Dental Care

Debate between Lord O'Shaughnessy and Lord Colwyn

Thursday 1st February 2018 Lords Chamber

[Lord O'Shaughnessy]

I am afraid I do not recognise the picture that the noble Baroness paints. She is quite right that 25% of five year-olds are not decay-free; obviously, that is not good enough, but that figure has been increasing over the past 10 years. I should also point out that there are more dentists practising in NHS dentistry than ever.

The noble Baroness is quite right that a pilot has been going on in 75 dentists’ surgeries. An evaluation report will be produced by the deputy Chief Dental Officer in the next few months. That will set out the path toward the full reform of the dental contract.

[Lord Colwyn (Con)]

My Lords, dental care would be improved by the addition of fluoride to the water supply. This has been agreed by my noble friend and his department, but not all water authorities are prepared to take this step. In the last decade, dentists’ average earnings have gone down by a third in real terms. This is of great concern to dentists, who do not receive any government funding and have to cover all costs—equipment, staffing and training—unlike medical general practitioners. I declare an interest as vice-president of the British Fluoridation Society. According to a recent BDA survey, more than half of all dentists intend to leave NHS dentistry in the next five years. Perhaps my noble friend could start by looking at the current salary structures and contractual arrangements.

[Lord O'Shaughnessy]

We have talked about fluoridation a lot in this House recently. My noble friend knows the position: it is up for local areas to come forward with proposals. On his particular issue about dentists, they are doing a fantastic job in the NHS. We have more of them than ever. I want to point out that the 1% cap that was applied—we know that was because of the fiscal retrenchment that has had to take place in this country—no longer applies; indeed, we are waiting for dental review bodies to report on it so that we can arrange future payments for dentists.

Health: Atrial Fibrillation and Stroke

Debate between Lord O'Shaughnessy and Lord Colwyn

Tuesday 12th December 2017 Lords Chamber

[Lord O'Shaughnessy]

Yes, I shall certainly write to NHS England to find that out, and I will write to the noble Baroness with that information.

[Lord Colwyn (Con)]

My Lords, it is quite clear that many people do not receive the anti-coagulants that they need, and my noble friend has reminded us of the figures relating to those suffering from this problem. Since 2012, four novel oral anti-coagulants—NOACs—have been recommended by NICE as both clinically and cost effective for the prevention of stroke in patients with AF. Their use is increasing but is lower than expected. Can my noble friend explain why access to the full range of anti-coagulation therapies is not acceptable to many GPs, who appear to lack confidence in their use of NOACs, and why some patients are still being given aspirin to prevent AF-related stroke? I should declare my interest as an officer of both the Arrhythmia Alliance and the Atrial Fibrillation Association.

[Lord O'Shaughnessy]

My noble friend is quite right to highlight the benefits that come from new treatments. We clearly have a long way to go, as half the people presenting with strokes have not had those anti-coagulants, but there has been an increase in the number of pre-stroke patients receiving anti-coagulants, up from 38% to 53%, so it is an improving picture. The NICE guideline recommends the use of anti-coagulants and, critically, encourages patient choice for the new breed of NOACs and DOACs. There is very clear guidance within the system. It is getting better, but there is some way to go.

Children: Oral Health

Debate between Lord O'Shaughnessy and Lord Colwyn

Monday 4th December 2017 Lords Chamber

[Lord O'Shaughnessy]

My noble friend is quite right that fluoridation is effective. The 2012 Act allows local areas to choose to introduce it—with local legitimacy, which is important because this issue still stirs passions. We encourage any local area considering this—I believe that Greater Manchester is one—to look at the study my noble friend mentioned in order to see its effectiveness.

[Lord Colwyn (Con)]

My Lords, I am delighted that my noble friend mentioned the dental contract because the current target-driven contract was introduced in 2006. The Government committed to reforming it in their 2010 manifesto, but progress has been very slow. The latest reports speak of a national rollout no earlier than 2021. We urgently need a new contract that rewards prevention. Does my noble friend not agree that patients and dentists should not have to wait so long?

[Lord O'Shaughnessy]

Yes, I agree with my noble friend. Preventive care is important. Pilot schemes have been going on in 75 practices to look at incentivising preventive care and population care. I understand that an evaluation report of that first full year of prototyping is due to be published in the new year.

--- Later in debate ---

[Lord O'Shaughnessy]

I am certainly happy to look again at that issue because we know the benefits of fluoridation. That is one reason why more children are having fluoride varnishes, for example.

[Lord Colwyn]

My Lords, I forgot to declare my interest, so I apologise.