HC Deb 06 July 1992 vol 211 cc21-5 3.31 pm
Mr. Robin Cook (Livingston) (by private notice)

To ask the Secretary of State for Health if she will make a statement on the decision by dentists, in a ballot, to withdraw in whole or in part from NHS service.

The Secretary of State for Health (Mrs. Virginia Bottomley)

We have already made it clear that, whatever the result of the ballot, we will take the necessary steps to safeguard NHS dental services.

I regret the results of the ballot. In recent years, there have been considerable improvements in dental care. There has been a 43 per cent. real terms increase in spending on general dental services since 1979. I hope that dentists will not jeopardise this progress. I hope that no patient is deterred from seeking dental care by this action. Patients currently have, rightly, high expectations and respect for their dentists. I hope that they will have no cause to change that over the coming weeks.

Dentists are independent contractors. They will now have to consider carefully their next steps.

Dentists' pay is decided on the basies of recommenda-tions by the independent review body. This year, we agreed to the recommendation that they should receive an 8.5 per cent. pay increase in full. To achieve the £35,800 recommended by the review body would have required a fee reduction of 23 per cent. We decided that a 7 per cent. fee reduction, with the introduction of prior approval for costly treatments, was a fair and reasonable way forward. This will give dentists an average income of about £41,000 this year. At the same time, we increased their allowance for expenses by 11.6 per cent. to more than £47,000, so that they will, on average, receive about £88,000, including expenses.

Patients will find it surprising that a profession which was prepared to accept £35,800 is now threatening to take action when we intend to pay them well over £40,000—substantially more than the review body intended.

All are agreed that the present system of remuneration needs a fundamental review; I have asked the Minister for Health to take this forward. Detailed arrangements will be announced shortly. We must find a system that is fair to dentists, fair to patients, and fair to the NHS. We are monitoring the situation through the family health service authorities to ensure that NHS dental services remain available. We have reminded them of their powers to seek to employ salaried dentists if necessary.

Meanwhile, I hope that the House will agree that the fundamental review offers a far more constructive way forward than action to withdraw NHS services from NHS patients.

Mr. Cook

The Secretary of State expressed the hope that the current dispute would not affect patients. Are we to understand from her reply that, apart from that hope, Ministers intend to do nothing in the face of a decision by 80 per cent. of dentists to accept no more NHS patients?

Do not Ministers recognise that the current crisis is a direct result of their policy of increasing charges to patients while cutting fees to dentists? As the Secretary of State appears to think that dentists are better paid than ever before, will she explain to the House why they are leaving the NHS in larger numbers than ever before?

I agree with the Secretary of State on one point. After the chaos created by the current contract, we urgently need a new system of dental remuneration, but how does she hope to get dentists to agree to a new contract if, on Wednesday, she proceeds with a cut in fees that breaks the existing contract? If she will not help dentists, will she at least help their patients? What is she going to do to guarantee the right of new NHS patients to dentistry on the NHS?

The Secretary of State mentioned salaried dentists. Is she aware that last week we were told that there are precisely nine salaried dentists in the whole of England outside London? How far does she think it is reasonable for a new patient to travel in search of a salaried dentist?

May I remind the Secretary of State that before polling day we were assured that the NHS would not be privatised —[Interruption.] What other word would Conservative Members prefer us to use now that more and more dental patients are being told that they must go private? Will the Secretary of State now admit the truth—that all those promises about the privatisation of the NHS were as hollow as all the claims about economic recovery?

Mrs. Bottomley

I can assure the House that we are monitoring the situation carefully and that there are no known cases where it has not been possible to secure an NHS dentist. FHSs are empowered to seek to employ a salaried dentist, and so far we have no reports of it not being possibile to find an NHS dentist.

The BDA said that it may take some months before the picture becomes exactly clear. I very much hope that it will co-operate with the fundamental review and will think long and hard before taking steps that will jeopardise the system of dentistry in this country which has, after all, delivered unprecedented results in the quality of dental care.

We have never had so many people participating in dental care in this country—30 million patients are signed up; there has been a 29 per cent. increase in the number of dentists; and 12 per cent. of family health service authorities now employ salaried dentists. We have made it clear that, although we wish to be fair and reasonable to dentists, we must also safeguard the interests of patients and of the NHS. I do not think that it bodes well that the Labour party seeks to support a professional group which is seeking to secure not only £5,000 over and above the 8.5 per cent. increase recommended by the review body. If I were one of the lower paid workers in the NHS, I would not have great confidence in the Labour party.

Mr. Roger Sims (Chislehurst)

Will my right hon. Friend tell the House a little more about the timing and nature of the fundamental review to which she referred? Does not she think that it is highly irresponsible of professionals to take the action that they have at this particular stage when there is a real prospect of the problems of dental remuneration being solved by the review to which she referred?

Mrs. Bottomley

I thank my hon. Friend. I hope that dentists will think long and hard before taking steps in relation to the future reduction at a moment when we all agree that we must find a better way of remunerating dentists. It may be a system that has stood the test of time for many years, but the time has now come when we need a system that inspires more confidence in dentists and in the NHS and is better for patients. There are a number of obvious difficulties. The BDA said that it was looking for a positive sign from ministers that there is a future in NHS dentistry. There is a future in NHS dentistry. I believe that the fundamental review, the arrangements of which we hope to announce shortly, will make that future very clear.

Ms. Liz Lynne (Rochdale)

Does the Secretary of State agree that NHS dentistry is in crisis because dentists are being penalised for making a success of a contract that they did not want in the first place? Now that dentists are baring their teeth, is not it about time that the Secretary of State swallowed her pride and ensured that dentists get their just deserts, that the nation's health does not suffer and that the nation's dental health does not go into terminal decay?

Mrs. Bottomley

NHS dentistry has never been more effective, with 30 million patients signed up for continuing care. The hon. Lady is correct in saying that the dental contract was a success. More work has been undertaken as a result. That is precisely why the dentists were given 8.5 per cent. by the review body when the nurses and the doctors were given 5.8 per cent. and 5.3 per cent. We are proposing that, in addition to the 8.5 per cent., the dentists should keep £5,000. I think that that is a fair and reasonable way forward for dentists.

Sir Paul Beresford (Croydon, Central)

May I, as a Member of Parliament as well as a dentist, ask the Secretary of State whether she agrees that we should be asking the British Dental Association to respond to this House? The BDA should be using its professional standing to look for changes within the global sum, as the argument with dentists as a profession concerns not so much the global sum as the way in which it is distributed.

Mrs. Bottomley

I very much hope that we shall be able to work closely with the BDA in taking forward the fundamental review. As my hon. Friend knows only too well, the system of dental remuneration is based on an average income, which applies across the country, and the average expenses required to deliver that average income. A number of practical and sensible proposals are coming forward, from the BDA and others, about how we might more appropriately develop a system of remuneration which is more fair to dentists, fair to the taxpayer, and fair to the NHS. I very much hope that the BDA will settle for this year's fair and reasonable arrangements and work constructively for the future.

Mrs. Margaret Ewing (Moray)

Does not the Secretary of State realise that her idea that there should be a fundamental review rings very hollow against what seems to be a fundamental dictatorship, given that she has indicated that she will go ahead with her plans irrespective of the democratically expressed views of the BDA? Does not she realise that, in seeking to have the national health service supported by salaried dentists, she is creating in many rural communities, particularly in the highlands, the north-east of Scotland and the islands, a situation in which people will have to travel many miles to find a dentist? She has alienated people who wish to continue within the health service. Will she agree to postpone her decision on Wednesday to allow a review and a discussion to take place?

Mrs. Bottomley

In order to deliver the income of £35,800 recommended by the review body—a reasonable income by any standard—we should have introduced a fee reduction of 23 per cent. A 7 per cent. reduction, together with the introduction of prior approval, seems fair and reasonable. The employment of salaried dentists should not be a first option. I very much hope that dentists will think long and hard before taking steps that would jeopardise NHS patients. But if they do take such steps, we shall have a duty to safeguard the interests of NHS patients, and we shall not hesitate to seek the employment of salaried dentists.

Mr. Jerry Hayes (Harlow)

Will my right hon. Friend warn the dentists robustly and clearly that two groups will be hit by today's ballot? The first group is those dentists withdrawing from the national health service who will suffer particularly in terms of their professional integrity. The second is the large group of poor people who are not poor enough to be on income support and, thereby, qualify for free treatment. These people regard it as quite outrageous that a group of professionals—who are supported by the Labour party—who have just had an increase of 8 per cent. granted by their pay review body and had their fees increased by 11 per cent., should leave the poor in the lurch.

Mrs. Bottomley

As ever, my hon. Friend makes his points very well indeed. This year, with the 11.6 per cent. increase in expenses, dentists will take home an average of £88,000 gross. That is a very sizeable amount of money, and every dentist should think long and hard, from his own point of view as well as in the interests of his NHS patients, before taking such a step.

Mr. D. N. Campbell-Savours (Workington)

Are there any circumstances in which the Secretary of State would preside over the creeping privatisation of dentistry?

Mrs. Bottomley

I have made it clear that I am committed to NHS dental services. That is why I shall not hesitate to encourage the employment of salaried dentists when the need arises. I think, however, that there are great strengths, and that there has been great progress, in NHS dental services. Since the Labour party was last in power, there has been a 43 per cent. increase in spending on dental services. There are more dentists, and more patients are treated now.

Mr. Den Dover (Chorley)

Does the Secretary of State accept that at a meeting with 12 dentists last Saturday two points came across—first, they all wanted the continuance of a first-class national health service dental system; secondly, whereas they were perfectly happy with the gross income, they had misgivings about the sampling in the first quarter of the year only, which led to their net income not being truly representative of their own experience?

Mrs. Bottomley

Some aspects of my hon. Friend's remarks should be discussed in the fundamental review. As for the average income and average expenses of the average dentist, the right place for the dentists to discuss them was at the dental rates study group. It was a great error on the part of the dentists to refuse to attend the meeting of that group; it is, after all, precisely the setting at which there is a rigorous deployment of the figures. They did not arise.

Mr. Nick Raynsford (Greenwich)

Will the right hon. Lady reconsider her over-optimistic comments about the health of national health service dentistry in this country? Will she recognise the extent to which dentists are withdrawing from offering a service to people under the health service and are continuing to threaten to do so? Will she think about the number of poor communities —for instance, the Ferrier estate in my constituency, where the only dentist operating has made it clear that he cannot afford to continue to operate—I have given the Secretary of State evidence of that—if she proceeds with her proposals? Will she think again, and think about the interests of the health of this country and its poor people instead of pursuing her dogmatic adherence to the Government's position?

Mrs. Bottomley

Dentists have always been indepen-dent contractors who could be selective about the patients whom they took on. Concerns about that should perhaps rightly be the subject of the fundamental review. Substantial resources go into NHS dental services. Last year, 30 per cent. of dentists earned more than £100,000, and the hon. Gentleman may be interested to know that 40 dentists earned more than £200,000—[Interruption] —as someone rightly says, with their expenses as well. If the hon. Gentleman suggests that there should be greater variation in the deployment of remuneration in the various regions, I accept that point; it should rightly be taken forward in the fundamental review.

Mrs. Judith Chaplin (Newbury)

Does my right hon. Friend agree that dentists' costs vary enormously and that that should be a key element in the fundamental review about which she speaks?

Mrs. Bottoniley

My hon. Friend makes precisely the point that the hon. Member for Greenwich (Mr. Raynsford) addressed from a different angle. There has never been a time, however, when dentists' remuneration incorporated those variations. My hon. Friend the Minister for Health and I take the view that this should be part of the fundamental review. When discussing the dental contract, we agreed to remunerate business rates for dentists more directly. That was a step forward.

As for expenses, it is fair to say that an 11.6 per cent. increase in expenses, up to £47,000—that is what we are introducing—is generous on any count. We hope that we can discuss these matters further. On the last three occasions when dentists thought that their expenses had been under-recorded it turned out on examination that we had overestimated them for each year in question.

Several hon. Members

rose—

Madam Speaker

Order. We must now make progress.