Mike Penning (Hemel Hempstead) (Con): It has been a short, but excellent debate, and I apologise to hon. Members who have not had the time that they deserved — perhaps having three statements at the start of the day did not help. I know that the Chairman of the Select Committee raised that during a point of order earlier.
I shall try to touch on some of the points raised by hon. Members this evening, starting with the Chairman of the Select Committee. I was a very proud member of the Select Committee, and we heard earlier that there were calls for an inquiry into dentistry some time ago. I agree that there were such calls, and I praise Committee members for calling for that. I also praise the Committee for the quality of the recent report, which was very fair. It is scathing in places, but it also offers forward-thinking and innovative ideas on how the contract could be progressed. I do not agree with parts of the report, however, and Her Majesty’s Opposition also have some ideas on how we could make progress, to which I will return shortly.
I was interested to hear the Chairman of the Select Committee, the right hon. Member for Rother Valley (Mr. Barron), refer to his dentist earlier, because unless he is having treatment at the moment, he has not got a dentist as this contract does not involve registration. Therefore, unless someone is undergoing treatment, they do not have a dentist. I would have liked that to be made clear in the report; I do not think it is generally known by the public, but it is a fundamental point of the contract, which was imposed on dentists in 2006, that people are not registered unless they are actually having treatment. That is a very important issue, because if we were to go out on to the high streets of this country and ask members of the public who rely on NHS dentistry whether or not they are registered with a dentist, the vast majority would still say they were even though they are not. They might turn up at the dentist and say, “I need treatment”, but that dentist might have already run out of UDAs; that dentist might already have said, “I can’t treat any more patients this year.” Those are the circumstances when some of the problems are occurring.
Dr. Murrison: Does my hon. Friend not agree that one of the most powerful ways of incentivising dentists is to register patients, as they would then have an incentive to build up a list of people with good oral health, which would ultimately reduce their work load? That aspect of incentivisation has been completely missed in this new contract.
Mike Penning: I completely agree with my hon. Friend and I will come on to that point later. I do not see how we can have preventive dentistry without having some form of capitation and registration. I think the right hon. Member for Rother Valley alluded to that in his speech.
The report digs deeply into what NHS dentistry is capable of doing in this country today. Should we actually give up on parts of the country that rely on NHS dentistry? There is a postcode lottery; it is a fact that in some parts of the country that I have visited there is a plethora of NHS dentistry. In Newcastle and the north-east there is almost no private dentistry, whereas in other parts of this country—I am referring to England now—there is almost no NHS dentistry. This is a national health service, however, and that is partly—although not completely—why this contract was created. It was already in difficulties before, which is why the Government, in good faith, tried to bring in a contract that would help, but instead it has made the situation worse.
When the Select Committee took its evidence, about 900,000 people who had had NHS dentistry had lost it. The latest figure is 1.2 million. That means there are now 3 million people in this country who need to rely on NHS dentistry but who cannot access it. As the economic climate becomes increasingly difficult, more people will need to rely on NHS dentistry. I listened carefully to the comments of the hon. Member for North Norfolk (Norman Lamb) when he said he is in Denplan. A lot of people who are in Denplan will not be able to continue to afford to make those monthly payments should they lose or change their job. The demands on NHS dentistry will, therefore, increase.
We must look at what the Government might propose in the review. My personal view is that this contract is a damaged brand, with its language of UDAs. From meeting dentists around the country, it is clear that they are not confident that the contract can provide for the British people the sort of dentistry we expect in the 21st century. I therefore look forward to the review with a degree of scepticism in terms of where the contract can go.
Sandra Gidley: The panel undertaking the review has been welcomed, but I note that it contains no community dentist and so some dentists will be wondering about its composition. It seems to be made up of a couple of academics, somebody who apparently wants to be the chief dental officer one day and a failed commissioner who commissioned dental services without doing a needs assessment. Does that augur well for the future?
Mike Penning: No, it does not. In fact, it resembles something similar to what happened when this contract was imposed in 2006.
Lots of hon. Members have discussed the importance of proper continuity and discussion with the professionals in the dentistry profession. As has been mentioned, no one body represents the whole of dentistry and the dentistry profession—perhaps it would be better for the dentists if they did have one body that could stand up and fight their corner. I am very concerned that there appears to be a lack of engagement between Ministers and the professionals.
I did not intend to upset the Minister at Health questions earlier today, but I clearly did so. Let me therefore go back for a second to where we were. I asked why no Minister went to the British Dental Association conference in Manchester this year to speak on behalf of the Government, given that the contract is so controversial within the profession. The Liberal Democrats spokesman was there, I was there and so, too, was the chief dental officer. He is a civil servant—he is not a Minister of the Crown and he is not elected; he is appointed by the Secretary of State for Health—and it is fundamentally unfair that a civil servant is there to represent the mistakes and problems that the Government have got themselves into on dentistry. Both the Liberal Democrats spokesman and I refused to debate with him in public, although I would have been more than happy to have debated with a Minister.
I understand that the Minister was busy that day, but I was with a Health Minister on the train to Manchester—the hon. Member for Bury, South (Mr. Lewis) was a Health Minister at the time. I said to him, “Fantastic, you are obviously coming to the BDA conference to represent the Government.” He replied, “No, I am going home.” The only person who was representing the Government was the chief dental officer, and that was fundamentally unfair on him, because he was put in a position that only an elected Minister should be put in.
As the process goes on and as this contract is reviewed, I am very concerned about whether the Government will have the courage to admit how much of the contract they have got wrong and how much of it has affected people in this country. We see reports in the press of people extracting their teeth with pliers and people going to the pharmacists to get do-it-yourself fillings, which are available in most pharmacists in this country, because of the lack of NHS dentistry. That might be down to fear; it may not be fact, but the perception of a lack of such dentistry exists.
We have discussed the UDAs at length today. It cannot be right that in band 2 up to six fillings or one root canal or an extraction can be carried out. The obvious situation to consider is that of a dentist who is under pressure. What is such a dentist going to do? I hope that all dentists do what is right for the patient, but given that they are looking at the UDA rather than at the outcomes, it is obvious that, at times, real problems will arise. Many dentists have said that they are not willing to work under this contract and they have walked away, and we have to encourage them to come back.
One area of the report that concerned me—this issue came up when I was on the Select Committee and we were examining charging—was the bit dealing with dentists who say “I will keep your children on only if you take me on as a private dentist.” Such an approach is fundamentally wrong, because it is blackmailing people by saying that they can have NHS dentistry only if they pay for a private insurance plan or they pay as they go. But I think that we have to accept the fact that because so few dentists have been working in some parts of this country, I cannot, at this stage, see anything wrong with a dentist who is willing to take on a child, with no strings attached, under an NHS contract. That is better than nothing, and we need to examine such an approach. I know that the Select Committee was concerned about people being pressurised into certain things. That is fundamentally wrong, but if we can encourage private dentists to come back into NHS dentistry and take children on without any strings attached, that has to be good. On average, children have 1.5 fillings or extractions by the age of five, so the oral hygiene of our youngsters is going in the wrong direction. If we do not address children’s oral health problems, that will have an effect as they get older. It is therefore vital to address the issue of oral health in the young.
We have to encourage more dentists to come back into NHS dentistry. We have to look seriously at the court case earlier this week, which the Government lost on appeal when a dentist objected to the fact that, whether he had performed well or poorly, the PCT could remove his contract at any time. The courts ruled that that was wrong. We should extend the length of contracts, so that dentists can invest in their practices. PCTs do not pay for surgeries or equipment: the investment has to be made by the dentists themselves. There must also be a presumption that should a dentist want to move on or retire, they have the right to sell on the goodwill in their contract. If we want dentists to come back into the NHS, or young dentists coming out of training schools—I have visited them and they are fantastic—to come into the NHS, we must give them the confidence to do so, especially in this difficult economic climate.
I agree completely with the Committee: if we want to understand what is happening to dental hygiene in this country, we have to have registration and a per capita system; otherwise, we will not have a national health service. Instead, we will have the postcode lottery that has put NHS dentistry into crisis today. I welcome the report and I congratulate the Committee on it.
9.46 pm
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OTHER INTERVENTIONS IN THE SAME DEBATE
Mike Penning (Hemel Hempstead) (Con): The professional bodies can defend themselves, but one of the reasons for that response is that they felt that the decision was imposed on them. It was not piloted, and the evidence from the previous pilots were ignored. If it had not been imposed on them, they might have stayed around the table to discuss a better contract, but it was imposed without their agreement.
Mr. Barron: Yes, but it was also imposed because they were not engaged in the process. In all the subsequent contracts, such as the hospital doctor contracts or the GP contracts, we have seen what some would call good trade union leadership in the negotiations. I would call it good trade union leadership—it is what I used to do before I came here as a politician—and my reaction is “Well done.” That is what people should do from that side of the table. There has been a lack of such leadership in dentistry, not just in the 2006 contract but for a substantial number of years before that, too.
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Mike Penning: With that in mind, will the Minister consider whether dentists should be allowed to prescribe nicotine replacement therapy?
Ann Keen: We should consider all aspects of smoking cessation.
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