Oral Health Services

Dan Poulter Excerpts

Wednesday 17th October 2012 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I congratulate the hon. Member for Plymouth, Moor View (Alison Seabeck) on securing the debate. I do not think that she needs to justify her pursuit of this issue to her local press, because it is an important issue, and we should all pay tribute to her long campaign. The need to improve dental health is often underestimated, and it is not discussed enough in the context of the health service. I am sure that the hon. Lady will continue to campaign strongly, as a member of the all-party group, in the Chamber and in her constituency, where she supports the medical and dental schools. I should be delighted to take her up on her invitation: I intend to go to Plymouth in the near future, and I hope to be able to visit the dental school then.

The hon. Lady rightly observed that, in health care generally, we do not talk enough about the fact that prevention is much better than cure. In many parts of the health service, payment systems have not properly rewarded staff in line with the recognition that good health care is about preventing people from becoming unwell in the first place, rather than picking up the pieces when they have developed cancer or other problems. The new dental contract makes it easier to identify key prevention issues. It focuses on the desirability of spotting early symptoms of ill health—in this instance, oral ill health—rather than spotting them much too late, when a patient’s cancer is already well advanced.

The hon. Lady also referred to important public health concerns about smoking and alcohol consumption. She was right to draw attention to the problem of binge drinking, not just among young men but nowadays increasingly among young women, and to the effects of excessive smoking and drinking on oral health. The links between high alcohol consumption and smoking and a number of cancers—particularly throat cancer and other cancers in the mouth—are well established. I am optimistic about the possibility that the new dental contract and the important focus on preventive care will enable us to identify cancers, and those who are at risk of developing them, much earlier, rather than waiting to treat people later when they are very unwell. The health service in general needs to be geared up in order to do that better, particularly in the context of oral health.

The hon. Lady also raised the issue of the European platform on oral health. I believe that the all-party group hosted a reception on that recently, praising its work. All the work we have been doing in this country has been rightly highlighted in that report, and I shall discuss that a little later. It is worth dwelling on how over the past 20 or 30 years, under consecutive Governments, we have had a record of improving oral health and improving access to dentistry, particularly in the past few years. If we are taking oral health seriously, it is important that we improve access, and we are beginning to do that well.

As the hon. Lady knows, in 1973 the average 12-year-old in England and Wales had five decayed, missing or filled teeth, but by 2003 the UK average was 0.7 fillings. So we have made great strides in the past 30 or 40 years. That improvement was partially due to the introduction of fluoride toothpaste in the 1970s—that brings me to the issues raised by the hon. Member for Strangford (Jim Shannon) in his interventions—and to the hard work of dentists up and down the country. They, along with dental hygienists, highlighted the importance of good tooth care and preventive measures through effective tooth brushing using toothpaste.

Adult oral health has improved in a similarly impressive manner. In 1968, the first adult dental health survey found that 37% of the adult population of England and Wales had no remaining natural teeth, but the 2009 survey found that the proportion had dropped to 6%. Again, that is a mark of how this country is taking this issue seriously, and we must continue to do so. Access to NHS dentistry has grown steadily, with more than 1 million more patients having been seen by NHS dentists since May 2010.

The hon. Lady rightly highlighted the European platform on oral health report and outlined some of its recommendations. I have read the report and it rightly identifies the promotion of good oral health as one of the most significant health care challenges facing EU countries. However, as she said, England’s oral health compares well with all the countries surveyed in the report, and we are especially pleased that it highlighted the “Delivering Better Oral Health” toolkit, which was a guide to prevention in practice published jointly by the Department of Health and the British Association for the Study of Community Dentistry as an example of good practice. Notwithstanding the fact that we have made good progress historically and that the European platform on oral health report highlighted the good things we do in this country, we must never be complacent. We must continue to ensure that we drive further improvements and reduce the inequalities in access and in oral health that still exist and are very real in some parts of the country.

The hon. Lady raised the issue of the new dental contract. The reforms of the contract focus on a number of things, including improving access to care. There is an important focus on preventive dentistry—preventing bad things from happening to people and on picking up things early. As she is aware, the new contract that we are introducing will be based on registration, capitation and quality, rather than a more payment-by-results system. Such an approach will allow more focus to be put on those preventive measures, rather than on the more reactive measures that a payment-by-results system tends to deliver. The new contract will replace the existing model that rewards units of dental activity rather than taking a more holistic view of what is good for the patient. We can learn from this approach as a good model of health care as we develop tariffs throughout the health care system. Such a model is already being used well in some parts of the country—in stroke care and other areas of preventive care, for example, where a more holistic, joined-up approach to what happens before hospital admission and afterwards in rehabilitation is as important as immediate treatment in a hospital setting.

Elements of that contract are being tested in 70 practices at the moment, and we are rolling them out to an additional 20 to 25 practices as part of the pilot to make sure that that contract is fit for purpose. When the further results from those are available, I will be happy to share them with the hon. Lady, so that we can ensure that we design the best contract.

[Alison Seabeck]

Perhaps it might be appropriate to share some of that information with the all-party group, rather than one to one.

[Dr Poulter]

Absolutely, and I would be very happy to do so. The hon. Lady’s commendable focus on this area of health care would, of course, lead me to wish to share that information with her, but of course I would be delighted to share it with the all-party group, too. The work done by a number of all-party groups, including hers, helps to ensure that many of these important issues are never forgotten and that they are kept at the forefront of the minds of our fellow parliamentarians.

Of course, as the hon. Lady rightly highlighted, there are some inequalities across the country and, as we know, among different socio-economic groups. Improving access to care will play an important part in addressing those health care inequalities. I draw the attention of the House to our progress in preventive care, in addition to the new contract. The number of adults being treated with fluoride varnish, which is one of the most effective preventive treatments available, rose by 43% last year. Among children the figure was 64%. By investing in preventive treatment, we are ensuring that future generations will enjoy good oral health throughout their lives. In addition to promoting the application of fluoride varnishes, we will seek to promote the learning of lessons from the best performing areas of the NHS and to work with the devolved Administrations and local and regional government to iron out inequalities across different geographical areas. It is important that in all areas of health care, including dentistry and oral health care, we learn from things that have gone well so that we can roll out that good practice elsewhere and ensure that it is learned from. We should also be open and honest when things have not gone so well, so that we can learn lessons and improve services for the benefit of patients.

The hon. Lady mentioned the Peninsula dental school and rightly stated that it was opened in 2007, under the previous Government, as a joint venture between Plymouth and Exeter universities. The school has been a great success. I know that she has been a great advocate for it and is rightly very proud of what it has achieved and of what it is doing in Plymouth. Earlier this year, the two universities announced changes in how the school is run. Exeter will now operate a medical school of its own while the teaching of both medical and dental studies will continue in Plymouth. I know that it is important that her constituents are reassured about that and that as we have a successful dental school we should recognise that and support its continuing function. Many of the changes were purely administrative, rather than to front-line services.

I acknowledge the concerns expressed by the hon. Lady tonight and elsewhere, but both universities have stated that the split will improve the administration of medical education in the south-west and we expect the changes to have no negative impact on the dental school. I know that she will ensure that the voices of the dental school and her constituents are heard loudly both locally and in Parliament, and I am happy to support her in that.

Let me finally make a few points about dentistry in the south-west of England. The hon. Lady talked about NHS dentistry in her constituency, including the case of an individual constituent who had problems accessing it. We know that we have further to go in improving access, but the Government have made good strides in that direction, as did the previous Government. We have made significant progress and the latest NHS figures show that since March 2010 the number of people who accessed an NHS dentist in the south-west over the previous 24 months has increased by almost 150,000. That is a strong step in the right direction.

In Devon, £500,000 was invested in four practices in March to provide a further 6,500 dental places, which will become available over the next 12 months. I understand that at the same time a further two practices have increased their capacity and will provide an additional 3,000 places over the next 18 months. We are continuing to ensure that we widen access to dental services in the south-west.

In the south-west, as in the rest of England, we are making vital improvements to access to NHS dentistry and putting in place the measures needed to continue the improvements in this country’s oral health. Access is rising, rates of decay have fallen and continue to fall, and we are piloting a new contract designed further to increase access and improve oral health, focusing on prevention as a key part of our efforts to improve people’s oral health and general health, and to keep them well. We are committed to ensuring that NHS dentistry is available to those who want it, and improving oral health is at the heart of what dentistry does.

Of course challenges remain. We must make sure that pilot studies are effective and that we listen to any concerns that emerge from them, so that we can improve the new contract accordingly. The fundamental focus is on moving away from a reactive service to a preventive care service. That will both improve oral health by reducing the incidence of cancer, and give children the best start in life by engendering good dental health habits through the involvement of hygienists and other practitioners. Our aim is to move dental care on to a more stable footing. This Government are committed to continuing the progress that consecutive Governments have made in widening patients’ access to dental services, particularly those patients who have had difficulty accessing such services in the past.

Question put and agreed to.