Queen’s Speech

Lord Colwyn Excerpts

Tuesday 15th May 2012 Lords Chamber

[Lord Colwyn]

My Lords, there is no reference to the National Health Service in the gracious Speech but I should like to use the opportunity provided by this debate to update the House on the state of NHS dentistry. In May 2010, I stressed the importance of continuing the process of reform that started with the 2009 Steele review. In the coalition agreement, the Government committed themselves to introducing a new dentistry contact, which would focus on achieving good dental health, and to fully piloting any changes before introducing them.

Good progress has already been made. Since last September, 70 dental practices around the country have been piloting a new contract based on a capitation model, with an additional focus on the quality of clinical outcomes. The early feedback from these pilots has been positive: practitioners and the public are happy that more time is being spent with each patient and that there is greater emphasis on preventing oral health problems. These pilots were originally commissioned to run for a year but the Department of Health recently extended the programme until March 2013. This is a commendable approach. Extending the pilot period will allow more time to produce meaningful results, which will be of great use when developing the final proposals for the new contract.

I also spoke of the mounting challenges that dental practitioners face in the management of their practices, drawing particular attention to the additional regulatory burden that registration with the Care Quality Commission was about to impose on them. As we now know, the CQC was not ready to take on the registration of dentistry by the statutory deadline of April 2011 and experienced severe administrative and policy difficulties as it attempted to do so. Last September, the House of Commons Health Committee’s review of the CQC concluded that the pressures imposed by the registration of dentists led directly to a 70% drop in the number of inspections that the CQC carried out, compared to the same period in the previous year.

That report also recognised how frustrating the experience of registration had been for dentists. The CQC seemed to have little knowledge or experience of how dental practices actually operated, applying a one-size-fits-all model of registration that was more appropriate for social care than any other health service provider. When dentists contacted the CQC with queries about the process there seemed to be no one with the necessary expertise in dentistry to assist them, which frequently led to contradictory advice being given out. It was as a result of these difficulties that the CQC and the Government took the decision to delay the registration of GP practices. Dental service providers were already heavily regulated. Many dentists felt that CQC regulation of dentistry was not appropriate or proportionate and their registration experience has not persuaded them otherwise. Recognising that this is an issue, the Law Commission recently launched a consultation into how the regulation of health and social care professionals could be made simpler and more consistent.

By coincidence, I talked this morning at the launch of the British Dental Health Foundation’s National Smile Month to the Chief Dental Officer, Barry Cockcroft. He assured me that all was well with the general dental practitioner CQC registrations and that any remaining problems were with general medical practitioners. Perhaps the Minister could write to me—or ask his noble friend Lord Howe to write to me—to clarify the current situation concerning the CQC and medical and dental registrations.

Dentistry also faces great changes as a result of the Government’s health reforms, with the commissioning of dental services transferring to the national NHS Commissioning Board. Local expertise will still have a vital role to play in the commissioning of services, and the Government need to ensure that this expertise is appropriately utilised. The role of consultants in dental public health is particularly important as they will need to be accessible not only to the national Commissioning Board but to local health and well-being boards. The Department of Health is also developing proposals for local professional networks in dentistry to work alongside the local primary care commissioning teams in developing and delivering local service plans. These networks will enable the dental profession to influence local and national strategy and policy, ensuring that best practice and clinical expertise are embedded throughout the system.

The coalition has made a strong start in tackling the issues facing dentistry. There is still more work to do on contract reform, regulation and commissioning. I urge the Government to maintain their focus and continue working with the profession to deliver the best possible outcomes for patients.