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Sir Paul Beresford:
I am pleased that the Minister has finally got round to mentioning fluoride, because fluoridation in the water supply and in toothpaste has been the biggest single factor, over and above any dentistry, that has brought about the change that he is proclaiming as an asset to his Government. He ought to realise that countries that have a school dental service
are teaching children to use fluoride toothpaste as well as the inspection. That is the biggest advantage and that is where some countries, particularly New Zealand, have moved ahead. He ought to look at those results before he comes out with a condemnation of what has been suggested.
Mr. O'Brien: I will look at those results. We are prepared to look at the evidence and to make judgments based on it. It is important that when we get independent reports that suggest that spending £17 million on NHS dentists going into schools is not the best way of spending that money, we consider the evidence and base our policy on it rather than on some historical view that that was a nice thing that might perhaps be popular. We need to base things on the evidence.
Bill Wiggin (Leominster) (Con): I am particularly interested in what the Minister said about continuity of care. Will he take the opportunity to look at what is going on in Herefordshire? I decided to test the NHS for myself and waited in the queue. I eventually got to the front and had a filling, which fell out two weeks later. I still cannot see a dentist to get it put back in again. Unless people are in pain, it is almost impossible to see a dentist. I am sure that that is not what the Minister wanted, and if there is something that he can do, I know that my constituents will be deeply grateful.
Mr. O'Brien: Only a Conservative MP can say, "I decided to test the NHS by using it." The hon. Gentleman symbolises where the Conservative party is on this issue. Fillings sometimes come out. I hope that he will be able to access a good NHS dentist who will ensure that he can get an appointment. I suspect that the best approach will be to go back to the person who originally did the work to ensure that it is done in a way that means that it does not come out.
Charlotte Atkins (Staffordshire, Moorlands) (Lab): Would not the Minister accept that the best way to promote oral health among children is to start very early? For instance, we could start in the many Sure Start centres up and down the country that bring together health, education and social services. Mothers can then work with their children to instil good oral health right from the start. Unfortunately, the Opposition are committed to closing down those centres, not expanding them.
Mr. O'Brien: My hon. Friend is right, and she presents a much more coherent argument than the Opposition have. As the hon. Member for South Cambridgeshire quoted the British Dental Association during his speech, may I point out that the BDA does not support mandatory school screening? It agrees with the National Screening Committee's decision. Given the comments made by the hon. Gentleman, it is worth adding that the BDA, in a report on local commissioning that was published yesterday, gave a positive picture of the opportunities offered by local commissioning, which he derides. It states that there are
"some truly excellent examples of innovation on the part of commissioning teams around the country".
"very positive attitudes towards liaison between practitioners and commissioners".
Dr. Lewis: The Minister has nailed his colours to the mast in favour of fluoridation. Does he accept the principle that no community should have its water fluoridated if a majority of the members of the community do not wish its water to be fluoridated?
Mr. O'Brien: We need to make judgments on fluoridation based on the evidence. Stories always go round that can frighten people, and we have seen in this country a whole series of scare stories about vaccinations that resulted in a significant number of people being frightened out of giving those vaccinations to their children. We need to ensure that we consider the evidence, that we base our judgments on the clinical evidence and that we ensure, too-
Mr. O'Brien: Let me answer the hon. Member for New Forest, East (Dr. Lewis), and then I will give way. As far as vaccination was concerned, there were some stories and as a result we are paying the price. We need to ensure that we consider the evidence on fluoridation and make judgments based on that evidence. We have already seen that there have been some moves towards fluoridation in the water supply, particularly in Southampton, although that is the subject of a judicial examination.
Sandra Gidley: The Minister mentioned the commissioning report and he slightly cherry-picked the results, but he must have been disappointed to read that 60 per cent. of dental leads and 77 per cent. of local dental committee secretaries agreed or strongly agreed that the national contract did not allow as much innovation as they would have liked. What steps does he think need to be taken to address that problem?
Mr. O'Brien: Far from being concerned by that, I welcome the fact that the BDA is saying that we must do more in relation to innovation and quality so that we improve some of the better ideas coming out of dentistry. That means that we have to look at the contract and make sure that it encourages innovation and best practice.
If I may be critical of the NHS for a moment, there is something that the service as a whole, and not just dentistry, is bad at. There are lots of examples of good practice in parts of the NHS, including in dentistry, with good ideas and work in both management and clinical practice, but those examples are not spread as quickly as they should be. I think that the hon. Member for Romsey (Sandra Gidley) has made a sensible comment. We need to take it on board and respond in a positive way.
The Minister will know, not least from what my hon. Friend the Member for Mole Valley (Sir Paul Beresford) said, that there are Conservative Members who agree with the principle of fluoridation. However, the point is not that we should judge the evidence that suggests that it makes a positive contribution, but that the legislation makes it clear that there should
be a process of public consultation. There was such a process in Southampton and Hampshire, but it began with the strategic health authority setting out the evidence in support of fluoridation and it ended with the SHA saying that it remained convinced by the same evidence.
The consultation process therefore added nothing at all: what is the point of consultation when a decision has been made already? The Minister and the health authorities need to think about that again and accept that, if evidence is to be presented in a public consultation process, people must be given a more objective opportunity-either through a referendum or some other means-to make their views known.
Mr. O'Brien: The difference between the hon. Gentleman and me on this is not as great as he makes out. I agree that the people who make decisions must take on board the views expressed by local people in the public consultation process. The process is not a referendum-
Mr. O'Brien: By the sound of it, the hon. Gentleman is committing the Conservative Front-Bench team to referendums all over the country. I believe that, when local people are consulted, those who make decisions need to take on board the views that are expressed-and, indeed, the votes that are taken-by people in local areas. Those views are important, and the people who make decisions must consider them and give them due weight, but they are not binding in the way that a referendum would be.
Dr. Lewis: The Minister is very kind to give way again, but 72 per cent. of respondents to the consultation said no to fluoridation, even though the local PCT had sent out a great many postcards, first-class postage paid, to get people to say yes when they replied. Presumably, if 72 per cent. of people saying no can be ignored, the same would be true of 82, 92 or even 100 per cent. What is the meaning of a consultation when an SHA can tell the overwhelming proportion of people saying no that the answer is nevertheless yes?
Mr. O'Brien: People who have to make a decision have to give due weight to the views of local people. They must ensure that all the arguments are taken into account, and that the views of local people are reflected but, in the end, they still have to make the decision.
I should have known, when I mentioned fluoridation, that we would get the reaction that we did from the reactionary side of the House. Fluoridation is an issue that, like Europe, produces an immediate reaction.
Mr. O'Brien: The Conservatives are proposing referendums once again. They want one on Europe, and now they seem committed to one on fluoridation as well. The important point is that we are working with the dentistry profession. There were difficulties following the 2006 contract-I do not dispute that for a moment-but we are now working with the dentistry profession to ensure that we produce a system of NHS dentistry that is right for England and the whole UK.
The Government are committed to providing high-quality dentistry for everyone who wants it. As I have said, in the past two years, we have increased funding by some 20 per cent., or about £385 million a year. Although about 90 per cent. of dentists continued with the NHS after the new contract was introduced in 2006, others did not. That led to an initial fall in the number of people able to access an NHS dentist-a fall that is now quickly being reversed. New practices are opening across the country. The Conservative Opposition would like to paint a picture in which things are the same as they were two years ago, but that simply is not the case. In fact, if Opposition Front Benchers want to see for themselves, I invite them to go round the corner from the House of Commons to Horseferry road, where a dentist's has opened today.
Mike Penning (Hemel Hempstead) (Con): The Minister wants Conservative MPs and Front Benchers to go and see dental surgeries, but can he explain why, when I asked in a freedom of information request when, in the past 12 months, a Government Health Minister of any description had last gone to see an NHS dentist, the answer was that zero had done so?
Mr. O'Brien: I have certainly accessed my NHS dentist in the past 12 months. [Interruption.] I gather that the Under-Secretary of State for Health, my hon. Friend the Member for Brentford and Isleworth (Ann Keen), has done so, too. We probably visit such practices in a way that the hon. Gentleman, and some of his Back-Bench colleagues, do not, in the sense that perhaps they do not use NHS dentists in the way that most of us do. However, that is not the key point.
What needs to improve is access. A Which? survey published in June 2009 showed that nine out of 10 people who tried to get an NHS dentist in the past two years were able to do so. With more dentists in the NHS last year, dentists delivered an extra 1.4 million courses of treatment, and I am confident that access will continue on its current track of improvement. All 10 strategic health authorities have now committed themselves to giving everyone who wants it access to an NHS dentist by March 2011 at the latest.
The Steele review made a range of recommendations on how to improve the incentives to promote access and quality. We welcomed its recommendations on developing contracts that encourage dentists to take on new patients and to provide them with high-quality continuing care. The right to continuing care, in a system that promotes quality, is key to Professor Steele's vision, and we know that patients and dentists value that right. That is why the new practices being developed under the access programme will pilot some of the review's recommendations. Existing practices will be invited to volunteer for pilots incorporating Professor Steele's full recommendations from next spring. We were encouraged to hear that as soon as the review was published, informal expressions of interest started to come in from the NHS and front-line dentists' practices.
Prevention and quality are two of the most important principles in today's NHS, and the review will help us further to embed those principles in the dental system. In 2007 we produced the world's first guide to evidence-based prevention in primary dental care. We published a second edition this year, and we are already seeing the benefits.
The prescription of high-concentration fluoride toothpaste has risen by almost 250 per cent. in one year, and fluoride varnishes are being used much more than ever before. Our focus on prevention is starting to work, and we will ensure that the new pilots that I have described will include preventive dentistry.
The Labour party founded the NHS. We have tripled funding to the service as a whole and we want dentistry in the NHS to succeed. By working with the profession to deliver the recommendations of the Steele review, within the framework of the 2006 reforms, I believe that we can ensure that it does succeed.
Norman Lamb (North Norfolk) (LD): The Liberal Democrats will support the motion tonight. We will support it, first, because it is rightly critical of access under the current contract. The Minister referred to statistics suggesting that 90 per cent. of patients are able to access dentists, but the fact that there are 10 per cent. who cannot should be a cause for concern. As my hon. Friend the Member for Manchester, Withington (Mr. Leech) said to me, if that was the case with access to GPs, there would be an outcry. For people who cannot access an NHS dentist, that creates a very real problem and the Government should not be satisfied with the current levels of access.
The motion is right to stress the importance of piloting before introducing change, something that the Government failed to do when they introduced the contract. That is one reason why it was so much resented by the dental profession. The motion is right also about the objectives. The objective should be improving oral health and introducing incentives for preventive care. The Minister rightly pointed out the importance of all dentists behaving professionally, but it must surely make sense for the system to ensure that the incentives are in the right direction to encourage and incentivise dentists to do the right thing. The motion is also right in identifying the need for an element of capitation-based funding and patient registration, and the importance of establishing a long-term relationship.
However, the motion falls short in two important respects. First, it says nothing about oral health inequalities. That is an issue of fundamental importance, about which we on the Liberal Democrat Benches feel very strongly. Resources should be targeted at areas of greatest need, and the motion is silent on that. Secondly, on the face of it, the proposal to reintroduce dental screening programmes in schools looks appealing, but it is wrong and should not be introduced. If we are moving into an era where public finances are stretched and where we have to ensure that every penny is spent effectively, the Conservatives should think again about this. All the evidence suggests that school dental screening is ineffective in achieving the objectives.
I have already referred to the survey undertaken by the oral health unit in 2002, but that is not the only research. There was a report in 2006 which concluded that the majority of the children studied
"derived little benefit from the school dental screening programme in terms of attending the dentist, and receiving treatment for their carious permanent teeth. School dental screening also fails to address inequalities in the prevalence of untreated disease and utilisation dental services."
"The evidence from the UK and elsewhere is that while the concept of dental screening is attractive to policymakers, there is no scientific evidence that it leads to improvements in health, either for individual children or for the child population."
This debate follows on from the Steele report in June. The Government deserve credit-it was an inspired move by the previous Secretary of State to appoint Jimmy Steele to undertake the review. It has been an independent process that has managed to secure the trust and respect of the dental profession and it has been stronger because of that. The recommendations of the report have secured widespread support. But the outcome of that report should embarrass Ministers, because it demonstrates that their repeated claims, made here on the Floor of the House, that the contract was working were nonsense. Back in 2007, the then Health Minister, now the Minister for Regional Economic Development and Co-ordination, the right hon. Member for Doncaster, Central (Ms Winterton), said:
"We know that NHS dentistry is expanding, and that new contract is working."-[ Official Report, 26 June 2007; Vol. 462, c. 154.]
"Access to NHS dentistry is getting better all the time."-[ Official Report, 5 February 2008; Vol. 471, c. 772.]
Those comments fly in the face of reality, and now the authoritative Steele report, which the Government accept, demonstrates that many claims by Ministers and the resistance to any challenge to the workings of the contract were nonsense.
Professor Steele highlights a number of issues. First, he points out that access is variable. In many parts of the country, access is fine and people can get to an NHS dentist, but in many other areas that is not the case. Steele makes particular reference to rural areas, where, according to a Which? survey that the report mentions, just 29 per cent. of dentists are taking on new NHS patients. We should be concerned about that. It compares with 46 per cent. of dentists in urban areas.
Norman Lamb: They may access dentists in urban areas, but they cannot register because they are not allowed to. However, many older people in rural areas, including my constituency, struggle to get to an NHS dentist, and that problem needs to be addressed. Everyone accepts that some people cannot access an NHS dentist, but Professor Steele says that for such older people, the problem is of great concern.
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