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The third thing that we need to do rapidly is to give people more access to NHS dentistry. That is not just about insisting that the PCTs issue more UDAs, or about simply piling money into the system-valuable though that might be. The issue is about winning more capacity from within existing resources. For example, there are unnecessary recalls, including cases of people finding their treatment being divided between a first attendance and a subsequent one more than three months later. The chief dental officer himself rightly criticised that practice, identifying it as a result of one of the perverse incentives in the current contract. Without such practices, we could be looking at a potential capacity for 2.3 million people to access NHS dentistry. We are not even assuming half that figure in our plan to give 1 million more people access to NHS dentistry by eliminating such unnecessary recalls.
We also need to get more out of dentists' working hours. We are therefore going to return to dentists the power to charge patients who repeatedly miss appointments. Five per cent. do so on a regular basis, and 1.8 million courses of treatment are wasted. If only a quarter of that waste were remove by this measure, it would enable 100,000 more patients to be treated.
Mr. Martlew: If I accept what the hon. Gentleman says on this issue, does he accept that the same principle should apply to general practitioners?
Mr. Lansley: No, I do not. Dentists already have a mechanism for charging patients. Since the late 1940s, there has been a clear expectation that the system of co-payment applies to NHS dentistry, but not to other NHS services-and I have no intention of changing that.
We need additional fundamental reforms so that we can move to a new registration-based contract with payments linked to the good oral health of patients through a capitation system properly adjusted for the patients being looked after-I recognise the Liberal Democrat point about the need to incentivise dentists in areas where oral health is poorest-while also providing a proper incentive for preventive care, as my hon. Friend the Member for Westbury (Dr. Murrison) has mentioned.
We also need to bring more dental professionals back to the NHS, which is why we have proposed-I am glad to say that the Liberal Democrats recently supported us-that NHS or state-trained dentists, who cost about £170,000 each, should be required to work in the NHS for at least five years. We need generally smarter commissioning where we open it up, so that people can access preventive work. I am particularly pleased to confirm today that we will widen access to preventive advice and treatment by removing the regulation that prevents a dental hygienist from seeing a patient if the patient is not directly referred by a dentist. We are seeking to empower the whole dental team to work together to deliver innovative and preventive advice strategies.
The Government, far from listening to the Steele review and moving in that direction, unfortunately appear to be moving in the wrong direction. At the time the Government received the Steele report earlier in the summer, they had started work on implementing not that review, but their own draft access contract-contrary to what is expressed in their amendment to our motion about meaningful consultation and
"working with the dentistry profession and other stakeholders".
This is yet another example of an activity-based contract focused on a narrow objective rather than on good oral health as a whole, which will not support preventive care as it should. It has so failed to engage the profession that the British Dental Association has advised its members not to sign the new contract.
I am not often minded to read with much care the amendments that Ministers table in response to our motions in Opposition debates, as they tend to be far too self-congratulatory. This particular amendment, however, seems to make a whole series of claims that are simply not justified-they are plain wrong. The Government are not working "through careful piloting" on either the current dental contract or their new proposed draft access contract. They are not working together with clinicians as they should. They claim that
"children's oral health in England is... among the best in the world",
but the evidence of recent years since the last child dental health survey points to a significant loss of access and dental problems among children. They talk about
"access for all... by March 2011",
but that is risible in the light of their utter failure to deliver improved access over the past decade.
The Government told everyone that they would offer access to NHS dentistry, but they failed. They talked about prevention, but they incentivised only treatment. The dental treadmill is just rolling forward in exactly the same way as it always did. No doubt money has been poured into the system. The Minister will doubtless talk about the level of inputs in dentistry, but the issue is not about inputs but outcomes. Once again, it is a familiar story from this Government: it is all about how much money has been spent and never about the proper structure of reform or the outcomes being achieved. The Government are pursuing that flawed approach all over again. Once more, we need a new approach to access and quality that is based on outcomes and results and not simply on processes. We need proper incentives for prevention and for delivering good oral health, working with professionals rather than against them. By those mechanisms, we will reverse the long and slow death of NHS dentistry.
4.59 pm
The Minister of State, Department of Health (Mr. Mike O'Brien): I beg to move an amendment, to leave out from "NHS dentistry" to the end of the Question and add:
"welcomes Professor Steele's review report and its endorsement that the principle of local commissioning introduced by the 2006 reforms provides a firm basis on which to develop NHS dentistry; agrees with the vision set out in the review of improving incentives to support dentists in delivering access and quality; acknowledges the Government's commitment to working with the dentistry profession and other stakeholders to ensure through careful piloting that it implements the recommendations in a way that delivers the best possible system for patients, dentists and the NHS; acknowledges that children's oral health in England is already among the best in the world; welcomes the commitment of the NHS to deliver access for all who seek it by March 2011 at the latest, supported by some £2 billion in central funding for dentistry, and understands that access is now growing again; notes that in the last four quarters the number of people seeing an NHS dentist in the previous 24-month period has grown by 720,000; further notes that the dental workforce is growing, with 655 more dentists working in the NHS in 2007-08 and a further
528 in 2008-09; and recognises the support that the dental access programme of the Department of Health is providing to clinicians and managers to help them rapidly expand NHS dental services where necessary.".
In 1997 we inherited an NHS that was on its knees and in a mess, and NHS dentistry was part of a system that was struggling. In 1991 two dentistry schools were closed by the Conservative Government. The number of dentists in the country was seriously down, and there were enormous problems.
The hon. Member for South Cambridgeshire (Mr. Lansley) disparaged the idea of looking at the record of his own party in government, and I understand why he does not want to look back. All that I can say to those who may be watching this debate is that we do not need to listen to the rhetoric, because we can look at the book. We can look at the history. We can look at what the Conservatives did to the NHS last time. We can look at the way in which they left it-and we can know that, if they are re-elected, they will do exactly the same again. This Government, on the other hand, are committed to providing access to high-quality dental care for everyone who wants it, and we are committed to providing it through the national health service.
Dental access has improved for the whole of the last year, with 720,000 more NHS patients seen by NHS dentists. The Steele review, which we set up, has been accepted and welcomed by the British Dental Association. We have increased spending, and yes, spending is important. The hon. Gentleman may not think that it is important, and he may well feel that his Government would be free to make the cuts in the NHS that they made on the last occasion, but we take the view that increased spending on dentistry is necessary. It was up by 11 per cent. in 2008-09, and it is up by 8.5 per cent. this year. This year funding is running at £2.25 billion net of patient charges. Since 2004 it has risen by 70 per cent.: that is £900 million more in six years. Let me say to any dentists who happen perchance to read the report of this debate that they will be able to look back and see what the Conservatives did last time, and to compare it with what this Government have done in terms of putting money into dentistry.
Dr. Murrison: Does the Minister not understand that dentists feel deeply demoralised? Nine years after the 1997 general election, the Government undertook wholesale reform of the system; just three years after that, they are winding the clock back to the previous position, and dentists are entitled to ask what on earth is going on. Such changes-welcome though they must be, because the Minister's system has clearly failed-must be seen as deeply demoralising to the dental profession, so perhaps the Minister would like to apologise.
Mr. O'Brien: Perhaps I would like to congratulate the Government on the fact that 850 dental students are expected to graduate next summer, an increase of 25 per cent. since 2005. I think that that is worth saying. I also think it may be worthy of a little congratulation that there were 655 more dentists in the NHS in 2007-08 than in the previous year, and 528 more in 2008-09 than in the previous year.
Yes, it is true that much is changing in the NHS, and much of the change constitutes improvement. Significantly more dentists are graduating, and more dentists are
coming into the NHS. That is a good record. As part of our expansion programme we have created two new dental schools, which opened in 2007 in the south-west and central Lancashire. That has reversed the Conservatives' closure of dental schools which was announced in 1987 and completed in 1992, and which caused a shortage of dentists in the early 1990s, when there were fewer of them than there are today.
The hon. Member for South Cambridgeshire made an extraordinary and, indeed, candid speech. In fact, he was so candid that he seemed to me to impugn the professionalism of every dentist in the country, saying that they were prepared to extract teeth with no clinical justification. He has been offered the chance to retract that statement, and he is shaking his head now: he does not retract it. I do not think that impugning dentists is a satisfactory way for someone who thinks that he may at some point be a Secretary of State to proceed.
Norman Lamb: Does the Minister accept Steele's conclusion that the incentives for dentists are not precisely aligned with the goal of oral health, which constitutes a fundamental flaw in the contract?
Mr. O'Brien: Let me just say the following about the way we have structured some of the charges and the funding. Previously, the funding levels and the charges patients paid were enormously complicated. We have simplified the whole process. We have a choice here. We can have multiple variations in the charging system so everything is charged at different rates for different sorts of systems. Frankly, that will create massive bureaucracy for dentists and massive complication for patients. Alternatively, we can simplify the system so that people can understand what they have to do. In that case, we have to rely on-let me make this very clear-the professionalism of the dentistry profession to ensure they are doing what is clinically necessary. We have taken the view that most dentists are in the job because they want to do the best for their patients-it is clearly a different view from that of the Conservative Front-Bench team but it is the view we take-and we have therefore decided that we need to have an appropriate system of charging and remuneration to take that into account.
Sandra Gidley (Romsey) (LD) rose-
Mr. O'Brien: I shall give way once more, after which I will want to make some significant progress.
Sandra Gidley: Does the Minister accept that the system has been oversimplified, thus leading to cases such as that of a constituent of mine who was told she could choose which tooth to have repaired and would have to wait six months to have the next one done? Thankfully, that is being investigated. I would hope it is a rare case, but nevertheless some dentists do seem to be forced down that path, as a direct result of an oversimplified system.
Mr. O'Brien:
I do not accept that dentists are being forced down that path. There will always be some in such professions who do not do what is clinically appropriate and do not use the system as it ought to be used-I put that at its mildest, perhaps. However, we believe it is important to recognise that the dentistry profession has responsibilities, standards and professional organisations
that seek to regulate it. We need to ensure that we have a system that not only makes sure that we have a good quality of care-and we have to rely on professionalism for that-but that also has a charging structure that is not overly bureaucratic. It appears that some in the Opposition want to introduce such an overly bureaucratic charging system, however.
In the years since the foundation of the NHS, dental health in our country has improved massively. I want to make it clear, however, that registration was not one of the reasons for that massive improvement. Registration payments were introduced only in 1990. There was continuity of care before that, and, broadly, there has been continuity of care in recent years. Therefore, before the hon. Member for South Cambridgeshire over-emphasises the importance of the registration issue, he had better check the historical facts. Registration is, in fact, just a payment system. Continuity of care is what matters. That is what Steele said; that is what he recommended we should ensure happens, and that is what we are seeking to put in place.
Let us look back to see how NHS dentistry has changed things in this country. In 1948, half of all adults had no natural teeth at all. By 1968, the NHS had cut the proportion to 40 per cent., and 10 years ago it had fallen to 11 per cent. We are about to start the next national adult dental health survey and we expect this figure to have fallen still further to about 6 per cent.
Let me give another example. Thirty-five years ago, more than 90 per cent. of all 12-year-olds in England had tooth decay. Today, that proportion is lower than 40 per cent. In fact-I do maintain this-our older children have some of the lowest rates of tooth decay in Europe, and they are comparable with the best in the world, including those of the United States. We can always do better, however.
Mr. O'Brien: I will give way to the hon. Gentleman a little later, but if he will forgive me, I want to make some progress now as I am conscious that several Back Benchers want to contribute to the debate.
The best decisions are those that are made as close to the patient as possible. In 2006, in line with the rest of the health service, we reformed NHS dentistry. The new system gave power to primary care trusts to commission the right dentistry services for their communities. PCTs have provided incentives to encourage prevention and improve quality, but in some areas progress has been too patchy and too slow. Therefore, in December 2008, the then Secretary of State for Health asked Professor Jimmy Steele to conduct a review of the new contract, which he published in June. I am delighted to say that the review joined the Select Committee on Health in strongly supporting the principle of local commissioning, providing a firm basis for the future of NHS dentistry.
The review also showed the range of services that are needed. It showed that the different generations need different types of dental care and that, rather than simply drilling and filling, maintaining oral health and preventing decay and disease must increasingly be a priority. I did agree with some of the points raised by the hon. Member for South Cambridgeshire, and it appears that we are at one on ensuring that we prevent decay and treat maintaining oral health as a high priority. On the basis that I have set out, the Government
wholeheartedly welcome Professor Steele's review. We will be rigorously testing its recommendations through pilots across the UK-there will certainly be pilots across England-over the coming months.
I am pleased to say that the British Dental Association, patient groups and other stakeholders have welcomed the review. The Government have shared their implementation plans with the BDA and others, and they will be playing their part in delivering them. We have made a good start. Professor Steele recommended that we should develop measures for monitoring the quality of dental services, and we are developing a set of key performance indicators for all new contracts under the dental health programme. The work has already begun to develop clinical pathways and procedures to ensure that all new patients receive an assessment of their oral health and the treatment that they need.
It is important that we ensure that oral health improves. The level of tooth decay among 12-year-olds in the UK is at its lowest ever and is among the best in European countries, although inequalities remain. We want every child to access dental services, but all the evidence shows that, contrary to what the hon. Gentleman suggests, mandatory school screening is not the way to achieve that. That is what the research considered by the National Screening Committee showed; children in deprived areas, who are most likely to be shown to need treatment, were found to be the least likely to be taken to a dental practice to receive the treatment that they need. In other words, the suggestion sounds good, but we need to examine this issue in a much more effective way.
If we really want to deal with the issues associated with child tooth decay, we will find that the better way to do so is to ensure that we have fluoridated water supplies and that we make changes in the way in which dental health is examined to ensure that we target those in the most deprived areas for the additional help and support that they need. We are examining ways in which we can identify and put help into areas where there are the most problems.
In addition, we have begun to look at the way to improve the information available to patients on NHS Choices so that, as Professor Steele recommended, patients have accurate and up-to-date information about what NHS dentistry entitles them to do and how they can best access it. We are working with the NHS Business Services Authority to improve the data that we collect from dentists, which was another of Professor Steele's recommendations. That will provide a better sense of the nature and quality of services that dentists are providing. I know that dentists did not like the 2006 contract that was introduced, but I hope that the way in which the review was conducted and the way in which its recommendations will be implemented will help to heal some of those wounds, because we want to work with the dental profession as we pilot and evaluate the changes. I promised to give way to the hon. Member for Mole Valley (Sir Paul Beresford), so I shall do so now.
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