HL Deb 21 February 1992 vol 535 cc1447-50

11.22 a.m.

Lord Carter asked Her Majesty's Government:

Why they propose to cut the fees paid to dentists from 1st April 1992.

The Parliamentary Under-Secretary of State, Department of Social Security (Lord Henley)

My Lords, we continue to negotiate with dentists' representatives and a further meeting took place yesterday afternoon. As part of those discussions we agreed to re-examine, in association with the dentists' representatives, the detailed elements of the levels of fees. At the next formal meeting in May the results of that work will be considered and the fees scale set accordingly. Meanwhile the proposed reduction in fees will not be implemented.

Lord Carter

My Lords, I thank the Minister for that reply. Is he aware that his right honourable friend the Prime Minister announced on 10th February an 8.5 per cent. increase in dentists' income? Presumably he was fully aware that the Secretary of State for Health would announce on the same day that the 8.5 per cent, increase would in fact mean a cut of 13.8 per cent. It is obvious that the Government have now panicked and, faced with a mass exodus of dentists from the health service, they have put the matter on ice until after the general election. Does this not confirm the view widely held by dentists and their patients that the national health dentistry service is not safe in this Government's hands?

Lord Henley

My Lords, unlike the noble Lord, I am not aware of the date of the election. We have put off consideration of these matters until May because that is when the next formal meeting of the body that will be examining dental fees will take place. We announced an increase in the targeted average national income of dentists of 8.5 per cent, and we stick to that. We hope to see an increase in what is known as TANI of 8.5 per cent.—that is, up to almost £36,000 —for the coming year. But over the past year we have seen what we expected to be expenditure on general dental services of £1.2 billion grow to £1.4 billion. It is not clear why the level of fees has risen quite so much. That is why we have agreed to the joint inquiry into these matters. But no responsible government could allow fees to grow quite at that rate in a quite uncontrolled manner. Therefore we consider that the best way forward would be to discuss the matter with the British Dental Association to see whether we can come forward with proposals that will lead to adequate remuneration and an increase in the TANI of 8.5 per cent.

Lord Ennals

My Lords, irrespective of whether the election will be held in early April or early May, is it not perfectly clear that the Secretary of State has simply bought off the problem and bought time until after the election, whenever that is? Will the Minister comment on the statement made yesterday by the British Dental Association that NHS dentistry is near to collapse due to the increasing number of dentists who are refusing to take patients other than private patients?

Lord Henley

My Lords, I do not see a growth from £1.2 billion to £1.4 billion as a sign of collapse. I can assure the noble Lord that some 76 per cent, of dentists still accept all NHS patients. Some 85 per cent, of all dentists will accept all children NHS patients.

Lord Skelmersdale

My Lords, is not the real story that dentists have treated more people in this current financial year than the Government have allowed money for? Furthermore, as inspections are required before treatment, does that not make absolute nonsense of the fears that charges are putting people off going to the dentist?

Lord Henley

My Lords, my noble friend is quite correct to say that dentists are treating more people.

Expenditure on NHS dental services has gone up by some 47 per cent. in real terms since 1979 and there are now 26 per cent. more dentists in Great Britain than there were in 1979.

Earl Russell

My Lords, I thank the Minister for his assurance that the Government are looking at this matter again. When they look at it again, will they take seriously the misgivings expressed by the British Dental Association which are shared by a great many dentists who as yet still provide the full National Health Service cover? When the Government look at this matter again, will they also reconsider the effect of the dentists contract on central London, especially as regards laboratory costs, the costs of premises and the costs of the uniform business rate, as those costs are causing severe problems in inner London?

Lord Henley

My Lords, I can assure the noble Earl that as well as looking into the level of expenditure and the reasons why it has grown over the past year, we have agreed simultaneously to begin a more fundamental review of the dental remuneration system as recommended by the Doctors' and Dentists' Review Body. One of the aims of the review will be to prevent a repetition of this current problem.

Baroness Gardner of Parkes

My Lords, I am relieved to hear my noble friend's statement that this matter is not just being deferred until after a general election, contrary to what was stated in The Times this morning. I am relieved to hear the matter will be examined in detail. I have been a practising dentist for over 30 years and I know that every time productivity is increased dental fees are cut by all governments. That has always been standard practice. Is it not time that the whole matter of the target average net income (TANI) was looked at because it is the word "average" that causes the problem? In some parts of the country dentists are barely surviving and dentists in certain age brackets are having problems surviving. Some dentists are doing well but we know that others are not.

Does my noble friend agree that the public suffer from misconceptions about dentists? When a target average net income of £35,000 plus is announced for the next year, the public think dentists receive that sum as a salary. However, they do not appreciate that dentists have to provide their own equipment and premises. The noble Earl, Lord Russell, referred to the uniform business rate. However, that is not relevant to this matter as dentists are now reimbursed by the Government for the uniform business rate. But all the other costs dentists face should be taken into account when considering this whole matter.

Lord Henley

My Lords, I am grateful to my noble friend for her comments. I can appreciate the problems she expounds as regards the use of TANI. I should stress that TANI stands for targeted average net income and not national income as I said before. The important point is that it is a targeted average net income and not a gross income. It is obviously important that the public should realise that we are looking at an increase in dentists' net income—that is, their income because they are self-employed—after all their practice expenses are taken into account. Those expenses will obviously be quite substantial. However, I can see no other way of managing these matters when one is dealing with the incomes of the self-employed.

Lord Bruce of Donington

My Lords, is the noble Lord aware that there are quite large areas of the country where it is not possible for patients requiring dental treatment to obtain it under the National Health Service? Will the noble Lord please explain how that squares with the responsibility of the Government to provide dental treatment under the National Health Service where it is required?

Lord Henley

My Lords, I have always accepted that there might be problems in some areas. Perhaps I may repeat the figures which I gave earlier: 76 per cent. of all dentists accept all NHS patients and 85 per cent. of dentists will accept all NHS children patients. If the noble Lord is having problems in any particular area I recommend that he goes to his family health services authority. Lastly, I should have thought expenditure of £1.4 billion on dental services belies the fact that dentists are leaving the NHS in droves.

Baroness Gardner of Parkes

My Lords, is the Minister aware that in the areas where dentistry is not available in some cases salaried dental services are being set up, and does he agree that the Government, through the regional health authorities, are meeting their commitment in that way?

Lord Henley

My Lords, I thank my noble friend for those remarks. As I said, if the noble Lord was having problems himself he could go to his local family health services authority and seek advice there.