HL Deb 17 June 2004 vol 662 cc859-61

Baroness Gardner of Parkes asked Her Majesty's Government:

Whether National Health Service primary care trusts are obliged to make National Health Service dental treatment available to all patients resident in their catchment areas; and what obligations they have to provide such treatment to non-resident patients.

The Parliamentary Under-Secretary of State, Department of Health (Lord Warner)

My Lords, currently, primary care trusts are required to make arrangements for the provision of dental services only where a general dental practitioner on their list has agreed to provide dental treatment and appliances to a patient. The Health and Social Care (Community Health and Standards) Act 2003 gives primary care trusts the new duty to provide or secure the provision of primary dental services in their area, to the extent that they consider necessary to meet reasonable requirements. That brings dentistry into line with NHS medical services. We will be implementing this new provision, which goes wider than residence of an area, alongside a new contract, which we are currently discussing with the dental profession.

Baroness Gardner of Parkes

My Lords, I thank the Minister for that Answer. From what he said, there seems no longer to be an obligation on the National Health Service to provide national health dentistry. The term with which he replied—"in so far as they see it appropriate", or something of that type—was very qualified. What can he assure me will happen, because dentists have still not seen the proposed new contract to be introduced next April? What does he propose will happen and how much better access does he think that patients will have to NHS dentistry?

Lord Warner

My Lords, I can tell the noble Baroness that we would not have proposed and passed the legislation if it was not going to lead to an improvement in the provision of NHS dental services. The new provisions will enable PCTs to commission dental services appropriate for their area, whereas at present they are reliant on the number of dentists that happen to be in the area to provide particular services. So that will be a strengthening of the position. As the noble Baroness knows, we have been consulting the dental profession on framework proposals for the new contract. The profession has expressed a number of concerns, although I believe that it likes the general direction of travel. We are considering its comments, and my honourable friend Rosie Winterton will make an announcement shortly.

Lord Dearing

My Lords, I hear that there is a shortage of dentists. Is the Minister aware that the shortage of suitably qualified academic dentists means that it is difficult to increase the number of dentists coming forward? What proposals do the Government have to respond to that situation?

Lord Warner

My Lords, the Government were faced with the closure of two dental schools under the previous administration.

Noble Lords

Oh.

Lord Warner

My Lords, I understand that Members on the Benches opposite have a kind of collective amnesia about some of these things and do not like to be reminded of them, but I feel that I have a public duty to remind them from time to time.

As I was saying before I started to enjoy myself, the Government have increased the output of existing dental schools during their time in office. They recognise that there are issues about academic provision, as there are in medical schools, and they are doing their best to strengthen those arrangements.

Baroness McFarlane of Llandaff

My Lords, what is now the average waiting time for a child to have extractions under general anaesthetic? Has that time been lengthened because anaesthetists must now have paediatric training?

Lord Warner

My Lords, I will have to write to the noble Baroness because I do not have those details at my fingertips.

Earl Howe

My Lords, is the Minister aware that the continuing uncertainty about the dental contract is causing a great deal of disquiet in the profession? When will the Government provide details of the new base contract and make clear to dentists the patients for whom they will be expected to be responsible?

Lord Warner

My Lords, I sometimes feel that we are damned if we do and damned if we don't. We have gone through a process of consultation with the dental profession. It has expressed concern about some aspects of the framework proposals. We are considering its concerns, which is the right and proper thing to do. The Government will respond to the dental profession and the public as quickly as possible when we have considered those concerns.

Lord Clement-Jones

My Lords, I hear what the Minister has to say on that subject, but we are only nine months away from when dentists are expected to implement that contract under PCTs. The Government still do not appear to have made available details of not only remuneration but other aspects of the contract, yet dentists are expected to invest in their practices to conform to the new contract and arrangements. Is there not a case to be made for postponing the coming into effect of those arrangements?

Lord Warner

My Lords, I take cognisance of the noble Lord's remarks, but we are working with primary care trusts to prepare them to take on their new dental responsibilities. They will be able to build on their recent experience of implementing the new contract for GPs so successfully. PCTs and dentists are already coming to us because they want to try out the new arrangements now, but we must first conclude the discussions with the British Dental Association, which wanted indefinitely to postpone this set of changes, to which we do not agree. In December, 20 practices wanted to proceed. There are now more than 400.

Baroness Gardner of Parkes

My Lords, does the Minister agree with the BDA that there are 30,000 registered dentists, which represents 11,000 high street practices? When the new proposals are introduced next April, at least 4,000—possibly as many as 5,000—extra dentists will be required. In view of his answer to the noble Lord, Lord Dearing, what can be done to provide extra dentists? Where will he find them?

Lord Corbett of Castle Vale

Australia.

Lord Warner

My Lords, like the noble Baroness, I am sure, I am always pleased to have suggestions for recruiting Australian dentists.

We are considering a range of measures to expand the dental workforce. We have expanded the number of places for dental therapists and about 650 are now registered. They make a contribution. I remind noble Lords that, on international comparisons, the number of dentists in this country is pretty well in line with those in western Europe and the USA.

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