§ Mr. Win GriffithsTo ask the Secretary of State for Wales what was the difference between the public expenditure estimate for general dental services in Wales in 1997–98 and the cost outturn. [75321]
Mr. Jon Owen JonesThe public expenditure estimate for gross general dental services in Wales for 1997–98 was £75.1 million and the cost outturn was £76.9 million, a difference of £1.8 million.
Following the transfer of functions, this issue will be a matter for the National Assembly.
Source:
Welsh Office Departmental Report 1998–99 and Appropriation Account 1997–98.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales how many adults have been seen by dentists under NHS regulations in each health authority area in each of the last three years for which figures are available. [75325]
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Percentage of population registered with a dentist for NHS care Bro Taf Dyfed Powys Gwent Morgannwg North Wales Wales Adults 30 September 1996 52.0 48.9 52.7 63.8 46.8 52.5 31 December 1996 51.4 48.1 52.2 63.8 47.3 52.2 31 March 1997 51.4 46.9 52.4 63.9 48.2 52.3 30 June 1997 51.3 46.4 52.4 64.1 48.8 52.3 30 September 1997 51.7 46.5 52.2 64.3 49.6 52.6 31 December 1997 51.7 47.2 52.8 64.8 51.4 53.3 31 March 1998 48.7 44.2 50.3 62.0 48.9 50.6 30 June 1998 46.5 41.8 48.4 59.3 47.6 48.5 30 September 1998 43.9 39.7 46.6 56.7 45.9 46.4 Children1 30 September 1996 60.9 59.6 62.8 73.3 60.0 63.0 31 December 1996 62.1 61.4 65.0 75.5 62.1 64.8 31 March 1997 54.9 54.2 57.1 67.0 55.9 57.5 30 June 1997 58.7 57.7 61.1 71.8 60.1 61.5 30 September 1997 61.6 60.0 63.6 74.3 62.9 64.2 31 December 1997 64.1 62.5 66.2 76.4 66.3 66.8 31 March 1998 56.9 55.8 59.3 69.0 59.9 59.9 30 June 1998 57.2 55.3 59.6 68.6 60.5 60.0 30 September 1998 56.8 54.8 59.6 68.1 60.8 59.8 1 Aged 17 or under
Mr. Jon Owen JonesInformation on the number of adult courses of dental treatment paid for under NHS regulations is given in the following table. It should be noted that one adult may have more than one course of treatment during a year.
Adult courses of dental treatment Health Authority 1995–961 1996–97 1997–98 Bro Taf — 323,151 342,422 Dyfed Powys — 200,078 209,149 Gwent — 247,599 260,096 Morgannwg — 276,136 286,479 North Wales — 309,824 347,795 Wales 1,349,622 1,356,788 1,445,941 1 Data for current Health Authority areas are not available prior to their re-organisation on 1 April 1996 Following the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales what changes by health authority area have taken place in dental registrations of(a) children and (b) adults since the introduction of the 15 month registration period. [75332]
Mr. Jon Owen JonesThe 15 month registration period was introduced in September 1996 and information on the percentage of the population registered with a dentist for NHS care for each quarter from that date to September 1998 is given in the following table. Prior to September 1996 the registration period for adults ran for two years from the date of registration or re-registration; the registration period for a child ran from the date of registration or re-registration to the 31 December of the following year.
The introduction of the 15 month period for adults and action by the Dental Practice Board to remove duplicate registrations, has led to a decrease in the number of adult registrations in all Health Authorities.
The main effect of the introduction of the 15 month period for child registrations has been to remove the seasonal effect resulting from the lapse of all child registrations at the end of each year. This last occurred in December 1997 and since that date the pattern of registrations has levelled out in all Health Authorities.
523WFollowing the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales what percentage of treatments requiring prior approval from the Dental Practices Board was submitted to dental reference officers for further examination in each of the last three years; what percentage was refused; and what was the(a) shortest, (b) longest and (c) average time taken to consider these submissions. [75310]
Mr. Jon Owen JonesInformation for 1995–96 is not available.
In 1996–97, 6 per cent. of prior approval applications in England, Wales and the Isle of Man were referred to dental reference officers for further investigation and 71 per cent. of these patients were seen ie 4 per cent. of the total number of applications. In 1997–98, 9 per cent. were investigated further and 56 per cent. of patients were seen ie 5 per cent. of the total number of applications.
Of those patients seen in 1996–97, the dental officer had a fundamental disagreement with the treatment plan in 0.47 per cent. of cases and had a major disagreement in 4.72 per cent. of cases. For patients seen in 1997–98, there was a fundamental disagreement in 0.38 per cent. of cases and a major disagreement in 3.48 per cent. of cases. However, refusal to give approval takes place only after further consultation at the Dental Practice Board.
In 1996–97, the quickest approval was given in 45 days, the average time taken was 85 days, and the longest time taken was 138 days. In 1997–98, the equivalent periods were 46, 97 and 124 days respectively.
Following the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales if he will make a statement about current audit and peer review projects for general dental practitioners; what assessment he has made of their effectiveness, value for money and prospects for further development; and what plans he has for additional financial support. [75312]
Mr. Jon Owen JonesA Peer Review scheme for general dental practitioners (GDPs) in Wales was introduced as a pilot in September 1991. The pilot scheme has been twice reviewed by outside consultants, and on each occasion it was concluded that the scheme was a valuable initiative. The latest review in June 1996 reported favourably on the cost effectiveness and benefit for patients.
The Peer Review scheme and Audit for GDPs is well established. An Assessment Panel composed of representatives from the dental profession and the Welsh Office, is responsible for the funding, probity, training and development in Wales.
Details concerning the budget for Peer Review in 1999–2000 will not be known until the end of March. Funding for dental audit will fall within the Clinical Governance remit of Local Health Groups which all have dental membership on their boards.
524WFollowing the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales when he expects to receive the report of the Health Authorities' Chief Executives' Group on oral and maxillofacial services in South Wales. [75315]
Mr. Jon Owen JonesThe South Wales Health Authorities' review of Oral and Maxillofacial Surgery Services is expected to be completed by October. The conclusions of the report will be for health authorities to consider and take forward.
Following the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales what percentage of all types of dental treatment in each of the last three years was referred to a dental reference officer for scrutiny; and what percentage was declared to be(a) of poor quality and (b) invalid. [75317]
Mr. Jon Owen JonesInformation for 1995–96 is not available. Of courses of treatment scheduled for payment for England, Wales and the Isle of Man in 1996–97 and 1997–98, about 0.5 per cent. and 0.6 per cent. respectively were referred to a dental reference officer for scrutiny.
Of those patients seen, the Dental Officer had a major or fundamental disagreement with the treatment in 1.75 per cent. of cases in 1996–97 and 1.37 per cent. of cases in 1997–98. These percentages cover both poor quality and invalid treatments. The Dental Officer was unable to comment in 3 per cent. of cases seen in 1996–97 and 4 per cent. in 1997–98.
Following the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales if he will make a statement about the problems of providing satisfactory dental services in rural areas and the steps taken to deal with them since 1 April 1998. [75327]
Mr. Jon Owen JonesI recognise that, in the more rural parts of Wales, patients who are not registered with a dentist can sometimes find it difficult to obtain NHS dental treatment close to home.
Stage 2 of the Welsh Office dental initiative, launched on 10 July 1998, introduced more flexible conditions specifically designed to address the particular problems being encountered in rural parts of Wales. It offers the possibility of enhanced levels of grant aid for dentists who want to open new part-time or branch practices in certain areas where this would be the best way of meeting local needs.
Following the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales what changes have taken place, by health authority area, in child dental registrations since June 1996; and what steps he has taken to encourage the registration with a general dental practice of children up to five years of age. [75331]
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Mr. Jon Owen JonesThe information requested is as follows:
30 June 1996 30 September 1998 Health authority Number Percentage Number Percentage Bro Taf 102,012 57.7 100,975 56.8 Dyfed Powys 59,450 57.0 56,965 54.8 Gwent 81,648 60.4 80,728 59.6 Morgannwg 79,872 70.5 76,968 68.1 North Wales 85,050 57.7 89,408 60.8 Changes introduced in September 1996 brought the child registration system in line with the adult system, with both running for a period of 15 months from the date of registration or re-registration. Prior to this child registrations ran from the date of registration or re-registration to the 31 December of the following calendar year, which created a seasonal pattern in registrations. The change was fully effective by the end of December 1997 but care should be taken when comparing data from different times of the year where one quarter was prior to September 1996 as data are not strictly comparable.
Despite general improvements in the oral health of the population, and of children in particular, there are considerable regional variations. Even in areas where the prevalence of tooth decay is low, there remain pockets of disease frequently related to social deprivation. The Department has developed a targeted incentive scheme to increase the registration of children in their early years. This will deliver enhanced fees to dentists for registered patients aged 5 and under who live in specified areas.
Following the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales what assessment he has made of the need for facilities for dento-alveola surgery. [75319]
Mr. Jon Owen JonesNone. Dento-alveolar surgery is mostly carried out within the facilities of primary dental care. Dento-alveolar surgery requiring more specialist treatment is provided by Hospital Dental Services based in District General Hospitals and it is for Health Authorities to assess local need for such facilities.
Following the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales what estimate he has made of the number of dentists required in each health authority area to provide a satisfactory level of service. [75323]
Mr. Jon Owen JonesIt is a matter for local health authorities to satisfy themselves of the adequacy of dental manpower in light of local needs. Health Authorities are free to make a case for Welsh Office grants to attract new general dental practitioners, subject to funding being available and criteria being met.
Following the transfer of functions, this issue will be a matter for the National Assembly.
526W
§ Mr. Win GriffithsTo ask the Secretary of State for Wales following the publication of the Poswillo Inquiry, how many general dental practitioners underwent training in anaesthesia and equipped their practices to comply with the appropriate recommended safety levels; and what contribution the Welsh Office made towards this training. [75328]
Mr. Jon Owen JonesIn 1992, £0.5 million was made available in Wales to assist the delivery of the exacting standards of the Poswillo Report wherever general anaesthesia, sedation were being provided.
The funding was available for:
- Community and Hospital Dental Services: £310,000
- Postgraduate Dental Education Facilities: £80,000
- General Dental Services: £105,000
- Resuscitation Manuals: £5,000.
As far as I am aware, no general dental practitioner in Wales underwent the postgraduate training for Non-Consultant Anaesthetists organised under the syllabus agreed by the Royal College of Anaesthetists, and the Faculties of Dental Surgery and General Dental Practitioners. A one-off uniform grant of £7,000 was available for individual practitioners or practices who were able to meet certain specified criteria, but there were no eligible applications. The resuscitation manuals were distributed to every NHS dental practice and to vocational trainees.
Following the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales what plans he has for the development of community dental services. [75320]
Mr. Jon Owen JonesIt is a matter for each Health Authority to determine, in the light of local circumstances, the appropriate level of Community Dental Service provision for its area.
The Welsh Office dental initiative, first launched in 1995, enables Welsh Health Authorities to offer grant aid for Community Dental Service expansion. To date, grant aid has been awarded for 13 additional posts in the CDS.
Following the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales how many dentists are employed by NHS trusts in their community dental services; how many children were treated in the last year for which figures are available in each trust; and how many treatments were made in each trust. [75322]
Mr. Jon Owen JonesThe information is given in the following table:
527W
Community dental service 1997–98 (a) (b) (c) NHS trust Dentists Children treated Total treatments Cardiff Community Healthcare 9.2 3,842 19,288 Carmarthen and District 1.3 459 2,509 Ceredigion and Mid Wales 2.3 2,959 9,004 Clwydian Community Care 15.9 5,014 45,043 Glan-y-Mor 8.8 6,022 20,492
Community dental service 1997–98 (a) (b) (c) NHS trust Dentists Children treated Total treatments Gwent Community 13.2 7,244 26,072 Gwynedd Community 5.6 4,920 16,442 Llandough Hospital and Community 4.1 2,977 10,977 Llanelli Dinefwr 3.6 2,521 7,256 Pembrokeshire and Derwen 4.6 3,176 13,892 Powys Health Care 5.9 2,688 10,005 University Dental Hospital 20.1 17,100 50,071 (a) Whole-time equivalent of dentists working in the community dental service at 30 September 1997 (excluding locums). (b) First contact in the financial year for children aged 15 or under. (c) Total contacts, all ages. May include examination only. Following the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales if he will make a statement on the impact of differences between health authority areas in the average number of dental registrations per dentist on dental health; and what steps have been taken to reduce such differences. [75326]
Mr. Jon Owen JonesA variety of factors determine the average list size of general dental practitioners, including the fact that as independent contractors, they can tailor list sizes according to their working practices and business requirements.
Current information on dental disease levels in the adult population is not presently available but surveys of children aged 5, 12 and 14 are regularly carried out by the British Association for the Study of Community Dentistry. Current information available from those surveys shows no correlation between list sizes and disease levels.
The Welsh Office is committed to improving the health and well being of the population of Wales and to reducing inequalities in health status. The primary aim of the Welsh Office dental initiative has been designed to address those inequities both in the provision of NHS services and in the dental health of the population.
Following the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales what percentage of fees paid to dentists was deducted to cover allowable expenses; and what was the(a) average, (b) highest and (c) lowest income recorded for dentists in each of the last five years for which figures are available. [75311]
Mr. Jon Owen JonesThe calculation of General Dental Practitioners' average earnings and expenses follow the convention established for the Dental Rates Study Group (DRSG)' of focusing on a subset of principal dentists who have been under contract for the previous year without substantial breaks in service. The information about dentists' expenses is derived from a528W confidential survey of a sample of dentists' practice accounts, undertaken by the Inland Revenue. Only DRSG principals are included in the sample.
Expenses, as a percentage of gross earnings, for General Dental Practitioners (in Great Britain) for the period 1991–92 and 1994–95 were:
- 1991–92: 54.0
- 1992–93: 53.9
- 1993–94: 55.7
- 1994–95: 54.6.
For the combined year 1995–96 and 1996–97 results from a survey of non-associate dentists indicate that, for all GDS dentists, expenses as a percentage of gross earnings would be around 56.8 per cent., the rise from 1994–95 reflecting in part the treatment of capital allowances.
The other information requested is not readily available on a Wales only basis and I will write to my hon. Friend as soon as possible.
1 The Dental Rates Study Group comprises representatives of Health Departments and the dental profession. Its main responsibility is to make recommendations on dentists' fees after taking into account practice expenses.Following the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales what assessment he has made of the effectiveness of the dental practice incentive scheme and the extent to which it has led to an increase in(a) the number of general dental practitioners and (b) the number of adults and children being seen and treated under NHS regulations. [75314]
Mr. Jon Owen JonesThe primary aim of the scheme was, and still is, to enable Health Authorities to attract new NHS dentists into those parts of Wales where they were most needed.
Grants have already been paid for 33 new practices and 29 expanded practices. There are also another 3 practices and 7 expanding practices for which grant offers have been made.
The number of dentists working in the General Dental Service in Wales is at an all-time high of 955—a 9 per cent. increase since September 1995 when the scheme was first launched.
The number of courses of treatment for adults increased from 1.35 million in 1995–96 to 1.45 million in 1997–98. Comparable data for children are not available.
Following the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales how many treatments requiring prior approval from the Dental Practices Board were submitted in each of the last three years; how many were refused; and what was the(a) shortest, (b) longest and (c) average time taken to consider these requests. [75318]
529W
Mr. Jon Owen JonesThe number of prior approval applications, which relate to England, Wales and the Isle of Man, received by the Dental Practice Board and the number of these referred for investigation is as follows:
Prior approval applications Number referred 1995–96 548,753 1— 1996–97 548,741 33,126 1997–98 554,584 49,833 1 Not available The number of applications referred in 1995–96 is not available.
The shortest time for dealing with applications was one day.
The longest time for approval was:
Days Referral not required Referral required 1995–96 138 1— 1996–97 35 138 1997–98 45 124 1 Not available The average time for approval was:
Days Referral not required Referral required 1995–96 5 1— 1996–97 6 85 1997–98 5 97 1 Not available Following the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales what assessment he has made of the advantages of dentists participating in information management and technology programmes; and what financial support he intends to provide for such in-service development. [75329]
Mr. Jon Owen JonesThe Welsh Office will be publishing a Strategic Framework for Information Management and Technology for Health Care and Health Improvement in Wales in mid-March.
66 per cent. of NHS general dental practitioners in Wales are already linked electronically to the Dental Practice Board, (DPB), and utilising information management and technology systems. Grants of £900 are available from the DPB to dentists, intending to establish electronic links, for the purchase of suitable computer systems.
The Directors of Dental Public Health for each of the Welsh Health Authorities, with advice and financial support from the Welsh Office, commissioned the Dental Public Health Unit of the University of Wales College of Medicine to carry out a project to assess the information technology requirements of the Community Dental Service in Wales. The recommendations from the project report will be considered within the provisions of the Strategic Framework.
530WFollowing the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales if he will list, by health authority area, dental practices(a) which accept all NHS patients, (b) whose NHS lists are closed, (c) which accept additional family members only on NHS lists and (d) which accept children for NHS treatment only if parents are private patients. [75333]
Mr. Jon Owen JonesThe information requested is not held by the Welsh Office. Each Health Authority maintains a list of practices with contracts to provide NHS dental services within its area. These authorities are best placed to provide the most up-to-date information to any patient who needs advice on the current acceptance policies of local practices.
Following the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales what estimate he has made of the number of dentists that need to be trained in Wales to ensure(a) the maintenance of the present level of service and (b) that his dental health targets are met. [75324]
Mr. Jon Owen JonesLong-term requirements for the numbers of medical and dental staff are modelled at a UK level and both the Department of Health and the Welsh Office receive advice on staffing in Dentistry from the Advisory Group in Medical and Dental Education, Training and Staffing (AGMETS). This Group brings together members of the professions and their regulatory bodies, the academic and research communities, the higher education sector, NHS and patients representatives as well as Welsh Office and Department of Health officials.
Within Wales the Dental Sub-Committee of our national advisory committee—the Medical and Dental Manpower and Education Committee (MeDMEC)—has set as its priority the examination of manpower in primary dental care. The Welsh Office has also funded a research project to investigate factors affecting the recruitment and retention of dentists which is to be carried out by the Postgraduate School of the University of Wales College of Medicine. This work will result in a robust assessment of the needs of the Principality as well as providing information from the situation in Wales to assist wider considerations at UK level.
Following the transfer of functions, this issue will be a matter for the National Assembly.
§ Mr. Win GriffithsTo ask the Secretary of State for Wales what assessment he has made of the cost of clinical waste collection and water service charges for general dental practices; to what extent these costs are accounted for in the payments made to dentists for NHS work; and what plans he has to make changes to the reimbursement of dentists in respect of these costs. [75330]
Mr. Jon Owen JonesInformation about dentists' expenses, including those referred to in this question, is derived from a confidential survey of a sample of dentists' practice accounts, undertaken by the Inland Revenue. These expenses are taken into account in determining the fee scale and include the costs of clinical waste collection. There are no plans to change this arrangement.
531WFollowing the transfer of functions, this issue will be a matter for the National Assembly.