NHS Dental Treatment (Hansard, 18 July 2001)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, perhaps I may say first how good it is to see the noble Baroness in her place in your Lordships' House and looking so well.
All health authorities have prepared dental action plans to ensure that everyone in the local area can access NHS dentistry, if they want it, within a reasonable time and distance.

§ Baroness Gardner of Parkes
My Lords, unfortunately the facts do not appear to balance that response. Is it not correct that national health dentists are paid according to nationally averaged expenses built into a fixed fee for each specific item of treatment? Does that not mean that those dentists who incur low costs fare well, but that those whose costs are higher than average fare badly? Indeed, they fare so 1473 badly that in high cost areas often they cannot offer any form of national health treatment. What does the Minister propose to do about that?

§ Lord Hunt of Kings Heath
My Lords, the point made by the noble Baroness is well taken. I imagine that she might argue that a special weighting should apply to dentists practising in London to reflect that. However, I have to say to the noble Baroness that relatively few problems are encountered when recruiting dentists in London as compared with other parts of the country. As regards the remuneration of dentists in relation to the General Dental Service, I can tell the noble Baroness that a dentist aged 35 and over who has the highest level of commitment to the GDS would have annual earnings, after expenses, of around —65,000 per year.

§ Lord Clement-Jones
My Lords, is it not the case that approximately 1,000 extra dentists are needed if the Government's plans are fully to be put into effect? The Minister may have seen a survey recently carried out among dentistry graduates. Few of them stated that they would consider the NHS as a career choice. How do the Government square those findings with their plans?

§ Lord Hunt of Kings Heath
My Lords, most dentists undertake a great deal of NHS treatment. So far as concerns the strategy, I am very confident that we will deliver on that strategy. We have said that we will make NHS dentistry accessible to all who require it by September this year. We shall ensure that that happens.
As to the number of students coming through, the figures for 2000–01 show an intake of 915 pre-clinical dental students, which is up on the previous three years. We are instituting a workforce review—the first for many years—to look at our future requirements in terms of the number of dentists that we need. We shall make sure that it will not be a snapshot review but one which will be ongoing over the next few years.

§ Lord McCarthy
My Lords, perhaps I may remind the Minister of a speech made by the Prime Minister in the Royal Free Hospital, a most appropriate place. He said that we should use the spare capacity of the private sector to help the public sector. There is an enormous amount of spare capacity in private dentistry, but the reason it is not used in the public sector is that people cannot afford it. Is it not the case that people cannot find National Health Service dentists; that there is a waiting list; that NHS dentists use inferior materials and offer a narrow range of treatment; and that 75 per cent of the costs have to be paid by the patient? What are the Government going to do about using the services available in the private sector? Will they cease the policy of underfunding started by the previous Government and pay for people to get a free health service?

§ Lord Hunt of Kings Heath
My Lords, I am grateful to my noble friend for that question. There is nothing 1474 like friendly fire. I do not agree with my noble friend. I believe that the quality of NHS dentistry is very high; we have a high quality profession and high quality training. Through continuing professional development and the work of the General Dental Council, we are ensuring that we enhance the quality of treatment.
So far as concerns the mix between public and private provision in NHS dentistry, most dentists provide both private and NHS treatment. The challenge for us is to encourage dentists to undertake more NHS treatment. We have introduced incentives such as commitment payments and modernisation funds to encourage that. Certainly, so far as concerns the comments about dentistry made by my right honourable friend the Prime Minister, I am confident that by September this year we will achieve the access that he pledged.

§ Lord Roberts of Conwy
My Lords, is not the Minister aware that there has been a 27 per cent decline in applications for dental student places at our higher education institutions? Does not that cause him some concern?

§ Lord Hunt of Kings Heath
My Lords, nevertheless dental places are being filled. There has been an increase in the numbers coming into our dental schools. I am assured that the quality of people applying is of a very high calibre. But, of course, we must keep the question raised by the noble Lord under review. It is an issue that we will address within the workforce planning review. Dentistry is a profession of a very high order and we want to attract the highest calibre of people to it.

§ Lord Tomlinson
My Lords, does my noble friend agree that he could assist National Health Service dental treatment by making rapid progress on the fluoridation of water supplies, particularly to those large cities referred to in the Question?

§ Lord Hunt of Kings Heath
My Lords, my noble friend surprises me by his question. He will know that we commissioned an up-to-date review of the evidence on fluoridation and health from the University of York. The review found evidence that fluoridating water does help to reduce tooth decay. It also considered evidence of its adverse effects on general health but found that there was no association with some of the allegations made in relation to osteoporosis, bone fractures, cancer, Alzheimer's disease or other irregularities. None the less, the report identified that there was a lack of good quality research in this area. For that reason we have asked the Medical Research Council to advise us on what further research should be commissioned. Any decision on legislation in regard to fluoridation must await the advice of the Medical Research Council.

§ Lord Lester of Herne Hill
My Lords, is the Minister aware that the adult dental health survey—a vast survey—shows that 42 per cent of the adult population 1475 suffer from quite serious periodontal disease? What steps can the Government take to ensure that there are enough periodontal specialists to tackle this pervasive problem?

§ Lord Hunt of Kings Heath
My Lords, the noble Lord raises an important question. The workforce review that I have mentioned will commence work tomorrow. It will look at all issues in relation to the workforce within the wider profession. I hope that it will come forward with proposals to ensure that we have the workforce we need to provide the range and quality of services identified by the noble Lord.