HL Deb 07 September 2004 vol 664 cc436-8

2.55 p.m.

Baroness Gardner of Parkes asked Her Majesty's Government:

Why the implementation of the new National Health Service dental contract has been put back to 1 October 2005; and what interim arrangements they will make to improve immediate access to National Health Service dental treatment for patients.

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

My Lords, responses to our consultation on the proposed new contractual arrangements indicated a preference for the new contract to be implemented in October 2005 rather than in April 2005. In the interim, dentists can move their practices into the new Personal Dental Services to gain advance benefit of most of the reforms proposed in the new contract.

We have allocated additional funding of £59 million in 2004–05 specifically to improve access to NHS dentistry, especially in primary care trusts with the most pressing access problems. We will be increasing the dental workforce capacity by the equivalent of 1,000 additional dentists by October 2005. Funding will be devolved to primary care trusts from October 2005, with a 19 per cent increase in expenditure over 2003–04—which is an extra £250 million a year.

Baroness Gardner of Parkes

My Lords, I thank the Minister for that reply. Will he join me in congratulating Martin Anderson, the principal dentist in a Sunderland practice, on winning this year's international Picker award for the advancement of patient-centred care? Further, what can the Minister say to reassure me that the deferment in 2005 he referred to in all those dates is not simply related to the date of the next general election?

Lord Warner

My Lords, I join the noble Baroness in offering congratulations to Martin Anderson on his award. It was for patient-centred care and we are seeing much more of this in the NHS under this Government.

This deferment was a result of consultation with the profession and other interests. We listen to people with whom we consult and we have deferred to October to meet their wishes.

Lord Skelmersdale

My Lords, why has it taken seven years for the Government to announce the extra 170 places which were announced in July? During that time the problems of NHS access to dentistry have been growing and growing and we have had questions and debates in your Lordships' House. Why has it taken so long?

Lord Warner

My Lords, the noble Lord will not be surprised when I say that some messes which we inherit take rather longer to clear up than others. He will recall that we have said on a number of occasions that the flight from NHS dentistry started with—and I use the word advisedly—a "shambles" on contracts in arrangements introduced in the early 1990s by his party's government. I remind the House that his party shut down two dental schools.

Lord Hunt of Kings Heath

My Lords, would my noble friend confirm that the 1991 contract had the result of penalising NHS dentists for doing more NHS dentistry by clawing back money that rightfully belonged to the dentists? Does that not show that we need to get the contract right rather than rushing into it—if indeed the details are not complete?

Lord Warner

My Lords, I am grateful to my noble friend. He has given a clearer explanation than that involving the technical term "shambles" that I used in describing the discussions on the contract under the previous government in the early 1990s.

My noble friend is right. The profession has called the contract arrangements a treadmill. That is why we are moving dentists off that treadmill with discussions over a new contract which will reward prevention as well as treatment.

Lord Addington

My Lords, Options for Change suggested that many of the changes that were needed—for instance, the move from invasive to preventive health care—should be field tested. Can the Government assure us that we can take advantage of the extra time to conduct field testing, given that much of the dentistry profession seems to think that it has been pre-empted?

Lord Warner

My Lords, we are continuing discussions with the profession on some of the detail of the new contract and I am sure that people will take the noble Lord's point into account.

Baroness Knight of Collingtree

My Lords, where are all these extra dentists going to come from? Was there a sudden influx of people studying dentistry some years ago? If so, why were we not told about it when we formed queues to get a place in a dentist's surgery? Are they coming from abroad?

Lord Warner

My Lords, my right honourable friend pointed out in his statement of 16 July that we will be increasing capacity by the equivalent of an additional 1,000 dentists. About one third of these—probably a shade more—will come from increasing the NHS commitment of existing dentists who have mixed practices, so the balance between their NHS and private work will change. We are working on a programme of getting more returners to dentistry. We are helping overseas dentists who are already here to qualify by working with the General Dental Council and others to speed up that process. We are also recruiting dentists from a number of foreign countries, including Poland, Spain and India. Dentists from Poland are already being interviewed for work in hard-pressed parts of the country.

Baroness Gardner of Parkes

My Lords, will the new contract help to offset the problems which occur between the higher-cost areas in the south-east and the north where this model practice is? What will the new contract do to equalise things? The cost of premises and staff in the south is a problem.

Lord Warner

My Lords, there is much more variety of arrangements for dentists to practise. They can commit themselves to much more work with the NHS—a much clearer commitment under the new contract. There are better rewards for preventive work under these arrangements. As I said, we are introducing dentists from a wider range of sources to work in some of the hard-pressed areas.

Lord Brooke of Sutton Mandeville

My Lords, when the Minister referred to one-third, or thereabouts, of 1,000 dentists increasing their service to the National Health Service, is he double-counting them in terms of the number of dentists in the service, or is he giving us the full-time equivalent figure of their extra work?

Lord Warner

No, my Lords, I was saying that a great number of dentists in this country have mixed practices—part private patients and part NHS treatment. We will be increasing the proportion of their time in a number of places to take on more NHS work. That is the equivalent of about a third of the 1,000 extra workforce capacity that I mentioned.

The Earl of Listowel

My Lords, is the Minister aware that while 72 per cent of children in public care—that is, children fostered or in residential care—had dental check-ups in 2002, 75 per cent had check-ups in 2003? Is he pleased with the progress being made in this area, particularly against the background of these children's poor dental health in the past?

Lord Warner

My Lords, I think we are making progress in this area, and that is good news. There is still more to do, and that is why we want to ensure that there is better dental access in some of the poorer areas for people who have in the past not always had access to the dental care they need.

Lord Roberts of Conwy

My Lords, what assurance can the noble Lord give that the measures he has talked about will end the existing shambolic situation?

Lord Warner

My Lords, we have every confidence in the work that we are doing and the extra money that is going into dentistry—some £368 million over the next few years, £250 million of which will be available to primary care trusts. We are confident that, with the new contract this will improve the quantity and quality of NHS dental care.