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Dental Services

Volume 131: debated on Thursday 14 April 1988

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4.11 pm

I beg to move amendment No. 60, in page 6, line 19, leave out 'and'.

With this it will be convenient to discuss the following amendments: No. 59, in page 6, line 27, at end insert:

'(c) The Secretary of State shall be required to provide dental inspection for pupils in attendance at schools who have opted out of local education authority control'.
No. 61, in page 6, line 27, at end insert:

'; and
(c) the following paragraph shall be added following subsection (2) (services the Secretary of State has power to provide)—
'(3) The Secretary of State shall report annually to parliament on the state of Dental Health and on trends in the incidence of dental disease in each health district, indicating in each case whether the corresponding health authority provides a school dental service.'.'.

Amendment No. 60 is merely a paving amendment. Amendment No. 59 makes it clear that the dental inspection service should be available in all maintained schools, not merely those under the control of local education authorities.

It seems to be the case that the Government's left hand does not know what their right hand is doing and that the Secretary of State for Social Services is not talking to the Secretary of State for Education about the Bill's effect. By moving an amendment to reimpose the duty in this case we are offering the Government an opportunity to admit that they have made a mistake.

Amendment No. 61 is important and is designed to allow Parliament to monitor the effect of the Government's change of policy. We fear that the effect of removing the present duty upon the Secretary of State will be that the dental health of children will deteriorate, or at least will not improve as fast as would otherwise be the case.

By keeping a close eye on what is happening we shall be able to see if that is so. I am working on the assumption that if the Government, or any future Government, discover that the policy is, as we fear, having a damaging effect, they will take action to reverse it.

I would like an assurance from the Minister that such action would be taken should there be any damaging effects. If I receive that assurance, I shall not seek to divide the House.

The Parliamentary Under-Secretary of State for Health and Social Security
(Mrs. Edwina Currie)

I recognise the interest and concern of the hon. Member for Southport (Mr. Fearn) and his colleagues in the community dental service, which we welcome.

Clause 7 amends existing legislation, as the hon. Gentleman has said, to remove the Secretary of State's duty to provide dental inspections and treatment for schoolchildren and replaces it with a power to enable the Secretary of State to provide those services. It also introduces an equivalent provision for Scotland. As I am sure the hon. Gentleman realises, the debate takes place against the background of a dramatic improvement in the nation's dental health, and, in particular, in the dental health of our children.

The discussion document on primary health care set out the need to reconsider the role of the community dental service. Its historical role of providing routine treatment for schoolchildren had once been vital at a time when general dental practitioners were struggling to cope with the demand for their services some 40 years ago in the face of rampant dental disease.

But the responses that we received to the discussion document agreed that emphasis on that role was no longer so appropriate, given the welcome increases over the years in dental manpower and the improvements in our population's dental health. Recent surveys show that the majority of schoolchildren already attend their own dentists for check-ups and the clause is intended to eliminate the undesirable situation where two services are duplicating provision for the same group.

Nevertheless, we see an important continuing role for the community dental service. There are areas, even in those health authorities where general dental practitioners are in good supply, where children are not receiving the best dental care. As we announced in the White Paper "Promoting Better Health", there is a need for increased effort in screening and providing treatment, help and advice in those areas. Therefore, the clause retains the power for inspections and treatments to be carried out where necessary.

4.15 pm

In line with our objective of providing better health, the clause also gives an explicit power to provide dental health education, where the law is rather vague at the moment. We also see a need for the community dental service to monitor the dental health of the general population, not just of children, and to provide services for groups that have difficulty in gaining access to dental care, such as the elderly or the mentally handicapped, who often have considerable difficulties in obtaining the care that they need from their general dental practitioner.

We shall also expect the community dental service to run group prevention and health education programmes for groups of the population, again, other than just for children. There will not be a cut, but we expect to see a major shift of emphasis by the community dental service to reflect the pattern of need in the community now and in the future, not just the pattern of 40 years ago.

Over the years I have repeatedly raised issues that are the concern of the British Dental Association. What is the BDA's attitude to the Government's attitude on this?

I was just coming to that. The British Dental Association has announced that it supports our objectives for the community dental service. It stated its view that they could be achieved without legislative change, but the advice that we have received is that that is not so. If we did not make the change that we have in this clause, we would find ourselves as a Government, on the one hand retaining legislation requiring routine dental inspection and treatment of schoolchildren, and, on the other hand, issuing guidance instructing health authorities to ignore their legal duty by redirecting resources away from that routine treatment of children towards other groups who now have genuine difficulties in gaining access to dental treatment. That dispute with the BDA is a technical one and our discussions with it on this matter have been completely amicable.

Apart from that, we are in close accord with the profession and we shall be discussing with it further the exact terms of guidance to be issued to the health authorities on the future role of the community dental service. I am confident that we shall agree on the outcome of those consultations.

As the hon. Gentleman has said, amendment No. 59 attempts to make it a legal duty that children in opted-out schools be given dental inspections. If the intention was simply to ensure that such children are covered by the general legislation on state schools, I would have complete sympathy with the hon. Gentleman. However, I can reassure him that the Education Reform Bill, which is now going through the other place, is the appropriate vehicle for the discussion of that provision. It already contains a section in schedule 10 which ensures that such schools will continue to be covered. On that basis, the amendment is unnecessary.

I share the views expressed in amendments Nos. 60 and 61 about the need for an annual report and full information. However, an annual report on the state of the nation's dental health is already published in the report of the chief medical officer. The data on dental health analysed by regions are collected every other year and are published in the general household survey. I shall ensure that the hon. Gentleman, who is the spokesman on health matters for the Social and Liberal Democratic party, receives a copy of both, but they are in the Library and always have been.

The fact that we collect and publish that information in the way that I have described demonstrates that we agree with him. I can assure him that we use the data in precisely the way that he has prescribed and I am sure that that will meet with his approval.

Having received an assurance that it will still be monitored and that children in deprived areas will fall into a routine, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.