§ Motion made, and Question proposed, That this House do now adjourn.—[Dan Norris.]
10.19 pm§ Mr. David Laws (Yeovil)I am very grateful to you, Mr. Speaker, for this opportunity to raise an issue of great importance in my constituency. It is one of the issues that has featured most in my postbag since the general election. Indeed, concerns about access to NHS dentistry in south Somerset were also raised consistently with my predecessor, Lord Ashdown.
Yeovil has a particular problem with access to NHS dentistry. At present, no dentists in the area are taking new adult NHS patients. That has been a problem not only in recent weeks and months, but since at least two years before the general election. It is shared by many other areas in the region and in the other part of south Somerset represented by my hon. Friend the Member for Somerton and Frome (Mr. Heath).
The issue can be encapsulated not only by the fact that no dentists in Yeovil are taking new adult NHS patients, but by the realisation that registrations of dental patients in Somerset have declined from about 69 per cent. of the adult population in 1993 to a low of just under 50 per cent. The level is now hovering around 50 per cent., which shows the great difficulty that many people in south Somerset are having in trying to get access to NHS dentistry.
That difficulty leads to a number of problems. First, the NHS dentists who are nearest to many of the towns in my constituency, such as Yeovil, Chard, Ilminster and Crewkerne, are based as much as 15 or 20 miles away. I am sure that the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), will agree that that is a great distance to go to benefit from a basic health service such as dentistry. In a rural area, transport is a difficulty for many people, which creates greater pressures.
The second problem that is caused by the lack of access to NHS dentistry is that many people are forced to opt for private provision, which is obviously more expensive and is very difficult for many people in the area to afford. Some people have found that their NHS dentists have converted to private practice and insisted that any NHS patients who want to stay with them should go private, at great additional expense.
Thirdly, there are many people who fall out of access to dentistry altogether and therefore cannot get the attention and especially the preventive care that they would expect. Progress on that problem has been slow in the constituency, which is a matter of concern for me and my hon. Friends in the surrounding area. A couple of years ago, the Prime Minister made a welcome pledge to increase access to NHS dentistry so that everybody had it. However, the Government seem to have modified that pledge over the past couple of years, so that people have access to a telephone number and operator for information, but not a dentist in their area.
I think that people in the main towns of my constituency—Yeovil, Chard, Crewkerne and Ilminster—would have expected the Government's commitment to mean that they would be able to get access to an NHS dentist in their area. I raise that issue with the desire not 1276 to make a political point, but to emphasise to the Under-Secretary how great the problem is and to see whether we can find a way forward.
I have recently had the pleasure of formally opening the new NHS dental access centre in my constituency. Others have been opened in Chard and—I believe—in Taunton. That has to be a welcome development. It means that people who need emergency treatment can obtain it, which is obviously helpful for those particular individuals. The Under-Secretary will appreciate, however, that that does nothing to provide the on-going dental treatment that most people would want. I am sure that the Government wish to encourage such treatment, given their emphasis on preventive treatment not only in NHS dentistry but in all aspects of health care.
I hope that the Under-Secretary will agree that such treatment cannot be provided unless people see dentists regularly. Although I welcome the money that has been invested, it will not deal with the dental access problems in the constituency and the Government should not be encouraging it as the only solution. In some senses, it is a solution that treats failure but not the dental and other health problems that a proper system of NHS dentistry should tackle.
We appreciate that the problems are not new and that they go back to the reduction in fees for NHS dental treatment under a Conservative Administration. Access problems have therefore been prevalent for some time.
Anxiety also exists about the lack of trained dentists. More dentists going through our medical schools would help to tackle the shortage throughout the country. Local dentists and other health experts believe that the Government should deal with those two major problems if we are to make progress not only in south Somerset but throughout the country. We need more dentists and a revision of the fee structures that govern NHS treatments.
Much modernisation is required. Most dentists who have gone private in the past few years are resistant to transferring back to a national health service system in which their fees and ability to treat patients to a high level are significantly curtailed. It will be difficult to get many of them back into the NHS. We must therefore try to ensure that new dentists remain in it.
Such changes will take many years to effect, and people in Yeovil do not want to wait that long for action. They are not encouraged by the mere provision of access centres or Somerset health authority's commitment to stabilise registrations at the current level rather than increasing the proportion of people who are registered. I should like the same solutions that were applied in other parts of the country, such as north Devon, to be tried in Yeovil.
In north Devon, the health authority, the Government and private partners have worked together to attract dentists to the area and even used professional dentistry publications to draw attention to the gaps. However, we also need action to help dentists who want to establish practices in black hole areas where there is currently no provision.
There are major problems in identifying those areas and help for new dentists. Local newspapers such as the Yeovil Express and the Western Gazette have highlighted those issues, and many of those who recently wanted to set up practices in the area have been alerted to the problem only through that means. Dental practitioners whom my 1277 predecessor, Lord Ashdown, and I have tried to encourage to come to those areas in the past couple of years have looked to funding from Government schemes such as investing in dentistry and its successors to tackle the problems. The Minister knows how expensive it can be to set up a new practice. One has to secure appropriate property and much equipment as well as staff.
Information and financial support have been lacking. Perhaps the Minister recalls that, a couple of years ago, one of the investing in dentistry schemes had bids of approximately £1 million in the Somerset health authority area, but only around £80,000 was granted. There is a definite shortfall in assistance with the start-up costs.
I would not support endless subsidies on top of the ordinary payments that are made to NHS dentists, but it is important to give additional financial incentives to dentists who are moving to the black hole areas that we are considering. I hope that the Minister will say whether the Government propose to continue such schemes as investing in dentistry so that we can assist dentists to move to such areas.
My final point is not political. I accept that the Government are trying to tackle lack of access and to renew NHS dentistry after a period in which it has suffered. However, I am worried that the Government's ambitions, which the Prime Minister expressed, are not matched by the policy achievements and that some Government solutions, such as dental access centres, seem to provide only emergency and safety net treatment, which is better than nothing but not good enough for many of our constituents.
§ Annette Brooke (Mid-Dorset and North Poole)I thank my hon. Friend the Member for Yeovil (Mr. Laws) for describing the situation so clearly. I am sure that many of us experience the same difficulties in our areas, and I want to make some general points that I think will support his case.
A recent survey by the magazine Health Which? suggested that two in five dental surgeries now accepted only private patients. We might well assume that there had been a mass exodus from NHS dentistry over the past 10 or 11 years. I believe that 1990 was a critical year: I am told that at that time the then Government were taking £15,000 from each NHS dentist. Although that was waived eventually, dentists obviously found that they could earn a better income without being in the NHS. As with all these things, once someone discovers something it sets the ball rolling in a direction that is difficult to change.
My hon. Friend mentioned a number of Government initiatives. Different initiatives are being operated by different local authorities in different areas. Has the Minister any evidence to indicate which are the most effective? Obviously local conditions should be taken into account, but the information would be interesting, given the range of measures that are being tried.
I am concerned because I feel that although a programme exists, the situation seems basically to be getting worse. I feel that we are treating the symptoms rather than the disease. We should be concerned not just about the shift, over time, of existing dentists to the 1278 private sector, but about the emergence of corporate bodies in dentistry. How much, for example—I have no idea of the answer—does a dentist employed by Boots receive for a check-up, compared with what the NHS would pay? That is cause for concern, because it could lead to further erosion. As my hon. Friend said, fee scales need to be addressed.
A recent survey of vocational trainee dentists showed that 75 per cent. were not prepared to commit themselves to the NHS. I understand that they felt there was no incentive, and also no real sense of the ethos of working in the public sector. This, I feel, is where the Government have a role to play in demonstrating that the NHS has a future, and in making the necessary investment.
Like people in south Somerset, my constituents often refer to the lack of NHS dentists. The problem arises when people moving into the area cannot register. They become quite distraught, and it is difficult just to pick up emergency treatment. I am also concerned—this probably applies to south Somerset as well—about people with special needs such as a lack of mobility and who therefore need home visits. I am told that home visits are not a very attractive option for private dentists. We must therefore rely on the NHS, and there are long waiting lists.
Let me illustrate the seriousness of the situation with the example of a ward in my constituency, Canford Heath, which contains 6,000 new properties full of families with young children. There are currently no NHS dentists. Single mums in particular have no incentive to take their children to the dentist. We are storing up so many problems for the future by failing to provide preventive care at that early stage. I ask the Minister to assure us that a much larger programme of investment in NHS dentistry is planned.
§ The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)I congratulate the hon. Member for Yeovil (Mr. Laws) on securing this important debate on NHS dentistry, particularly as it affects his constituents. I know about his written question in June. He is already building up quite a record of pursuing these matters on behalf of his constituents, and I am aware that his predecessor had several meetings about the issue.
This is an excellent opportunity for me to tell the hon. Gentleman and his hon. Friend the Member for Mid-Dorset and North Poole (Annette Brooke) some of the good news that we do have, while recognising that we still have a long way to go in providing full coverage for access to NHS dentistry across the country, as well as in south Somerset.
It is true that Somerset has suffered from long-standing problems. As both hon. Members said, the 1990s witnessed a nationwide decline in patient registration with NHS dentists, with a corresponding increase in access problems for the public. Additionally, in September 1996, the then Government cut the maximum time allowed between visits for a patient to remain registered with an NHS dentist from 24 months to 15 months. That caused many patients' registration to lapse without their even knowing it. In total, the number of adults registered plummeted from a 1993 high of about 21 million adults to just over 16 million adults by 1999. That is the scale of the problem, and I would not seek to minimise it.
1279 About 45 per cent. of adults and 68 per cent. of children in Somerset are registered with an NHS dentist. Although that is not a wonderful figure, it is slightly higher than the national average. However, a worryingly small number of practices in the area have been willing to take on new NHS patients. There has also been a scarcity of urgent and emergency dental care across the county.
We recognised the access problems when, in September 2000, we published "Modernising NHS Dentistry—Implementing the NHS Plan". The plan committed the Government to ensuring that everyone can access an NHS dentist if and when they need to do so; to trying to improve the quality of service offered by NHS dentists; to raising the level of oral health, particularly in children—a preventive care issue that both hon. Members have raised today; and to trying to tackle the inequalities that exist across communities.
Alongside the Government's review of dentistry, in September 1999 the Prime Minister pledged that by the end of September 2001 everyone would be able to find an NHS dentist simply by telephoning NHS Direct. People do not simply receive a telephone number, they receive information on how to gain access to an NHS dentist. I acknowledge that that service is not about on-going registration; it is about providing access to care, not only for urgent and emergency cases but for routine cases.
In the past 18 months the Government have spent £100 million in trying to implement that dental strategy. That is not a small sum, and it shows the importance that we attach to trying to get NHS dentistry back into the mainstream of the service. We have spent £7 million from the dental care development fund to try to improve existing NHS practices, and £35 million from modernisation fund moneys to try to encourage dentists who are committed to the NHS to improve their practices. We have also asked every health authority to produce a dentistry action plan to set out the practical action that has to be taken to ensure that dentistry is available in communities.
Given the long-standing problems in Somerset, we were particularly keen to ensure that the area should receive the benefit of the whole range of the Government's current schemes. The Somerset dentistry action plan adopted a set of standards for the maximum time that patients should have to wait and the maximum distance that they would have to travel to gain access to NHS dentists. The standards are that they should have to travel a maximum of 10 miles for routine care—not 20 miles, as the hon. Member for Yeovil said, although 10 miles is still a fair distance to have to travel—and a maximum of 15 miles for urgent care and emergency care. Those standards are on a par with those set for rural areas by other health authorities in England.
The action plan identified several areas of risk that were likely to fail those standards and noted several very vulnerable areas, such as Wincanton and Chard. It also recognised that, across the county, patients who did not have an on-going registration found it very difficult to access urgent and emergency care.
The action plan therefore tried to identify practical action that we could take to address those issues, and the local health authority bid for considerable funds to try to put in place facilities. In 2000–01, the Government invested £71,000, and, in 2001–02, that figure has doubled 1280 to £144,000. That investment should allow registration for an extra 2,500 patients in Yeovil, 3,500 in Langport and 2.500 in Castle Cary. That should help to ease the pressure.
As well as encouraging those initiatives, we have tried to channel funds into Taunton, to ease pressure on dentists in the south Somerset region. South Somerset also received almost £59,000 of modernisation fund moneys for distribution to existing practices.
§ Sir Paul Beresford (Mole Valley)I have an interest in this subject, albeit not in the particular area. The hon. Members for Yeovil (Mr. Laws) and for Mid-Dorset and North Poole (Annette Brooke) touched on one of the core problems—the fee structure. The Government have to decide whether they are providing a basic service or a full service. In doing so, they must recognise the escalating costs—running costs and capital costs—and the increasing complexity of dentistry today. The service that the Minister is speaking of is mis-targeted, and dentists will move into the private sector. She must also recognise that in providing a service through the private sector, dentists are supplementing the NHS, and that frequently, especially for children, the cost to the patient is low or—as in my case—zero.
§ Ms BlearsThe hon. Gentleman should recognise that the Government's aim is to try to rebuild NHS dentistry after the devastating effects of the early 1990s. From my discussions with the profession, it is obvious that many dentists welcome change. They want to change the way they work and to try to move from payments for items of service into more preventive work in oral health and in tackling inequalities. Many excellent young dentists are coming through the system who are keen to explore new ways of working. That needs to be reflected in the fee system. My dealings with the profession have shown a real willingness to engage in new ways of working to try to ensure that NHS dentistry begins to recover from the tremendous onslaught of the early 1990s.
We have tried to put considerable money into Somerset. We have allowed £20,000 for spot contracting, to try to purchase additional sessions from existing dentists. That has been fairly successful and has resulted in 100 extra appointments a week in the area. The hon. Member for Yeovil mentioned dental access centres, and I am delighted that he had the opportunity to open one. 1 am sure that it was an enjoyable occasion. The first DAC was opened in Yeovil and the second in Taunton. The first site involved £500,000 of capital investment and costs £855,000 a year in revenue expenditure. That is a considerable service. There are plans to extend the DACs to cover the entire county, and an additional £1.5 million will be provided to do so.
Once all the sites have been opened, the DACs will employ eight practitioners and will look to provide more than 15,000 courses of treatment a year. They will also be able to deal with 8,000 emergency cases a year. It is a new form of provision, especially for the routine care that people need. We are trying to rebuild the NHS dentistry service and of course we want existing dentists to come into the system and increase the proportion of their NHS practice. In places where that is not happening, however, the DACs are providing a much-needed service to local people.
1281 We are also trying to ensure that we work closely with health authorities and primary care groups to try to recruit new dentists to the basic service. I am sure that the hon. Gentleman will accept that that is not easy, and he mentioned the need to make information available about the location of areas of unmet need and to provide support.
§ Mr. LawsI welcome the dental access centres, but my great concern is that they are not a replacement for the on-going dental care that people need. Does the Minister accept that it is unsatisfactory that my constituency has no dentist who will take new adult NHS patients? Would it be satisfactory if that were still the situation in a year's time?
§ Ms BlearsThe hon. Gentleman will recognise that the Government have little power to compel dentists to take part in NHS activities. This is a market. Dentists decide for themselves whether they want to be in the NHS or to undertake extensive private practice. The Government are trying to put in place incentives so that existing NHS dentists increase the proportion of their practice that is in the NHS. Other incentives are aimed at getting dentists to improve their premises and equipment, so that they stay in the NHS.
The Government are also undertaking longer-term work to do with fee structures and new ways of working. In that way, we hope to encourage some exciting and innovative new dentists to work in the NHS. We are working with health authorities and primary care groups to support the recruitment of dentists for mainstream services. We are helping with advertising costs, which are crucial in recruitment. We are also providing relocation expenses to dentists willing to move to new areas.
1282 Most importantly, we are offering assistance with short-term accommodation. Taking on new premises is a very big step, so the Government are helping dentists to move on a short-term basis initially, with accommodation provided to which they do not have to commit in the long term. In that way, we hope that dentists will be enticed back into the NHS, and that they will want to remain because they enjoy the work. We are therefore trying to be as imaginative as possible in providing incentives to draw people back into the service.
The Government have asked dentists locally for recommendations about what else they would like us to do. We want to help, and we have asked dentists for their ideas about how we can draw them back into the NHS. The dental access centre in Yeovil has been able to recruit dentists: the fact hat there are eight whole-time equivalent dentists in that centre shows that the task is not impossible. I hope that the same persistence will pay off elsewhere, and that the support mechanisms on offer to existing practices will help them to augment the work that they do.
We must accept that being a general dental practitioner became distinctly unattractive in the 1990s. The Government are now working nationally with the profession to change that and to make dentistry an integral element of NHS care. People's teeth and oral health are as important as any other aspect of health care. Drawing dentists back into the centre of the NHS is a top priority for the Government, and I would welcome ideas and suggestions—from the profession and elsewhere—about how we can create a vibrant NHS service. Such a service is needed by people in Somerset and in Yeovil, as it is by people right across the country.
§ Question put and agreed to.
§ Adjourned accordingly at twelve minutes to Eleven o'clock.