National Health Service (Dental Charges) Regulations 2005

rose to move, That the draft regulations laid before the House on 22 November be approved. [11th Report from the Joint Committee and 17th Report from the Merits Committee]. The noble Lord said: My Lords, I should quickly like to summarise the key elements of the new charges regime before us today and then respond in a little more detail to the issues raised by the amendment to the Motion.I have already written to the chair of the Merits Committee and addressed the committee’s concerns in detail. I have copied the letter to other noble Lords. At the moment those NHS patients who are liable for charges pay 80 per cent of the dentist’s treatment fees. From April 2006, dentists will work for new NHS contracts. These will have an annual contract value, agreed in advance, in return for which they agree to carry out a certain number of courses of treatment over the course of the year. A new system of patient charges, not related to fees for individual items of treatment, is therefore needed. We asked Harry Cayton, the National Director for Patients and the Public at the Department of Health, to review the current system of patient charges, with considerable input from representatives of consumer interests and dentists, including the British Dental Association and the Consumers’ Association, which both signed up to the report’s recommendations at the time of its release. The review recommended that in future there should be a series of banded charges linked not to individual items of service, such as fillings or extractions, but to the overall course of treatment that a patient receives, with three bands related to the level of service provided in this course of treatment. The regulations before us were drafted on the basis of that report. We believe that the new dental charging system will be fairer because the maximum cost of NHS dental treatment will be reduced by more than a half; it will be simpler because we are moving from 400 individual charges for individual treatment items to simple price bands; and it will be clearer because patients will be sure of knowing how much they are being charged and what treatment they will receive. Under this new scheme, patients will make one single payment for their course of NHS treatment. For example, a patient requiring a filling would pay a single Band 2 payment which would cover not only the initial examination but the preventive advice received and the filling. Patients who do not currently pay dental charges, such as children, will continue to receive free dental care. The new dental charges systems also reflects guidance from the National Institute for Health and Clinical Excellence that patients be recalled within between three months and two years depending on their clinical need, as opposed to the traditional six-monthly recall. For a large majority of the population, a six-monthly check-up is unnecessary. A 12-week public consultation on the draft regulations took place over the summer and we published our response on 2 December. Broadly, consumer representatives were cautiously supportive of the proposals but had some concerns about particular aspects of them. The Consumers’ Association commented that the proposals will,"““bring real improvements for patients””." Patients and the public agreed that a new dental charging system was needed and were in support of many of the aims of the proposals. They agreed that our proposals would improve affordability for those with higher treatment needs. The BDA was represented on the review group and initially supported the proposal for a charging system based on three bands. I have already dealt with its recent specific concerns in the letter to the chair of the Merits Committee. The charges included in the consultation document were at 2005–06 prices and were rounded figures. The level of the charges for 2006–07 have now been finalised at £15.50 for a Band 1 course of treatment; £42.40 for a Band 2 course of treatment; £189 for a Band 3 course of treatment; and £15.50—which is the same as Band 1—for an urgent course of treatment. The cost of the most expansive Band 3 course of treatment has been reduced by a half from £384 to £189, making dental treatment significantly less expensive for those charge payers with the greatest oral health needs—a significant improvement. These charges are at 2006–07 prices and will not therefore require any further uplift before they are expected to come into force. I turn now to the amendment to the Motion. On the question of forward planning and communication, I should like to make three points. First, we could not advertise the new charging regime without the necessary parliamentary approval. Proactive publicity prior to approval from Members of this House and the other place would not have been welcomed, I would suggest, by many noble Lords opposite. Secondly, we have none the less been clear since Harry Cayton’s report was published on 7 July, more than five months ago, that we favoured a three-band system of patient charges. Thirdly, we received more than 400 responses to the consultation and the charging regulations do not come into force for another three months. As I made clear in my letter to the Merits Committee, we are putting in place a proactive programme of communication, subject to Parliament’s approval of the regulations, with patients’ leaflets and posters and, for the first time, backed up by the power of regulation. I do not believe it is fair to say that the level of the charges will have a disproportionate impact on those who can least afford it. There is no increase for the 5 per cent of people in band 3 who need complex bridgework and dentures, with charges reduced by more than a half, from £384 to £189. These are often required by older people who are least able to afford an increase. I hope we can agree that patient charges for the most complex treatment are cut in this way. In Band 2, which covers all treatments apart from appliances, the charge will be £42.40. Around 42 per cent of patients fall into Band 2. We expect three-quarters of these patients to pay more than previously and a quarter will pay less—about 10 per cent of the total number of patients. I turn now to Band 1. As I outlined in my letter, the new charge is little different from the current cost of a basic scale and polish and check up, but it does provide around 53 per cent of patients with a more comprehensive diagnostic and preventive package of care where clinically necessary. We are cutting charges in half for complex bridgework and dentures in Band 3; reducing costs for a quarter of people in Band 2; and offering negligible change in Band 1, but in return for access to a more comprehensive package of care. Just over two-thirds of patients may well be better off as a result of our proposals. Inevitably, there are some people who, relative to the previous current charging system, will pay more at a single visit. The consultation document made this clear, but also said that it was recognised by the Harry Cayton group that, at the point of change, there could be some winners and losers but that a banding option improved overall affordability and equity and that individual patients who lose on some occasions will gain on others. It is absolutely clear that our proposals reflect the analysis of the members of the Cayton group. It is just not the case that there will be widespread increases. The alternative is to keep the current 400 charges, maintain confusion for patients, operate a system that patients themselves do no want, and fly in the face of what all members of Harry Cayton’s group recommended. I turn to the next point raised by the Merits Committee. It is simply not the case that charges are being raised because we need to protect dentists’ income as their activity falls. As a matter of principle, we have said that we will not raise more in charge income as a proportion of overall expenditure on dentistry than now. The patient charges have been modelled to deliver the same 26 per cent of overall expenditure on dentistry as they do now. I will now address the suggestion that the impact of charges will be greatest where access to dental services is more limited. If the noble Baroness, Lady Neuberger, is referring to areas where demand for NHS dental services exceeds the current availability of services—which we and the NHS are successfully tackling in many parts of the country—then the new patient charges would not make a difference. We have made very clear that we want dentists to continue to see their existing patient base—charge payers or otherwise. We have also strengthened the regulations to make clear that if a dentist currently concentrates his NHS commitment on children and exempt patients, he may continue to do so, as long as the local primary care trust is in agreement. The new arrangements for local commissioning also start to address the concerns of the noble Baroness. The money devolved to PCTs is ring-fenced for dentistry and when a dentist leaves the local area or retires, the resources return to the local PCT to be reinvested in local dental services in ways that best meet local needs. Some PCTs with personal dental services practices have already used their local commissioning powers to address service equity. In conclusion, the key issue that we must all be clear about is that the new system is fairer, simpler and clearer. Charges are cut in half for those with the greatest needs, three well-advertised charge bands replace 400 obscure charges, and overall the new system is a good deal for people with less complex needs, many of whom will visit the dentist less often in future, allowing other new patients to access primary dentistry. Charges raise only the same proportion of overall expenditure on dentistry—26 per cent—as they do now. I hope that I have reassured the noble Baroness in particular about some of her concerns. I commend these patient charges and the regulations to the House. I beg to move. Moved, That the draft regulations laid before the House on 22 November be approved [11th Report from the Joint Committee and 17th Report from the Merits Committee].—(Lord Warner.)