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Health: Dentistry

Volume 687: debated on Tuesday 21 November 2006

asked Her Majesty’s Government:

How many of those dentists who previously provided National Health Service dental services have not signed the new National Health Service dental contract; and whether there is sufficient access to National Health Service dental treatment for all.

My Lords, there were 1,051 cases, representing about 4 per cent of NHS dental services, where dentists chose not to take up new NHS dental contracts in April 2006. Most of these contracts are likely to have been for individual dentists, but some may have been for practices covering more than one dentist.

At national level, the new dental services commissioned by primary care trusts since April already exceed the level of services associated with those 1,051 contracts. So far, the evidence from the dental reforms implemented in April 2006 strongly suggests that the NHS is now much better placed to improve access to services.

My Lords, I thank the Minister for that reply. Is he aware that the new index of treatment is greatly restricting orthodontic treatment to straighten children’s teeth, and that at least 20 per cent will no longer be eligible for it? Those eligible have to wait up to three years for treatment. Is the Minister aware that there is an optimum moment at which you treat a child’s teeth to straighten them, and that beyond that timescale it is more difficult for the child and more expensive because it prolongs the treatment needed? What can be done to improve the orthodontic service, which used to be available in simple cases from general dentists but is now only available from specialists?

My Lords, I have a slightly different view. In the past, the availability of NHS orthodontic services, like other dental services, has depended on where dentists chose to set up business. That has led to growing inequalities in service levels around the country. The new commissioning arrangements we introduced in April enable PCTs to design and promote high-quality treatment and fairer, more consistent assessments of children’s need for orthodontics. It will take time for that to have an effect, and there are undoubtedly problems in some areas with children’s access to orthodontic services, but the new arrangements will stop the deterioration that was happening under the old arrangements.

My Lords, on 1 November the NHS Primary Care Contracting Group revealed that patient charge revenue from dentistry was less than expected, which, it said, could be because,

“an increasing number of charge-payers are moving to private treatment”.

What is the shortfall in patient charge revenue expected to be in this financial year, and what are PCTs that face a shortfall expected to do, other than commission less NHS dentistry?

My Lords, it is a bit soon to see what the full-year effect will be of the changes in charges. It is far too early to say what the final income level will be. The new contractual arrangements only took effect on 1 April, and there are always time lags before the reporting of charge income builds up to normal levels. We need to wait a bit longer and see.

My Lords, does the department have a system in place to monitor the effect of the basic charge of £15.50 for basic oral hygiene advice? If such a review were to show that there was an increase in preventable oral disease, would the department have a plan in place to tackle that?

My Lords, we have established an implementation review group made up of representatives of patients, dentists, the NHS and other stakeholders. The group is reviewing the impact of the reforms, including the charges, to check that they deliver their intended benefits for patients. Where necessary it will recommend ways of improving the new system.

My Lords, does the Minister agree that the new contract has exchanged the old drill-and-fill treadmill for another treadmill driven by targets? It is not clear to my profession that anything has been done at all to create better access and improve quality of care.

My Lords, I find it astonishing that I regularly come here to be told that we should go back to what now seem to be the halcyon days of drill and fill. The truth is that we have responded to what the profession said critically about the old system. We put in place a new set of arrangements that give far more emphasis to oral health and enable PCTs to keep the money to contract the services when a dentist decides either to give up NHS work or to move to another area.

My Lords, can the Minister tell us to what extent titanium implantology techniques are being performed in the NHS? This system is growing rapidly in the private sector. What numbers have been dealt with in the NHS?

My Lords, I am afraid that the Minister cannot tell the noble Baroness the answer to that question but he will certainly make inquiries and write to her.

My Lords, will the Minister confirm that more than 2 million patients are seeking NHS treatment, to which they cannot get access?

My Lords, we are aware that a number of people cannot get access to NHS treatment. The number of units of dental activity commissioned under the new contract exceeds the number provided under the old system which ended in April.

My Lords, if this new general dental contract is so good, why have so many dentists opted out of the National Health Service entirely?

My Lords, as I said in my original Answer, 4 per cent of NHS dental services patients have been affected as a result of dentists not signing the contract. That has been more than compensated for by the contracts that PCTs have let to new and additional dentists. In many parts of the country we have good evidence that the supply of dental services has improved. Leicestershire County and Rutland, Lincolnshire, North Cumbria, west Norfolk, Milton Keynes, and Oldham are just a few samples, and I could go on.