NHS Dental Contract (Hansard, 16 December 2004)

§ Baroness Andrews
My Lords, we have been holding discussions on contractual guidance for over a year with the leadership of the British Dental Association. The BDA has made a valuable contribution, and we were surprised by its decision to suspend discussions.

§ Baroness Gardner of Parkes
My Lords, I thank the Minister for her Answer. Is it not a fact that at the beginning of those discussions—which, as the Minister said, have gone on for over a year—dentists were led to believe that the new contract would give them more time for patient care and preventive dentistry, but that recent discussions have been on a completely different basis? Would it not be better for patients to have immediate access to a basic NHS service to meet their dental health provisions and for the Government to 1426 drop the current pretence of providing a fully comprehensive National Health Service, which they are not delivering and are unable to deliver?

§ Baroness Andrews
My Lords, no one will understand better than the noble Baroness how important it is that we strike a balance between the interests of patients and the interests of dentists in the new contract. After all, these are the first major reforms of the NHS for over 50 years. We believe that New Ways of Working, which is expressed in the emphasis that we are putting in the contract on prevention, and widening access for NHS patients—which is the real challenge that we have, because of the problems that we face—are compatible. That is what the discussions have been about. Dentists seem to agree with us as we are finding, and the National Audit Office report showed, that they are joining the personal dental services contracts in increasing numbers. We believe that we have got the balance right.
In any case, additional time will be freed up for dentists above and beyond the need to commit 95 per cent of their time to NHS patients. In terms of the basic contracts, I understand what the noble Baroness is saying, but we do not believe that a core service is sufficient to meet the dental needs of the nation. We do not want to narrow options down; we want to expand and improve the NHS dental service.

§ Lord Hunt of Kings Heath
My Lords, does my noble friend agree that there is no reason why dentists cannot provide NHS services to the people of this country? In fact, many millions of people do enjoy NHS services at the moment. Speedy agreement and implementation of the contract provides an optimum way of extending NHS services throughout the country.

§ Baroness Andrews
My Lords, I entirely agree. We have shown on the basis of the evidence from the personal dental service pilots that when you move to a more preventive service, which does not enforce recall at unnecessary intervals and which does not enforce unnecessary treatment, dentists have more time, and with that time they will be able to make more provision for NHS dental patients. In addition, we have put £59 million extra into dentistry this year to develop the service, and we intend to put an extra £250 million a year over the next three years.

§ Lord Addington
My Lords, would it not help everyone if the Government were able to make a list available to all patients letting them know exactly what treatment is and is not available under the NHS under any new contract?

§ Baroness Andrews
Yes, my Lords, that is a fair point. One of the problems with the traditional structure of the NHS is that no one was absolutely sure what was covered by NHS charges and what was covered by private charges. Indeed, that was picked up on recently by the Office of Fair Trading. The review of patient charges, under the charge of Harry Cayton, is looking at that; it 1427 is potentially looking at banding and is certainly looking at making it more transparent. We expect to be able to make an announcement soon.

§ Lord Chan
My Lords, are there any lessons of good practice to be learnt from primary care trusts in areas of disadvantage, where the NHS has offered dentists a personal dental service contract in order to meet the needs of people with poor dental hygiene and care?

§ Baroness Andrews
My Lords, that is one of the most optimistic developments. We have seen the development of PCTs and the personal dental services in areas of high need. We are putting some of the strategies in place, for example, the idea of recruiting overseas dentists. We will be targeting areas where dental waiting lists are long and where services are not so good. Some 29 or 30 Polish dentists are going to start work in the south-west of the country soon to help to meet demand in those areas.

§ Lord Ackner
My Lords, can the noble Baroness tell the House whether patients will have a clearly defined list of what treatment is and is not available on the NHS?

§ Baroness Andrews
My Lords, in the new arrangements for patient charges we are hoping to make those differences very clear, so that no patient will be under any illusion what the NHS covers and what private costs will cover.

§ Lord Colwyn
My Lords, leaving aside the moral issue that in India there is one dentist to every 36,000 people, and in the UK there is one dentist to every 2,000 people, will the Minister confirm how many dentists are expected to be recruited from India and whether they will be offered the same pay and conditions as all foreign dentists and not used as cheap labour?

§ Baroness Andrews
My Lords, I very much hope that I can give the noble Lord that assurance. When we have been looking overseas to see from where we might draw additional help, we have been looking to countries where there are surplus dentists. I take the ethical point very seriously, but the discussions we have had with the Indian High Commission have convinced us that this is perfectly appropriate. I understand that we have had some 1,200 expressions of interest from India. I cannot give the noble Lord any more details on that, but we know that they will be offered open work permits. We expect that many will return to the country of origin, and they will be offered the same conditions of service as any other dentist in the UK.

§ Baroness Masham of Ilton
My Lords, will dentists coming from countries such as Poland have a language test? In dentistry one needs to understand what patients are trying to say. Some people coming from Poland have a language problem.

§ Baroness Andrews
My Lords, dentists coming from EU countries, whether Poland, Spain or Germany, will be carefully selected. They will be subject to a 1428 robust induction programme, which I am sure will include language. I shall write to the noble Baroness to give her more details if she would like that.

§ Earl Howe
My Lords, I hope that the noble Baroness will not think this an unfair observation, but should the Government not now take responsibility for the fact that dentists are leaving the NHS in their droves? That obliges very many patients to go private when they otherwise might not have done. Will the Minister take a clear message to her right honourable friend that on no account must NHS dentistry be allowed to collapse altogether, which many people now fear, and that the Government must act to restore the confidence of dentists as soon as possible?

§ Baroness Andrews
My Lords, I do not believe that NHS dentists are leaving in droves, although I understand that dentists want to ensure that they have a contract that enables them to practise in their best interests as well as those of patients. We are seeing increasing numbers of dentists coming forward to take up the PDS contract. We are hopeful that the balance of preventive work that dentists want to do—the original reforms were certainly popular—will convince and keep dentists in the NHS. We intend to make the NHS dental service, with extra resources and with extra staffing, a better service than we have had in the past.

§ Lord Elton
My Lords, how many dentists are there in the National Health Service, and how many would be required to provide the service that the Government feel that they should give to the public?

§ Baroness Andrews
My Lords, although I may have to correct this in writing, I believe that there are 19,000 dentists in the NHS. I believe that the latest estimates, which were for 2001, were that we were short of about 1,800 dentists. We aim to recruit the equivalent of 1,000 dentists by October next year, which is why we are looking overseas for some of those dentists and why we are putting additional money into creating additional capacity—for example, by giving dentists who are working on mixed contracts more NHS work and helping to recruit people who wish to return to the profession.

§ Baroness Gardner of Parkes
My Lords, I do not accept the Minister's statement that this is the first reform in dentistry; it is a matter of how one looks at it. There have been many reforms over the years and the last new contract was, I think, in 1991. Is it not correct that under the new contract the original proposal was to give dentists more time for preventive work, as the Minister said, but new targets have now been imposed whereby the dentist must carry out 90 per cent of the courses of treatment that he carried out before and at least 5 per cent of those must be on new patients? Is it not the case that unless the dentist matches those requirements, which means no less 1429 work—still on the treadmill as he was in the past—the promised guaranteed income for three years will not apply?

§ Baroness Andrews
My Lords, when I referred to reform I was talking about a much more significant reform in terms of the structure of payments in relation to the traditional ways in which dentists have been paid and getting away from the treadmill of "drill and fill" and unnecessary recalls and so on. That is what I meant.
Regarding the noble Baroness's second point, we all have to understand that when we make an income guarantee over three years we must be able to quantify what the NHS gets for that, because we have serious under-capacity in NHS dentistry. That is why over the past year, as discussions have proceeded, this matter has come into the frame in a more focused way. I believe that as a result of that we will obtain value for money; dentists will know what they are able to and want to do; and essentially NHS patients will have better access to NHS care. Surely, that is what we all want to see.