National Health Service (Dental Charges) Regulations 2005

rose to move, as an amendment to the Motion, at end to insert ““but this House regrets that the Government have ignored the concerns expressed by the British Dental Association and the National Consumer Council about insufficient forward planning and communication of the new and radical restructuring of the way that the public are to be charged for dental services, which will have a disproportionate effect on those least able to afford the increases, particularly in areas where access to dental services is already restricted””. The noble Baroness said: My Lords, there is no doubt that there will be a general welcome for the simplification of dental charges. None of those who have raised concerns about the regulations has suggested that the Government have been anything but brave and sensible in trying to sort out a complex—and, often, incomprehensible to the layperson—system of dental charges. Nor do I wish to detain the House long at this late hour. I am particularly aware of the Minister’s rapidly disappearing voice. It would be a great shame if he did not have a chance to reply to the debate. Let me raise a few objections and explain why I have tabled this Motion of regret. First, the British Dental Association has expressed its concerns about affordability, particularly on the £15.50 entry point. I am grateful to the Minister for sharing with me his reply to the noble Lord, Lord Filkin, as chairman of the Merits of Statutory Instruments Committee, after it drew those regulations to the special attention of the House, on the basis that they might,"““imperfectly achieve their policy objectives””," and that they,"““give rise to issues of public policy likely to be of interest to the House””." The Merits of Statutory Instruments Committee suggested that the House may wish to ask the department about the robustness of its forecasts on how those changes will operate. The British Dental Association is concerned that, among other things, the banding system will encourage patients to save up their problems to get as much work done as possible for a single charge, which will work against the stated objective of improving preventive care. The Minister’s reply to the Merits of Statutory Instruments Committee suggests that government and dentists have learnt a lot from the extensive piloting of personal dental services. He suggests that many patients will attend less frequently than they do now, thanks to new NICE guidelines, but he does not tackle with any conviction the issue of people storing up their dental problems and being dissuaded by charges. His answer is simply:"““I have rather more faith in people’s reasonable behaviour””." However concerned people are about their oral health, however reasonable they are and however much they listen to their dentist, if the initial charge is set too high of course people will save up their problems. If they can get urgent treatment at £15.50 rather than have to pay £42.40 for simple treatment, as this system imposes upon them, many of the poorest will do just that: wait, unless they are in agony. They will save their problems and the policy objective of more preventive treatment will not be met. It is not just the British Dental Association. The Consumers’ Association, which was quoted by the Ministers here and in another place as supporting these proposals, has written to me supporting my Motion to amend. It was a member of the NHS dentist patient charges working group that advised the Minister on the new system. It points out that the level of charges that it considered and supported was much lower than those proposed. It is particularly concerned that the Band 3 charge, while significantly lower than the current maximum charge, is significantly higher than the current cost of replacing dentures, particularly partial dentures. It says:"““It is our view that these new charges will put undue financial pressure on many people, especially the older people. In many cases these charges will make people think again about getting the treatment they need””." Although the Minister tackles the reduction in maximum charges in his letter to the noble Lord, Lord Filkin, he makes no mention of the increase in the cost of replacing dentures, yet he prays in aid how beneficial the reduction will be for older people, even though denture repair is very much an older people’s issue. Equally, the National Consumer Council has raised the issue of the cheapest band, starting at £15.50, being a deterrent for the poorest in our society. The Minister’s letter to the noble Lord, Lord Filkin, suggests that the current equivalent of Band 1 treatment, the scale and polish that the Minister has just talked about, would be £15.42 by next year and therefore much the same as now. If they attend less frequently, as new NICE guidelines suggest, the actual costs will be reduced. But that fails to redress the issue that the poorest in our society often have the worst teeth. They will not go less frequently; they will in fact need more Band 2 treatment. The Minister himself has just admitted that around three-quarters of patients within Band 2 will pay more than previously and only a quarter less. Is that fair to the poorest in our society? In any case, will it encourage them to seek treatment? Others will no doubt address the issue of communication of those changes to the public and to dentists alike. I do not wish to detain the House too long. I shall end with a quotation from the letter that the National Consumer Council sent to the Committee on the Merits of Statutory Instruments:"““We are not convinced that the current system of exemptions is sufficient to prevent charges becoming a heavy burden on some people. While receiving some state benefits gives automatic exemption from charges, in many cases people on low income have to go through a complex process to apply for full or partial exemption. Those who fall outside the NHS low income scheme, even by a few pounds a week, may still pay the full 80% of the cost of dental work. We believe that the Government should examine the system of exemptions and that the affordability of any changes to the payment system should be reviewed””." It ends:"““This has particular relevance to improving equity of access to dentistry and improving oral health””." I hope that the Minister can reassure the House that these new bands will not impact upon the poorest beyond what he has said in his letter to the noble Lord, Lord Filkin. I hope too that the Government will now monitor both dentists’ activity and patient access to NHS dentistry to measure the impact of the reforms. Perhaps the Minister will be able to reassure the House by asking the Healthcare Commission to collect information on patients’ experiences of the new dental charges, particularly as they affect people on the lowest incomes? If these reforms are found to have a deleterious affect on the poorest, will the Government reduce the charges again by April 2007 so that they are in line with the level of charges considered and supported by the NHS Dentistry Patient Charges Working Group? I beg to move. Moved, as an amendment to the Motion, at end to insert ““but this House regrets that the Government have ignored the concerns expressed by the British Dental Association and the National Consumer Council about insufficient forward planning and communication of the new and radical restructuring of the way that the public are to be charged for dental services, which will have a disproportionate effect on those least able to afford the increases, particularly in areas where access to dental services is already restricted””.—(Baroness Neuberger.)