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10.29 pm

Annette Brooke (Mid-Dorset and North Poole): I thank my hon. Friend the Member for Yeovil (Mr. Laws) for describing the situation so clearly. I am sure that many of us experience the same difficulties in our areas, and I want to make some general points that I think will support his case.

A recent survey by the magazine Health Which? suggested that two in five dental surgeries now accepted only private patients. We might well assume that there had been a mass exodus from NHS dentistry over the past 10 or 11 years. I believe that 1990 was a critical year: I am told that at that time the then Government were taking £15,000 from each NHS dentist. Although that was waived eventually, dentists obviously found that they could earn a better income without being in the NHS. As with all these things, once someone discovers something it sets the ball rolling in a direction that is difficult to change.

My hon. Friend mentioned a number of Government initiatives. Different initiatives are being operated by different local authorities in different areas. Has the Minister any evidence to indicate which are the most effective? Obviously local conditions should be taken into account, but the information would be interesting, given the range of measures that are being tried.

I am concerned because I feel that although a programme exists, the situation seems basically to be getting worse. I feel that we are treating the symptoms rather than the disease. We should be concerned not just about the shift, over time, of existing dentists to the

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private sector, but about the emergence of corporate bodies in dentistry. How much, for example—I have no idea of the answer—does a dentist employed by Boots receive for a check-up, compared with what the NHS would pay? That is cause for concern, because it could lead to further erosion. As my hon. Friend said, fee scales need to be addressed.

A recent survey of vocational trainee dentists showed that 75 per cent. were not prepared to commit themselves to the NHS. I understand that they felt there was no incentive, and also no real sense of the ethos of working in the public sector. This, I feel, is where the Government have a role to play in demonstrating that the NHS has a future, and in making the necessary investment.

Like people in south Somerset, my constituents often refer to the lack of NHS dentists. The problem arises when people moving into the area cannot register. They become quite distraught, and it is difficult just to pick up emergency treatment. I am also concerned—this probably applies to south Somerset as well—about people with special needs such as a lack of mobility and who therefore need home visits. I am told that home visits are not a very attractive option for private dentists. We must therefore rely on the NHS, and there are long waiting lists.

Let me illustrate the seriousness of the situation with the example of a ward in my constituency, Canford Heath, which contains 6,000 new properties full of families with young children. There are currently no NHS dentists. Single mums in particular have no incentive to take their children to the dentist. We are storing up so many problems for the future by failing to provide preventive care at that early stage. I ask the Minister to assure us that a much larger programme of investment in NHS dentistry is planned.

10.33 pm

The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I congratulate the hon. Member for Yeovil (Mr. Laws) on securing this important debate on NHS dentistry, particularly as it affects his constituents. I know about his written question in June. He is already building up quite a record of pursuing these matters on behalf of his constituents, and I am aware that his predecessor had several meetings about the issue.

This is an excellent opportunity for me to tell the hon. Gentleman and his hon. Friend the Member for Mid-Dorset and North Poole (Annette Brooke) some of the good news that we do have, while recognising that we still have a long way to go in providing full coverage for access to NHS dentistry across the country, as well as in south Somerset.

It is true that Somerset has suffered from long-standing problems. As both hon. Members said, the 1990s witnessed a nationwide decline in patient registration with NHS dentists, with a corresponding increase in access problems for the public. Additionally, in September 1996, the then Government cut the maximum time allowed between visits for a patient to remain registered with an NHS dentist from 24 months to 15 months. That caused many patients' registration to lapse without their even knowing it. In total, the number of adults registered plummeted from a 1993 high of about 21 million adults to just over 16 million adults by 1999. That is the scale of the problem, and I would not seek to minimise it.

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About 45 per cent. of adults and 68 per cent. of children in Somerset are registered with an NHS dentist. Although that is not a wonderful figure, it is slightly higher than the national average. However, a worryingly small number of practices in the area have been willing to take on new NHS patients. There has also been a scarcity of urgent and emergency dental care across the county.

We recognised the access problems when, in September 2000, we published "Modernising NHS Dentistry—Implementing the NHS Plan". The plan committed the Government to ensuring that everyone can access an NHS dentist if and when they need to do so; to trying to improve the quality of service offered by NHS dentists; to raising the level of oral health, particularly in children—a preventive care issue that both hon. Members have raised today; and to trying to tackle the inequalities that exist across communities.

Alongside the Government's review of dentistry, in September 1999 the Prime Minister pledged that by the end of September 2001 everyone would be able to find an NHS dentist simply by telephoning NHS Direct. People do not simply receive a telephone number, they receive information on how to gain access to an NHS dentist. I acknowledge that that service is not about on-going registration; it is about providing access to care, not only for urgent and emergency cases but for routine cases.

In the past 18 months the Government have spent £100 million in trying to implement that dental strategy. That is not a small sum, and it shows the importance that we attach to trying to get NHS dentistry back into the mainstream of the service. We have spent £7 million from the dental care development fund to try to improve existing NHS practices, and £35 million from modernisation fund moneys to try to encourage dentists who are committed to the NHS to improve their practices. We have also asked every health authority to produce a dentistry action plan to set out the practical action that has to be taken to ensure that dentistry is available in communities.

Given the long-standing problems in Somerset, we were particularly keen to ensure that the area should receive the benefit of the whole range of the Government's current schemes. The Somerset dentistry action plan adopted a set of standards for the maximum time that patients should have to wait and the maximum distance that they would have to travel to gain access to NHS dentists. The standards are that they should have to travel a maximum of 10 miles for routine care—not 20 miles, as the hon. Member for Yeovil said, although 10 miles is still a fair distance to have to travel—and a maximum of 15 miles for urgent care and emergency care. Those standards are on a par with those set for rural areas by other health authorities in England.

The action plan identified several areas of risk that were likely to fail those standards and noted several very vulnerable areas, such as Wincanton and Chard. It also recognised that, across the county, patients who did not have an on-going registration found it very difficult to access urgent and emergency care.

The action plan therefore tried to identify practical action that we could take to address those issues, and the local health authority bid for considerable funds to try to put in place facilities. In 2000-01, the Government invested £71,000, and, in 2001-02, that figure has doubled

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to £144,000. That investment should allow registration for an extra 2,500 patients in Yeovil, 3,500 in Langport and 2,500 in Castle Cary. That should help to ease the pressure.

As well as encouraging those initiatives, we have tried to channel funds into Taunton, to ease pressure on dentists in the south Somerset region. South Somerset also received almost £59,000 of modernisation fund moneys for distribution to existing practices.

Sir Paul Beresford (Mole Valley): I have an interest in this subject, albeit not in the particular area. The hon. Members for Yeovil (Mr. Laws) and for Mid-Dorset and North Poole (Annette Brooke) touched on one of the core problems—the fee structure. The Government have to decide whether they are providing a basic service or a full service. In doing so, they must recognise the escalating costs—running costs and capital costs—and the increasing complexity of dentistry today. The service that the Minister is speaking of is mis-targeted, and dentists will move into the private sector. She must also recognise that in providing a service through the private sector, dentists are supplementing the NHS, and that frequently, especially for children, the cost to the patient is low or—as in my case—zero.

Ms Blears: The hon. Gentleman should recognise that the Government's aim is to try to rebuild NHS dentistry after the devastating effects of the early 1990s. From my discussions with the profession, it is obvious that many dentists welcome change. They want to change the way they work and to try to move from payments for items of service into more preventive work in oral health and in tackling inequalities. Many excellent young dentists are coming through the system who are keen to explore new ways of working. That needs to be reflected in the fee system. My dealings with the profession have shown a real willingness to engage in new ways of working to try to ensure that NHS dentistry begins to recover from the tremendous onslaught of the early 1990s.

We have tried to put considerable money into Somerset. We have allowed £20,000 for spot contracting, to try to purchase additional sessions from existing dentists. That has been fairly successful and has resulted in 100 extra appointments a week in the area. The hon. Member for Yeovil mentioned dental access centres, and I am delighted that he had the opportunity to open one. I am sure that it was an enjoyable occasion. The first DAC was opened in Yeovil and the second in Taunton. The first site involved £500,000 of capital investment and costs £855,000 a year in revenue expenditure. That is a considerable service. There are plans to extend the DACs to cover the entire county, and an additional £1.5 million will be provided to do so.

Once all the sites have been opened, the DACs will employ eight practitioners and will look to provide more than 15,000 courses of treatment a year. They will also be able to deal with 8,000 emergency cases a year. It is a new form of provision, especially for the routine care that people need. We are trying to rebuild the NHS dentistry service and of course we want existing dentists to come into the system and increase the proportion of their NHS practice. In places where that is not happening, however, the DACs are providing a much-needed service to local people.

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We are also trying to ensure that we work closely with health authorities and primary care groups to try to recruit new dentists to the basic service. I am sure that the hon. Gentleman will accept that that is not easy, and he mentioned the need to make information available about the location of areas of unmet need and to provide support.

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