HC Deb 15 January 2002 vol 378 cc55-61WH

1 pm

Janet Anderson (Rossendale and Darwen)

It gives me great pleasure that the Under-Secretary of State for Health, my hon. Friend the Member for Salford (Ms Blears), is to respond to the debate. She knows Rossendale only too well. Some years ago, she had the good fortune—some may say the misfortune—to work at the town hall there.

My hon. Friend the Member for Hyndburn (Mr. Pope) would have been here, but he is engaged in important Select Committee business this morning. He very much wishes to be associated with the debate because the town of Haslingden, in the borough of Rossendale and very much part of the Rossendale valley, falls within his parliamentary constituency.

The lack of national health service dentists in Rossendale has been a growing problem in recent months. It is not confined to Rossendale. A recent survey of 91 health authorities in England and Wales claimed that only half of all adults are registered with an NHS dentist. The situation in Rossendale is especially acute and now demands urgent attention and special treatment. It has been raised with me by several of my constituents, of whom I mention one or two.

Mrs. Sheila Charleson of Loveclough wrote to me recently about her family's experience. She said: Today I have spent over an hour on the telephone trying to acquire a dental appointment for my son with an NHS dentist. This task has proved impossible despite the fact that the whole family, including previous generations have worked all their lives and paid tax and national insurance contributions! The family were all previously patients of Wood and Duffy at Waterfoot but they now only see private patients and my son cannot afford to pay for private treatment nor indeed afford the insurance premiums required to offset some of the dental expenses It would appear that within the whole of Rossendale there is not one dental practice taking on NHS patients, a situation I find deplorable and totally unacceptable. I have been informed that the nearest dentist with an NHS list is in Accrington and his list is apparently closed until at least January 2002! After much frustration and hard work I managed to secure him an appointment at Waterfoot for emergency treatment next Monday 19th November but this will only be for his immediate pain problem and further check-ups and treatment will have to be done elsewhere (where that might be seems to be anyone's guess!) Something needs to be done immediately about this unacceptable state of affairs as I am sure my son is not the only person faced with this disregard for the health and welfare of the hard working citizens of East Lancashire. Another constituent whom I would particularly like to mention is David Walsh of Newchurch, whose experience was very sad indeed. He wrote: Dear Janet, On Boxing Day I had to walk from my home here in Newchurch…to the nearest NHS Walk In Centre outside the Rochdale Royal Infirmary. I had a huge tooth abscess. I set off at 7.10 in the morning on foot and I got to the Rochdale Infirmary (the NHS Walk In Centre is just opposite the Accident and Emergency) at 9.50! The dentist was amazed that I'd walked so far to get his help…p.s. I had to walk to Rochdale on Boxing Day because there was no public transport and I cannot drive or ride a bike. What are the reasons for that situation? They were recently clearly outlined to me by Dr. J. G. Whittle, the consultant in dental public health at the East Lancashire health authority. He told me: The underlying problem with NHS dentistry in East Lancashire is the shortage of dentists willing to come and work in this part of the world. The problem has been compounded by the reduction of dentists in training since the 1980s. The introduction of vocational training in the 1990s means that the first job for many dental graduates is close to the university where they train and this gives the practices involved in that training an advantage in obtaining new dentists It is true that the number of registered dentists has grown considerably in recent years. However, this is mainly because of dentists from overseas coming to work in Britain. This has not helped East Lancashire because these dentists want to work in the major metropolitan centres which they hear about at home. East Lancashire Health Authority has advertised for dentists in Europe but with no success for this reason For these reasons our practices have been unable to attract new dentists to the area and their present dentists have been struggling to cope with large lists of NHS patients. Last year the three large practices (in Haslingden, Rawtenstall and Waterfoot), all owned by the same partners, decided that the only way to reduce their workloads was to privatise. The knock-on effect of this has been to overwhelm the other six practices to the point where they are unable to take on any new NHS patients When we submitted our expression of interest in providing a Personal Dental Services (PDS) pilot for Rossendale in 2001 we requested a dentist for five sessions a week. A few months later when we came to writing the full proposal we increased this to 10 sessions. The PDS we have set up at Haslingden and Waterfoot now provides 11 sessions However"— this is perhaps the most disturbing point— recent figures from the Dental Practice Board, show that during the quarter ending 30 September 2001, the number of patients (adults and children) registered with East Lancashire dentists fell by 15,358 from 241,873 to 226,515. I was astonished to learn that ninety per cent. of that fall was accounted for in Rossendale where the number of registered patients fell by 13,765 over the three months. At the same time the Emergency Dental Service which was set up to provide care for up to 20 patients a session in the evenings and at weekends is regularly having to cope with 40 patients and more We have therefore worked with Rossendale PCG and the Burnley Trust to develop proposals for a much larger PDS pilot in Rossendale. We have identified vacant accommodation at both Rawtenstall Health Centre and at Rossendale Hospital. Refurbishment of either would create a unit containing four dental surgeries. Subject to recruitment of dentists this unit could provide up to 40 additional sessions of dental treatment each week. Our first estimates of the costs of such a service are set up funding of approximately £259,000 and recurrent expenditure of about £442,000 per annum Experience of setting up a PDS in Rossendale has shown that there are some, but not many, dentists who would prefer to work in such a system rather than the general dental service. Therefore, even if we got the funding, it might take some time until it was fully staffed. Dr. Whittle ends with these thoughts, which I commend to the Minister, on how the Government could help to improve access to dental services in east Lancashire. They could introduce fluoridation of the public water supplies in the area. This would reduce dental decay by up to 50 per cent. and reduce the demands on dental services. They could also increase the provision of salaried dental services in Rossendale by supporting the PDS proposal described above", and train dental graduates in Lancashire. The Cumbria and Lancashire Strategic Health Authority Area will be the only one in the North of England without a dental school. Lastly, and perhaps most important, the Government could direct dentists to under-dentisted areas for their vocational training. So, in the Rossendale valley at the end of September last year, nearly 14,000 fewer of my constituents were registered with an NHS dentist than were registered three months earlier. That is a staggering statistic, and the situation is likely to be even worse now. As health watchdogs have warned, serious health problems can arise if people stop seeing a dentist altogether. Problems such as cancer of the mouth may not be detected before it is too late.

I hope, therefore, that the Minister can offer some comfort to my constituents by acknowledging that the Government understand the serious situation now facing us in the Rossendale valley and will take urgent steps to put matters right.

1.9 pm

The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)

I congratulate my hon. Friend the Member for Rossendale and Darwen (Janet Anderson) on raising this extremely important issue. I have no doubt that her constituents will be pleased that she has raised them in such detail. She has also pointed the way forward with some practical suggestions about action that the Government can take, with local health organisations, to ensure that the problem is eased for her constituents. As she rightly says, I know the Rossendale area quite well. It is a beautiful area that has a lot going for it, but I recognise that her constituents have particular health problems and need a good service.

The whole of east Lancashire has had long-standing problems in gaining access to NHS dentistry. Throughout the 1990s, not just in east Lancashire but in many parts of the country, the NHS dentistry system went through a great deal of strain, with many dentists deciding to opt for private practice instead of concentrating on work in the NHS, as many of them had done previously. That was partly due to some dramatic changes in the remuneration system for dentists and the contractual situation, which meant that working in NHS dentistry became a much less attractive proposition for many dentists. Since the Government were elected, we have tried to take practical steps to draw dentistry back into the NHS, by looking at remuneration and extra incentives for dentists who do a greater proportion of their work in the health service and by training young dentists and involving them in communities across the country.

We must recognise that dentists are independent contractors and can therefore choose whether to practise in the private sector or in the national health service. This may be one area where the Government have fewer levers to direct what happens and must therefore be more imaginative in creating a climate in which dentists want to be part of the national health service. That is a challenge that I face and am enjoying trying to meet.

In September 1996, the Government cut the maximum period allowed between visits so that patients could retain their registration with an NHS dentist. Originally, the period was 24 months between visits. It went down to 15 months and, as a result, hundreds of thousands of people were removed from the registers of their NHS dentists. We saw a dramatic fall in the number of people registered and thus the number of people who can get on-going care rather than the emergency care to which my hon. Friend referred. In 1993, 21.6 million adults were registered in this country. That had fallen to 16.8 million in 1999—a dramatic reduction. My hon. Friend is right that in east Lancashire now, and particularly in Rossendale, a worryingly low number of dentists are prepared to take on new NHS patients.

The health authority runs an emergency access service, which is open every night of the week, so that patients can get emergency care. I understand that it is in Accrington, about six or seven miles from Rossendale. At present, 30 to 40 patients a night seek access to that service, so it is clear that the demand exists in the community for dentistry services.

In trying to address those issues, the Government published "Modernising NHS Dentistry-Implementing the NHS Plan", which is part of the overall NHS plan. That document commits us over the next few years to ensuring that everybody can have access to an NHS dentist and to raising the level of oral health, particularly in children, to reducing the massive inequalities in oral health between different communities, and to improving the quality of service offered by NHS dentists. In addition to the plan, the Prime Minister pledged in 1999 that by the end of September 2001, although not everyone would necessarily be registered on a long-term basis, they would at least be able to find a dentist, which they had not been able to do before, by phoning NHS Direct. That system is working in the constituency of my hon. Friend the Member for Rossendale and Darwen and people are being signposted by NHS Direct to dentists who are taking on new patients. However, people often have to travel some distance from their homes for that access.

During the past 18 months, £100 million has been spent on introducing the strategy to increase NHS dentistry. We have tried to be innovative about the way in which that money has been spent to give patients the maximum value. Every health authority had to produce a dentistry action plan to identify gaps in its community and areas in which people were least well served, and produce practical solutions.

The health authority in east Lancashire has come up with a plan to provide dentistry in the community and has set standards that state that people should be able to get routine care within a 10-mile distance, urgent care within 18 miles and emergency care within 12 miles. Those are long distances for people to have to travel, so we would like to improve on the standards. However, it is important to secure a base framework for an NHS service. The plan identifies areas with particular problems such as Burnley, Pendle and Rossendale. The situation is slightly better in Blackburn, Hyndburn and the Ribble valley, but gaps exist there, too.

The health authority plans to introduce incentives into the system to encourage NHS dentists to increase the proportion of its practices devoted to NHS patients; payments are now available to dentists for that. We have given £50,000 to the dental care development fund to incentivise dentists, to which the health authority added £20,000. That is a fair-sized fund, which means that an extra 11,000 people can be registered in the area. I take note of my hon. Friend's worry about the dramatic decrease that has happened during the past three months. That has arisen from a decision of three major practices in her constituency to privatise their service and move towards a Denplan system. Those practices are owned by the same dentist, but a decision of such magnitude in a relatively small community can have a disproportionate impact on services available to local people.

The health authority has also put almost £500,000—a significant amount—into the Modernisation fund for distribution to general dental practitioners. In his letter, Dr. Whittle highlighted the difficulties of staffing and the fact that, despite extra funding, it is not always possible to convince young dentists that they want to work in Rossendale, Darwen or other areas away from major metropolitan centres in which those at the beginning of their careers often think they will receive the best practice.

I am pleased to tell my hon. Friend that, in 2001–02, seven dental practices in east Lancashire have been approved as vocational training practices and can take on new trainees. It is hoped that young trainees will get to know the community, become settled in the area, appreciate the benefits that Rossendale and east Lancashire have to offer them and their families, and develop practices. The fact that seven practices participate in the vocational system should draw new dentists into the area. New finance will help to establish new practices and the NHS will help to support the costs of establishing dentists in an area—we want to do everything we can to draw them in. We hope that, at the end of their vocational year, the dentists will stay in the communities where they have got to know the patients and the health service.

Another creative way in which we have tried to provide services is through a fourth-wave personal dental services pilot. Salaried dentists are employed by the health authority to provide services to local people. Funding of £360,000 went to a third-wave pilot based in three areas: Rossendale, Burnley and Pendle. The one in Rossendale, in my hon. Friend's constituency, operates at Haslingden and Waterfoot on Mondays, Tuesdays and Fridays, and is well used. My officials will discuss the proposals to extend that personal dental services pilot with the health authority and local people to see whether we can expand the service to provide a greater range of sessions for local people to attend. I do not pretend that that will be easy, because of the staffing issue, and if a service is set up, we must be sure that we can attract the dentists, dental therapists and hygienists so that we obtain value for the money invested. I am more than happy to give the assurance that my officials will explore the prospects for expanding the fourth-wave dental services pilot in my hon. Friend's constituency.

I recognise that some access problems are fuelled by higher-than-average levels of dental disease in people living in my hon. Friend's constituency. As Dr. Whittle said, water fluoridation offers the most effective means of reducing inequalities in oral health, but, as hon. Members know, that is very controversial. We responded to concerns about the safety of water fluoridation by commissioning research into the evidence of its effect not just on oral health but on health generally. The Medical Research Council undertook a review that should be completed within the next couple of months and we shall review our policy in the light of the MRC's findings.

In the meantime, I am pleased to confirm that east Lancashire is included in the areas involved in the national "brushing for life" scheme, which I was delighted to launch last autumn. In the scheme, families with young children are given packs containing fluoride toothpaste, a toothbrush and a leaflet on oral hygiene. Health visitors show children how to brush their teeth almost before they have teeth and help them into a habit of good, early oral health care and of regularly brushing their teeth, which can help to reduce some of the problems that arise later in life. I am delighted that east Lancashire is included in that scheme. There will also be regular checks on children's teeth and oral health with lots of encouragement.

We are not encouraging a nanny state telling people what to do; we are making a genuine attempt to persuade people into good habits early in life because what we learn then tends to remain with us for many years. I hope that my hon. Friend will see the scheme in action in some of the schools and child health clinics in her constituency. I am pleased to offer my hon. Friend the comfort that we are trying to direct dentists into her area.

Another matter that Dr. Whittle raised was training. He said that there is no dental school within the Lancashire and Cumbria strategic health authority area and that it is the only strategic health authority in the north-west without a dental school. However, two dental schools—in Liverpool and Manchester—are fairly close to the area and of the 28 strategic health authorities throughout the country, only 10 have dental schools, so Lancashire and Cumbria are not unique in not having a dental school in their immediate area. I accept that, when training young dentists, we must encourage them to spread their wings a little wider than the conurbations of Manchester and Liverpool. That is important for the residents of the whole north-west region.

I hope that I have provided some comfort to my hon. Friend. It is impossible to spirit dentists out of the air. They must be trained and encouraged to work within a national health service that recognises their skills and values their contribution, and in which we have a proper dialogue with them. In recent years, the dental service may have become a little detached from the NHS as a whole. In my negotiations with dentists and in discussions with their professional and representatives groups—I have met them on many occasions—many of them have said that they want to change the way they practise. They want to be part of the NHS, but they want their skills to be properly value and rewarded. We want a national health service in which dentists feel that they are a key part of the primary care team rather than simply drilling and filling, and in which they use their skills to advise on improvements to young people's health in particular. They will then have the satisfaction of seeing people's teeth gradually improve with less need for emergency care and the sort of pain relief required by my hon. Friend's constituent, Mr. Walsh, who had to go through such a gruelling and terrible experience on the day after Christmas. I cannot imagine anything much worse than his experience. I hope that in future we can ensure that generally, if not on Boxing day, he has access to an NHS dentist. That is what most people want to find for themselves and their families.

I am pleased to say that the rewards for the profession have been appreciated in recent years. We have paid in full the Doctors and Dentists Remuneration Review Body pay awards. They have not been staged. This year the basic pay increase is, I think, 3.6 per cent., which is above inflation. I hope that that will show dentists that we value the services that they provide. We have incentives to try to make them increase the amount of NHS practice that they do. The more dentists we can involve in improving the teeth and oral health of everyone in the country, the better. This is not simply about teeth, but about such matters as oral cancers and general health. Good early dental examination can make a real and significant difference to people's health.

I am delighted that my hon. Friend the Member for Rossendale and Darwen has raised the issue. I am sorry that my hon. Friend the Member for Hyndburn (Mr. Pope) could not be with us, but I fully appreciate his concern about the matter on behalf of his constituents. I shall certainly endeavour to do whatever I can, through my officials, to ensure that NHS dentistry in Rossendale improves in the months to come. My hon. Friend the Member for Rossendale and Darwen has done us all a service by raising this important issue here today.

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