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Baroness Gardner of Parkes: My Lords, I thank the noble Lord for that Answer. Does he therefore deny reports in two national newspapers which say that the provision of orthodontics to children is to be removed from the National Health Service? Is he aware that at present there are 650 specialist practices which do nothing but tooth straightening but half of the straightening of teeth is carried out by 8,000 ordinary dentists in practice?

The British Dental Association is extremely concerned about what will happen to general practitioners and the role they play in straightening teeth. Does the Minister not agree that aesthetics are very important but in this case it is more than aesthetics; it also a question of a child's bite and his whole mouth arrangement?

Lord Hunt of Kings Heath: My Lords, that was an extremely instructive question. I certainly agree that aesthetics are important for many people. However, I do not think that we should go down the route of certain countries where there seems to be a fashion for everyone to have orthodontic treatment and they all seem, to me at least, to end up looking as though they are wearing false teeth.

On the specific matter which the noble Baroness mentioned, she is right that many general dental practitioners undertake the work that she described. Certainly, under the new arrangements, many of them

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can continue to do some limited orthodontic work. We are trying to ensure that the most pressing treatment is delivered as quickly as it possibly can be because at present we have a situation were people who really need treatment are having to wait too long, and we must put that right.

Lord Clement-Jones: My Lords, children's teeth are very important and I share many of the concerns of the noble Baroness, Lady Gardner. Fluoridation is a matter of some controversy in this context too. Can the Minister give an indication of the Government's response to the York University study into fluoridation?

Lord Hunt of Kings Heath: My Lords, fluoridation had a very good ride in the debate on health yesterday. York University undertook a very thorough review. It found that evidence showed that fluoridated water helps to reduce tooth decay. It found no clear evidence of other adverse effects on general health associated with water fluoridation, other than the increased risk of dental fluorosis. The report also identified the need for more good quality research. We have asked the Medical Research Council to suggest where it might be possible to strengthen the evidence. We have said also that we consider that, in those parts of the country where dental disease is a particularly serious problem, fluoridation is one policy which health authorities may consider.

Baroness Nicol: My Lords, does my noble friend accept that what he described as minor cosmetic work could be of very great importance to a young teenage child? Is he suggesting that under the new regulations--and I apologise for not knowing what they are--many children will have to put up with minor irregularities which may become very important in their lives?

Lord Hunt of Kings Heath: My Lords, we are talking about very minor cosmetic treatment which it would be unnecessary for dentists to provide. At the moment, we reckon that 20 per cent of children have orthodontic appliances every year and about 120,000 of those will have work done in the GDS. It is expected that there may be a reduction of about 20,000 in the number of children who will have orthodontic appliances. However, I assure my noble friend that in those cases where a child might not need treatment for a clinical reason but there was a particular problem in relation to appearance, application can be made to the Dental Practice Board for approval in those circumstances.

I should say that this matter is out for consultation and we are at present considering the comments that we have received.

Baroness Oppenheim-Barnes: My Lords, what yardstick is it intended to apply in determining what is cosmetic and what is a necessary straightening of teeth for the child's future?

Lord Hunt of Kings Heath: My Lords, it is all very straightforward. There is an index of orthodontic

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treatment need which attempts to rank those matters in terms of dental health need. That consists of ranking that on a scale of one to five. That is based on reasonably objective measurements. There is a separate aesthetic component on a scale of one to 10 where number one is the most attractive and 10 the least attractive. Essentially, it is considered that grades 1 and 2 need either no treatment or little treatment and grade 3 is borderline but it will be tipped into treatment need when associated with an aesthetic component of six or above. Grades 4 and 5 all benefit from treatment on health grounds alone. So there is a very careful scheme under which those judgments are made.

Healthcare: Reciprocal Arrangements

3.16 p.m.

Lord Rotherwick asked Her Majesty's Government:

    What steps they are taking to ensure that the United Kingdom's reciprocal healthcare arrangements with other countries are in practice fully reciprocal.

Lord Hunt of Kings Heath: My Lords, the arrangements give travellers healthcare on the terms available to the host country's own people. As countries have different healthcare systems, variations in benefits provided are inevitable. Overall, however, the Government believe that the present arrangements provide a reasonable outcome for the people of this country.

Lord Rotherwick: My Lords, if it were a truly reciprocal arrangement, surely it is wrong that if we fall ill in France, we have to pay 25 per cent of the costs of treatment whereas if a Frenchman falls ill in England, he receives that treatment totally free of charge? Furthermore, will the Minister confirm that in April of this year, a certain London psychiatric hospital stated that it thought that 20 per cent of its beds were being utilised by foreigners?

Lord Hunt of Kings Heath: My Lords, I know that various allegations have been made over the years. I have yet to see hard conclusive evidence that that is so.

On the substantive point raised by the noble Lord, it is true that, for example, France and Belgium require a personal contribution of respectively 30 and 25 per cent of costs from patients in many cases. But there are also examples of UK citizens receiving more favourable treatment in other EEA countries than they would from the NHS; for example, prescription charges are lower in several countries, and access to dental treatment and physiotherapy is immediate and free in Germany. The EEA countries and those with which we have a bilateral agreement number over 50. To negotiate NHS-type provision for people in those countries and vice versa would be a bureaucratic

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nightmare. Although in some cases, UK citizens may be disadvantaged, surely the arrangements represent a sensible and reasonable outcome.

Earl Howe: My Lords, is not part of the problem with this issue of so-called Xhealth tourism" that it is possible for a visitor to this country simply to lie when he is asked whether he has lived here for more than certain length of time? Is the Department of Health considering some form of smartcard identification system which could weed out people who were trying to abuse the system?

Lord Hunt of Kings Heath: My Lords, although allegations have been made, hard evidence is very difficult to find. Hospitals are asked to ask all patients whether they are ordinarily resident in the UK. If they are not ordinarily resident, further questions may be asked to determine whether they are liable to be charged for using the NHS.

I accept that the guidance currently issued to the NHS on how to deal with the kind of issues which the noble Earl mentioned may well be in need of updating. That is being done at present. When that work is completed, we shall issue it to the health service. If there are specific problems such as those which the noble Earl mentioned, I hope that we can deal with them. Overall, I believe that the general arrangements that we have in place are very sensible.

Lord Clement-Jones: My Lords, is it not the case that sometimes the provisions are too fiercely enforced against British citizens who return to this country? When charity workers who have worked abroad for a temporary period in Asia or Africa return here, they are not eligible for National Health Service treatment except in the case of an emergency. Will the Minister undertake to look at that matter as part of a revision of the Patient's Charter to see whether that unfair provision can be mitigated?

Lord Hunt of Kings Heath: My Lords, I am grateful to the noble Lord for advance notice of that Question. People who work abroad, either for the UK Government or in employment that is financed in part by the Government, retain their entitlement to free hospital treatment. That would include anyone recruited to work abroad under the British volunteer programme. In addition, people who have lived in the UK for 10 years and who are now employed by charitable organisations abroad outside that category may retain their entitlement to free treatment for at least five years and perhaps for longer, depending on their individual circumstances. If there are specific issues that the noble Lord would care to bring to my attention, I shall investigate whether there is a problem in the way in which the regulations are drawn at the moment.

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