Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 120 - 129)



  120. You recognise you have got to alter the structure of your contract with GDS?
  (Lord Hunt of Kings Heath) I think we have got to have a very good, constructive discussion with the profession to see if it is possible to make changes in the contract which will be in the benefit of NHS patients.

  121. That is almost a "yes", Minister!
  (Lord Hunt of Kings Heath) I have probably gone too far then!
  (Miss Robinson) I think the Minister has really covered the main points, that we have not been putting in access centres where there has been free access to the GDS. They are very much to supplement what is available and to make provision where, for one reason or another, there is not good access to GDS. In some areas that is where there may be a lot of private dentistry and that is why you cannot get NHS Dentistry. In other areas it has been specifically areas of great deprivation. There have been several which are specifically targeted at areas where the GDS probably would not thrive immediately because the population has no tradition of going to a dentist. In many areas, as the Minister has said, initially patients have been told that there will be priority for those who have not been able to get treatment and for those who have specific pain, but in all cases we would expect a Dental Access Centre to offer a full course of treatment not just pain relief.


  122. Minister, could I pick up your point where you more or less said one of the tasks is to get health authorities to take dentistry seriously. Certainly the witnesses we had in the earlier session from Birmingham ,and Cornwall and the Isles of Scilly Health Authorities gave us the impression they certainly tried to take it seriously, but they feel to some extent handicapped by the lack of levers, as they put it, to affect dentistry at a local level, certainly the issue of recruitment of dentists to difficult areas, the balance between the business interests of dentists who will be attracted to the wealthy areas, and the service element in the poorer areas is a problem. How do you see your role in offering health authorities more levers in enabling them to undertake this serious role that you recognise?
  (Lord Hunt of Kings Heath) First of all, you have had this morning two health authorities who have a long record of being concerned and being proactive in the field of dentistry. The challenge that I face is ensuring that every health authority in the country takes a similar robust and proactive role. We have ensured that dentistry issues are in the planning guidance and priorities for the Health Service, which is very important because that gives the clearest message possible to the NHS that looking at dentistry issues is important. Second, we have established a robust process of performance management in relation to dentistry so that we will be reviewing very, very carefully over the next new weeks the action plans that they have developed specifically in relation to access issues. In addition, those authorities which we consider to be struggling or not having produced an effective action plan or strategy will receive a visit from departmental officials.

  123. You can send all the officials you want, it does not overcome the problem that we have picked up this morning very clearly that there are some nice attractive areas in the South of England to pull in loads of dentists who are very willing to practise there but in the north and areas like mine perhaps less so.
  (Lord Hunt of Kings Heath) I can assure you—

  124. I am concerned about how we help authorities, like the one in my area, to develop the strategies we are all wanting to when they are disadvantaged by the lack of a national strategy over many years, and that predates your Government to be fair.
  (Lord Hunt of Kings Heath) I accept the point. These are going to be robust visits. This is going to be strong performance management, but it is not just about that. In relation to waiting lists we have set up what we call the NPAT Team, which is very much about sharing good practice across the system so that you can help people develop new ideas.

  125. But you know with doctors who treat patients, it is all very well having nice visits from the Department of Health and officials around at a local level but you have got to have the people who can do the work. The worry I have got is you can send your people from Richmond House up to wherever but if you have no dentists to do the work anyway you are not going to have a great deal of success.
  (Lord Hunt of Kings Heath) I understand that but the point I am trying to make is a lot of health authorities have not really tried to do this at all. We know some have been successful. The whole purpose of some of this supportive work is to take the good ideas that some people have been successful in implementing and actually getting it implemented throughout the country. In addition, in the strategy we proposed, and we are putting it into practice, that the NHS can pay what we call extra sessional payments. That means that they can actually use their general resources for the first time to actually provide incentives to local dentists to provide more services. So, for instance, if with the access issue, with your DACs, your Personal Dental Service schemes, you have still got an access problem, it will now be possible for health authorities to sit down with individual dentists, and with the Local Dental Committee and groups of dentists, and say "can we collectively solve the problem of access?" and come to some agreement about payment. That is a very, very important development. We should not-under-estimate the ability of PDS pilots for health authorities to actually lead change by having much more flexible arrangements to employ dentists. If you take that with Dame Margaret's work on encouraging more women dentists to come back into the profession and do more work, I think the combination of that will give health authorities more leverage in the future.

  Chairman: I have trespassed to some extent on John's territory on manpower.

Mr Gunnell

  126. You have talked about the manpower strategy already but with what we have heard from Mr Renshaw and with what we have heard from you it is very clear that what you are doing is not generally recognised. You have obviously looked very carefully at the manpower problem whereas Mr Renshaw felt that nobody was really taking hold of it and plotting the position, but you have obviously done so. You are obviously prepared to consult with people but there was a feeling from him that there was not sufficient consultation with the Department of Health and that you were not grasping the problem. I do not know whether he is still here but I hope he is able to hear or get an account of what you had to say to us because it really seems you are doing far more and you are far more open to what dentists have to say than we got the impression. Are you convinced that we shall have sufficient dental manpower in the future to deliver the strategy, especially when we consider the changing composition? We have already talked about the increased proportion of women but there is also an increased proportion of new registrations from foreign countries. How do you see that affecting the manpower numbers? We learned earlier on that the number of students entering the universities are sufficient in a sense from the universities' point of view because they have to have very high grades to get on to the dental courses, but one wonders whether there are sufficient university places to provide the number of dentists we are looking for in the long run. Have we got plans to increase the number of places so, in fact, far more people can get started on dental training?
  (Lord Hunt of Kings Heath) This is a crucial question of workforce planning. I think that the reality is that the last proper study of the number of dentists required was undertaken in 1987.

  127. That was mentioned earlier on.
  (Lord Hunt of Kings Heath) They came up with a figure that we needed to train just over 800 dentists per year. The latest figures we have show that we have just over 900 who came in over the last year, so there has been an increase, but what there has not been is the same approach to workforce planning that the Department has traditionally had in relation to doctors. There has not been an annual, standard review so that the figures are constantly changed according to the needs of the service. One of the issues that we are now considering is whether we need to go back to basics to look at workforce planning in relation to dentists, and take into account, one, as you rightly say, the impact of women coming through the dental schools, secondly, the issue of workload. If our discussions are successful in relation to looking at the contractual arrangements and the work of dentists, what impact would that have? I would hope over the next few weeks we would be able to conclude some thinking about that and make some announcement. The point is at the moment I cannot answer the question in terms of how many extra dentists we need. What is clear is we need to do some work in that area.

Mr Amess

  128. Unless you do not smile at all teeth are pretty important and, so I am advised, wearing dentures is rotten. It is appalling in this day and age that our children's teeth are still so rotten. I am very interested in prevention. Can I first of all for the record have your views on fluoridization of our water?
  (Lord Hunt of Kings Heath) Can I just say that all dental disease in children is something to be avoided, but I have to say that over the last 50 years there has been a dramatic improvement overall in the teeth of the people of this country as the strategy makes but clearly there is more we can do and, equally, there are pockets of variation that we need to iron out. On fluoridation we commissioned the effectiveness people at York University to undertake a study on the effectiveness of fluoridation and also to look at research in relation to some of the allegations that have been made that fluoridation is harmful to general health. The York people reported a few months ago and essentially concluded that, yes, fluoridation is effective and, second, that they found no evidence that it was the cause of some of the illnesses that people had alleged, although it did cause fluorosis (and that could be easily dealt with). The other point it did make, which is very important, is it criticised the fact that the research they had been able to look at was not as robust as they would have wished because most of the research on fluoridation was done 30 or 40 years ago when they had very different ideas about how research should be conducted. We have asked the Medical Research Council to see if they could come up with further proposals for research we could commission to make sure this is bottomed out. In the meantime I think it is clear that in areas of dental deprivation fluoridation remains one of the tools which health authorities can use. I should say I live in Birmingham so I am well acquainted with fluoridation and the beneficial effects it has on children's teeth. You then come to the issue of whether new fluoridation schemes can be brought in under the present law and the reluctance of the water companies to agree to new schemes. I started a process of meetings with the water companies to see to what extent they would be prepared to agree to schemes. We will see how these talks proceed before we decide to take any further action.

  129. Very, very quickly, I asked Ministers at one of our previous sessions about the problems with head lice and there is no doubt, as I far as I am concerned, that when we had the nurses going around it did not seem to be the problem that it is now, it is ridiculous. Again, when I was at school we used to have nurses going around showing children how to brush from the top of the gums and all that but we do not have that now. We do not have enough dentists. I would not fancy looking in people's mouths all day long, it is a rotten job, but obviously I hope you recruit the number of dentists we need. Is there any chance that you are going to target getting these nurses back into our schools to educate our children about brushing their teeth?
  (Lord Hunt of Kings Heath) The School Screening Service is an area that we need to look at. I have not been convinced that we have been getting the most out of that. I think we need to focus them, first of all, on identifying the most vulnerable children. Perhaps I could take that away.

  Chairman: Minister, can I thank you and your colleagues for that very helpful session. There may be issues we may want to write to you about subsequently. We are grateful for your co-operation in this inquiry, thank you.

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