Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 60 - 64)



  60. Clearly there is a shortage of places, which was indicated by your reference to grades.
  (Dr Husband) People want to do dentistry, they want to study it, but there just are not the places there. Also, we train a lot of people from abroad as well who we then lose.

John Austin

  61. While we are on the issue of the staffing resource, presumably the Association has made some estimate of the additional training places that are required for dentists. Perhaps you could share that information with us. Also, there are people other than dentists who are involved in the profession, what is the position regarding training of oral hygienists, dental nurses, technicians, the whole range? Could the dental team be used more effectively than it is at the present time?
  (Mr Ross) It comes in with that and goes back a little to the access problem. We do not actually believe there is a shortage of general practitioners out there. Some Access Centres will be placed logically but some of them will be placed in areas where there is a very high dentist to population ratio, it is just that the populations in those areas do not want to avail themselves of NHS Dentistry. It is Department of Health figures taking over. The area I am thinking of is in Barnet where there is one dentist to every 800 people, yet there is an access problem there but there are very few complaints about patients not being able to get to a dentist. The other problem with some Access Centres is that they will be in competition with local practitioners. We have already heard cases where an Access Centre opens up and local High Street practitioners are forced to close their practices. It may just be moving the problem from one area to another.
  (Mr Renshaw) I would be happy to comment on that. The workforce issue is a very, very serious problem and we are not absolutely convinced that there is a desperate shortage of dentists. What we are convinced of is that nobody has looked at the problem seriously for such a long time, we do not actually know whether there are enough dentists. We do not know whether it would be possible to have a more effective use of the staff that we do have. We do not know whether a large increase in the professionals complementary to dentistry would help out. You cannot decide that on the strength of what happens in a particular area, that needs to be a real look at the whole issue.

  62. Nobody has made that assessment?
  (Mr Renshaw) Nobody has looked at that. I have to say, and I am sure Lord Hunt will tell you when he comes along later, that we are talking to him right now about whether we can set up a proper workforce review under the new National Workforce Development Board. We are very, very keen to see that happen because until we get the results of that inquiry we do not know the answers to these questions.

  63. Nobody has actually looked at the cost-effectiveness of having an oral hygienist on the team or not?
  (Mr Renshaw) There is very little evidence to support it one way or another. I am not saying it is not a good idea but the evidence is relatively poor. The studies around the world do not point in one direction or another. We need to look at that very, very carefully because we do not want to train people for work which is unnecessary but nor do we want to be short of the required workforce to deliver a proper service to the population. The last time this issue was addressed was in 1987. That was 14 years ago. The world has moved on. We have a figure of 800-odd graduates coming out of dental schools in this country every year that was set back in the 1960s or 1970s, it is nonsense. I do not know whether it is right, I suspect it is not right and I think it is probably not enough. There are people out there who would like to be able to do this job as a career and I would like to be able to encourage them, but it has to be done within a framework of looking carefully at the whole issue.

  John Austin: Could each of you say one key thing which the Government could do to improve access to NHS Dentistry?


  64. Briefly, please.
  (Mr Ross) Simply to stop the treadmill effect and then there are enough dentists out there willing to do the work.
  (Mr Bosley) Manpower.
  (Dr Husband) Give us the ability to do what we trained to do.
  (Mr Renshaw) Dentists do not leave the NHS for ideological reasons, they leave because they are over-stressed and overworked and until somebody does something about that you are not going to turn this situation around.

  Chairman: Can I express the Committee's appreciation for your participation this morning. It has been a short session but I think it has been a very valuable one. It may be that arising from our questions subsequently you want to write in with further information, or it may be that we pick up further points we would like to put to you. Can I express our appreciation and if you wish to remain for the rest of the session you are very welcome. Thank you very much.

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