National Health Service (Dental Charges) Regulations 2005

My Lords, we have had an interesting short debate, with many useful points raised. On the issue of communication, the proposals have been and will continue to be well-advertised. They will have been in the public domain for nine months prior to the introduction of the new system in April 2006. During this time we have listened to the public response. We considered carefully the merits of reducing the band 2 and particularly the band 3 charge, as the consumer organisations asked. However, if such a reduction had been made, it would have had a disproportionate impact on the charges for other bands. We have reduced the cost of replacement orthodontic appliances to 30 per cent of the £189 band 3 charge—a substantial reduction. For the first time, we have new powers in regulations to communicate and advertise a fairer, simpler system. Schedule 3, Part 5 of Regulation 34 of the contract regulations states that a dentist,"““must display in a prominent position in its premises in a part to which patients have access information relating to patient charges, as supplied by the PCT, for the purposes of providing information to patients””." Noble Lords may be interested that in the early road testing of three key messages with users, one which contrasted the current 400 charges with the new charging regime, most people were shocked that there were over 400 charges and believed that this was not something that the NHS should be advertising—their words, not mine. And in response to this debate we will redouble our efforts to make clear to patients that information on charges is now guaranteed by robust regulations. I would be happy for the noble Baroness, Lady Neuberger, and other noble Lords to write to me with any key points which she or they would like the new information leaflet for patients to incorporate. As I explained in my opening remarks and the letter to the Committee on the Merits of Statutory Instruments, in devising the new charging regime we have learned from the experience of the PDS scheme, but could not pilot a parallel system of charges, because it would have been unlawful to do so. The noble Earl, Lord Howe, recognised that. Section 26 of the National Health Service (Primary Care) Act 1997 allowed for PDS pilots, but said that the charging regime had to be the same as GDS. I turn to the issue of whether we backed away from Cayton. I repeat that members who now criticise signed up to the Cayton group report. Whatever aspersions that some members of the Cayton group, such as the BDA, may wish to cast on the conclusions of that report now, they did sign up to it when it was published and we have kept faith with it in these regulations. As I said in my opening remarks, the Cayton report was frank in stating that there may be winners and losers. We acknowledge that. The report stated that its proposals for banded charges would improve affordability and equity. We have stuck with banded charges. The cost of the most expensive treatment has been cut in half, and up to two thirds of people may pay less in charges overall. The alternative would have been to keep the current 400 charges; maintain confusion for patients; operate a system that patients do not want; and fly in the face of what the Cayton group recommended. It is considerably easier to criticise reform of patient charges than it is to think up new arrangements and to enact them. Our proposals are faithful to those of Cayton. I dealt with the issue of why we did not pilot the new system of charging, but we drew on the experience of the personal dental services arrangements which now cover more 30 per cent of dentists. Those have shown a considerable drop in the number of item-of-service payments involving a dentist using that new system. A number of noble Lords asked why we claim to have changed the ratio for the three bands. The figures in the report were only illustrative, based on the Dental Practice Board’s classification of treatments, and the new ratios reflect the grouping of treatments into three units of dental activity. The Cayton report recommended that the relative weighting of the bands should be maintained. In relative terms, there is still a much greater difference between band 3 charges and bands 1 and 2. The band 1 charge, which most people will pay, has simply moved over time from the £12 to £15 banding that was suggested, to £15.50, which, as I said in my opening remarks, includes a provision for inflation next year. A number of noble Lords suggested that the combination of the new charges and the new contract will not provide incentives for the promotion of oral health among patients, because it is still based on units of dental activity. One of the objections to the item-of-service remuneration system, on which the current charges are based, is that it rewards dentists only for treating dental decay—drilling and filling. The need to pay dentists for advising people on how to maintain good oral health by preventing dental disease is fundamental to the new contract. Preventive work is included in the list of mandatory services, and an exhaustive list of these services is included in the description of the band 1 courses of treatment. By taking dentists off the drill-and-fill treadmill and allowing them to spend more time with patients, we have allowed them time to give oral health promotion messages. As I said on several occasions and in the letter to the merits committee, the number of items of service in the PDS pilots was reduced by about 30 per cent, and that has provided dentists with much more time to carry out health promotion and preventive work. A combination of the changes of approach that we are introducing gets dentists of the drill-and-fill treadmill and provides opportunities for preventive work with patients. I may not have responded in as much detail as a number of noble Lords would have liked, but the hour is late and I am about to lose my voice. I recognise the anxieties that a number of noble Lords have expressed. We will of course keep all these arrangements under review and we will no doubt return to this issue at some later stage when we have more experience.