Dentists: Under-Employment (Hansard, 4 June 1984)

§ Baroness Gardner of Parkes
My Lords, I beg leave to ask the Question standing in my name on the Order Paper.

The Earl of Caithness
My Lords, following last year's review of future dental manpower needs, the intake of the United Kingdom dental schools is to be reduced by 10 per cent. in the autumn, and we propose to undertake later this year a further review of future dental manpower needs.

§ Baroness Gardner of Parkes
My Lords, I thank my noble friend for that reply. May I ask him whether he is aware that the national health dental service has since its inception been essentially a piece-work dental repair service and that such repairs have now reached the point where, as was confirmed in a written reply on 21st December last, over 29 per cent. of patients examined under the health service required no further treatment? Does he agree that that type of repair service is rapidly becoming inappropriate as the need for routine fillings is diminishing in the United Kingdom and in all developed countries because natural teeth are being retained much longer? Does he also agree that in the future greater emphasis will need to be placed on maintaining oral health, especially in older patients who would in former years have lost their teeth at an earlier stage?

The Earl of Caithness
My Lords, a number of points have been raised. With regard to the future of the dental service, we believe that we should move over to prevention rather than the piece-work and repair service. That is why we are about to launch our pilot study into capitation and have given priority to dental health education programmes.

§ Lord Ennals
My Lords, is not the British Dental Association much more concerned about the Government's decreasing commitment to the dental health service? Will the Minister confirm that between 402 1976 and 1983 the patient's share of dental costs rose in real terms by 50 per cent.? Is he aware that the British Dental Association is also very much concerned at the decreasing proportion of people who are prepared to go to their dentists because of the increased costs that they would incur?

The Earl of Caithness
My Lords, I am not conversant with the exact figures that the noble Lord has given, but I can assure him that every year, I think, in the past 10 years the number of people attending dentists has gone up. Despite some increases in charges under this Government, the number has gone up steadily year by year.

§ Lord Kilmarnock
My Lords, is the noble Earl aware that the practice of a once-a-term inspection of school children's teeth is an extremely effective way to avoid the need for later dental care? Can he tell us how widespread that practice is across the country? If it is not widespread, will the Government undertake to promote it?

The Earl of Caithness
My Lords, I am afraid that I cannot give the noble Lord, Lord Kilmarnock, an answer on that. I will, however, write to him.

§ Lord Leatherland
My Lords, may I ask the noble Earl whether he is aware that there is a problem here, and will the Government undertake to get their teeth into it?

The Earl of Caithness
My Lords, this Government are doing everything they can to make the situation better for patients. If more patients would go to dentists, that would also help to solve a lot of the problems.

§ Lord Ennals
My Lords, what evidence is there that dentists are under-employed? I know that the noble Baroness suggested that that was the case, but what evidence do the Government have of that? Is it not simply that fewer people are having check-ups because of the rising costs? If I send the Minister the recent publication of the British Dental Association which sets out all the facts, will he please read it?

The Earl of Caithness
My Lords, of course I shall read it.

§ Baroness Cox
My Lords, can my noble friend the Minister say whether he is confident that the reduction in numbers entering the profession will achieve the necessary adjustment in the ratio of dentists to patients; and/or can he indicate whether thought is being given to a policy of voluntary early retirement for general dental practitioners?

The Earl of Caithness
My Lords, one cannot be confident about future manpower needs because it is such a highly complex problem, as my noble friend will be aware. However, we consider the 10 per cent. reduction in dental school intake to be fine tuning that will improve the position. As I said in my original Answer, we shall keep a check on the situation.

§ Baroness Gardner of Parkes
My Lords, may I ask my noble friend to accept my evidence that there is under-employment? I recently visited 12 dentists in the inner London area. Most of them told me that they could take any patient the next day, and quite a number of them that very day, and that they were desperately under-employed. I ask him to accept that as evidence which I have personally gathered. I would also ask my noble friend whether he is able to reconcile the fact that, as I say, many dentists are in need of work, and yet many of the people one meets say that they cannot get a national health dental appointment. I would ask him how to reconcile those two facts. Finally, I should like to ask him to comment on the dental strategy review body report, Towards Better Dental Health, published in 1981, and to say what action the Government have taken about that. I know that he mentioned the capitation fee. Does he consider that that report has now been superseded—

Noble Lords
Too long!

§ Baroness Gardner of Parkes
—and that a new review should be undertaken?

The Earl of Caithness
My Lords, with regard to the point about some patients not being able to get NHS treatment, I am sure that the position is much better than it was several years ago, when many dentists were providing only selective items of treatment under the NHS; but I recognise that there are still a few areas where difficulties remain. Any patient seeking an NHS dentist should ask the local family practitioner committee, which will usually be well placed to advise people. With regard to my noble friend's further supplementary question on the dental strategy review group report of 1981, it is still current. It is not to be revised. We have in fact implemented a large number of the report's major recommendations.