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Health: NHS Dentistry

Volume 691: debated on Thursday 19 April 2007

asked Her Majesty’s Government:

How many dentists are now providing National Health Service dental care under the general dental services contract introduced in 2006; how much has been spent by primary care trusts on primary dental care provided by general practitioners since then; and how much has been generated in patient charge revenues towards funding this care.

My Lords, there were 20,887 dentists listed on NHS contracts at the end of December 2006. This is 1,500 more than in March 2005. Data on NHS dental expenditure and patient charge income for 2006-07 will be available later in the year.

My Lords, I thank the Minister for that reply. He may not be aware that I asked him an almost identical question almost exactly a year ago. Has he seen the Which? report which states that although there has been a slight improvement since 2005, the situation,

“is worse than the figures in 2001 … and … much worse than the Government’s 1999 pledge to provide access to an NHS dentist for all who want it”?

In particular, there is concern about the lack of access to emergency treatment, which leaves people in pain.

My Lords, I have seen the Which? survey, which does not give the whole picture since it does not show the patients already receiving treatment; it is concerned with patients looking for NHS dentistry. Clearly, there are still challenges in ensuring that all patients who require NHS dentistry receive it, but the new contract, which gives far more responsibility to local primary care trusts, is the best way to have a much more proactive approach to providing that. There are good examples. For instance, the local PCT in Cumbria has now commissioned 50,000 new places for NHS patients. This is the first year of the contract; we have just moved into the second year. We expect PCTs to learn the lessons and enhance patient services in the future.

My Lords, is the Minister aware of evidence that primary care trusts, which as he will know were very short of cash towards the end of the previous financial year, were diverting money away from dentistry into other services and therefore leaving patients untreated? Is he aware that that has been a widespread problem? I have had several reports of it.

No, my Lords, I am not aware that it is a widespread problem. The noble Earl is right to suggest that we have made it clear to the health service that deficits needed to be cleared by the end of the previous financial year, and that has been done. That has involved primary care trusts making some tough decisions. I reassure the noble Earl that the PCTs entered into contracts with individual dentists to provide services for the whole of that financial year, and PCTs must remain committed to such contracts and pay up those contracts that were agreed at the beginning of the financial year.

My Lords, does the Minister not agree that, despite all that he has said, the general public and the dental profession do not believe that the new contract is working? Will he undertake to initiate further discussions with the British Dental Association, the Dental Practitioners Association and other dental organisations to agree changes to the contract to finalise the new system, which dentists and patients hoped would provide NHS treatment for all who need it?

My Lords, of course my department will continue to meet the BDA and other dental organisations. A review group is also meeting on a regular basis to look at aspects of the contract. The contract is about moving away from the treadmill of the drill and fill procedures that dentists did not want to be so involved in; it is about providing incentives for more preventive work. We have just reached the end of the first year. It is early days, and it will take time to bed down, but I am encouraged that in many parts of the country it has worked well and particularly that primary care trusts now have the ability to deal with the access problems.

My Lords, the Minister will be well aware that the latest survey by the British Association for the Study of Community Dentistry has shown huge disparities in the standards of oral health across the country. The highest instance of decay was seen in Merthyr Tydfil, where 76 per cent of five year-old children have decayed, missing or filled teeth. How does the Minister think that a dental contract that thus far seems to have involved some 69 per cent fewer patients seeing an NHS dentist, including 11,000 children, will tackle that inequality?

My Lords, overall we see the figures for dentistry as being stable in terms of the number of patients receiving NHS dental treatment. We expect that to improve as the contract beds down. Regarding public health measures on oral health, I have always believed that water fluoridation is one of the most effective measures. I would refer to my own city of Birmingham in the West Midlands, where the city council many years ago—a Labour council—took the far-sighted decision to fluoridate the water supplies. The result is that in Birmingham we have half the level of dental decay among children living in similar demographic areas, such as Manchester, Liverpool and Yorkshire. I think that fluoridation really is the answer here.

My Lords, the noble Baroness said that the numbers treated were going down. The Minister said that they were stable—and the population is going up. Where actually are we in all of this?

My Lords, the figures I have suggest that 55.7 per cent of the population visited NHS dentists at least once in the two-year period ending December 2006, which includes a part period of the new contract. That is pretty stable—it was 55.8 per cent for the two years ending March 2006, when the contract started. So far there has been very little difference, but we think that we have a good foundation for improving access in the future.

My Lords, the noble Lord mentioned fluoridation. Dentists look after not only teeth but gums as well. In order to keep your teeth in your mouth, you have to have healthy gums. I am particularly concerned about the reports on children’s oral health. Is the Minister sure that any child in any part of the country who needs to see a National Health Service dentist can do so?

My Lords, of course the noble Countess is right; fluoridation is not the only answer, but it is a very important foundation. There are many other aspects of good oral health promotion, including sensible eating advice for children and adults. If patients, whether adults or children, have difficulty in gaining access to an NHS dentist, they should contact their local primary care trust, NHS Direct or access the NHS UK website. The NHS stands ready to help people who cannot gain access.