I beg to move,

That leave be given to bring in a Bill to amend the Video Recordings Act 1984 to extend certain provisions of that Act to video games and to make provision about the labelling of video games.

Video games have increasingly life-like graphics and antisocial themes. Their regulation has improved, but it has not gone far enough. The voluntary code must be made statutory and further safeguards put in place to protect our children.

Over the past two years, other hon. Members and I have campaigned to control the sale of video games to young people, following the tragic death of Stefan Pakeerah—a 14-year-old Leicester schoolboy who was brutally murdered. Stefan's parents believe that the perpetrator of that savage attack was influenced by the video game "Manhunt". Stefan's mother, Giselle Pakeerah, has been campaigning to ban the sale of the game. I pay tribute to Mrs. Pakeerah—a brave and courageous mother who, in her grief, could easily have let matters pass by doing nothing, but who started an impressive campaign on this issue.

Towards the end of 2004, Mrs. Pakeerah and I met the Prime Minister and urged him to tackle the menace of violent video games by examining the existing law governing the classification of such games and, in particular, labelling, and by requesting the British Board of Film Classification to take a more cautious approach. I am most grateful to the Prime Minister for his concern on this issue. Following the meeting, in December 2004, the Department for Culture, Media and Sport and the Department of Trade and Industry met representatives from the video games industry to consider the adequacy of existing provisions. Some new voluntary measures were introduced. New labelling for age restrictions is now twice the size it was a year ago. I welcome the industry's efforts in beginning to take action.

I am also grateful to the Secretary of State for Culture, Media and Sport and the Under-Secretary of State for Culture, Media and Sport, my hon. Friend the Member for Stalybridge and Hyde (James Purnell), who has responsibility for the creative industries, for meeting me to discuss their Department's continuing willingness to explore ways to strengthen such protection.

The concern about video and computer games is based on the belief that violent games are totally inappropriate for young children. Between the ages of seven and 17, children will play an average of eight hours of video games a week. However, despite recent voluntary steps, this aspect of children's entertainment is highly under-regulated. Moreover, the regulation that does exist is barely enforced.

The video games industry in the United Kingdom is widely and rightly seen as one of our many economic success stories. The latest figures show that the software development and publishing industry in the UK is worth £711 million. Most games on the market are appropriate for young players, but the few games that feature violence, crime and antisocial behaviour have led to concerns being raised. The Bill is not intended to censor the industry. However, we must recognise that it is our duty to protect our children from inappropriate influences such as violent video games.

The current trend in video games is for players to be the bad guys and act out criminal fantasies, earning points for attacking and killing innocent bystanders. In the forthcoming Rockstar video game "Bully", players take on the role of Jimmy Hopkins, a school boy at a boarding school. They get points for physically and psychologically tormenting other children. More than 50 Members have signed early-day motion 1172, which calls for the game to be banned.

The 2004 game "Grand Theft Auto: San Andreas" has been among the top 10 best-selling games for the past two years and has sold a total of 12 million copies worldwide, including 1 million copies in the United Kingdom in the first nine days after its release. The game contained a hidden code that could be unlocked by players and which introduced to the game scenes in which characters performed sexually explicit acts. Following campaigns in the United States, the publishers were forced to recall and rewrite the game to remove the hidden code.

Although those games are rated 18 for adult audiences, they are extremely popular among young people. This type of content is wholly inappropriate and unacceptable, but, regrettably, that is the path down which the games are heading. British research into the effects of video games has been inconclusive so far. A number of studies, including research published by DCMS today, have found no conclusive evidence that video games can influence children's behaviour. However, studies into the long-term effects of video games are in their infancy and are at best speculative. Due to ethical difficulties associated with exposing children to adult material, it is difficult to secure conclusive evidence either way—difficult, but not impossible.

On 25 January 2006, during Prime Minister's questions, I raised the findings of new research published by Professor Bruce Bartholow of the university of Missouri-Columbia last year, which shows that people who play violent video games become desensitised to violence and are more likely to commit aggressive acts. It is the first research to show that playing violent video games diminishes brain reactions to violent images. It shows a link between the playing of violent video games and a propensity to commit aggressive acts. Those who believe that violent video games have no effect on the person playing them are ignoring the facts. The link exists and should give us great cause for concern.

The implications of the research, which was published in the Journal of Experimental Social Psychology, are far-reaching. Every precaution should be taken to ensure that children are not exposed to games that will diminish their sensitivity to violence. Children need to be protected from violent games for this reason: although a child's morality continues to grow and mature as they grow older, they are still immature and lack the necessary capabilities to deal with the exposure to violence that these games give them. The warnings offered by the research need to be taken seriously and should urge us all towards cautionary, preventive regulations to protect our children.

At the moment, regulation is very confusing, as two rating systems are in use: the British Board of Film Classification, which rates about 2 per cent. of games, and the voluntary PEGI, or pan-European game information, system. The director of the Entertainment and Leisure Software Publishers Association, Roger Bennett, concedes that the ratings are not always clear. He states:

"BBFC ratings are on the front of games boxes, while ELSPA's are on the back. If a game does not have a BBFC rating, people sometimes assume it is suitable for children, forgetting to check the back."

Furthermore, a study by the Swiss firm Modulum showed that

"parents perceive age ratings as a guide but not as a definitive prohibition".

Current regulations are often ignored by retailers. An investigation for "Tonight with Trevor McDonald" in November 2004 uncovered the fact that children as young as 12 had managed to buy adult video games. Over two thirds of 11 to 14-year-old boys questioned admitted to playing video games with an 18 certificate. On camera, children between the ages of 12 and 14 were shown buying adult video games from Tesco, Virgin, Dixons, John Lewis, Sainsbury's and Asda.

Other countries have adopted a different approach. In Canada, in the European Union and even in the United States, action has been taken. This Bill will make it a requirement not only to have a larger sign indicating the certificate but to have an accompanying description of the content that led to the game being given that rating.

This is not about adult censorship; it is about protecting our children. We need to act now before it is too late.

Question put and agreed to.

Bill ordered to be brought in by Keith Vaz, Annette Brooke, Mrs. Betty Williams, Mr. Edward O'Hara, Mr. Elfyn Llwyd, Mrs. Iris Robinson, Jessica Morden, Miss Julie Kirkbride, Mr. Mike Hancock, Sir Nicholas Winterton, Mr. Stephen Crabb and Derek Wyatt.

Video Games

Keith Vaz accordingly presented a Bill to amend the Video Recordings Act 1984 to extend certain provisions of that Act to video games and to make provision about the labelling of video games: And the same was read the First time; and ordered to be read a Second time on Friday 12 May, and to be printed [Bill 136].

I must announce to the House that I have selected the amendment in the name of the Prime Minister and placed a 10-minute limit on Back-Bench speeches. May I also add that the amount of time available to Back Benchers will depend to a great extent on the restraint shown by the three Front-Bench spokesmen?

I beg to move,

That this House supports the achievement of good oral health through the provision of NHS dentistry; calls, therefore, on the Government to fulfil its commitment that everyone should have access to NHS dentistry; is alarmed that the British Dental Association regards the new dental contract as 'a shambles' and is concerned that many dentists will reduce their commitment to NHS dentistry; and further calls on the Government to withdraw the National Health Service (General Dental Services Contracts) Regulations 2005 and the National Health Service (Personal Dental Service Agreements) Regulations 2005 and immediately to re-open negotiations with the dental profession on dental services contracts which are piloted and linked to patient registration and capitation payments, support for preventative work and the achievement of good oral health.

In September 1999, the Prime Minister said that by 2001 everyone would have access to NHS dentistry just by calling NHS Direct. Six years after he made that pledge fewer people than ever are registered for NHS dentistry. In those six years we have seen queues forming outside the premises of NHS dentists who are opening up their registrations. We may not see that in future because the Government propose that people will not be able to queue outside NHS premises to be registered; they will have to register by letter or by telephone—queuing is too embarrassing. Indeed, the situation has now become so bad that the public are queuing outside private dentists.

Patients in Torbay are being told that they must not queue outside any new NHS dentist. I am advised that they have received letters informing them that it would be embarrassing for the primary care trust to have people queuing because it knows that so many people want dental treatment and that there are so few NHS dentists. Is that not outrageous?

It is outrageous.

I visited Torbay before the last general election and talked to the secretary of the local dental committee. If I recall correctly, the number of patients registered in south Devon was under 30 per cent.—among the lowest in the country. Indeed, the number in my constituency was also among the lowest in the country.

A Castle Point dentist and a local dental committee secretary, Mr. Foreman, states in a letter dated 21 January:

"Under the terms of the new contract our CACV has been reduced by some 80 per cent. from our historic NHS gross average."

Dentists in Castle Point do a great job and we must fund them properly. We must stop ill-thought-out cuts. Does my hon. Friend agree that the Government's policy is a shambles and will reduce the number of NHS patients?

My hon. Friend is absolutely right. It is not only me who thinks that the policy is a shambles. The British Dental Association also thinks that it is a shambles. The association said that Ministers conducted the contract negotiations leading to a new dental contract with "extraordinary ineptitude". It described it as a "shambolic process". It has been a shambles. Over recent years, dentists have reduced their commitment to the NHS because they have been on a treadmill of drill and fill. We have known for years that change is necessary. That was why the Conservative Government, before the 1997 general election, introduced legislation that established primary care trusts and personal dental services contracts.

The Government have pursued a new dental contract based not on new ways of working but on targets. They propose a target-driven process that does not recognise the needs of the profession or of patients.

My hon. Friend and the Minister might be interested in an e-mail that I received a few days ago from a constituent. It reads:

"Since I moved to Ashford some 40 years ago I have attended the same dental practice. Last Tuesday, after my six-months check-up, I was advised that due to Government contract changes I would not be able to make a new appointment."

That is what dentists believe and that is what their patients believe. Contract changes are driving people away from the NHS.

I am grateful to my hon. Friend for that intervention. His experience is the same as mine in Bar Hill in my constituency, where a dental practice has walked away from a new dental contract. That experience is mirrored throughout the country.

I thank my hon. Friend for visiting the town of Hornsea in my constituency. As he knows, it is an isolated rural town. It is the largest town in the country without an A-road into it. The threat, when he visited the town, concerned community hospitals. That threat still remains. However, there are three dental practices in the town, two of which have announced in the past week that, thanks to the Government's shambolic handling of dental contracts, they are leaving the NHS. Seven thousand fewer of my constituents are now registered with NHS dentists than before the Prime Minister's promise was made.

Order. I should have added that the length of interventions will have some impact on opportunities to participate later in the debate.

I am grateful, Mr. Deputy Speaker, but I am grateful, too, to my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) for making that important point. Apart from persistent inequalities in terms of dental outcomes and dental health, inequality is increasingly apparent in terms of access to NHS dentistry, all of which is a condemnation of the Government.

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How can I resist the hon. Member?

I am grateful to the hon. Gentleman for reminding us of a previous Conservative Government with his reference to funding issues. On the "Today" programme this morning, the Leader of the Opposition confirmed that it was his party's policy to introduce a third fiscal rule—the proceeds of growth rule—which would mean that spending would fall as a percentage of gross domestic product under a Conservative Government. Does the hon. Gentleman expect the NHS and dentistry to be carved out of that rule, or does he expect it to apply to them too? If so, public spending would fall as a percentage of GDP on dentistry services.

I am grateful to the hon. Gentleman, whose point comes from the bottom of page 2 of the Labour party briefing—we will see if we reach the rest of those listed. One would have thought that the hon. Gentleman could at least write his own interventions. We made clear before the election what we intended to do about dentistry, and our proposals would have made an enormous difference. I do not know whether the hon. Gentleman in his previous occupations had occasion to read "Proposals for modern oral health", which was published in October 2004 by the Conservative party, but before the election we set out proposals based on registration

"to encourage an ongoing relationship for patients with a general dental practice."

The Government, however, propose to abolish registration. We proposed, too, a shift from fee-based remuneration to capitation. The Government propose to retain an activity-driven system, instead of introducing a system in which finances are driven by the number of patients on a practice list. We proposed a low-cost monthly payment scheme for non-exempt adults—the Government propose to increase the charges for patients—and oral health promotion focused on children. The Government, however have enabled primary care trusts—and, in some respects, they have encouraged them—to refuse children for treatment and exempt adult contracts for dentists. Finally, we proposed an

"evidence-based schedule for NHS dentistry designed by the National Institute for Clinical Excellence".

At least the Government have begun to introduce that proposal.

Will the hon. Gentleman give way?

No, of course not. If the hon. Gentleman does not have anything original to say, I am not going to help him.

Will my hon. Friend include in his policies a commitment that the Government of the day should fund private dental care if someone is wholly unable to obtain NHS dentistry because none is available?

I am grateful to my right hon. and learned Friend, but I am not going to make that pledge. My objective, and the objective of the Conservative party, is to secure access to NHS dentistry for people in this country on an equitable basis. Inequalities of access have given rise to the need for a new contract. The purpose of the motion is to make the Government realise that it is the eleventh hour—it is one month to the day before the new dental contract comes into force. The profession are against the contract, and it profoundly disagreed with it in earlier discussions. The Government, however, refused to listen. In December last year, the British Dental Association literally walked away from the negotiations, and said that talking to the Government was akin to a one-way street. It talked to the Government, but the Government did not respond.

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I shall give way to my hon. Friend, as I know that he is anxious to contribute.

I am always anxious to contribute to debates secured by my hon. Friend. Does he agree that there is concern about oral health because of the lack of access to dentists, and that cancers of the mouth may increase and orthodontic provisions could be affected?

That is absolutely right. A central reason why dentists as a profession want to spend more time with patients is that they want to undertake proper preventive work and good oral health work. In the mechanics of the contracts, the Government have not taken proper account of the time that it takes for new orthodontic practices to establish their work. Practices across the country, including one in my own constituency, have written to me, because they have been offered a contract that dramatically underestimates the amount of work that they need to do. The base year or target year did not include their work because they had established themselves more recently.

The dentists walked away from negotiations with the Government, so the Government proceeded on the wrong basis. They did not introduce proposals based on registration or a capitation system. Their proposals did not encourage preventive work or promote good oral health. They should work with the profession, rather than against it. Not only is the profession against the Government, but this morning, Which? published a survey in which 79 per cent. of the public said that they do not trust the Government to improve dentistry in the next year. The profession and the public are saying the same thing, so the Government must think again. The motion is designed to make sure that they do so. The contract is a shambles, and it is not based on the primary dental services pilots. It does not include a UDA system. I apologise to the House. There are no Northern Ireland Members in the Chamber, but by "UDA" I mean "units of dental activity". The personal dental services contracts were not established on that basis, although the UDA system allows dentists to spend more time with patients and takes account of the size of patient lists. The Government would not proceed with such proposals, which is tragic.

Is it not irresponsible of the Government to introduce an untried and untested system, which is causing chaos throughout the United Kingdom, and will not achieve their aim of improving the quality of care for patients, securing access to dentistry and improving the nation's oral health?

My hon. Friend is right, and has captured the profession's view. I have already cited the British Dental Association, which has said:

"The new contract will not secure patient access, improve oral health or raise the quality of care."

Those are the things that we are supposed to target, but the Government are not setting out to achieve them. The contract is seriously flawed.

Leicestershire primary care trusts have a £6 million shortfall, so it will be impossible to deliver even the care that is available this year. That is on top of the complaints by the Leicestershire local dental committee, which is almost unanimously against the proposals, particularly the decision to charge on a treatment basis rather than per visit.

My hon. Friend is quite right. The pictures of people queuing for a dentist in the the Member for Westbury (Dr. Murrison) to say that they have ceased to provide NHS dentistry. We need a new contract. Not only do practices find it impossible to secure contracts that will enable them to continue to look after their patients—90 per cent. have experienced difficulties with contract values—but, as I have said, they have lost the ability to charge for missed appointments. They can no longer offer services to exempt adults and children.Leicester Mercury are testament to the difficulties that they are facing in the light of the withdrawal of services. The Secretary of State has not bothered to stay in the Chamber to discuss dentistry, but there are dental practices in her own constituency that have written to my hon. Friend

Absolutely.

Well, there is a problem with which we must deal, as some dental practices say that adults can only register their children for NHS work if they enter into a private contract themselves. PCTs, however, have told practices that they cannot offer a contract to treat children and exempt adults on the NHS, whether or not the practice has made that condition. Children have therefore been thrown off NHS lists, even though their dentist is willing to offer NHS dentistry.

As the hon. Gentleman knows, because of demands in this House dentists were following exactly the practice that he outlined by saying, "We'll take your children on the NHS if you as parents go privately." There can still be children-only lists under the new system. I am sure that he agrees that if primary care trusts believe that it is better for dentists to offer services to children and parents at the same time, it is absolutely right that they have the discretion to do that.

As the BBC survey said this morning, 5 per cent. of primary care trusts are saying that one cannot have exempt adult and children-only lists. I know why they are resisting it—because then there is no patient income.

That brings me on to another essential point—charges. The British Dental Association has accused the Government of using the new contract as a revenue-raising measure contrary to the principles of the national health service, yet this is a Government who talk about a free NHS. In 2004–05, dental charge income was £465 million; in 2006–07, it will be £623 million. Those are the Government's own figures. I only received the latest figures this morning, having asked the question in November—we can only get information out of the Government by bringing this debate to the Floor of the House. That is a 28 per cent. real-terms increase in dental charge income. The Government's contribution to dentistry over those same two years is rising by just 9 per cent.

That is completely contrary to the Government's previous claim that the contribution made by patients towards the cost of dentistry would remain the same. In fact, it is rising—I have just stated the figures. There are three bands of charges. That is simpler, but not necessarily fairer. For example, a check-up will cost £15.50 instead of £5. Lord Warner, the Minister in the other place, said that 42 per cent. of patients get their treatment in band 2 and, of those, three quarters will pay more under the new system. That is what is going on—more charging and more costs for patients. Of course, the Government will parade the fact that £2.7 billion is being spent on dentistry, neglecting to say that the cost of dentistry to patients has increased by one third, on the Government's figures, in the space of two years.

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Perhaps the hon. Gentleman would like to explain that.

Given the hon. Gentleman's concern about charges, does he agree that there is something unethical—indeed, perhaps involving a breach of data protection legislation—in dentists who are voluntarily opting out of the NHS writing to patients to advise them of private insurance arrangements without disclosing the benefits that they themselves stand to make? Is that appropriate?

I can understand that the hon. Gentleman is embarrassed that dentists are leaving the NHS and writing to their patients, but that is, regrettably, what is happening. They have a relationship with patients and are contacting them to give them details of what they are proposing to do. Instead of the hon. Gentleman criticising dentists, it would be better if he and his hon. Friends tried to work with them. The dentists we have talked to who are leaving NHS dentistry or reducing their commitment to it deeply regret having to do so.

The way forward is clear. Many dentists who sign up to the contract will do so reluctantly. They will be very unhappy with the straitjacket of activity targets that they are being put into. If they start to move beyond the 4 per cent. tolerances, they will find that they have no confidence that contract values will be honoured in future. They may well find that penalties are imposed on them. As time goes on, particularly as the income protection period expires, many will say that they are going to give up and go outside the NHS. A third of the dentists who got together in Birmingham at the local dental committee said that they would not sign the contract, and dentists in many other parts of the country are saying the same.

Instead of dentists reducing their commitment, we must go in the opposite direction. Their commitment to the NHS must be increased if we are to avoid recurring inequalities in access to dental care.

The hon. Gentleman has repeatedly mentioned inequalities. He is probably not aware that last week, in my constituency's most deprived ward of Coundon, a new health centre was opened with provision for two dental chairs, where there has never been a dentist before. His point is not borne out across the country as a whole.

I received an e-mail from a dentist in north-west London—I think that he was in the constituency of the right hon. Member for Holborn and St. Pancras (Frank Dobson)—who was abandoning NHS dentistry and was deeply depressed about the Government's implementing of the new contracts. I am afraid that wherever one goes, including in north London, there are dentists who are going to do that. This morning the Minister and I discussed on the radio what is happening in Barnsley. I do not know whether any Members from Barnsley are here. That is not a wealthy area, but patients there have been queuing for private dentistry because their dentist has abandoned the NHS.

It is time for a new system. We know where the Government are heading because the Minister has made it perfectly clear in previous discussions. She is threatening dentists by saying that if they do not choose to do NHS work, she will find other dentists who will. There will be dentists coming in from Poland.

Perhaps, like me, my hon. Friend would like to disabuse the hon. Member for Bishop Auckland (Helen Goodman) of the notion that everything is rosy in NHS dentistry. In my constituency, 34,000 patients have been deregistered, with a huge impact on lower income groups, older people and young families. What is worse is that the primary care trust has been forced into political posturing by operating a hotline that patients have to phone secretly to be told where the new NHS registrations are. That is spin under the NHS.

As my constituency is nearby, I have seen that that is indeed what is happening in my hon. Friend's constituency, where the enormous loss of NHS dentistry is affecting a large proportion of his constituents. I sympathise with him and agree with the support that he is giving to NHS dentistry in his constituency.

It is not only certain constituencies that are in crisis, but the whole country. When the Select Committee on Health looked into this, the Minister eventually admitted that 30 million people in this country do not have an NHS dentist.

That is right. Only about 40 per cent. of non-exempt adults have access to NHS dentistry. Of course, the Government are going to abolish registration and manipulate the figures. They will say that increased numbers of people see an NHS dentist, but that does not mean that they are necessarily registered with them or have access as they did in the past on the basis of a long-term relationship.

It is deeply worrying that fewer children are getting access to NHS dentistry. This morning's Which? report said that 82 per cent. of the public think it extremely important that children get free dental treatment, but that too is being lost. The inequalities are dramatic. In some places, a quarter of adults have access to NHS dentistry, while in other places it is 60 per cent. That is deeply unacceptable in a national health service.

The Minister always used to say that we need a new way of working; well, we do. We need a new way of working that is not about dentists on a treadmill, particularly a new treadmill that is governed by primary care trusts, which, as the National Audit Office made clear, have none of the expertise necessary to put this new system in place. We cannot move towards the system that the Government seem to be proposing whereby patients have perverse incentives to delay treatment or present as urgent cases with pain because it will be cheaper than if they have the work done while not being in pain. We must have a system whereby the patient's relationship with their dentist is geared around preventive work and good oral health, patients know that they have security of access to NHS dentistry, and dentists are incentivised to offer NHS dentistry and to increase their commitment to NHS dentistry instead of reducing it.

The hon. Gentleman almost certainly knows that the deadline for the first return of contracts was yesterday. If people have not returned their contracts by yesterday, payments will be delayed by a month. The secretary of the Birmingham dental committee told me that 75 per cent. of NHS dentists had not returned their contracts by the deadline. Some may be returned this month but the figures show a massive reduction in the number of NHS dentists in Birmingham.

I understand the hon. Gentleman's point. We held discussions with the Birmingham dental committee, as he doubtless has. Dentists in Birmingham are rightly anxious and angry.

Will the hon. Gentleman give way?

No.

As I explained, we need a new way of working. However, we have made it clear that it is most important not only to commit ourselves to improving the NHS overall but to trusting NHS professionals. Happily, in this instance, the desires of the patients and the profession are exactly the same. Patients want a relationship with a dentist in which they have security of access and certainty that what is in their interests—good oral health—is being pursued, with their making a reasonable rather than an excessive contribution through charges. That is what we need. The motion calls for that, even at the last minute.

Two weeks ago, the Minister met representatives of the British Dental Association, who left the meeting deeply disappointed with its results. It is not too late for the Government to withdraw the contract, suspend the use of units of dental activity and work through a piloted system that is based on capitation. That is the way forward. I urge the Government to do that even now, and I urge the House to support the motion.

I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:

"welcomes the Government's Oral Health Plan for England, which builds on major oral health improvements in the last 30 years, and the additional £368 million for improving dental services in England announced in July 2004; recognises the Government's substantial achievements in improving the short and longer term supply of dentists for the NHS including recruiting the equivalent of an extra 1,459 whole-time dentists between April 2004 and October 2005, compared to the 1,000 extra dentists promised, and funding an additional 170 training places; further recognises that the Government is investing £80 million in improving dental school facilities, and has approved the establishment of a new dental school in the South West Peninsula; notes that the total number of primary care dentists in the NHS had increased to more than 21,000 by the end of October 2005, compared with 16,700 in 1997; further welcomes the reduction in the maximum patient charge from £384 to £189 from 1st April; further welcomes the new ways of working tested through Personal Dental Services pilots; supports the framework for new dental contracts which will free up significantly more time to provide preventative care, remove the requirement for NHS dentists to treat patients on a fee for service basis and ensure that a committed NHS dentist can expect to earn on average around £80,000 a year; and further welcomes the fact that, where dentists do not take up new contracts, primary care trusts will commission replacement services from other dentists."

Although the motion is flawed, it gives us the opportunity to debate NHS dentistry as we approach the implementation of the most significant reforms to dental services in the history of the NHS. It is worth reminding the House why we are making those changes to NHS dentistry. The current system provides no real stability for patients or the NHS. Under the traditional general dental services system, dentists can set up in practice where and when they wish and decide how much or how little NHS dentistry they wish to undertake. There have traditionally been no local budgets for dentistry. When dentists decide to reduce or abandon their NHS work, the NHS locally has no power to commission replacement services. I know that that has affected hon. Members of all parties and caused immense problems. That volatile system has not served patients well.

On top of that, the contract under which dentists have worked has been extremely unpopular with them, especially following changes that were introduced in the 1990s and the subsequent fee cuts. Let me remind hon. Members that the traditional way of paying dentists is based on payments for 400 individual items of service, for example, a filling, a crown or having a tooth out. That put the emphasis on invasive work rather than preventive treatment. As hon. Members have said in the House previously, it has been confusing for patients, who often did not understand what they were paying for on the NHS and what they were paying for privately. I am sure that many hon. Members have experienced constituents saying, "I've just paid £1,000 for treatment on the NHS." When they have come to me, I have told them that they could not have paid that amount because the maximum that they can currently pay on the NHS is £384. However, confusion between NHS and private treatment has occurred.

The dental profession, especially the British Dental Association, complained for many years about the treadmill effect of how dentists were paid. As I said, that put the emphasis on invasive rather than preventive treatment and was an incredibly bureaucratic system for dentists. Two dental schools were closed under the previous Administration. Again, that significantly reduced the numbers of dentists in training.

To tackle the genuine shortages in access to NHS dentistry, we have taken some immediate action.

I want to speak about clinical dental technicians, who specialise in making dentures, especially for senior citizens. The Minister knows that they are subject to a regulatory review by the General Dental Council and that they want to be brought within a new regulatory framework to remove the anomalous situation under which they have operated for many years. They have two key requests. First, they want a reasonable transition period. Secondly, if retraining must occur, they ask whether it can take place on a part-time basis in the United Kingdom to allow them to retrain in a way that does not destroy their livelihood. Does the Minister agree that that is reasonable and will she make that point to the GDC?

I hope that the hon. Gentleman understands that the GDC makes its own rules about what it considers to be appropriate training and registration requirements. However, he is right to point out that there are many opportunities under the new system not only for dental technicians but for dental therapists and hygienists. As we change the way in which dentistry is provided, we can increasingly make better use of different skills in the dental team. I believe that, when we consider the role of dental nurses and hygienists in future, they can increasingly take on some of the minor work that dentists currently do, leaving dentists to do the more complex work. However, I shall consider the hon. Gentleman's points and I am sure that the GDC will be aware of his comments.

The Minister was about to consider access. Will she clarify a point about the position after 1 April? Will two people who live next door to each other, one registered with an NHS dentist and the other not, have different rights of access to NHS dentistry after 1 April? Does being on an NHS dentist's list now grant more rights than not being on such a list?

The person who is currently registered with an NHS dentist will remain attached to that dentist on a dental list. That is not the same as registration because people currently fall off the register. We want to stop that because it has caused difficulties in the past. However, the person who is currently registered will remain attached to his dentist. I hope that the changes that we are introducing will free capacity and that the person next door who is not registered with a dentist can get registered. We are aiming for that. That is why it is so important that primary care trusts have the power to commission locally, examine the needs of their population and commission accordingly.

Since 1999, we have set up 53 dental access centres in areas where there was a clear shortage of NHS dentists. Those centres mostly provide urgent treatment but some provide routine treatment. Compared with 2003, we are now investing an extra £250 million every year in NHS dentistry, with a further £65 million to follow next year. We have recruited the equivalent of more than 1,400 whole-time dentists to work in areas with the greatest access challenges.

I am sorry that the hon. Member for South Cambridgeshire (Mr. Lansley) chose to denigrate the contribution of Polish dentists. In many areas of the country, they do an excellent job. In areas of particular shortage, we have been able to assist the position through careful international recruitment and carefully passing people on to those areas. I am sure that many Conservative Members are grateful for their contribution.

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In the circumstances, I feel that I must give way to the hon. Gentleman.

I am pleased that the Minister has acknowledged in the Chamber the tremendous work that Polish dentists do in the United Kingdom. Almost all the new dentists in Shrewsbury have come from Poland. I speak to many Polish NHS dentists in their mother tongue and they tell me that they will return to Poland after a couple of years. That is a tremendous problem.

Order. I hope that the hon. Member will not spoil the moment by making a speech. Perhaps he could ask a final question.

Will the Minister look into the difficulty caused by those Polish dentists being here on only a short-term basis?

I hope that I shall be able to reassure the hon. Gentleman later in my speech that there are dentists coming from all different quarters. NHS dentists are now offering to do more NHS work, and others are coming in through the international qualifying examination. Some of them may well wish to stay for only a short time, and that can be helpful in that they take different skills back to other parts of the European Union. I do not have a problem with that; it does not mean that we are going to experience a shortage. Indeed, in some ways, quite the opposite is the case.

When I was out on a Saturday morning recently knocking on doors, as we do at the weekends, I met a Swedish dentist who thanked us for helping with his planning permission. May I thank the Minister for the £28.4 million investment that has been made in Plymouth, and ask her how soon she expects the new dentists to come on stream following that extra investment in dental training?

Obviously it takes some time to train a dentist. We have recruited extra dentists over the past year, as well as announcing 170 more dental training places from September last year. In January, I announced the creation of a new dental training school in the south-west of England, and I suspect that that is what my hon. Friend was referring to. I was pleased that a good bid was put in by her area, and that we were able to make that announcement.

Does the Minister agree that the reason why we can recruit dentists from all over Europe is that even those dentists who work for the NHS are among the highest paid in Europe?

My hon. Friend is absolutely right. I believe that 12 new dentists have been recruited to his area recently. A dentist with a fairly high commitment to the NHS can expect to earn about £80,000 a year, with practice expenses on top of that. That is not a bad deal.

I am grateful to the Minister for working to bring 14 new dentists to my constituency. However, even with those new dentists, registrations have gone down since she came to the Isle of Wight. In two years' time, when the 24,000 people who have asked to register with those new dentists have done so, about 50,000 people in my constituency will still not be registered with an NHS dentist. Is that satisfactory?

As the hon. Gentleman said, I have visited his constituency. I know that there were considerable problems there, and I am glad that we have been able to assist him. His was one of the first areas that our support team went into to help with recruitment. I do not think that there were any NHS dentists there before that, but we managed to recruit eight into the area. I shall explain later how, under the present system, there will be room for extra capacity as the changes bed in, as well as the ability to have funding at local level to commission NHS dentistry if there are needs in the local area.

I want to explain how we are introducing a radical shake-up in regard to how NHS dentistry will be delivered in the long term. To go back to the basics of the plan, from April this year, primary care trusts will for the first time be able to commission and develop primary dental care services in ways that reflect the needs of their local populations. For the first time, they will have the financial power to commission new services when a dentist leaves the area or reduces their NHS commitment. That was one of the problems in the hon. Gentleman's constituency. For the first time, we will have a system of dental charges that is simple and transparent for patients, and a remuneration system that no longer encourages the drill and fill treadmill.

The new contract that we are offering to dentists will mean that a committed NHS dentist can expect to earn about £80,000 a year, with practice expenses on top of that. That £80,000 will be guaranteed for three years, for 5 per cent. less work. In return, dentists will be expected to carry out an agreed number of courses of treatment over the year—again, at least 5 per cent. below the levels in the old contract.

I am sure that dentists will be pleased to hear those figures. However, will the Minister explain how the technical application of the new contract has led to the situation in my constituency about which I wrote to the Secretary of State on 19 January? The single major NHS dentist in the area, whose practice covers 22,000 people, expects to lose 30 per cent. of those patients—that is, 6,500 people—as of 5 April, as a result of incorrect base-lining and problems with the calculations. I wrote to the Secretary of State about this on 19 January, and the clock is ticking. That dentist needs an answer.

The way in which the contracts were calculated involved a reference period that ran from October 2004 to September 2005. During that time, the activity of the dentists was measured, along with the amount that they were paid during the period. The calculation should reflect those two figures, and produce the amount that the dentist would be offered, which would be guaranteed for three years. If a dentist has a problem with the calculation, they should pursue the dispute resolution procedure. However, the primary care trust might be able to identify the reason for the problem—the dentist might have taken on an associate during the year, for example. It is difficult for me to comment on individual cases, but there is a dispute resolution procedure to deal with problems with the amount in the contract.

Is there not a problem for practices such as the Caledonia practice in my constituency, which is expanding fast and has taken on two dentists since the end of the base-line period last September, but is now having to lay off those dentists because it cannot afford to pay them, given the amount that it is being offered? Will the Minister also confirm that a PCT is required by law to use any funds made available through the closure of a dental practice for dentistry and for no other purpose?

Yes, I will. The way in which the budgets have been given out is quite complicated, but I will try to explain it. During the reference period that I mentioned, an overall measurement was taken of the activity in a particular area. It is possible that, during that time, certain dentists might have worked for only half the year, because they had started up half-way through the reference period. Others might have closed during the period. The calculation took into account the balance between those that had opened and those that had closed, so that a dental practice that had opened half-way through the year would be able to use the money that had become available from one that had closed. So that would have added up. If, however, it did not add up in that way, extra money would be allocated, but it would not be able to meet every local circumstance. The instance that the hon. Gentleman has cited involves a dental practice expanding after the reference period. We had to have a cut-off point—[Hon. Members: "Why?"] Otherwise, it would not have been fair in terms of allocating the funds. The PCTs wanted to know the size of their budgets. We had that reference period so that we could make that calculation. On top of that I should say that £65 million has gone out to PCTs to ensure that there can be expansion. That is the difficulty that the hon. Gentleman might be facing. However, I should also say in relation to 31 March that the PCT will retain all its money locally. If there are dentists who decide that they do not want to stay with the NHS, the PCT will have the absolute right to go back to dentists such as those the hon. Gentleman has mentioned to say, "This is how we can replace the NHS dentistry that may have been lost." I am sorry if that is a rather long and complicated explanation, but that is basically how things work.

rose—

May I move on? I am conscious that we are getting towards the time when Back-Bench Members will want to contribute.

Today's debate has shown that concerns have been voiced by some dentists about the changes, but that is not altogether surprising, because they are quite radical. New ways of working have proved popular in the personal dental services pilots, which cover some 30 per cent. of dentists.

To return to a point made by the hon. Member for South Cambridgeshire about a system of payment per head for those registered, we considered that suggestion during the piloting and found a lot of problems, not least because in some areas the number of treatments carried out fell by about 50 per cent., but without an equivalent increase in the number of people seen. Such a system also has a bias towards people with good oral health who would be taken on under it.

I quite understand why the hon. Gentleman is making that suggestion and I am more than happy to send him the data—[Interruption.] If he wants to intervene, I am perfectly happy to give way.

The National Audit Office report was very clear. Yes, there was a reduction in the number of treatments, because the drill-and-fill system had an incentive to overtreat. Of course the number of treatments reduced. We have to measure outcomes—that is what we should be doing—and the NAO was clear about the fact that the 10 per cent. reduction in treatments, on average, was none the less associated with no deterioration in the oral health of people on those patient lists.

But that is not the point about the system that the hon. Gentleman is suggesting. He is suggesting that each dentist be paid per patient. The difficulty with that, as I have said, is that we tried it in the pilot schemes and it effectively contained a bias towards taking on people with good oral health as opposed to those with a variety of types of oral health. I am perfectly happy to send him the data from those pilots so that he can look at them. All I am saying is that I can assure him that we considered and piloted that suggestion, but the evidence that came back suggested that it is not the right system.

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I give way to the right hon. Member for Wokingham (Mr. Redwood).

Can the Minister explain why we do not have enough NHS dentists? Is it something to do with the extremely elaborate remuneration method, which seems to be freezing the system in aspic when we need a dynamic system that allows growth for new dentists?

That is quite astonishing, coming from the right hon. Gentleman. We have a lot of these problems—this is very well recognised—because of the contract changes and fee cuts made in the 1990s, as well as the closure of two dental schools. We are turning round the system that we inherited and introducing some changes.

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I shall move on, because I want to make some remarks that I hope will help the House.

As I have said, I know that, for some dentists, the changes are a fundamental shift from the traditional way of working. Understandably, they are quite nervous about that, so I have decided to set up an implementation group with representation from the profession, patients and the NHS to review the impact of the reforms and ensure that they are delivering their intended benefits, for patients and for dentists. I have invited representatives from the British Dental Association to join the group, and I hope that that is a way to reassure dentists that we are looking closely at the implementation of the reforms and ensuring that if any adjustments need to be made, they can be.

Will my hon. Friend include orthodontists in the group? As has been mentioned, there seem to be specific problems with how the lists will be compiled for orthodontists. It is only fair that those valuable servants be included.

I will certainly consider the point my hon. Friend raises, particularly perhaps with reference to the British Orthodontic Society, which we have been in discussions with recently. He is right to say that there have been problems with orthodontics, because obviously such services are offered over a number of years. If new practices have been set up, which we have been able to do because of the increased investment that we have put in, they might have had a short contract value during the reference period. Recently, we have again issued guidance to PCTs including principles such as current treatment having to be completed. They need to look at orthodontic requirements locally and ensure that there is proper commissioning. I acknowledge that this has been a problem, but we have tried to clarify it.

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If I may, I shall move on, because it is important to say that we will not know until the end of this month precisely how many dentists are taking up the new contracts. However, the current view from PCTs is that the vast majority of contracts will be signed by 31 March.

I should stress that, in the minority of cases where dentists choose not to take up the new contracts, the NHS will use the same funding to commission replacement services from other dentists. I am extremely confident that the NHS will generally be able to bring in new capacity very quickly. In the small number of cases where people say that they no longer want to remain with the NHS, we are finding that other dentists are coming forward to say that they want to expand their NHS provision.

Would the Minister like to tell us whether this alternative commissioning will be like the dental access centres? The average cost per patient episode, according to the Government's own figures, is £141 compared with £41 for high street dentists.

I am not sure that the hon. Gentleman has quite understood exactly how the new commissioning will take place. If a dentist chooses to leave the NHS, that money can be used by the PCT to provide what it feels is appropriate in the local area. If it feels it is appropriate to have a dental access centre, it can have one. However, it is more likely to want to commission dentistry from the existing dentists in the area.

rose—

I shall give way to the hon. Member for Congleton (Ann Winterton), then I shall finish my remarks.