HC Deb 15 July 2004 vol 423 cc1634-40

Motion made, and Question proposed, That this House do now adjourn.—[Paul Clark.]

6.15 pm
Mrs. Janet Dean (Burton)

I welcome this opportunity to raise the concerns of my constituents who have difficulty in finding an NHS dentist. This problem is not confined to east Staffordshire; nor has it recently arisen. It stems from the reduction of dental training places in the 1980s and the dispute between the dental profession and the Conservative Government in 1992, which led to many dentists moving into the private sector. Those practices that loyally remained with the NHS were placed under pressure by patients moving from dentists who had left the NHS.

It is impossible to determine the exact number of whole-time equivalent dentists offering NHS treatment, because many dentists undertake variable amounts of both private and NHS work. However, the answer that I received in response to a written parliamentary question in March this year showed that the number of dentists per 10,000 population, on a head-count basis, was 2.8 in east Staffordshire, compared with 8.8 in Westminster. Not only do we have a comparatively low number of NHS dentists, but we also have a high demand for regular, routine dental care in east Staffordshire. The uptake rate per hundred of the local population is good compared with the figures for the midlands and for England generally. To some extent, that masks the problems that people have in accessing NHS dentistry in my constituency.

Those problems can arise when people move into the area, or if they fail to attend for a check-up within 15 months of their last appointment. However, a more difficult situation arises when dentists decide to de-register patients en masse. Such a situation arose in Burton in 2001 and, in March this year, two dentists at one of the only two practices in Uttoxeter notified their NHS patients that they would no longer treat them as NHS patients, following their next appointment. The patients were offered the opportunity to join a private dental health insurance scheme. Indeed, it appeared that the notification letters had been distributed by that scheme, as they had been posted in Winchester, where the company is based.

Many of my constituents in Uttoxeter who received those letters were extremely angry because, in many cases, they had been with the practice, and the previous dentist at the practice, for most of their lives. They were angry because they were faced with the difficult choice between joining the private scheme, paying for private treatment or having to find an alternative NHS dentist. Some constituents were also angry because they knew that the dental clinic in question had received investing in dentistry funding in 1999, which had helped to increase the amount of NHS dental treatment available in the town.

It was with great sadness that I reported the decision of those dentists to de-register their patients to the East Staffordshire primary care trust on Monday 1 March 2004, following phone calls from my constituents over the previous weekend. I was particularly saddened by the dentists' decision because I had supported their bid for investing in dentistry funding in 1999. I had also had the pleasure of accepting the invitation to open their new premises in Uttoxeter. Somehow, it felt like a kick in the teeth—no pun intended, but there had to be one, did there not?—that they should decide to take a decision that so badly affected so many of my constituents at a time when the Government had recognised the problems with the current general dental service contract and were in negotiations with the British Dental Association regarding a new contract. The receipt of the letters by my constituents followed about a week after I had publicly welcomed the extra Government funding being made available to support dentists in east Staffordshire from the beginning of the financial year. There is something wrong with a system that leaves 3,500 people without an NHS dentist and where a decision taken by an individual dentist affects so many people. I am disappointed that dentists who have stuck with the NHS through all of the years of pressure within the system since the early 1990s should feel the need to cease to treat NHS patients.

Dentists give several reasons for ceasing to treat adults as NHS patients. They claim that remuneration has been inadequate in the past and that the proposals put forward in the new contract do not address the perceived underfunding of the service. They also suggest that patients' quality of care will be compromised under the new proposals. Looking at the reduced opening hours of those practices where dentists decide to leave the NHS, it appears that their quality of life improves, but those constituents who cannot register with an NHS dentist pay the price. Some dental practices in my constituency have remained totally or mainly with the NHS, increasing or maintaining their NHS registrations, and I pay tribute to them for their loyalty and dedication to their patients.

Since 1997, the Government have made dramatic improvements to our health service. In my constituency, that investment has increased the number of people employed at Burton's Queen's hospital by 35 per cent. The number of consultants whom the trust employs has risen from 65 to 92. There are 255 more nurses and midwives, 41 more ancillary staff and a 68 per cent. increase in the number of doctors. There has been an improvement in primary care for my constituents in Winshill, with the opening of a medical centre, made possible by the employment of a GP by the East Staffordshire PCT.

In spite of funding initiatives for dentistry, such as the investing in dentistry and modernising NHS dentistry programmes, the lack of capacity within NHS dentistry in east Staffordshire remains. I know that the Government are committed to tackling the problem. The importance of retaining NHS dentistry for adults as well as for children cannot be overstated. The issue is about not only the care of teeth, but overall oral health and the early identification of wider disease, which is important. Oral health care should not be jeopardised because people cannot afford to pay into private insurance schemes.

In east Staffordshire, we are fortunate that our children have low levels of tooth decay because our water supply is fluoridated—naturally in Uttoxeter, and artificially in and around Burton upon Trent. However, we have difficulty in recruiting dentists. I understand that there are currently vacancies for four associate dentists, three in Burton and one in Uttoxeter. The primary care trust has paid for adverts in the "British Dental Journal", but to no avail, and discussions have occurred between the PCT and the Department of Health regarding the recruitment of overseas dentists. Will my hon. Friend indicate the time scale for overseas recruitment and how PCTs can support such dentists?

The difficulties in recruitment have their origins in the decision in the 1980s to close two dental schools and to reduce the number of places at the Birmingham dental school. One reason why we have a particular difficulty in recruiting dentists in east Staffordshire is that we are on the fringe of the west midlands, and some distance from the nearest dental schools in Birmingham, Sheffield and Manchester. There is a tendency for dentists to practise close to the area in which they have trained, because after five years at university they have often developed close ties to that area.

I welcome the Government's commitment to open two new dental schools. May I seek my hon. Friend's reassurance that one of those will be in the midlands, bearing in mind the work force problems in the area? At present, all training of dentists, hygienists and therapists takes place in Birmingham, so not only is there a tendency for them to stay in that area, but local students may be hindered in accessing that training in the first place. There are also concerns about the capacity for dental nurse training in the area, as dental practices in east Staffordshire also report difficulty in recruiting and retaining dental nurses, especially as salaries are higher in the private sector. Can my hon. Friend tell me whether an increase in the local training capacity would assist east Staffordshire?

I commend the efforts of the NHS dentistry support team and the East Staffordshire PCT over recent months in looking for ways to improve the situation in my constituency. Following my representations to the Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central (Ms Winterton), I know that representatives of the new special health authority have been in close contact with Staffordshire primary care trusts and the strategic health authority. I am pleased to say that a new dental access centre has been opened at the Balance street health centre in Uttoxeter for two days a week. That will complement the full-time service at Cross street clinic in Burton and help many people who are displaced by the deregistration of NHS patients to access urgent treatment and pain relief.

The East Staffordshire PCT has been in discussions with three local dental practices over their potential transfer to personal dental services contracts in advance of the move to local commissioning in April 2005. They are also in negotiation with five practices over grants under the general dental services initiative scheme. I am pleased that the Government made £113,000 available for 2004—05 to East Staffordshire PCT for that purpose. That will help to stabilise capacity at some practices and help others to expand. Will my hon. Friend say whether East Staffordshire PCT could be considered in any further round of funding available through the dentistry support team? Will he also confirm when PCTs are likely to receive their indicative dental services budget, which would allow them to test the requirements for live commissioning in 2005–06?

I turn to the funding arrangements from 2005. I understand that my hon. Friend the Minister of State has made a commitment to the British Dental Association that if any dentist wishes to increase his or her NHS commitment now or in the run-up to the new arrangements we will fund that extra commitment and make sure their PCT is adequately resourced to sustain that funding level under the new contract. If it proves difficult to fill vacancies for some months, will it still be possible for the necessary funding to be made available to PCTs for the three years from 2005? Indeed, will the historic inequalities in NHS provision be addressed in the funding of dentistry through primary care trusts from next year?

Can my hon. Friend assure me that it will possible to avoid a postcode lottery in dentistry in future? There is a fear that when PCTs are given cash-limited budgets, they will, after the three-year base contract guarantee period has ended, be forced to prioritise what is commissioned in order to maximise the impact of funding. That could mean that some traditionally provided services might no longer be supported if PCTs are to address the challenges on access of service and oral health inequalities. It is likely that PCTs will vary in the decisions they take at that time.

I am aware that the Secretary of State for Health is due to set out the Government's plans to strengthen NHS dentistry tomorrow. I hope that that announcement and my hon. Friend's response today will give reassurance that the problems in NHS dentistry that we have seen for many years can be overcome. I hope that dentistry provision can e experience the same expansion that has taken place in other sectors of the NHS. I believe that if we can increase the number of NHS dentists in east Staffordshire and elsewhere where there are shortages, more people will be treated as NHS patients rather than as private patients or through private insurance schemes. We may then see the end of the downward spiral, and some of those dentists who have left the NHS may choose to return to the fold.

6.28 pm
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman)

I congratulate my hon. Friend the Member for Burton (Mrs. Dean) on securing this important debate on NHS dentistry in east Staffordshire, on the interest she shows in these important matters, and on the constructive way in which she put her case. I sympathise with her and understand how she feels let down by those dentists who have taken the NHS shilling in order to expand their practice, then decided to abandon the NHS.

I am well aware of the keen interest that my hon. Friend takes in access to dentistry in her area. I know that she raised the matter with the Secretary of State at oral questions last week, as she has on other occasions, and that she has written to the Minister of State, my hon. Friend the Member for Doncaster, Central (Ms Winterton), on the subject. I want to address not only the specific issues that she raised, but to talk about the programme of action that is under way nationally to reform the overall system. First and foremost, as my hon. Friend said, my right hon. Friend the Secretary of State for Health will make an announcement tomorrow that will detail the Government's plans for improving access to dental services in future. I know that she is eager to hear that announcement, but I hope that she will forgive me if I do not let the cat out of the bag, as that would not do my career any good at all.

The oral health of the population has improved enormously since the NHS was set up, and the number of dentists has increased year on year. There are now more dentists than ever before—more than 19,000 dentists provide NHS care, compared with just 15,411 in September 1992. While the number of dentists has been going up, we accept that the commitment of dentists to the NHS has fallen. As a result, in some areas people have difficulty accessing NHS dentistry, despite the fact that the Government have increased dentists' fees in line with the doctors and dentists pay review body recommendations, resulting in an increase in fees of 32 per cent. since 1997. We accept that some areas have a serious shortage of NHS dentists. The problem is not new, however, and has its roots in the actions of the previous Government, including the contract debacle of 1990 that led to a fee cut in 1992 and caused dentists to start to move away from NHS dentistry. That might explain how the problems came about but, of course, it does not help us to make progress and solve them. One set of clauses in the new Health and Social Care (Community Health and Standards) Act 2003, however, which was welcomed by Members from all parties in both Houses, covered the reform of NHS dentistry, and represents the most significant reform of dentistry since NHS dental services were established in 1948.

The reform will provide a better deal for patients, dentists and the NHS. It will allow dentists to spend more time with patients and provide patients with the dental care that they need. Our policy, therefore, is not to maintain the status quo but to rebuild NHS dentistry and provide a more up-to-date legal framework that will better allow primary care trusts to develop and plan those services strategically. It will enable services to be more responsive to patient needs while improving the working lives of dentists and their teams. The general principles of the new primary dental service were set out in the report "NHS Dentistry: Options for Change", which was published in August 2002. One of its key recommendations was for the local commissioning of a high-quality dental service. It proposed that funding should be devolved to the local level to allow PCTs to secure the provision of a new service. The implementation of the Health and Social Care Act 2001 will enable those changes to be made.

The existing patterns of NHS expenditure on dentistry reflect the varying willingness of dentists to treat NHS patients. However, we need to move to a system in which the NHS locally decides what is necessary to meet the needs of the local population, and the new arrangements will enable us to do so. Under the new system, we are giving PCTs the responsibility for £1.3 billion of financial resources that are currently held centrally. We have transferred decisions about the commissioning of local services to the local level. At the same time, current spending will be protected. The devolved funding will be used to commission more dentistry locally, for example, through extra sessions for NHS patients. In the short term, however, we accept that there are serious problems with access. Since last year, we have provided new investment totalling £90 million to support PCTs as they get to grips with the new agenda, of which £59 million will support access and £30 million will support IT. The balance of £1 million will support organisational development locally.

In my hon. Friend's constituency, East Staffordshire PCT is working closely with Shropshire and Staffordshire strategic health authority. They are being supported by the Department of Health in their efforts to improve local dental access by using their share of the access funds—some £1.4 million in Shropshire and Staffordshire in 2004–05. We also aim to bring more dentists back to practice after a career break, and have recently placed advertisements in the national press. The keeping in touch scheme is designed for people on a career break who want to return to practice. We have also begun to recruit dentists from abroad, including Europe and further afield.

It is not just about dentists but about the whole dental team. We have already increased training places for dental therapists from just 50 to 200, and the first newly trained therapists will be entering the work force in autumn 2006. In addition, there are a number of avenues available to support the training of dental nurses. We are exploring how best to make those more readily accessible to dental practices.

In the longer term, NHS funding allocations for dental services will need to take oral health needs into account, as general NHS allocations currently do in relation to general health needs. We already have the experience of five years of local commissioning of dentistry under the personal dental services pilot programme, where resources are devolved to the front line. The pilots, now treating 750,000 people a year, have shown what works well and what works less well. The field sites are building on that learning experience to refine a simple but robust base contract, which all PCTs and dentists can have in place for 2005. PCTs are already building up relationships with their local dentists, and we are confident that devolving commissioning responsibility for dentistry to PCTs will enable areas to tailor more appropriate local solutions to any particular access issues that they may have.

I appreciate the real concerns that my hon. Friend has raised, and can well understand that her constituents may be worried that they will have to wait for those changes to come into effect. East Staffordshire PCT is aware of the problems that local people are having in accessing NHS dental services. At the moment, there are two practices in the area, one at Burton, and the other at Uttoxeter, which are accepting new NHS patients. I am informed by Shropshire and Staffordshire strategic health authority that in the past both of those practices have been forced to stop accepting new registrations due to the high demand.

Mrs. Dean

My hon. Friend might like to be aware that although one of those practices is accepting new patients, there is a waiting list of several months before someone can see a dentist and join the list properly.

Dr. Ladyman

I accept that point entirely, and that is why the local PCTs are working so hard to try to address those issues.

While there are dentists in other PCT areas that may have been able to take some of the demand, it is recognised locally and by me that that does not really tackle the underlying problem. The PCT has therefore been working hard to develop a range of local solutions to those difficulties. For example, the PCT has commissioned a dental access centre in Burton, and dental access centre services are now available for two days a week in Uttoxeter. The PCT has used previous grant initiatives to support local practices under the investing in dentistry and modernising NHS dentistry programmes.

The PCT received —113,000 in grants for 2004–05 under the general dental services initiative scheme and is in negotiation with local dental practices about stabilising and expanding capacity. The PCT is also looking into pooling its £11,000 share of salaried primary care dental service capital funding with other PCTs in Staffordshire in a fund of £55,000, which can be used to improve premises and efficiency across the area.

The PCT is also in discussion with three dental practices about the potential transfer to personal dental services arrangements in advance of the move to local commissioning in 2005. It is hoped that that will stabilise practices, which otherwise could move further towards private treatment. Work is also under way within the PCT to establish the extent of inequalities in dental health between affluent and relatively deprived communities. In addition, the Department of Health is working closely with local NHS organisations to ensure that they have appropriate support. With the additional funding from the Department, PCTs are now in a position to develop firm plans for the future and are now developing dental action plans to set out how they will use that additional funding.

I have listened carefully to all of the issues raised by my hon. Friend today. At a national level, a reform programme is in hand, and national support is being provided to those areas that are most challenged until those reforms are safely in place. I know that my hon. Friend wants more practical action, however, so I am happy to announce that further support should soon be available to east Staffordshire from the Department of Health. The Department's dental support team has just decided its next programme of visits, which will include east Staffordshire. The Shropshire and Staffordshire SHA, including the East Staffordshire PCT area, will be prioritised for around 10 of the next tranche of dentists who will shortly be recruited from Europe by the Department of Health. I am pleased to tell my hon. Friend that as a result of her campaigning, and that of her Labour colleagues in the area, two have been identified for specific vacancies in East Staffordshire PCT.

I hope that that additional help will please my hon. Friend and, of course, her constituents. The changes will take time, but the framework is in place, and the extra investment and support from the Department should enable much-needed improvements in dental services to be delivered in east Staffordshire.

Question put and agreed to.

Adjourned accordingly at twenty minutes to Seven o 'clock.