DENTAL SERVICES (Hansard, 1 November 1988)

§ Mrs. Currie
I beg to move, That this House doth agree with the Lords in the said amendment.

§ Mr. Deputy Speaker
With this we shall discuss Lords amendments Nos. 19, 46, 47, 49 and 50. I draw the attention of the House to the fact that some of the amendments involve privilege.

§ Mrs. Currie
The amendment will replace the absolute duty that originally stood in the legislation on community dental services with a duty to provide dental services at a level to meet all reasonable requirements. I think that the profession will regard our concession as something of a victory, but I do not mind that in the least. In practical terms, the proposals will not change the requirement to develop the community dental service.
Labour Members will recall that we had extensive discussions in Committee on how the community dental service should advance. We believed that the community dental service should offer an improved service to those people who have difficulty in obtaining the services of a general dental practitioner. That would remove the requirement for the community dental service to duplicate the services that are already adequately provided by general dental practitioners. The Lords amendments will satisfy the concerns that have been expressed.

§ Ms. Harman
I want to make two points about Lords amendment No. 18, which concerns the community dental service. First, how much do the Government plan to spend under the new arrangements on the community. dental service? Will existing resources be targeted to where they 857 are most needed, or will fewer resources be targeted to those who most need them? Secondly, how do the Government plan to ensure that district health authorities comply with the statutory obligation for the dental inspection of schoolchildren and the maintenance of the community dental service? The financial pressure that the Government are putting on district health authorities is so great that many district health authorities see the community dental service as a soft target. How will the Government keep district health authorities up to the mark in respect of the community dental service?

§ Mr. Peter Griffiths (Portsmouth, North)
My hon. Friend will recall that when we discussed the matter in Committee I was keen to press the point that going to the dentist is a family activity. Primary responsibility for dental care falls on parents. There was a difference of opinion between the Government and the Opposition in Committee over the prospect that, following the line of argument that I had put forward, if the requirement that the Secretary of State should provide a comprehensive dental service for children of school age were removed, there might be areas in which the service would not be provided. That was the nub of the political disagreement in Committee.
I am grateful for the fact that we have come to an acceptable compromise. The Secretary of State will have the power to ensure that "all reasonable requirements" are met and, at the same time, it has been made clear that the responsibility to ensure that children receive dental treatment from either general dental practitioners or the service provided by the health authority falls basically on parents.

§ Mrs. Currie
With the leave of the House, Mr. Deputy Speaker, I shall reply.
I thank my hon. Friend the Member for Portsmouth, North (Mr. Griffiths) for his sensible summing up of where we stand on the issue. However, the Secretary of State will have more than a power in this respect. He will have a duty to provide the service as far as is reasonable. The word "reasonable" will be written into the Bill. It is a sensible compromise between those who insist that we should continue to run the community dental service in the old way—when the main problem was the poor dental health of children in particular—and those who see that the general dental practitioner service is first class and who believe that it is entirely right and appropriate that people should go to the dentist as a family, including such important people as the spouses of hon. Members and other people who regard dentistry as important.
The hon. Member for Peckham (Ms. Harman) spoke about the mechanism for ensuring that the legislation is followed and that the law is obeyed. The mechanism is the review system in which Ministers review the regional health authorities and the chairmen of the regional health authorities and their colleagues review the district health authorities. As I mentioned at Question Time this afternoon, Basingstoke and North Hampshire district health authority is being reviewed today. We expect the quality of work that the community dental service does and the degree to which it responds to patterns of dental health to be taken into account in such a review and for the health authorities to be held accountable.
858 The hon. Member for Peckham also asked whether more or less money was to be given to the service. That is a matter for the district health authorities to decide. If the hon. Lady re-reads the White Paper, which sets out some of the provisions that we are discussing tonight, she will find that we have proposed other functions for the community dental service which need to be developed, such as the monitoring of levels of dental health and the care of special groups. It is not just a question of how much money we spend; it is a question of what we get for that money. Dental health in this country is improving extemely fast, and we have been able to identify and look after some groups that have had little dental care in the past. We are determined that the community dental service should fulfil that obligation and look after dental health in a much more general way.