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That this House welcomes the record number of students attending university or college this year meaning more students benefiting from higher education (HE) today than at any stage in UK history; commends the Government for its record levels of investment in HE, an increase of over 25 per cent. over the last decade compared to a 36 per cent. decline per student under the previous Government; recognises the Government's commitment to expanding opportunities to participate in HE, including an extra 10,000 opportunities this year in courses related to science, technology, engineering and mathematics subjects and 10,000 recently allocated additional student numbers for 2010-11; commends the Government's generous student support package and regrets that this year the Student Loans Company (SLC) has been unable to provide the level of service students and their families have rightly come to expect; notes that 800,000 English-domiciled students have already had their applications for funds approved and that following additional Government support the SLC has allocated extra resources to deal with enquiries and processing; further notes that the vast majority of students who applied within the deadline will have received their money, that interim payments are available for students and the Government's Access to Learning fund provides help for students suffering financial hardship; further notes the significant contribution international students make to the UK, and believes that the new student immigration system is effective and fair; and further notes the Government's confidence in future economic growth which will enable a viable sale of the student loan book.
That this House supports maximising public access to NHS dentistry; notes that under the Government's new contract considerable numbers of patients now do not have access to an NHS dentist; believes the dental contract imposed by the Government is not adequately meeting its objectives for improving oral health or access to dentistry; recognises that any future contractual arrangements should be appropriately consulted on and piloted; calls for stronger incentives for dentists to carry out preventative care; recognises the opportunity to bring about better patient care by ensuring the best treatments are provided at the appropriate time and by fostering the stability that will allow new investment in NHS practices; supports an approach to NHS dentistry focused on preventative care; further believes that the oral health of children should be protected by re-introducing dental screening programmes in schools; and further supports the introduction of patient registration, allied to capitation-based funding rather than fee-for-service, restoring a relationship between patient and dentist conducive to an improvement in long-term oral health.
"Everyone will have access to an NHS dentist within two years."
The Labour party conference a couple of weeks ago might have done well to remember that the nature of promises from Labour Governments is that they are not delivered. In fact, the record shows a loss of access. After the introduction of the new contract, the number of people accessing NHS dentistry fell by 1 million. Some 7.5 million people are not going to an NHS dentist, because it is hard to find one. Fewer children are accessing NHS dentistry-more than 100,000 fewer than before the new dental contract. Dental caries is now the third most common reason for children's admission to hospital.
What is the public's view of the state of NHS dentistry? The British social attitudes survey shows that only 42 per cent. of the public are satisfied with NHS dentistry, compared with a 76 per cent. satisfaction rate with the general practitioner service-although the Government constantly claim that we should be dissatisfied with that service. No doubt the Minister will attempt to pretend that the public are satisfied with NHS dentistry, but they are not.
Promise after promise on NHS dentistry has not been kept. After every failure, the Government make a new set of promises that, in their heart of hearts, they know they will not be around to keep. Their latest promise is to deliver access for everyone who seeks it by March 2011 at the latest. There is no evidence of how they intend to achieve that.
The Government knew that NHS dentistry needed change, and in preparation for the new dental contract, they rightly piloted new schemes. The personal dental services contracts were designed around the proposition that instead of the dentist treadmill-under which dentists were paid fees for services-dentists would be paid on a capitated basis for the number of patients registered.
The idea was to incentivise dentists for encouraging good oral health, rather than simply for activity. But what happened? The PDS contracts were examined by the Audit Commission, which concluded that patient charge income had fallen by 30 per cent. as a consequence of the pilots, because there were fewer treatments. The Government should have said, "Well, that's worked then. We wanted to incentivise not just treatment, but good oral health, and a consequence of that will be a reduction in the number of treatments that are chargeable to patients." But no, completely the opposite happened. They said, "Well, we can't have that. We can't have the economic viability of the NHS dental service being undermined by the fact that patients aren't paying enough," so they scrapped the PDS pilots and imposed a new contract on the dental profession that had not been piloted. Contrary to the dental profession's expectation that it would be able to get off the dental treadmill, it remained on it, only with the primary care trusts, instead of it, in charge of the speed of the treadmill. We have ended up, therefore, with a continuing activity-based contract, and one that, owing to the way in which it was imposed and the nature of the contractual provisions, actually led to a substantial reduction in the number of dentists willing to sign up to the contract.
Stephen Hesford (Wirral, West) (Lab): The reverse is true in my constituency, where three new dental practices have opened in the past year-I had the honour of opening all three. The hon. Gentleman's experience of the new contract is considerably different from mine.
Mr. Lansley: The hon. Gentleman must explain why nationally the number of dentists choosing to enter a direct contractual relationship with their PCT has fallen by 7 per cent. in the past year-it involves only 31.8 per cent. of dentists. I freely acknowledge that there are more dentists in this country than ever before, but that is not the point. The point is this: how many dentists are willing to be NHS dentists? And how many of those who are NHS dentists find that the access provided to their patients in the locality is not as good as it used to be?
Mr. Lansley: I will not give way. I tell the hon. Gentleman, and other Labour Members, that the Health Committee produced a report last year into dentistry. The report said that there were four criteria-not its criteria, but the Government's-for the new contract, namely access, clinical quality, NHS commissioning and improving dentists' working lives. I remind Labour Members what the Select Committee report said about those four criteria. On access, it stated:
"The Department's original goal that patient access to dental services would improve from April 2006 has not been realised."
"While the Department argued that the new contract would improve preventive care, this was disputed by dentists who claimed that the new contract failed to provide the time and the financial incentive to do so."
"The Minister admitted that PCT commissioning of dental services has been poor."
"The new remuneration system based on UDAs"-
"has proved extremely unpopular with dentists."
Stephen Hesford: To make it clear, not only is the experience on the ground in my constituency different from what the hon. Gentleman is describing, but the new dental practices are NHS dental practices.
Mr. Lansley: I do not know what point the hon. Gentleman is trying to make. I have new NHS dental practices in my constituency. The Minister might even have a note about them to use later in the debate. That is not the point. The point is this: what is the overall picture? That picture is very clear. The number of people accessing NHS dentistry after the introduction of the new contract in April 2006 fell by 1 million. It has now recovered by about 500,000. That is across the country. I do not think that those figures are disputed. The point is that even now-three and a half years after the contract was introduced-access to NHS dentistry is poorer than when that access was one of the central criteria.
Many people think that they have access to an NHS dentist-I suspect that many in the House think that they have such access. However, if they went to their NHS dentist, especially if they did so in the first quarter of the calendar year-the last quarter of a financial year-they would find dentists who have reached their UDA limit and that their dentist is not their dentist at all, because registration has gone away. We do not have "our" NHS dentist; we have access to NHS dentistry on sufferance of the local primary care trust.
Norman Lamb (North Norfolk) (LD): Is it not the case that the Steele report confirms the problems with access? Access is variable around the country, particularly in rural areas, where it is often very difficult, which rather confirms the hon. Gentleman's point.
"We recommend that patient registration be reinstated because dental care is most effective when delivered over time and as part of a trusting dentist-patient relationship."
When Government Members start snorting about the fact that people do not have access to an NHS dentist because they are no longer registered with an NHS dentist, they need to get up to speed. That is what their Government have done to dentistry in their contract. They have removed registration. The Government effectively admitted the failure of their contract by establishing the review under Professor Steele within three years of introducing the contract.
Dr. Andrew Murrison (Westbury) (Con):
Does my hon. Friend agree that the Government completely missed the point about registration? The value of registration is that it encourages prevention, because dentists develop long-term relationships with their patients, which incentivises good practice and oral hygiene and inevitably leads to better mouths with better teeth in
them. That produces less onerous work for dentists, who will practise prevention instinctively if their patients are registered.
Mr. Lansley: My hon. Friend is exactly right, and I appreciated the time that he and I spent working on the issue in years past. Indeed, when the new contract was introduced, we argued that registration was precisely the basis on which it should be structured. We have now reached the point where the new contract not only does not incentivise prevention in the way that it should, but has incentivised treatment in a way that is completely counter-productive. For example, a dentist might have the option either to fill a tooth and repair it or simply to extract it. The structure of incentives in the contract points towards extraction, which is why there has been a significant increase in the number of extractions.
Sir Paul Beresford (Mole Valley) (Con): Does my hon. Friend agree that registration is the best proof of access? Whether the patient goes ahead with national health treatment or chooses an alternative, private treatment, it is that access coming from registration that counts.
Mr. Lansley: I am grateful to my hon. Friend, who brings his extensive personal knowledge as a dentist to the issues. He will know, because it has been his experience in his professional practice, that the relationship between a patient and their dentist is a critical part of delivering good quality care.
Mr. Eric Martlew (Carlisle) (Lab): I will check in Hansard, but I think that the hon. Gentleman just said that dentists will pull teeth out instead of filling them because they get more money for that. Is that really what he is saying about our dentists? I am sure that that is on the record.
Mr. Lansley: I will give way to the hon. Gentleman in a moment, but he has mentioned the Steele report and, although I will not go on about it at length, I want to make this point. The Steele review said:
"Making the transition from dental activity to oral health as the outcome of the NHS dental service will be a challenge for everybody, but it is essential if NHS dentistry is to be aligned with the modern NHS."
Norman Lamb: We very much support that approach, but let me refer back to the hon. Gentleman's comments about perverse incentives. He talked about the increase in extractions, but is it not also the case that there appears to be a perverse incentive against doing complex work such as root canal fillings, which appears to have lead to a deskilling of the dental profession, with a lot of dentists simply no longer doing that work?
The Steele report identified that the current contract was based on activity and was therefore misguided, and that we needed to move to a contract based on prioritising and incentivising good oral health and preventive care. However, there is no plan to move from A to B. We have consistently made it clear that it is our objective to make that move to a contract based on registration and capitation that incentivises quality and outcomes rather than simply focusing on activity. I want to say a few words on how we propose to do that.
There are two parts to our proposal. First, we propose to take immediate steps to ameliorate the problems in the existing contract. Secondly, we propose a more fundamental phase of reform. The immediate steps, under the current structure of units of dental activity, would enable preventive care to be incentivised. We know that every £1 spent on giving a patient preventive dental treatment can save at least £8 in subsequent curative work. We need to support children with information and advice on how to look after their teeth. I have read the Department's toolkit to support that activity, but we need to make it more systematically available. That is why we will restore school dental checks for every child, which have been surreptitiously phased out by primary care trusts since 2007. We will also enable children to continue to access NHS services through child-only contracts.
Norman Lamb: I am sure that the hon. Gentleman is aware of the studies that have looked at school screening. In particular, is he aware of the study undertaken in 2002 by the oral health unit? It concluded that screening did not improve dental health in the target child population, that it did not increase dental attendance among those who had screened positive, that it did little to improve the dental health of those who had screened positive and that it tended to exacerbate social division. There is not much academic support or support in the dental profession for the hon. Gentleman's proposal.
Mr. Lansley: The hon. Gentleman and the Government need to recognise this point. In their amendment to our motion, the Government claim that children's oral health in England is already among the best in the world. The evidence for that is the 2003 child dental health survey. We have not had such a survey since 2003, however, and we will not have one until 2013. We know, however, that children are presenting at hospital with dental caries, and that that is the third most common reason why children are admitted to hospital. In 2001-02, just before the last child dental health survey, that did not feature among the five most frequently reported diagnoses when children presented. We also know that children are not accessing NHS dentistry to the extent that they did. Significant numbers of children are therefore not seeing a dentist, and we need to ensure that that changes. It is perfectly obvious from looking at the Department's toolkit to support better oral health among children that there needs to be a focus to bring about that change. School dental checks, if they are integrated into the local commissioning of dental services, could do that.
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