Examination of Witnesses (Questions 60
THURSDAY 15 FEBRUARY 2001
60. Clearly there is a shortage of places, which
was indicated by your reference to grades.
(Dr Husband) People want to do dentistry, they want
to study it, but there just are not the places there. Also, we
train a lot of people from abroad as well who we then lose.
61. While we are on the issue of the staffing
resource, presumably the Association has made some estimate of
the additional training places that are required for dentists.
Perhaps you could share that information with us. Also, there
are people other than dentists who are involved in the profession,
what is the position regarding training of oral hygienists, dental
nurses, technicians, the whole range? Could the dental team be
used more effectively than it is at the present time?
(Mr Ross) It comes in with that and goes back a little
to the access problem. We do not actually believe there is a shortage
of general practitioners out there. Some Access Centres will be
placed logically but some of them will be placed in areas where
there is a very high dentist to population ratio, it is just that
the populations in those areas do not want to avail themselves
of NHS Dentistry. It is Department of Health figures taking over.
The area I am thinking of is in Barnet where there is one dentist
to every 800 people, yet there is an access problem there but
there are very few complaints about patients not being able to
get to a dentist. The other problem with some Access Centres is
that they will be in competition with local practitioners. We
have already heard cases where an Access Centre opens up and local
High Street practitioners are forced to close their practices.
It may just be moving the problem from one area to another.
(Mr Renshaw) I would be happy to comment on that.
The workforce issue is a very, very serious problem and we are
not absolutely convinced that there is a desperate shortage of
dentists. What we are convinced of is that nobody has looked at
the problem seriously for such a long time, we do not actually
know whether there are enough dentists. We do not know whether
it would be possible to have a more effective use of the staff
that we do have. We do not know whether a large increase in the
professionals complementary to dentistry would help out. You cannot
decide that on the strength of what happens in a particular area,
that needs to be a real look at the whole issue.
62. Nobody has made that assessment?
(Mr Renshaw) Nobody has looked at that. I have to
say, and I am sure Lord Hunt will tell you when he comes along
later, that we are talking to him right now about whether we can
set up a proper workforce review under the new National Workforce
Development Board. We are very, very keen to see that happen because
until we get the results of that inquiry we do not know the answers
to these questions.
63. Nobody has actually looked at the cost-effectiveness
of having an oral hygienist on the team or not?
(Mr Renshaw) There is very little evidence to support
it one way or another. I am not saying it is not a good idea but
the evidence is relatively poor. The studies around the world
do not point in one direction or another. We need to look at that
very, very carefully because we do not want to train people for
work which is unnecessary but nor do we want to be short of the
required workforce to deliver a proper service to the population.
The last time this issue was addressed was in 1987. That was 14
years ago. The world has moved on. We have a figure of 800-odd
graduates coming out of dental schools in this country every year
that was set back in the 1960s or 1970s, it is nonsense. I do
not know whether it is right, I suspect it is not right and I
think it is probably not enough. There are people out there who
would like to be able to do this job as a career and I would like
to be able to encourage them, but it has to be done within a framework
of looking carefully at the whole issue.
John Austin: Could each of you say one key thing
which the Government could do to improve access to NHS Dentistry?
64. Briefly, please.
(Mr Ross) Simply to stop the treadmill effect and
then there are enough dentists out there willing to do the work.
(Mr Bosley) Manpower.
(Dr Husband) Give us the ability to do what we trained
(Mr Renshaw) Dentists do not leave the NHS for ideological
reasons, they leave because they are over-stressed and overworked
and until somebody does something about that you are not going
to turn this situation around.
Chairman: Can I express the Committee's appreciation
for your participation this morning. It has been a short session
but I think it has been a very valuable one. It may be that arising
from our questions subsequently you want to write in with further
information, or it may be that we pick up further points we would
like to put to you. Can I express our appreciation and if you
wish to remain for the rest of the session you are very welcome.
Thank you very much.