NHS DENTAL SERVICE: FUTURE (Hansard, 14 July 1994)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)

My right honourable friend the Secretary of State for Health is publishing today a consultative document calledImproving NHS Dentistry. Copies of the document itself and a summary have been placed in the Library and are available in the Printed Paper Office. They are a response to the report of Sir Kenneth Bloomfield, published in January 1993, and to that of the Health Select Committee.

The Government's purpose in putting forward these proposals for consultation is twofold. Firstly, we wish to strengthen and improve National Health Service dentistry, maintaining a high quality service available and accessible to all and one which responds to the modern needs of patients. Secondly, we wish to build on the excellent improvements to oral health of recent years and, in particular, to improve further children's oral health and address regional variations. We are also publishing today proposals for an Oral Health Strategy for England. Copies have been placed in the Library and are also available in the Printed Paper Office.

The Government are determined that all patients will continue to have access to an NHS dentist; under the proposals, this would be the case. The Government propose to develop and strengthen the community dental service to ensure that there is an effective safety net where necessary. NHS treatment would continue to be available free or at reduced cost to those currently exempt or remitted from charges and all children would continue to receive free NHS treatment. The Government will also consult on improvements to the system of charging to encourage examination and 111WA routine treatment along the lines proposed by the Health Select Committee. One possibility is a reduced examination charge.

The proposals would provide a more flexible system better able to match dental treatment to the varying needs of patients. There would be incentives to encourage a greater emphasis on the quality of care and prevention rather than the number of patients treated. The system for paying dentists would be simpler to operate and provide better overall financial control for the taxpayer. The Government also believe it would be fairer to dentists.

The Government believe that, in the longer term, there is a case for moving towards a system in which local family health services authorities (FHSAs) (or Health Commissions) are responsible for purchasing dental services for their area, taking full account of local need and the state of oral health. This would represent a significant change. The Government therefore believe it would require careful piloting and evaluation before any change were made. The Government propose to invite FHSAs to volunteer to participate in pilots.

The Government also believe the current system of remuneration for dentists should be improved. They are consulting on two options. One is for a sessional fee model which would link payment to dentists to the time spent treating NHS patients rather than the number and type of treatments carried out. An alternative approach would be a modified fee-per-item system. In both these options the emphasis would be on linking to the quality of care and prevention.

These proposals follow the dental profession's request for a fundamental review of the dental remuneration system, which is largely unchanged since the foundation of the NHS. We have consulted widely with the profession and taken full account of Sir Kenneth Bloomfield's Report. We have also taken on board a number of the recommendations from the Health Select Committee. The Government note that, while there is consensus on the need for change, there is no consensus on the best way forward. The options set out for further consultation offer the opportunity of a simpler, more flexible system which responds to the needs of patients and reflects the great improvements in oral health of recent years and the changing nature of dentistry. The Government now seek the views of dentists and their patients on the best way forward.