NHS Dentistry

Speech delivered on Wed 12th Jan 2005

Mr. Paul Burstow (Sutton and Cheam) (LD): I congratulate the hon. Member for Ashford (Mr. Green) on securing the debate. It is useful for the House periodically to review progress on the issue. The progress has been rather depressing; the figures suggest that it is still in reverse rather than going forward. I want to comment on two or three points that have been raised in the debate, which is timely in view of the written statement that was made on Monday, with its remarkable closing words. It stated:

"The changes which we have been making to NHS dentistry are proving to be very successful as evidenced by the high level of interest among dentists in moving to new ways of working."—[Official Report, House of Commons, 10 January 2005; Vol. 429, c. 8WS.]

Surely the best measure of how the Government are doing is the number of people with access to an NHS dentist.

Reference has been made to the Prime Minister's promise of 1999. Back in 1997, 51.8 per cent. of adults were registered with an NHS dentist. According to new figures that I obtained from a written answer in December, the figure for 2004 had fallen to 38.8 per cent. The number of children registered has fallen alarmingly from 65.7 per cent. in 1997 to 54.6 per cent. in 2004. The hon. Member for Milton Keynes, South-West (Dr. Starkey) referred to the aspiration—I think that that is how it must be described at the moment—of 9,000 new NHS registrations. On the basis of answers that I have received, I would suggest that only one in five NHS dentists is registering children at the moment, and that only 14 per cent. are registering charge-exempt adults.

The most vulnerable are struggling to find an NHS dentist anywhere with a book that is open and to which they can be added. In my constituency, I found from a survey that I undertook last year that 30 of the 69 practices were not taking NHS work. Some people might uncharitably claim that the Government's two pillars of approach to dental reform—the local commissioning of dental services by primary care trusts and the new contract—are fundamentally undermined by what the Government said in their written statement on Monday; they might say that they are crumbling.

Mr. David Drew (Stroud) (Lab/Co-op): Would the hon. Gentleman agree that part of the problem is the extent to which dentists have ceased to believe that the British Dental Association speaks for them? Dentists in my area feel that the negotiations are problematic because of uncertainty about whether they are truly represented.

Mr. Burstow : I am not here to speak for the BDA, which will speak for itself. I am sure that dentists will make representations through hon. Members such as the hon. Member for Stroud (Mr. Drew).

Hugh Bayley : Will the hon. Gentleman give way?

Mr. Burstow : No. I am trying to make progress in a very short time, and the hon. Gentleman has made several interventions.

The PCTs were found by the National Audit Office to have had little experience of high street dentistry, as the hon. Member for Mole Valley (Sir Paul Beresford) said. They are already absorbing a huge agenda of change, not least of which is the GP contract. Monday's written statement explained that the delay is needed to give PCTs the time to prepare for their new role. It also explained that a longer lead-in time is necessary to allow public consultation on key aspects of the matter, and so that the parliamentary process can be fully observed.

How on earth can we be presented with a statement at the beginning of this year telling us that the parliamentary process needs fully to be observed? Why was the Department unaware of the need to do that when it was programming the implementation of the reform years ago? Why on earth has the Department only now woken up to the fact that the National Audit Office warns that PCTs are not ready? Why did it not make its own assessment and reach the same conclusion, so that it could have put in place the measures to provide PCTs with the necessary capacity?

The dental work force review was commissioned by the Department in July 2001, and was the first since 1987—it was very welcome for that reason—but it was not published until July 2004. It had sat in the Department from autumn 2003. We have heard that shortages of up to 5,100 dentists are forecast for 2011 and that the numbers going through training in the next few years will not fill the gap. Surely, that will necessitate substantial overseas recruitment, and regardless of whether one supports the idea of open access and the free movement of labour, there must be serious questions about safeguarding the ethics of overseas recruitment to ensure that we do not poach resources from countries that can ill afford to lose them.

The hon. Member for Ashford referred to NHS Direct, and it is worth noting that calls to it about dental matters have increased by 77 per cent. over the past two years, against an overall increase in calls of 10 per cent. So, there is a huge underlying problem, with people failing to gain access to NHS dentistry services and seeking emergency access.

The second pillar is the new contract. We need the details of that contract, and it would be helpful if the Minister could say when they will be shared with those in the BDA, with whom the Government are negotiating, so that things can begin to move forward.

Will the Minister also say something about how the new charging regime will interact? There is a question about the extent to which it will generate a financial shortfall in funding for NHS dentistry. Given that the NHS health economy has a £500 million deficit, which is growing, according to the Health Service Journal, how will that shortfall be met?

The hon. Members for Milton Keynes, South-West and for Mole Valley referred eloquently to prevention, and the absence of a reference to it in the White Paper on public health gives cause for concern. I hope that the Minister can clear up an issue arising from the written statement. It would be useful if she could clarify the Government's attitude and intentions towards the National Institute for Clinical Excellence guidance on the call-up for checks by saying when they will be rolled out and implemented.

There is no magic solution to fixing NHS dentistry. The current direction of travel—local commissioning through PCTs, provided that they have the necessary capacity and skills, the long overdue reconstruction of the work force, and the new contract, which will, I hope, move us to a system that is about prevention, not drill and fill—has to be the right way forward.

The question, however, is whether the Government have prosecuted things in an aggressive way that shows that they recognise that there is a serious problem. I do not think that they have, in their eight years in office, prosecuted the reform and improvement of NHS dentistry with anything like the pace that was necessary. That is why things have become worse over the past few years, not better. Indeed, that is why I fear that they will get much worse and why, for some years to come, many of our constituents will continue to suffer the anxiety of being unable to find an NHS dentist. Although the Government inherited a very poor legacy from the Conservatives, they have not done enough to put things right.