NHS Dentistry

HC Deb 01 December 1999 vol 340 cc47-69WH

Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Sutcliffe.]

9.30 am

Jackie Ballard (Taunton)

I am pleased to have secured this debate on a matter of great concern in my constituency and to many other hon. Members, who may try to catch your eye, Mr. Deputy Speaker.

The House last debated NHS dentistry when my hon. Friend the Member for Southwark, North and Bermondsey (Mr. Hughes) initiated a debate on the subject in 1998. Sadly, little has changed since then, and in Somerset the position has worsened. In 1998, 10 out of 71 practices accepted new adult registrations on the NHS; today only five do so. In 1998, 72 per cent. of children in Somerset were registered with a dentist; today, that figure is 70 per cent. In 1998, 63 per cent. of adults in Somerset were registered; today, only 49 per cent. are registered.

Many of the dentists who accept NHS patients have a much higher than average list, so waiting time is increasing. In 1998, 200 people called the dentists' telephone helpline each week because of problems with accessing an NHS dentist; today, the number of calls has doubled. In 1998, only two practices in my constituency were taking new NHS patients, and I complained about that at the time; now, there are none in my constituency.

Many people, especially in the more rural parts of my constituency, have no access to NHS dentistry unless they travel long distances.

Mr. David Heath (Somerton and Frome)

As my hon. Friend knows, my constituency borders hers and I have the same problem. Only one dentist is accepting NHS patients, who may have to travel for one hour to reach a dentist. The initiative that we were promised to solve that problem has done nothing to improve matters. In fact, they have got worse.

Jackie Ballard

I thank my hon. Friend. I shall refer to the investing in dentistry initiative later.

As my hon. Friend said, many people must travel long distances to reach a dentist and, in a rural county, 11 miles may be a very long distance for someone without easy access to transport. For people living in Wellington in the south of my constituency, the nearest dentist who is taking patients is in Cullompton, which is in Devon. For people living in Taunton, the nearest dentist is 25 miles away in Minehead, and Taunton is the county town of Somerset. Those who rely on public transport—the elderly, the poor, the most vulnerable and those who cannot drive—are disadvantaged, and inequalities in health are worsened. The Labour party manifeso promised that access to NHS services would be based on need and need alone. Clearly, in many parts of the country, access is dependent on transport, finance and mobility, not on need alone.

In many parts of the United Kingdom, NHS dentists are becoming as rare as hens' teeth. Dental services are now a lottery of postcode and geography. Dentistry is being rationed, and that has happened by stealth, not by Government decree or after public consultation. We do not have a national dental service. The previous Government seemed to be content to allow that. During their 18 years in power, there was a steady erosion of access to NHS dentistry, with a reduction in the services provided on the NHS and a drop in the number of people registered with an NHS dentist.

I became interested in the subject long before I was elected to the House. In 1991, I was deregistered by my dentist because the fee structure made it difficult for him to repay his practice loan, earn a living and provide a high-quality service. When I raised the matter in the local press, I was denigrated by the local Tories who, with their usual grasp on reality, said "Problem! What problem?"

People who pay national insurance contributions for many years think that it is a sort of insurance policy which enables them to use the NHS when they need it. We know that national insurance does not work like that, but that is the impression that many people have, and they feel cheated. I hope that the Minister will not brush aside my anxiety and that of other hon. Members, or deny that there is a problem. I hope that he will be able to assure us that he is committed, not just in theory but in practice, to dentistry as a core part of the national health service.

The Government cannot expect dentists to make a commitment to the NHS unless they too make a commitment and spell it out clearly. For example, the Government promised to publish a dental strategy later this year, but, according to a recent parliamentary answer, publication is now expected in the new year. Perhaps the Minister will be more specific this morning.

After the debate in 1998, I received a letter from a local dentist, stating: The morning I received your letter I took thirty minutes to surgically remove an abscessed tooth under NHS regulations. The fee was £25.90, of which the patient paid £20.72. After deduction of expenses I receive £5.90 before tax. I regard this as completely inadequate remuneration. A hospital referral would cost the NHS several hundred pounds and the patient would receive their treatment free of charge. This is an intolerable situation. I emphasise that the fee received by the dentist before tax was £5.90 for half an hour's work. I do not believe that any of us in the House would do half an hour's work for £5.90. [Interruption.] My hon. Friend the Member for Montgomeryshire (Mr. Öpik) is prepared to sell himself cheaply. Not surprisingly, the dentist who wrote to me is no longer taking new NHS patients.

Dental health should be an integral part of primary care. I am disappointed that many primary care groups do not seem to involve local dental practitioners. Oral and dental health is mentioned in health improvement plans, but without easy and affordable access to NHS dentistry, the nation's oral health will decline.

Mr. Lembit Öpik (Montgomeryshire)

Does my hon. Friend agree that dental provision in the NHS is omitted from primary care strategy almost altogether and has been virtually forgotten by many people in rural areas?

Jackie Ballard

When we debated the setting up of primary care groups, I remember the Minister saying that dental practitioners should be an integral part of the primary care groups and their service. That is certainly not happening in my part of the country, and I do not believe that it is happening elsewhere. I hope that something can be done to encourage primary care groups to include dental practitioners.

Mr. David Heath

And optometrists.

Jackie Ballard

I shall not stray into the realm of eyes, although I realise that they usually go with teeth.

Oral examination is important. In Britain, there are as many deaths from oral cancer as from cervical cancer and skin cancer. Dentists can spot the early signs of oral cancer. I have been told by local general practitioners that there has been an increasing demand on their time because of poor oral hygiene, gum disease and mouth infection, which would previously have been seen at an earlier stage and prevented by dentists. Only this week I received a letter from a GP in my constituency, who stated: I very much support your attempts to improve access to NHS dentistry. As a GPI must admit to being very fed up with having to sort out people with dental problems who cannot access a dentist, either because they have not registered with an NHS dentist or they are not prepared to pay dentistry fees. In particular it is acute dental infections which cause problems. From my point of view the most important aspect of this is that dentists should be able to provide 24 hour emergency care. Another GP wrote to me stating: I share your concern about NHS dentistry. It is amazing how a Government can quietly see the service disappear without any hue and cry. My local GP out-of-hours co-operative, Deane Doctor, reports a 25 per cent. increase this year in the number of calls related to dental problems. The simple fact is that decay and infection will not go away without treatment and, if that treatment is not easily accessible from a dentist, people will go to their general practitioner, adding to the pressure of work which they are already under.

In Somerset, 51 per cent. of adults are not registered with a dentist. Others, like many in my constituency, were registered and seeing their dentist on a regular basis, but recently, out of the blue, received a letter telling them that their dentist would no longer see NHS patients, that there were no vacancies with other dentists in the practice and that patients therefore had the choice of paying into a private dental health plan or registering with a dentist 20 or 25 miles away. In those circumstances, many people will not register, but wait until they have an emergency. Not only will their dental and general health decline as a result, but they will find that emergency treatment is not available in Taunton; they will have to travel far to find it.

In responding to the debate, I am sure that the Minister will draw attention to the investing in dentistry initiative, which the Government have introduced to improve access. Coincidentally, the day that I learned that I had secured this debate—I believe in coincidences—the Secretary of State for Health sent a letter to all hon. Members, in which he said that the initiative had spent £10 million on the expansion of NHS dental practices. However, two years ago, the British Dental Association said that £40 million was needed to reverse the decline in the number of NHS dentists and the problem of access to dentistry. When the scheme was introduced, the then Minister said that it would improve the availability of general dental services and extend the benefits of good oral health by focusing help on the areas with the most serious problems.

The Minister knows that Somerset has a particular problem. I am sure that he will tell us how much has been spent in Somerset, but I know those figures. Bids totalling more than £800,000 went to the Department of Health from Somerset health authority, but only £200,000 has come into the area under the investing in dentistry scheme. In my constituency, a bid for a new surgery was rejected, as was a bid for a new computer system. A new surgery was approved, but that bid has not been taken up because of difficulties in recruiting dentists. Another bid for a new surgery was rejected and a further bid for a new practice was approved, inasmuch as £15,000 of a £25,000 bid was accepted.

The investing in dentistry scheme has clearly had a minimal effect in my constituency; it has not even stopped the decline. The problems in my constituency go back eight or nine years. Therefore, is the Minister content that the scheme has focused help on the areas with the most serious problems?

Before the general election, the Labour party said that NHS dentistry was in crisis. At Prime Minister's Question Time on 15 October 1996, the then Leader of the Opposition, the right hon. Member for Sedgefield (Mr. Blair), said that he did not know how the Prime Minister could dare mention dentistry in the national health service after what his Government have done to it."—[Official Report, 15 October 1996; Vol. 282, c. 584.] However, in responding to an Adjournment debate in 1998, the then Minister, now the Secretary of State for Health, said: we must not create a crisis out of a problem."—[Official Report, 18 February 1998; Vol. 306, c. 1161.] Before the general election, Labour Members believed that there was a crisis, but by 1998, they believed that it was just a problem. I do not know how the Minister can think that the crisis ended in 1997. If he does not think that there is a crisis when my constituents are deregistered by their dentists, for whatever reason, or when people move into the area and cannot find a dentist to take them as an NHS patient, I hope that he thinks that it is a problem that he must solve sooner rather than later.

The Department of Health is piloting phone-and-go dental access centres, but my constituents will not be amused to phone and be told to go 20 miles. I hope that the Minister will tell us his definition of a reasonable distance that people should be asked to travel to a dentist. I hope that the debate will enable hon. Members to tell the Minister of their concerns, so that he can tell us, and our constituents, how and when he intends to improve access to NHS dentistry.

9.44 am

Ms Joan Walley (Stoke-on-Trent, North)

I congratulate the hon. Member for Taunton (Jackie Ballard) on securing this morning's debate, which is taking place in a format that I hope the Minister will not find too painful. He is here with all of us to try to find a solution to the problem that we have inherited from the previous Government. I shall frame my speech in the context of that inheritance. No matter how painful finding a solution might be, we must do so simply because of the cuts in NHS dentistry that have taken place during the past 18 years. Several changes in dental provision have occurred in recent years.

Mr. Philip Hammond (Runnymede and Weybridge)

Is the hon. Lady aware that there were 4,500 more NHS dentists when the previous Government left office than when they took office, and that spending on NHS dentistry was 60 per cent. higher in real terms than in 1979?

Ms Walley

The important issue is access to NHS dentists for those who need treatment. From birth, people should receive regular preventive dental care and treatment when they need it.

The dental registration scheme which was introduced as part of the new 1990 NHS dental contract has caused the crisis that we have inherited. Following those changes, the number of children and adults registering was much higher than the then Government expected, so a 7 per cent. cut in fees was soon introduced. That consitituted a threat to withhold approximately £15,000 in earnings from each dentist and was due to an overspend. The hon. Gentleman must consider the effects of his party's policies, which changed the formula and the basis on which dentistry had traditionally been agreed. For that reason, we must accept that we have inherited a crisis and turn to the future to discover what needs to be done.

The core of the problem is that, in those areas where access to NHS dental care is not easy, people are angry. They are often in pain and that grim problem should not be tolerated. We must do something about it. Dentists have been squeezed by the formula. The cost of the treatment that they provide must be looked at; dentists must have the time and funds to provide the necessary treatment.

The problem is not necessarily one of too few dentists, but one of too few NHS dentists, especially in the areas of highest need—the postcode syndrome. Access to treatment is unequal, and I implore the Minister to take urgent, considered action. He should decide on the strategy that is needed in the long term in the context of the forthcoming comprehensive spending review.

The hon. Member for Taunton gave a thorough introduction to the debate. We heard that the investing in dentistry scheme was launched in 1997 and that, initially, £9 million was made available for it. We in north Staffordshire expected that that funding would make a difference to the problem that we had inherited. However, only £175,000 was paid out in the first year of the scheme, despite a provisional allocation of £9 million. I accept that an additional £10 million was made available in the following financial year. The problems of launching that new system emphasise how difficult it is to set up new facilities, especially given the training and other cuts that have taken place during a sustained period over the previous 18 years. It takes time for such schemes to make a real difference.

I am pleased that 10 practices in north Staffordshire, out of the 310 practices nationwide, were successful under the investing in dentistry scheme, but that is a drop in the ocean and the problems of north Staffordshire remain. I make no apology for being parochial and speaking about the problems that my constituents face in being unable to get to an NHS dentist.

I draw the Minister's attention to the further problem of the recruitment and retention of dentists. In north Staffordshire, the health authority has appointed a designated officer to address that problem. Much innovative work has been done to encourage people in dental schools to move to north Staffordshire. North Staffordshire does not have the necessary training places, and people often practise in the area where they trained. If there are no dental training facilities in a particular area, that area will find it even more difficult to recruit and retain people. However, in the past few months, our health authority has funded one third of the educational element of a vocational training scheme based in Crewe. We have high hopes that, after one year of vocational training based in north Staffordshire, two practitioner trainees will continue to practise after completing their educational qualifications. Two practitioners, however, is a drop in the ocean. It does not solve the problem, although I admit that it is a tiny step forward.

I should like to concentrate briefly on the scale of the problem in north Staffordshire. In the week beginning 12 September, a constituent who had suffered intense toothache for about four weeks and was unable to find a dentist consulted north Staffordshire's emergency advisory services. She was given a list of NHS dentists practising in my constituency, one of whom was available to see her, but in four weeks' time. That is termed an emergency service. The constituent was provided with pain-killing relief, but was able to obtain an earlier appointment—only because of my intervention. That should not happen.

We have already heard how not receiving treatment at the right time can lead to far greater dental problems, and greater recourse to general practitioners. Anyone who is in immediate pain should be given emergency treatment; otherwise, the problem will be exacerbated. I am greatly concerned about the human suffering that results from the lack of NHS dentists where they are needed.

In statistical terms, north Staffordshire has a poor dentist to population ratio—1:4,100. The ratio for England and Wales is 1:3,045, and that for the west midlands is 1:3,597. North Staffordshire's adult registration rate is the lowest in the west midlands. I take no pride in that whatever. It is also significantly lower than the average in England and Wales. The England and Wales average is 45 per cent.; ours is 38 per cent. Therefore, one in six people in north Staffordshire is not registered with a dentist, which shows the scale of the problem. A dental advice line monitors where calls come from, and a disproportionate number—650 to 710 a month—come from what is defined as the north Stoke area.

Applications are being made for third wave personal dental service pilots. When the health authority bidding is assessed, it is crucial that the Government should consider north Staffordshire's need for that pilot. The success of the bid on its own will be insufficient; again, it will be a drop in the ocean. We want a formula whereby patients can be registered with dentists, allowing a linkup with the sure start programme. That will ensure that children are registered from the start of their lives through to old age. A strategy to link with primary care groups is also urgently needed. I recently met the chairman of the primary care group in my constituency, and the chairman and chief executive of the health authority, and it is crucial that a dental strategy should be built into primary care groups.

When the Minister considers our personal dental service pilot bid on which I hope that he will look favourably, will he also consider the long term? Will he consider north Staffordshire as a pilot area? We need to start to think about how to make NHS dental services available to the 63 per cent. of people in north Staffordshire who are not registered. Joined-up thinking with other Departments would enable a link with the sure start scheme and the new primary care groups.

We must also consider how to ensure that children receive the dental care that they need. In the next few months, a national debate on fluoridation will take place. I would much prefer that debate to take place after we have been assured that everybody has the right access to NHS dental care.

9.56 am

Mr. David Heath (Somerton and Frome)

I congratulate my hon. Friend the Member for Taunton (Jackie Ballard)—who is also my neighbour—on securing this extremely important debate. Had she not secured it, I would have sought to do so in the coming weeks. The situation in Somerset, which she has already described, is becoming worse by the day. Sometimes hon. Members are guilty of hyperbole, but, in the past two weeks, people have come to my surgeries to tell me about two practices in my area that have reluctantly decided to move away from NHS dental work. Those practices have asked their patients to move on to private dental insurance, and the people affected are rightly worried.

This problem must be put in the overall context of health care provision in rural areas. It is difficult to access the health service if one lives in a rural area. Services that are taken for granted in urban areas and throughout most of the country are not available in much of rural Britain. That should concern all hon. Members, and the Minister will know, from his own constituency, what difficulties sparsely populated rural areas can present.

The situation in Somerset seems to be worse than elsewhere; I am sure that the Minister will confirm whether that is the case. The perception is that there has been a wholesale flight from NHS dentistry in Somerset. I am aware of only one practice in my constituency that is admitting NHS patients, and my constituency covers the best part of 900 square miles. As I said, many practices are moving patients from NHS lists on to private dental insurance arrangements.

The location of practices, which are few and far between anyway, is a problem. As my hon. Friend the Member for Taunton mentioned, some people have to travel 25 or 30 miles to visit a dentist. It would be ridiculous if everyone in London was told to go to a dentist in Slough—the equivalent distance—and people would object. In our part of the world, however, travelling such a distance is considered normal. It is questionable whether there is genuine access if there is a complete absence of public transport. If the only way of getting to the dentist is by private car, many of the people who are most in need of dental check-ups will not be able to go because of inconvenience and inaccessibility.

The reason for that is, I suspect, based on a number of factors. I do not blame the dental practitioners in question, because many of them stopped providing NHS access with the greatest reluctance. They do not want to be private practitioners. They want to continue to provide the service that they have provided throughout their working lives, but the arrangements that govern their remuneration and practice are currently so unattractive that they feel unable to do so.

An article in the Health Service Journal, published on 9 September, examined why dentists move from NHS to private provision. It found that dentists have increased private provision principally to improve the quality of dentistry, to increase choice in clinical decision making, to get more time with patients and to widen the range of treatment options. Each of those reasons is, in effect, based on a clinical decision as to how to provide the best treatment for patients. Rightly or wrongly, dentists have concluded that they cannot provide such treatment in the context of the present NHS arrangements.

Financial security is also an important factor. It is difficult to run a small practice when one's remuneration fails to meet its overheads or enable it to work effectively, or when one seriously doubts whether that remuneration will continue. That is a particular problem for a dentist who, at some stage, intends to sell the practice because he or she wants to retire or move elsewhere, and who realises that it will not fetch a reasonable price as an NHS practice. Such a practice cannot be passed on because it will not provide a sufficient return on the necessary capital investment. Practitioners are concluding that their interests, and their patients' interests, do not lie in the provision of NHS care. At the same time, people desperately want access to NHS care, but the practitioners simply are not there.

The initiative that was announced two years ago with considerable fanfare may have achieved wonders across the country, but it has had a limited effect in my constituency, where the arrangements have been subject to further decay. People who move there are astonished. Recently, the wife of a Royal Air Force officer who is based at the Royal Naval air station in Yeovilton—somewhat confusingly, her husband is in a different service from the base at which he is stationed—was unable to find dental care. The Royal Navy would not provide dental care because she was RAF; nor would anyone else provide it. She had been moved to an area that she did not know at the behest of the Ministry of Defence, yet could not obtain dental care for her family. I had to write to the health authority and various other people to try to put her name on lists that were effectively closed. Such problems are encountered regularly.

I cannot stress sufficiently the importance of primary care across different disciplines. I know that you would rule me out of order, Mr. Deputy Speaker, if I were to stray too far into the world of optometry, in which I used to practise, but there are many parallels. If we fail to get primary care right, not only in general practice but in dentistry, optometry and other disciplines, we will not achieve the hoped-for reduction in disease, and we will see increased hospitalisation because diagnoses will not have been made at the appropriate point. In the long run, that will cost the Government and the health service more, and will subject people to inconvenience and distress that could have been avoided.

For heaven's sake, let us treat the matter as a major problem that needs urgent and serious attention. We must get NHS dentistry right and look at those areas where provision is bad. Provision in Somerset is particularly bad and requires the Minister's urgent and special attention. We must get the contracts right, so that we recruit and retain practitioners in health service practice. Perhaps we shall then provide the service that people reasonably expect from the NHS throughout the country, including rural areas, not just in areas that are lucky enough to have an abundance of practitioners.

10.6 am

Dr. Peter Brand (Isle of Wight)

I congratulate my hon. Friend the Member for Taunton (Jackie Ballard) on securing this debate. It is somewhat disappointing that all the examples that have so far been cited are from the west of England or, in my case, the south of England. For that reason, I was particularly pleased that the hon. Member for Stoke-on-Trent, North (Ms Walley) contributed to the debate. It is not merely a question of localised pockets of difficulty; there is a national, structural problem with NHS dentistry.

The debate is particularly apt at the moment because dentistry may illustrate the direction in which the rest of the NHS is moving. There has been a covert move away from a publicly funded service, albeit with contributions from patients, to a purely private arrangement. Many of my friends in dentistry are extremely concerned about that. They feel a conflict between their social conscience, and their clinical and professional responsibility towards patients. The hon. Member for Stoke-on-Trent, North said that registration may have caused the crisis, but that is wrong. Registration was a good idea. It created a link between dental practitioner and patient, and could have formed the basis of preventive dental care.

Some 15 years ago, enormous improvements were being made in the dental health of the whole population. The Isle of Wight was proud to have the lowest number of dental caries in children under 10. We regularly sample our school population, and I am sorry to say that that record has been completely ruined. The Isle of Wight now has one of the highest rates of dental caries in children. That is largely a result of changes in access to NHS dentistry. West Wight now has no national health dentist. The practice there closed down overnight, and people must now take a bus into the county town of Newport and travel to the depths of Ventnor or Cowes in the hope of finding a dentist. That constitutes a bus journey of about two and half hours, which is ridiculous.

It is clear that we need to make dentistry available and accessible to people everywhere, and there are two possible answers. We could take the view, which is overtly taken by the Conservative party, that the NHS can survive only with more insurance-based funding. Clearly, organisations such as Denplan, which have taken over the funding of NHS dentistry, may have a role to play, but the majority of my constituents cannot afford such a service. They truly believe that, having paid into the NHS, they are entitled to some care. The alternative answer, which is emerging from the Government's actions—

Mr. Hammond

In the light of the hon. Gentleman's comments, is he opposed to a mixed economy in dentistry, in which NHS dentists see NHS patients but can offer a menu of treatment that includes NHS options and options that are not available through the NHS? Does he see that as a positive or a negative step?

Dr. Brand

I am a firm believer in a mixed economy of provision. It is sad that, at the moment, the better dentists and those who are best equipped have moved away from the NHS. In the past, those people found it possible to mix their practice. The Government-based fee system can take time to catch up with reality, so their private work often helped them to invest in leading-edge technology. That is one of the problems at the moment. I have no problem with a mixed economy of provision, except when it is no longer mixed and becomes available only to those who can afford private insurance.

The Government's apparent solution to the problem is not to talk to dental practitioners to see how a contract can be devised to enable them to offer their services to NHS patients, but to supply a range of services through dentists directly employed by district or area health authorities. I do not have a problem with that if it is the Government's overt policy, but if that is the case, they should say so. If we are no longer to use independent dental practitioners to provide national health services, let us make sure that a comprehensive service is set up alongside them. It would be sad if that happened, because I agree with the hon. Member for Runnymede and Weybridge (Mr. Hammond) that it is useful to have a mix within the same practice.

I have had extensive correspondence with my health authority over dental problems on behalf of my constituents. I was interested to learn that health authorities are not obliged to provide NHS dental care for patients other than those needing emergency treatment. This is ridiculous. It is 18th-century stuff. It is inadequate that the NHS is responsible only for yanking out teeth and putting in the occasional filling. So much can be done now to retain people's dentition throughout their lives. We seem to be going back to the pre-war set-up, when people were given an appointment with the dentist to have all their teeth out and receive a full set of dentures for their 30th birthday. It is disgraceful to deal with dental care by concentrating only on dental emergencies.

That policy also has a major effect in the medical field, not only by increasing the work load for general practitioners—all GPs moan about that, but they can cope with it. There is a real problem about the dental part of medical training. I think that I had two lectures on dentistry. Proper dentists spend five years studying, and the average GP is not suited or trained to cope with dental problems. Doctors do, however, need help from their dental colleagues in cases of patients with heart disease—especially valvular heart disease—or other diseases that make it imperative that they should not suffer from oral sepsis. Such patients need regular access to dental hygienists and regular checks.

A great many of my constituents do not have access to such services. My health authority informs me that the new pilot dental service, to which it hopes to recruit people, will deal only with those needing emergency treatment, or those with learning difficulties—a special group that has always been catered for by the directly employed service.

We face a crisis in dentistry of successive Governments' making. The present Government owe it to the nation to say which course they wish to take. They must either reinvest the money that they are not currently spending on NHS dentistry into a comprehensive, directly employed, accountable service—there must be an honest debate about the advantages and disadvantages of that—or they must have meaningful discussions with general dental practitioners to ensure that they can once again offer their services in the NHS.

10.15 am

Mr. Philip Hammond (Runnymede and Weybridge)

I, too, congratulate the hon. Member for Taunton (Jackie Ballard) on securing this debate, which gives me the opportunity to experience for the first time the somewhat unusual sensation of standing in this Chamber. I was not quite sure where to sit when I came in, and I wonder whether we might be encouraged to change our positions depending on the nature of the debate, and on how close to, or far from, each other we feel on the subject. If it is anything to go by, I notice that today both the Minister and I have positioned ourselves as close to the centre as we reasonably could in the seating available.

The number of Members attending this debate is smaller than it might have been had the subject been debated on a Wednesday morning in the main Chamber. The distractions there are somewhat different for us, because if the debate tends to flag, one can always look at the Public Gallery. We do not have that option in this format, but there are buses passing outside, and a JCB busily working in Parliament square.

There are approximately 21,000 general dental practitioners providing NHS care in England and Wales. About three out of four adults registered with a dentist receive NHS care, while one in four is a private dental patient, often, but not always, through choice. Dentists derive 39 per cent. of their income from private treatment, which is a significantly increased percentage. Most of that increase is due to private work being carried out on NHS patients.

As I said in my earlier intervention on the hon. Member for Isle of Wight (Dr. Brand), we have achieved a genuine mixed economy among NHS dentists, where it is working properly, in which patients are able to access their dentist under the NHS, but, once the need for treatment has been determined, are offered a genuine menu of choices, including treatments that are available on the NHS and those that are not. I hope that hon. Members will agree with the hon. Member for Isle of Wight and me that more choice is always better than less, provided that it is a genuine choice. I accept the caveat that patients must have access to a dentist on the NHS in the first instance.

The scare stories that one reads, especially in the local and regional press, about there being no NHS dentists in an area are largely untrue. In reality, there is a population of mixed-practice dentists who are, in many cases, unwilling to expand their NHS lists. That does not mean that they have ceased to practise in the NHS altogether. It means that, having regard to the need to assure their own gross incomes—a point to which I shall return—in order to meet their practice overheads and to provide adequate care and time for their patients, they no longer feel able to take on additional NHS patients and remain viable at the current level of NHS fees for service.

That is the core of the problem about which most hon. Members are approached by constituents who are unable to access an NHS dentist as a new patient. The problem is probably getting worse. Half the health authorities in a recent British Dental Association survey reported that the shortage of accessible NHS dentists during the preceding year had worsened.

The number of adult patients registered with a dentist peaked at 24.8 million in 1993 and, as the hon. Member for Stoke-on-Trent, North (Ms Walley) said, has been falling since then. That is partly due to changes in the registration time limits. The fall put on its greatest spurt between December 1997 and December 1998, when the number registered fell from 22.3 million to 19.7 million. During 1997–98, the Government underspent their NHS dentistry budget by £56.5 million.

The BDA estimates that 20 million adults do not seek regular dental treatment. For whatever reason—cost, fear or simply apathy—that group of people tends to use emergency dental services only. In the longer term, it will clearly be necessary to tackle the issue of those 20 million people who do not pay regular attention to their oral health. That crucial cultural change will not be achieved quickly or easily. I accept that the concept of phone-and-go centres—in areas where they are working—will probably appeal to people who want to be able to access NHS dentistry quickly and easily on the occasions when they need it, but do not seek continuity of care from an NHS dentist.

A more immediate problem—which many hon. Members will have come across in their postbags and I understand is to be the target of the investing in dentistry programme—concerns the estimated 4 million patients who would like to register with an NHS dentist but are unable to do so. They represent an unmet demand for registration that it is imperative that the system should meet.

There is a significant geographical misdistribution of dentists. As one might expect, problems exist in deprived areas with socio-economic difficulties. However, there are also problems in more affluent areas in which premises and establishment costs are particularly high. That is part of the nub of the matter, and I should like to put some points to the Minister about it later.

The way in which general dental practitioners are remunerated is distinctly different from the way in which general medical practitioners are remunerated. General medical practitioners receive reimbursement for their premises and establishment costs, whereas general dental practitioners receive item of service fees on a national scale across the country, from which they then have to meet the costs of their premises and establishment. That can present grave problems to general dental practitioners who operate in areas where the costs of premises are exceptionally high but are reimbursed only with the same fees that colleagues in lower cost areas of the country receive. I am sure that the Minister is armed with the fact—and will refer to it if I do not—that the investing in dentistry programme has addressed that problem at the margin. Indeed, it has addressed it in my constituency, where at least one new NHS dental practice has been enabled to start up by a grant that has helped it to overcome the high initial capital cost of premises. However, the scheme has been widely condemned as heavily bureaucratic, and its impact has been localised.

The hon. Member for Taunton mentioned the long-awaited strategy for NHS dentistry, which has now been in gestation for 18 months and is presumably under lock and key in Richmond house in a state of partial completion. As a result, this debate is taking place in something of a vacuum. It would be interesting if the Minister were able to enlighten us as to the contents of the document and when we are likely to see it.

I recognise that Health Ministers are regularly embarrassed by the phenomenon of finding that, while they are slaving away in Richmond house over a policy or strategy, some spin doctor in Downing street has managed to wind up the Prime Minister to announce yet another undeliverable pledge. In this case, the pledge was that within two years everyone will be able to see an NHS dentist. To the man in the Dog and Duck, the phrase "see an NHS dentist" would have meant "be able to be registered with an NHS dentist". He would not have thought that the Prime Minister meant "catch a glimpse of an NHS dentist crossing the road". Four million unregistered potential patients want the chance to access, and be registered with, an NHS dentist. However, it now appears that the Prime Minister's pledge should be interpreted in a rather more literal sense—and even that is probably undeliverable. He appears to be offering a drop-in dental service, which, although it may address the urgent needs of the 20 million people who do not seek regular and preventive dental care, will do nothing significant to address the needs of the 4 million who would like to be registered and to engage in proper preventive oral hygiene and dental care.

Thirty phone-and-go centres will not even begin to scratch the surface of the problem on a nationwide basis-that figure represents approximately one centre for every three health authority areas. Two phone-and-go centres are currently running as pilots, one of which, in Shropshire, has already become a phone-and-wait centre. Its capacity is completely filled and patients are unable to gain immediate access to a dentist, which was the whole point of the project.

Jackie Ballard

Does the hon. Gentleman agree that one reason why 20 million people do not register is that many people are still afraid of going to the dentist? They hope that nothing will go wrong with their teeth, and put it off. If fewer and fewer people register and go to the dentist regularly, that is likely to perpetuate across the generations. As a parent, I found that, if I took my child with me to the dentist when I had a check-up, she could see that it did not hurt. If the only time one goes to the dentist is to have emergency treatment, it is more likely to hurt, and one's child will be less likely, as he or she grows up, to seek dental treatment voluntarily.

Mr. Hammond

I am sure that the hon. Lady is right. In a moment, I shall ask the Minister about those 20 million people, specifically whether any analysis of their motives for not engaging in the system has been undertaken. I suspect, as Liberal Democrat Members have suggested, that the future lies in closer integration of primary dental care with the general primary health care system. We should try to break down that wall and encourage people to access the system more easily and overcome their fears.

It is estimated that to register the 4 million people who can reasonably be categorised as seeking registration would require an extra 2,000 dentists. Where does the Minister think the dentists required for the Prime Minister's initiatives will come from? I entirely endorse the comments of the hon. Member for Isle of Wight about the trend towards salaried dentists. If that is the Government's intention for the future, they should state it clearly. The obvious source of salaried dentists for the new service is the existing community dental service. People involved in that service are deeply worried that, because it is already overstretched by having to deal with the increasing needs of the elderly and trying to act as a back-stop service provider, it will be denuded by salaried dentists going off to serve in the new phone-and-go centres.

The Prime Minister's announcement represents a sticking plaster solution, which will be a high-cost way of dealing with a relatively small number of patients, but one—no doubt this has been noted—that will create 30 separate photo opportunities for Ministers throughout the country. Likewise, the much vaunted NHS Direct access to dentistry scheme, whereby NHS Direct will provide guidance for patients on where they may access an NHS dentist, is nothing new. It is no more than formalising a service that most health authorities provide already.

I have noted from this morning's comments that others share our belief that there must be greater integration of primary dental services into the primary health care system in the future. Oral health is a helpful part of overall health, and dentists, like pharmacists and, in deference to the hon. Member for Somerton and Frome (Mr. Heath), perhaps optometrists, consider that they are left out of the mainstream of the primary health care system. They are left out of the general thrust of the Government's policy in developing primary care groups and primary care trusts. They are not involved in initiatives, such as the NHS net, yet they, too, need access to patients' records to provide proper continuity of care.

The hon. Member for Isle of Wight cited the example of a patient with heart disease, when it is essential that dentists are aware of a patient's overall medical history. Dentists have not been involved in discussions on referral patterns although they, too, refer patients to hospital and play a significant role in the primary detection of cancers of the head and neck. Will the Minister say whether dentists are included in the Government's cancer referral pledge that all urgent referrals with suspected cancer will be seen by a specialist in a hospital within two weeks? I asked the British Dental Association that question yesterday. It said that it did not know the answer and had received no guidance from the Department of Health about it.

It is self-evident that there is no chance in the short term of recruiting enough new dentists to solve the problem. Clearly, the solution will lie in incentivising existing NHS dentists to do more NHS work and to be open to new additional NHS patients, some of whom may then go on in the mixed economy to buy private care from them as part of the overall solution to their dental hygiene problems. Has the Minister considered the fee basis? Has he compared the way in which GPs are remunerated with reimbursement of their premises and establishment costs? Has he considered how changes to the general dental practitioners' remuneration system could impact on the current situation by addressing the high costs that general dental practitioners face in some areas?

Does the Minister see a way forward, either by cost-related premiums on fees in specific areas or by separate premises reimbursements? Perhaps such an initiative could include incentives not only to overcome high localised costs, but to attract dentists to what are currently unattractive areas. The contributions of Liberal Democrat MPs from the far south-west have put the thought into my mind this morning that the Government may deal also with the additional costs that are associated with sparsity in rural areas.

What assessment has the Minister made of the impact of existing charges for NHS dentistry on those 20 million people who are not seeking regular dental treatment? Has his Department undertaken any study to see whether the charges that are currently levied are a significant deterrent to those people, or are other factors keeping them away from a continuing relationship with their dentist and a programme of preventive oral care? What cost-benefit analysis has the Department of Trade and Industry carried out in relation to encouraging additional attendance for preventive dental care, given the established interaction between oral hygiene and general health?

Can the Minister say whether patients who visit phone-and-go centres will have access to the full range of options offered by most general dental practitioners, including the choice to have private treatment which is not available on the NHS tariff—for example, non-amalgam fillings? Alternatively, will the phone-and-go centres effectively become the second tier in a two-tier service, with patients offered only the limited NHS menu if they are forced to visit such centres rather than to register with an NHS dentist who is offering a mixed economy practice?

It may surprise some people to know that dentistry is the second largest cause of lost working days in the country. In Glasgow, it is the single largest cause of general anaesthesia being applied. It is not a side show. Clearly, there is a major problem, which can be tackled only by incentivising dentists to do NHS work, to address the real problems of their cost basis in high-cost areas and to integrate dentistry more effectively into the primary care system. That will make them feel part of the mainstream of our health delivery system. The problem will not be solved by soundbites and the creation of photo opportunities for Ministers—although I acknowledge that the Department of Health has some very photogenic Ministers—nor by the Prime Minister raising expectations that cannot be met.

As in so many cases, no one doubts the ability of the Government, and particularly that of the Prime Minister, to spot the opportunity for a soundbite. The Prime Minister leaves a trail of pledges for others to try to meet, as, sadly, we have seen elsewhere in the NHS, often regardless of the cost in terms of disruption to the smooth running of the service and real clinical priorities. I look forward to the Minister's answers this morning to my specific questions and those raised by other hon. Members, and to hearing—in the absence of the promised White Paper on the strategy for NHS dentistry—what the policy is, beyond the soundbites that have already been announced.

Mr. Deputy Speaker (Mr. Frank Cook)

I call Minister Hutton.

10.37 am

The Minister of State, Department of Health (Mr. John Hutton)

That is the first time that I have been referred to as Minister Hutton. However, this is a modernising Parliament and we have a modernising agenda.

I congratulate all hon. Members who have been fortunate enough to take part in the debate, particularly the hon. Member for Taunton (Jackie Ballard). Whenever NHS dentistry is debated in the House, it is clear that right hon. and hon. Members have strong feelings about its accessibility. They are concerned about the current situation, as are the Government. That is why we have taken the steps to which reference has been made during our debate to try to remedy the situation that we inherited in 1997.

We can analyse the problems, there has been much today with which I do not disagree. However, even more important than that is the need to find solutions to the problem. Of course, it is the Government's job to examine the matter, and I shall be outlining the measures that we have taken so far and those that we intend to take. We all share the responsibility for that. It is easy to criticise, but it would be nice now and again to hear some ideas about solving the situation from Opposition Members. They have been conspicuously missing from today's debate so far.

I again congratulate the hon. Member for Taunton on introducing the debate and on her thoughtful comments. The Government have begun an ambitious programme of modernising the national health service. We have also set challenging targets for improving the health of the population through our White Paper on a public health strategy. We are building a national health service for the future, creating a service that is both fit for the new century and one that will be there when people need it. Although it must always remain true to its founding values, the national health service must—I am sure that it will—rise to the challenges ahead if it is to meet the growing demands of our population in the next millennium.

The hon. Member for Taunton expressed concern that I would brush her anxieties aside. I shall not do that. I want to expound on some of the actions that the Government are taking and our vision for the future. The Government believe that NHS dentistry plays a key part within our modernisation agenda for the national health service. All those who have ever suffered from simple toothache know how crucial good oral health and good dentistry can be to the quality of their lives. In the past 50 years, the hard work and skill of dentists and other members of the dental profession have served our population well. Needs and demand are changing; so must the provision of NHS dentistry. It needs to adapt and keep pace. I recognise that people are impatient. We need a faster, more convenient health service which is better attuned to the needs of our modern society; and that obviously includes NHS dentistry.

I must make it clear to the Chamber, and I shall not apologise to the hon. Member for Runnymede and Weybridge (Mr. Hammond) for doing so, that when the Government took office in 1997, they inherited an NHS dental service that faced some serious problems which were caused by the neglect and the indifference of the previous Administration towards NHS dentistry. The provision of dentistry was, at best, patchy. In parts of the country, there were big gaps between the demand for NHS dentistry and its availability. There were acute problems, and I agree with hon. Members about access to dentistry in the south-west.

Nationally, about a third of health authorities report problems for some of their residents. In recent years, the number of patients registered with NHS dentists had dropped significantly. Patient registration, which was introduced by the previous Government in October 1990 as part of a new pay contract with dentists, peaked in December 1993, when 21.6 million adults were registered. Since then, the number has fallen to 16.8 million—a drop of nearly 5 million.

In September 1996, the previous Government cut the registration period for adults from 24 to 15 months. That meant that people who did not re-visit their dentists in 15 months—previously 24—were taken off the list. That change alone led to a drop of nearly 3 million in the number of registered adults. I was one of them. I came across that new rule when I went back to my dentist in my constituency in Barrow only to find that I had been deregistered. I think that the hon. Member for Taunton said that she or one of her hon. Friends had had that problem, too. The duplicate registrations that can arise when patients change dentists have been weeded out, accounting for another 1 million of the drop. The balance of about 1 million represents people who either deliberately chose not to reregister or who became deregistered because dentists decided not to treat some or all adults on the NHS. It is constructive to consider why that should be.

Before 1990, access to dentistry was informal, with many patients building relationships with an individual dentist over a long period. With a new contract in 1990, relationships between patients and dentist were formalised by a system of registration. Since then, dentists' incomes have been partly based on registrations and, consequently, access to dentistry has depended heavily on registration. Registration was intended to promote continuing care, but it quickly became an end in itself. The previous Government introduced the 1990 contract without fully piloting many of the changes that it contained.

Mr. Hammond

The Minister seems to be generally hostile to the principle of registration. Will he make it clear whether the Government are committed to registration in principle or are hostile to it?

Mr. Hutton

I am trying to explain the drop in the figures that the hon. Gentleman and others have mentioned. I shall come to the new dental strategy in a minute, so I ask the hon. Gentleman to be patient.

As I said, the previous Government introduced a contract in 1990 without piloting many of the changes that it contained. Its intentions were therefore based largely on theory rather than practice, and the consequent results were mixed. In particular, there were significant drawbacks for oral health, NHS dentistry overall and expenditure. The new contract resulted in an overspend of £200 million, which eventually had to be written off. The contract was based on future activity forecasts to guarantee dentists' incomes. They were unsound and resulted in a 7 per cent. fee cut, which led to many dentists increasing their commitment to the private sector—a fact that has been widely commented on this morning. The level of treatment per adult rose while the level of treatment per child fell, and it is difficult to see any clinically based reasons why that should have been so.

The shift towards dentists doing more private work has been slow, but it has been steady. Only a small number of dentists do no NHS work at all, but the amount of time that the rest devote to the NHS has fallen. In a 1993 British Dental Association survey, 75 per cent. of general dental service dentists said that they received 75 per cent. or more of their earnings from the NHS and just 12 per cent. said that they received less than 25 per cent. By 1999, those figures had changed to 58 and 18 per cent. respectively. More than 1 million people now have private dental plans.

Dr. Brand

The Minister said that most dental practitioners still did NHS work. Does he have the facts available to differentiate between NHS work for children and NHS work for adults? My impression is that a large number of NHS dentists have dropped NHS adult work. That is where the difficulty arises.

Mr. Hutton

I am afraid that I cannot give the hon. Gentleman the figure immediately. I will write to him with the requested information because that is an important point.

It is true that availability problems are not spread evenly across the country or our society as a whole. There tend to be fewer access problems for children than for adults, which partly addresses the concerns of the hon. Member for Isle of Wight (Dr. Brand). Access is more difficult for charge-paying adults than for those exempted from charges altogether. In many areas, dentists' lists remain open, and anyone who wants NHS treatment can get it. In others, the situation is worse. For example, in the Stockport health authority area, 56 per cent. of the adult population is registered with a dentist, whereas in Bromley the figure is, I am afraid, only 25 per cent. Across England as a whole, the average is 43 per cent.

The hon. Member for Somerton and Frome (Mr. Heath) asked whether the Department considered that the situation in Somerset was particularly worse than elsewhere in the country. I shall share with him my understanding of the position in Somerset. In the 12 months from September 1998 to September 1999, adult registrations in Somerset declined from just under 183,000 to just over 177,000—about 45 per cent. of the population. Over the same period, child registrations fell slightly from 69 to 68 per cent. of the child population.

Those figures do not exactly correspond to those given by the hon. Member for Taunton. I cannot explain why they differ slightly; perhaps we will explore that matter in correspondence. In general terms, although the figures are clearly low, they compare favourably with the average for England of 45 per cent. for adults—the average in Somerset—and 62 per cent. for children. In fact, the figures for children in Somerset are higher than the national average.

We accept the point that the hon. Member for Somerton and Frome and others have made about the problems of equity of access; of course, that is a fundamental concern which we share with all hon. Members who have spoken in the debate. Even where there are enough NHS dentists to meet demand, the process of finding one can be awkward, time-consuming and off-putting. Today, we have heard accounts confirming that position. The Government are committed to reversing that decline. We want the service to be faster and more convenient for patients—a modern dental service which meets the demands of modern life. Our target, which was announced in September by my right hon. Friend the Prime Minister and my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), is that, by the end of 2001, everyone who needs NHS dentistry will be able to get it.

We have already taken significant and positive strides forward and improved access to dentistry by using the investing in dentistry initiative and personal dental services. The investing in dentistry initiative spent £10 million expanding NHS dental practices. Across the country, 363 locations benefited from the scheme and 830,000 more patients can register with an NHS dentist. Eight investing in dentistry bids were approved from Somerset, including two from the constituency of the hon. Member for Taunton. Those two grants, totalling more than £30,000, have been approved for two dental practices in her constituency. When the new dentists are approved, which we hope will be done soon, they will deliver treatment to thousands more patients in her constituency. Throughout Somerset, the eight schemes should raise 19,000 new NHS patients. Of that target, 6,000 new registrations have already been achieved. I accept the criticism that Opposition Members made about the situation in Somerset, but we are trying to deal with the problem.

Jackie Ballard

Yes, funding has gone to practices in my constituency but, as the Minister knows, there are difficulties recruiting dentists. I suspect, but I do not know, that dentists feel that Somerset is an affluent area containing quite a few people who can afford to pay for private treatment, that they can make more money in a private than in an NHS practice and that there is no demand for NHS treatment in Somerset.

I return to the Minister's comments on the Prime Minister's promise. He said that everyone would have access to NHS dentistry within two years. Will he define what he believes to be a reasonable distance to travel? I have with me the health authority list that is given to people who are looking for a dentist in Somerset. It gives two addresses in Minehead and one in Shepton Mallet. Interestingly, the other two postal addresses are not in Somerset, which means that the list contains only three addresses in Somerset. How far does he believe someone should have to travel for treatment?

Mr. Hutton

I do not want to avoid answering the hon. Lady's question, but effectively I am being asked to tell the Chamber what is in the new dental strategy. I had the same problem with some of the questions that were asked by the hon. Member for Runnymede and Weybridge. Clearly, I am not in a position to discuss the details of that strategy. With great respect, hon. Members will have to be more patient. When we publish the new dental strategy in the new year, the answers to some questions will become more apparent. However, I share the hon. Lady's concerns. If I were in opposition and my constituents were told that they had to travel 30 or 40 miles to see an NHS dentist, I should not be satisfied.

Mr. Hammond

I accept what the Minister says, and I shall wait with bated breath for the strategy document. If my questions are not answered in it, I shall put them to him again. Will he say precisely what he meant when he said that everyone who wants access to NHS dentistry will have it by 2001? Does that mean that everyone who wants to register, and to have an on-going relationship with an NHS dentist and to obtain preventive care, will be guaranteed the ability to do so?

Mr. Hutton

We certainly want to improve access to NHS dentistry. That was made clear by my right hon. Friends at the Labour party conference and on other occasions. I give credit to the hon. Gentleman, who is once again trying to get me to announce what will be in the new dental strategy. With the greatest respect, I am afraid that he will have to wait until it is published.

We accept that the previous arrangements for the provision of dental services were too rigid. Local nuances and the need for such services could not always be met. The personal dental services pilots have successfully overcome some inflexibilities. They were introduced in 1997 to test whether new arrangements could serve as an alternative to the national contract for general dental services. The framework that is contained in the National Health Service Primary Care Act 1997 was used by the pilots.

Dr. Brand

Will the Minister give way?

Mr. Hutton

With great respect, I shall not give way any further. Time is short and I need to conclude my remarks.

The first wave of 15 personal dental services pilots began in October 1998, and the second wave of 23 pilots began in October 1999. They are concerned with access and seek to guarantee a higher quality of service, but they should have the flexibility to meet the varying needs of different elements in our society. The pilots involved, for example, the provision of services to children, deprived communities and the homeless. Some specialist services, such as sedation, general anaesthetics and restorative dentistry are also part of those innovative schemes.

Proposals for the third wave, which my hon. Friend the Member for Stoke-on-Trent, North (Ms Walley) asked about, are being considered. Access to services for those with special service needs, such as the elderly in residential homes, are included in those expressions of interest. There have been expressions of interest in the third wave of personal dental services from Somerset and from Stoke for the establishment of dental access centres. I am sure that my hon. Friend the Member for Stoke-on-Trent, North and the hon. Member for Taunton wish those projects well. I hope that they understand that I am not in a position today to say whether those expressions of interest have succeeded. An announcement will be made when a decision is taken.

The personal dental services complement general dental services practices, which remain the key way by which most people get high-quality NHS dentistry. There was some concern that phone-and-go centres would provide only a second-tier service. The hon. Member for Runnymede and Weybridge had something of a cheek to refer to a two-tier service, since that was precisely the legacy that his party left behind when it left government.

I confirm that phone-and-go centres will provide all the treatment that is necessary to maintain oral health, including check-ups—they will not merely be emergency clinics. They will plug gaps when there are problems of availability. They will provide a high-quality service that is based around the needs of patients. At those centres, people who cannot register with an NHS dentist but who want to see one can simply ring to make an appointment. They can be confident that they will receive good NHS care.

Those centres are fully consistent with our ambition to provide faster and fairer treatement through the NHS. Schemes will be set up in various locations, including high streets, clinics and in some of the new primary care walk-in centres. Opposition Members emphasised the importance of linking dental practice with primary care, and we accept that. That is why the new phone-and-go centre in Swindon, which will open later this winter, will be co-located with a walk-in primary care centre. That is how we want such services and initiatives to develop.

There will be about 30 dental access centres, which will ease the most acute problems of access across the country. Expressions of interests for the third wave of access to dental access centres are currently under consideration along with the third wave of the personal dental services pilots. We are confident that there is sufficient manpower in the dental profession to staff those centres. The number of dentists continues to rise. The phone-and-go centres and personal dental services offer the opportunity of making the most of all the talents in a dental team.

I have more to say on this matter but, sadly, time is about to run out. I confirm what I said to the hon. Member for Taunton at the outset—that the Government attach great importance to improving access to NHS dentistry, and that the present situation is not acceptable. That is why we have taken action. We are investing in dentistry and improving access, which has had a significant impact. Despite some of the criticisms that have been made this morning, we are developing a new dental strategy for the NHS, which we shall publish in the new year. We have also made clear commitments today and on previous occasions about restoring access to NHS dentistry.

We recognise the importance of good health and value the well-being of our nation. I hope that hon. Members agree that the Government are trying to deal with those concerns, which we take seriously, and that we are putting in place appropriate measures to tackle the problems.

Mrs. Cheryl Gillan (Chesham and Amersham)

On a point of order, Mr. Deputy Speaker. What progress has been made to ensure that the parallel chamber is televised throughout Parliament in our offices? I spoke to my staff five minutes ago and I understand that the arrangements for televising broadcasts from this Chamber to our offices have still not yet been completed. I believe that a feed is available to the press, but that it is not available to staff, researchers or parliamentarians around the Palace. I hope that you can throw some light on the matter.

Mr. Deputy Speaker

The light that I can throw will simply reflect the comments that Madam Speaker made in the Chamber yesterday. I am sure that they were widely heard. She said: I am taking steps to find out whether we can have that for next week."—[Official Report, 30 November 1999; Vol. 340, c.159.] Next week has yet to arrive.

Mr. Crispin Blunt (Reigate)

On a point of order, Mr. Deputy Speaker. Yesterday, I was slightly confused about the status of the gentleman who sat next to the Deputy Speaker. I tried to establish whether the Modernisation Committee recommended that Officers of the House should not dress as Officers of the House when they are in attendance in Westminster Hall. I believe that this Chamber is not a Committee of the House, but an extension of the House. It is hard to sustain the dignity of the House of Commons in this Chamber if Officers who are working in the Chamber do not dress in a way that maintains the dignity and traditions of the House. Would you give a direction to the Officers of the House that they should treat this Chamber in the same way they treat the House itself, of which this place is an extension?

Mr. Deputy Speaker

I remind the hon. Member that the report of the Modernisation Committee that gave rise to the experimental activity in which we are engaged gave no formal approval for the use of the Mace, for prayers or for formal attire. I also remind the hon. Member that, when not in the Chamber but still on duty, Officers of the House do not wear their formal rig. For that reason, no such attire is required here.

Further to that, I must remind the hon. Member that points of order of this sort are an unwarranted intrusion on private Members' debating time. If he seeks to take the matter further, I suggest that he make it part of his report to the Modernisation Committee—everyone is entitled to make a report—which the Committee will consider at the end of the experimental period.