Debate on the Address

My Lords, I listened with great interest to the opening speech of the noble Lord, Lord Warner, and I am now looking forward to the closing speech of an ex-Department of Health Minister, the noble Lord, Lord Hunt of Kings Heath. Under both Ministers the Government have discussed bold healthcare policies. I accept that these take time and that tough decisions have to be made. I shall confine my remarks this evening to the provision of dental services, and declare an interest in that I am a registered dental surgeon. Sadly I have hung up my drill, but I still continue to provide sedation services. The Health and Social Care (Community Health and Standards) Act 2003 represented some of the biggest changes to dental commissioning in the history of the NHS. The Government have made strides to change a system that remained basically unchanged since the inception of the NHS in 1948, but there are severe endemic problems within the system. The reforms to NHS dentistry have not improved access for patients. According to a recent survey by the British Dental Association, 55 per cent said that the new contractual arrangements did not allow them to see more patients. A further 23 per cent said that they were seeing about the same number, and 62 per cent were not optimistic that they would be able to see more patients in the future. I am reluctant to repeat the Prime Minister's 1999 pledge on NHS dental access, but there is still an inability to get to grips with the cumbersome, gigantic system of NHS dentistry. The changes being offered do not reflect enough radical, bold and brave thinking. The Government have accepted that 2 million people who wanted to see an NHS dentist prior to 1 April were still unable to do so after the new contract was implemented. About 1,700 dentists who previously had an NHS commitment did not sign the new contract, and although about 90 per cent of dentists did sign the contract, it included those who signed in dispute—many of whom are still negotiating individual aspects of the contract with their PCT. The latest figures from the Department of Health show that 1,130 of the new contracts originally signed by dentists in dispute have yet to be resolved. The number in dispute at the onset of the new contract was 2,770. At a time when the Government are trying to increase access to NHS dentistry, the loss of any dentist to the service has an impact. These figures reflect the uncertainty felt by both dentists and patients. The significant number of contracts that have yet to be resolved means that uncertainty is set to continue, and it may be well into 2007 before all these disputes are dealt with. Prior to the implementation of the new contract, 32 per cent of respondents performed 95 per cent or more of their work in the NHS. That figure had reduced to 25 per cent in the months after implementation. Furthermore, only 15 per cent believed that they would be carrying out that much NHS work by the middle of 2007, and only 9 per cent thought they would by mid-2009. There are many and varied reasons for this drop in NHS work that need to be examined, but perhaps not this evening. As I said in Questions this afternoon, the Government's reform has simply exchanged the drill-and-fill treadmill with another treadmill—this time driven by targets. This new system for measuring the work undertaken by NHS dentists and setting targets for their productivity was never tested. Last year the PCTs measured the number and type of courses of treatment delivered by all NHS dentists in their areas. Based on this information, PCTs wrote into each contract a target for the number of courses of treatment each dentist or practice should perform. There are different targets for different areas. Dentists must meet their target to receive payment. Dentists believe that the new contract will not help prevent tooth decay, nor will it promote or maintain good oral health. For some reason, preventive care does not have a specific value in the new contract and therefore does not count towards the work that dentists perform to meet their target. For preventive care to be effective, dentists need to be able to spend time with their patients to discuss diet, drinking and smoking habits; to show them how to clean their teeth properly; and to discuss any areas of concern. The dental contract includes a 5 per cent reduction in previous activity levels during which dentists are meant to spend extra time with their patients for clinical governance, practice meetings, administration and continuing professional development. However, contrary to these admirable aims, very little time is freed up for preventive oral health advice. If an average dentist were to see 30 patients a day for five days, it is calculated that an extra one and a half minutes becomes available for this important activity. Dentists are no longer allowed to make a charge for missed appointments—a problem that has become worse since the new contract. In an answer to a Question about this on 6 November in another place by Sandra Gidley, the Government said that figures on missed appointments were not collected centrally. I believe that this is being reconsidered and the Minister might be able to update me on any new information; it is very important to dental practitioners that this problem is properly aired and discussed. The figures present a worrying picture for the future of NHS dentistry. The new contract is failing to achieve its aim of making access to NHS dentistry easier for patients. The results reflect anxiety and frustration among the dental profession and highlight the need for an urgent and thorough impact review of the recent reforms. There are also concerns regarding growth funding. The Government’s current spending commitment for NHS dentistry is limited up to 2008-09. The ring-fencing of PCT funding will stop on 1 April 2009. This will further destabilise an already anxious profession. The squeeze in fee levels by successive Governments over the past 10 years has led to underinvestment in dental practices. The dental share of the total NHS budget was 5 per cent in 1992 but has now fallen to just 3 per cent. It is essential that funding and future funding details are made available so that practices can plan for the future. So many of my colleagues have an ideological commitment to the NHS—to the principle of providing the highest quality of care available to all patients, no matter where they live or what their background may be. But the reformed health service, despite the Government's good intentions, just does not allow them enough time to deliver the quality of care they feel their patients deserve. In conclusion, I shall comment on dental research and teaching, which is an important part of the debate about patient access and how good oral health is central to good general health. The UK is a major contributor in oral and dental research but often lacks the infrastructure to take on the opportunities to develop the applications. The adoption of new technologies is more likely when they are demanded by patients and when financial incentives are available. Despite a marginal increase of 1 per cent, the number of dental clinical academics is still 7 per cent lower than the 2003 figures. It is vital to increase the number of individuals entering academic dentistry at clinical lecturer level to replace those moving onwards through the normal cycle of promotion and retirement. Earlier this year, the Government announced the creation of 100 new student places in dentistry in addition to the new places announced in 2005, and the new dental school in the south-west—the Peninsula Dental School—will take 62 of these students from autumn 2007. These new places should be welcomed, but an increase in clinical academics will be required to meet the educational needs of these new students. The Department of Health must conduct a full review of funding and the effects of the new contract on patient access and care and the NHS dentist workforce. Why not consider the first year of the contract as a test year to take note of all the lessons that have been learnt and the changes that could be made? The Health Select Committee has called for a review and the implementation review group is monitoring the effects of the new contract. I look forward to the publication of this report, as it will have a significant and vital effect on NHS dentistry in the future.