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NHS Dentistry

Volume 462: debated on Tuesday 26 June 2007

Since April last year, primary care trusts have commissioned a growing volume of new dental services. Once those services are fully up and running, approximately 500,000 patients will gain access to NHS dentistry.

In the past 12 months, the number of adults seen by an NHS dentist has fallen by 63,000. The latest figures show that 45 per cent. of the population have not seen a dentist in the past 24 months—a figure that has remained stable over time. How can the Secretary of State claim that the new contract has increased access to NHS dentistry, and when will she implement an urgent review of the system?

In the hon. Lady’s constituency, some 14 of the 33 practices in the PCT are accepting new patients. We know that the number of units of dental activity commissioned has increased from 77 million last April to 78 million; some of them are yet to be provided, but they have been commissioned. We know that NHS dentistry is expanding, and that new contract is working. We have a review group to ensure that we continue to discuss the implementation of the contract with the profession and representatives of patients. The hon. Lady is quite wrong to say that the new contract is not making a difference. It is.

In the past couple of months, I have had 7,000 health survey responses returned to me, and 70 per cent. of respondents said that getting access to an NHS dentist was extremely difficult. Furthermore, according to an orthodontist I met yesterday, the situation will get worse when the contracts expire in 2009. What discussions has the Minister had with PCTs about provision after 2009? At what point would she expect PCTs to inform the dentists of their plans, so that dentists can prepare their own investment plans and budgets for post-2009?

I am not saying that the situation has been fully resolved—far from it. What I am saying is that the new dental contract is proving that we can increase access to NHS dentistry. As I said, already approximately 500,000 more people are able to get access to an NHS dentist. One thing is absolutely clear: if an NHS dentist leaves the NHS, we now have the money at local level to recommission NHS dentistry. That is the difference between the old contract and the new one—now, local people have power to recommission at local level.

My right hon. Friend needs to stop making excuses for the primary care trusts. She has given them the money and they have it, but they are not providing the dentists. We do not have NHS dentists. The waiting lists are growing and there are no vacancies for the people in Chorley. Please get a grip: make the PCTs spend the money and make them provide NHS dentists. They are letting her down.

The PCTs are not allowed to spend the money allocated to dentistry on anything else; they cannot switch it to other services. We work closely with the PCTs, through the strategic health authorities, to make sure that if an NHS dentist leaves the NHS, the PCT recommissions at the local level. If my hon. Friend knows of examples in which that is not happening, I am more than happy to meet him to discuss the issue.

Does my right hon. Friend agree that denturists, the highly skilled people who make dentures, particularly for older people who may not have been able to look after their teeth as well as people can now, are an important facet of dental services? I am deeply grateful to her for the many letters that we have exchanged, and she is to see me and one of my constituents, a denturist, about the issue. Will she say whether there might be any changes to the rules to allow people direct access to denturists, or any other changes that might be helpful to many thousands of people?

Obviously, the issue of denturists being able to treat patients directly has been discussed. It is difficult, because the regulations insist that proper training be undertaken. If people who had not undertaken that training practised directly on patients, it would be illegal. We have had to consider that carefully. It is important that proper training be available to people performing that health care task.

I clearly have an interest in the subject. People outside the House in NHS dentistry do not quite recognise the glorious oil painting that the Minister just painted. Will she tell the House what changes she has introduced through the implementation group that she set up at the beginning of the contract—or was that just a sop to keep the dentists quiet?

The issues that we are considering, particularly as we come to the end of the first year, have to do with the banding system and units of dental activity. We are looking carefully at whether dentists are able to meet the targets that have been set relating to units of dental activity. The evidence is that the vast majority have been able to meet the requirements of the contract. The group is a way of keeping an open dialogue about any difficulties that occur. I will write to the hon. Gentleman. On a number of occasions, we have been able to issue further guidance to PCTs about some of the issues raised through the review group.

Milton Keynes primary care trust has used the new system very effectively to open new dental surgeries and completely clear the waiting list. Will the Minister take steps to make sure that that good practice is spread to those PCTs which do not seem to be performing as well as that PCT does?

My hon. Friend is absolutely right. There have been good instances of PCTs taking real action to recommission services and really prioritise dentistry. Lincolnshire, which is represented by the hon. Member for Grantham and Stamford (Mr. Davies), has taken real steps forward in recommissioning dentistry, and I am sure that he appreciates the works of the Labour Government.

The Minister may not be aware that the incidence of tooth decay among under-fives in my constituency is above the national average. What specific measures is she taking to ensure that some of the resources that she has described this afternoon will be targeted on the dental health of that important group?

We have introduced a number of initiatives, such as Brushing for Life, which works through schools. It is about teaching young children how important it is for them to keep brushing their teeth, using fluoride toothpaste. There are a number of public health initiatives that have been very successful. Obviously, local authorities and PCTs can now consult on the issue of fluoridation, which can in itself be very helpful in improving dental health.

Will my right hon. Friend congratulate County Durham PCT on the opening of the new Pelton Lane Ends NHS surgery in my constituency, as it not only offers provision for existing NHS patients but extends NHS provision to those of my constituents who were abandoned by the private sector?

My hon. Friend is quite right. At our meeting yesterday it was encouraging to look at the steps that the PCT has taken to deal with an area with poor access to NHS dentistry. The majority of people are on quite low incomes, so they could not purchase private sector dentistry. That is therefore a very good example of the way in which PCTs that prioritise dentistry can provide for many thousands of people care that has been severely lacking for some years.