NHS Dentistry (Hansard, 10 January 2005)

§ The Parliamentary Under—Secretary of State, Department of Health (Lord Warner)
My Lords, a new system of patient charges is required to implement the new contract, which will pay dentists for meeting the overall oral healthcare needs of their patients rather than on an item-for-service basis. I can confirm that in the summer we shall publish for consultation the new regulations for the local commissioning of primary dental services and dental charging. Further details are in the Written Ministerial Statement that my right honourable friend the Secretary of State for Health and I made earlier today.

§ Baroness Gardner of Parkes
My Lords, I thank the Minister. I understand that the Written Statement refers to a further extension of six months before the new contract comes into effect. But is the Minister aware, as I am sure he must be, that the National Audit Office is quite concerned? It feels that, the details of the new patient charging system are critical to the base contract and the delay in announcing the details is creating uncertainty and anxiety". 7 When you went to the dentist in the past, best practice dictated that the dentist would tell you roughly what treatment was required and how much it would cost. If the new contract is on a sessional basis, can the Minister tell me, first, how the dentist will determine a patient's treatment plan and the relative cost; and, secondly, whether what is being promised in terms of treatment and value will be made clear to both patients and dentists?

§ Lord Warner
My Lords, it is also worth bearing in mind that in its report of 24 November the National Audit Office welcomed—I use the term advisedly—the Government's reforms. It acknowledged that there was a strong rationale for reforming NHS dentistry in this way. In terms of what the patient experience will be and the items of service received, we are moving the new contracts on to a basis of paying much more for overall oral healthcare rather than for drill and fill. The charging system will be commensurate with that move. There will be full consultation with the public before regulations introducing the new charging system are put before Parliament.

§ Baroness Howe of Idlicote
My Lords, can the Minister tell me whether the NHS is any nearer to offering titanium implant treatment so that, as with the digital hearing aid, this important new dental technology can become available in appropriate cases without undue cost to either the NHS or the patient?

§ Lord Warner
My Lords, I think that that goes a little wide of the Question but I shall look into the matter and write to the noble Baroness.

§ Lord Wedderburn of Charlton
My Lords, will the Minister be able to give us, in written form, the number of National Health Service dentists who exclude visits to an oral hygienist in the surgery and practice which they run?

§ Lord Warner
My Lords, the Minister will not be able to give that information today but he will certainly look into it and write to the noble Lord.

§ Baroness Barker
My Lords, following his Answer to the noble Baroness, Lady Gardner of Parkes, can the Minister define "summer" more tightly? Can he tell us whether, in the interim period, the Department of Health will be working to reduce the 400 separate dental charges that dentists now have to administer?

§ Lord Warner
My Lords, we know that there is a great deal of patient dissatisfaction with the present charging arrangements, and Harry Cayton's group was set up to look at that system. The noble Baroness is right that we need to change the charging system if we are to have a dental contract which concentrates on oral health. At this stage, I cannot go into greater detail about precisely how the charging system will be changed, but it will be the subject of a consultation 8 document in the summer. So far as I am aware, summer has not changed. During 2005 it will be roughly the same as it was in 2004.

§ Lord Stoddart of Swindon
My Lords, is it likely that the new contract will be such, and be generous enough, to persuade dentists who have left the NHS to go into private practice to return to the NHS? That is what is needed if we are to have a good NHS dental system.

§ Lord Warner
My Lords, the Government have taken a number of steps to increase the capacity for NHS dentistry. In the current year, they have made available 59 million to buy back more NHS dentistry time from dentists. In 2005–06, an extra 250 million will be invested to buy back, and thus increase, the capacity for NHS dentistry. We are also recruiting overseas dentists. Those measures, alongside the new contract, will expand NHS dental capacity.

§ Baroness Park of Monmouth
My Lords, can the Minister say what the position will be as regards emergency treatment for patients? Will only the emergency be dealt with or will advice be given on the permanent treatment needed, and when the time comes for patients to have that will they pay a further charge or will any credit be given for the earlier emergency treatment?

§ Lord Warner
My Lords, it will be for the 300 or so primary care trusts in this country to enter into new contracts with the dentists who provide dentistry under the NHS, and it will be for the PCTs to specify the obligations of the dentists that apply under those contracts.

§ Lord Elton
My Lords, following his Answer to my noble friend Lady Gardner of Parkes, can the Minister confirm that under the new arrangements, whatever they prove to be, patients will be given a treatment plan and an estimate of the cost before the work begins?

§ Lord Warner
My Lords, dentists already have an obligation to explain to patients the dental work that will be carried out and the charging system. Nothing will change under the new arrangements.

§ Baroness Gardner of Parkes
My Lords, discussions with the British Dental Association have broken down completely. Can the Minister confirm that the Government have made arrangements to restart those discussions?

§ Lord Warner
My Lords, we hope very much that the British Dental Association will continue to discuss with us the new arrangements for the guidance for primary care trusts. Our decision to postpone implementation of the new contract allows more time for that to happen. We hope that the BDA will join us in those discussions.