Queen’s Speech

My Lords, the gracious Speech announced a new health Bill and made further commitments to providing a healthcare system organised around the needs of the patient. The Minister has explained that the Bill looks to build on his report, to improve the quality of NHS care and services and to improve public health by creating an NHS constitution. This debate enables me to bring to noble Lords’ attention the state of NHS dental services in the UK, with the progress that has been achieved throughout 2008, and to suggest what needs to be done in the coming year to provide the dental service that the Government clearly realise is needed. Providing quality care and services is something that dentists pride themselves on. I must declare an interest in that I am on the dental register and, although I am not practising, from time to time I offer noble Lords advice on their teeth. The April 2006 dental services contract had the stated aims of improving access, getting dentists off the treadmill and enabling a more preventive approach to care. Sadly, the combination of a target-driven, treatment-focused contract, with poor commissioning by primary care trusts and a lack of prioritisation by strategic health authorities has made it increasingly difficult for dentists to provide the high quality and personal service for which they have been trained. I look forward to hearing from the Minister how the health Bill will impact on dentistry. Figures released two weeks ago by the NHS Information Centre showed that not only had access to NHS dentistry not improved, but a million fewer adults and more than 200,000 fewer children have been able to access an NHS dentist in England since the contracts’ introduction—that figure being on top of the two million who wanted, but were unable, to access treatment before the new contract started. That leaves the Government even further away from their 1999 election promise of full access to an NHS dentist by September 2001. In July, the Commons Health Select Committee concluded that, as measured by the department’s own success criteria, the new contract had failed to improve access to dental services or to create a more preventive service. It concluded that it was extraordinary that the unit of dental activity payment system was neither piloted nor tested. The report also noted the variable quality of commissioning of dental services by PCTs, and criticised some of the UDA targets as unrealistic and in need of urgent review. It also commented that an improvement in financial forecasting of dental charge revenue was needed to address their 2006-07 overestimate of £159 million, which resulted in PCTs having to cut dental services or divert money from other areas to make up the shortfall. The British Dental Association, which represents some 20,000 dentists, has explained that the new contract is too target-driven, with a focus on treatment rather than prevention. It said in its evidence that unless the UDA is scrapped as the sole measure of dentists’ work, access and oral health were unlikely to improve. Many dentists have been unhappy with the contract, some being unable to accept it. The BDA has called for a more flexible way of monitoring NHS dentistry using indicators that emphasise factors such as preventive care, improved oral health, timely and appropriate access, quality and patient experience. A report in the Times on 25 November highlighted the possibility that NHS dentists will be required to pay back some £120 million to the health service because they were unsuccessful in reaching the targets set by commissioners. Nearly half of dental practices fell short of their targets, and individual practices are likely to have to repay tens of thousands of pounds. This exerts a destabilising influence on dental businesses, whose partners will rely on their NHS revenue to invest in the equipment or resources necessary to treat their patients. It must be remembered that all capital, consumable and staff costs are funded within those UDA targets. PCTs must provide more flexible contract arrangements and be supported by SHAs in the development of dental health strategies, the collection of local oral health data and improvement of performance management. Dental commissioning should not be viewed as low priority, and I support the Health Select Committee’s recommendation that the department and SHAs should clarify how they intend to improve this performance management. The noble Lord, Lord Darzi, in his review High Quality Care for All, recognised the importance of dentistry in primary care and noted that access to NHS dentistry is still a problem. He stressed the importance of the delivery of preventive, high-quality care and recognised that target-driven systems are not the way forward. I hope that the noble Lord will be able to address the profession’s great concern over the report’s aspirations and the general concern over the reality of NHS dentistry under the current contract. The Minister set out a commitment to continuous improvement in the quality of care received by patients, noting the recent consultation on the role of the Care Quality Commission in regulating the safety and quality of medical and dental practices, and pledged to spread the Quality and Outcomes Framework approach, noting that some PCTs were already developing ““quality scorecards”” for dental services. I welcome the Government’s support for fluoridating water supplies in conjunction with a general oral health strategy, but regret that proposed new legislative options for strengthening tobacco control may now only apply to display rather than use. I am sure that the noble Lord will let me know if that is incorrect. Tobacco use is the leading cause of oral cancer in the UK and, despite improvements in survival rates for many cancers, continues to kill some 50 per cent of those who develop the disease within five years of its detection. As well as the well publicised issues of making tobacco less appealing and less available, dentists must be provided with the time to build trusting relationships with their patients so that they can offer preventive health advice and support—time to explain the importance of not smoking, not drinking to excess, eating a healthy and varied diet and taking care of their teeth. I hope that the Government will raise awareness of oral cancer and the importance of visiting the dentist regularly so that problems can be spotted and treated early. Looking forward to 2009, I hope that dentists will see a more constructive dialogue with the Department of Health. Progress must be made in the development of new models of effective and innovative commissioning of dental services with a more flexible contract, which, as I have said, should be amended to make way for the more preventive dental health service that I have explained. It is also important in 2009 that steps are taken to guarantee the future of dentistry—the future of aspiring dentists currently studying in, or contemplating application to, dental school. Expansion of dental education in recent years, whether it be the increasing number of students or the opening of new institutions, means that the already stretched pool of dental academics has come under further pressure. The number of dentists opting for academic careers will need to be carefully monitored to ensure that the pool does not diminish to the extent that the quality of dental research and teaching are jeopardised. In conclusion, I am sure that the Minister will join me in welcoming the formation earlier this week of an All-Party Group on Dentistry, to be chaired by Charlotte Atkins. It is the group’s intention to monitor the progress of the Health Select Committee’s recommendations for NHS dental services while investigating and raising awareness of oral health issues in general.