing wrong. The terror of the newspapers felt by the Royal Society was such that it had to sack him. One sees that quite frequently in schools. Tim Hastie-Smith was recently sacked twice in two days and had done nothing wrong. It was purely a lack of courage in the institution that he served and the one that he was about to serve. If we are to expect individuals to have courage, it is important that institutions also have courage and learn not to be too bowled over by what appears in the press.
Since Parliament has become so weak and the press has become so short of money, it has become easy for people to run headlines into the press to achieve effect, and we have all become frightened of the consequences of those headlines. A couple of noble Lords mentioned
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“45% of people disagreed with the statement 'People refer to children as feral but I don’t think they behave this way’.”
Why was the question asked in such a strange and convoluted way? It was so that people did not understand it and so that if they even half agreed, they contributed to the 45 per cent. If the survey had asked the honest question, “Do you think children are feral?”, it would have received a much lower percentage.
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