HL Deb 16 January 1992 vol 534 cc347-50

3.16 p.m.

Lord Dean of Beswick

asked Her Majesty's Government:

Whether they are aware that people in certain areas are having difficulties in obtaining dental treatment under the National Health Service, and what proposals they have to deal with the situation.

Baroness Hooper

My Lords, we are aware of some pockets of difficulty; but more than three-quarters of the country's dentists accept all patients who seek National Health Service treatment. An even higher proportion accept all children. Over 25 million patients are now registered under the new system with a dentist in England or Wales. Nevertheless, we are in discussion with family health service authorities and representatives of the dental profession further to improve the implementation of the new dental contract.

Lord Dean of Beswick

My Lords, I am extremely grateful for the welcome details given by the Minister. Is she aware that a recent report issued by her own department, the Department of Health, showed that in parts of London 75 per cent. of dentists refuse all national health patients. Does she agree that if certain dentists want to behave badly it leaves the people in those areas open to some form of exploitation? Can she indicate whether the Government are aware of this situation and whether they will try urgently to resolve it?

Baroness Hooper

My Lords, we are certainly very much aware of it. To some extent the findings of the survey and analysis that we made reflect a situation which was already in existence. A number of dentists already offered a mixed service of private and national health treatment and some remained exclusively private, particularly in the central London area. It is true to say that in Kensington, Chelsea and Westminster there are more dentists per capita than in any other family health service authority in the country. Nevertheless, as a result of our survey, I met with the chairmen of the FHSAs in the four worst areas. They assured me that if anybody goes to them they are able to find a suitable National Health Service dentist. We are looking at other ways of communicating to people that when seeking a National Health Service dentist they need to approach their FHSA in order to obtain the information that they require. We are also looking at use of the community dental service and the employment of salaried dentists, where appropriate.

Baroness Gardner of Parkes

My Lords, will the Minister confirm that it is the high cost areas, such as London, in which the problem exists? Does she agree that the situation was drawn to the Government's attention before the new contract came into force? Will she also confirm that those members of the British Dental Association General Dentists Services Committee who negotiated the contract were not re-elected by the members of their profession because they considered that the contract had not taken into consideration the high cost areas and the inability of dentists, even those who wished to provide National Health Service treatment, to do so? I ask the noble Baroness to confirm that the Government will review the matter with the newly elected committees which may be more aware of the real problems.

Baroness Hooper

My Lords, we are aware of the problems indicated by my noble friend. Indeed she herself drew them very forcefully to my attention during the course of your Lordships' proceedings. We reacted by ensuring that there should be direct reimbursement of rates for all dentists. We are continuing discussions with the GDSC in terms of simplification of the administration and documentation relevant to the new contract. We are looking at other ways of improving its administration.

Lord Ennals

My Lords, does the Minister accept that, even from the figures that she has given us, one quarter of all dentists now deny NHS treatment, and that there are some parts of the country where it is virtually impossible for patients to obtain their dental health treatment on the National Health Service? Is that not depriving them of the choice about which we have been told so much by this Government? Is there not something more energetic and active that the Secretary of State can do to deal with a serious problem?

Baroness Hooper

My Lords, it is simply not true to say on the evidence that we have that it is impossible to find National Health Service treatment in any part of the country. I have already indicated that anyone who has difficulties must approach his or her local family health service authority.

Earl Russell

My Lords, the noble Baroness mentioned the difficulties in Kensington, Chelsea and Westminster. Is she aware that a number of the dentists who offer comprehensive health service treatment in those areas are in a great deal of doubt about how long they can afford to continue to do so? In reviewing the treatment of high cost areas in the dental contract, will she convey that the anxiety expressed by the noble Baroness, Lady Gardner of Parkes, is not confined to any one quarter of the House?

Baroness Hooper

My Lords, I emphasise that in terms of funding and remuneration of dentists, the new contract did not change the level of dentists' remuneration: it simply changed the way that they are paid. It is welcomed by many dentists up and down the country. It gives a stable, regular income from continuing care payments for adults and the capitation fees for children. The proportions of the dental pool allocated to adult and child care were not changed by the new contract.

Lord Carter

My Lords, does the Minister agree that it is not a problem for London alone? The survey referred to quoted no less than 15 areas. In Bolton 36 per cent. of dentists and in Surrey 52 per cent. of dentists refused to offer NHS treatment to all their patients. In the Minister's first Answer she used the phrase, "some pockets of difficulty". I am sure that that is an understatement of the problem.

Baroness Hooper

My Lords, no. In the department's own survey, which was a sample survey of the 90 family health service authorities throughout the country, it was quite clear that every authority area can provide National Health Service treatment. It is only in certain small areas that there are specific problems which we are now addressing.

Lord Molloy

My Lords, many examples have been cited from both sides of the House of people unable to get to a dentist. Does that not oppose the principle of preventive medicine? Children and grown-ups may not have something seriously wrong, but they believe it advisable to visit their dentist before they do.

Baroness Hooper

My Lords, the concept of the new contract which emphasises the need for continuing care was to reinforce that preventive approach. We believe that any problems that may have arisen over implementation of the new contract will be, and should be, ironed out shortly.

The Countess of Mar

My Lords, has not the combination of the new contract and the charges raised for dental inspections and so on previous to the implementation of the new contract reduced the numbers of dental patients? For example, I can now obtain an appointment with my dentist within a week whereas I used to have to wait six weeks. That seems an indication that he does not have so many patients and that therefore dentists' income is not so high as it was.

Baroness Hooper

My Lords, we have no indication that fewer people are being treated; on the contrary. The figure of about 25 million people who have already registered is over and above the expectations that had been suggested by the profession and estimated within the department.