NHS: Front-line and Specialised Services

Lord Colwyn Excerpts

Thursday 13th January 2011 Lords Chamber

[Lord Colwyn]

My Lords, I congratulate the noble Lord, Lord Turnberg, on securing the debate and on his knowledgeable contribution. It was a privilege for me to work with him for a number of years at the Medical Protection Society.

I am delighted to be so far up the list this afternoon, although I am not sure if it is an advantage. I was given the number 2 slot in the last debate on health on 16 December and failed to excite the Minister with my questions. He has now kindly been in touch to tell me that there is a letter in my box. I am aware of the tremendous pressure that he must be under. I also failed to make an impression at Question Time earlier today and will make a comment on the regulation of herbal practitioners at the end of my few remarks, which will inevitably concern the dental aspects of front-line and specialised services.

NHS dentistry’s place in the health reforms is unusual. As well as being subject to a change in commissioning arrangements, with responsibility for primary care dentistry being transferred from primary care trusts to the new national commissioning board, dentistry will undergo a parallel overhaul of the way it works, with completely new contractual arrangements being developed. This is a pivotal time for NHS dentistry, in which the mistakes of the previous Government's 2006 reforms can be rectified. It will be vital that our reforms engage the dental professionals who will deliver care under the new system, and I am pleased to say that the British Dental Association has offered its broad support to two important parts of the reforms. The decision to transfer responsibility for commissioning from PCTs to the new national commissioning board has been viewed positively by the profession. Given the problems and inconsistencies witnessed under PCT commissioning, that is unsurprising. Dentists have also been positive about the reforms to the dental contract that the coalition Government are undertaking. These reforms build on the work of Professor Jimmy Steele, whose critical report on the current system has produced a vision of a better system. Pilots will begin in April to develop this.

On the face of it, dentistry looks to have a bright future. The risks inherent in changing systems and commissioning arrangements simultaneously were highlighted by Labour's reforms in 2006, when the ability of PCTs to manage the introduction of the new dental contract was undermined by a reorganisation of primary care trusts that saw their number halved. The success of the coalition Government's reform of dentistry will depend on having the right people in place to manage change at an early stage of the reform process. It will also require a balance to be struck between central commissioning and engaging the local expertise of bodies such as local dental committees and figures such as consultants in dental public health.

Dental public health is an important issue in its own right, and ensuring that dental public health expertise inputs into new arrangements and is integral to the wider reform of public health will also influence the success of the reform of dental care. This House needs assurance that the Government plan to utilise those local dental experts in the new commissioning arrangements.

Another lesson we must learn from the 2006 reforms is the importance of properly testing elements of reform. Two major parts of those reforms, the revised patient charges and the system of units of dental activity by which dentists' work is measured, were not piloted in the lead-up to April 2006. As I said, pilots for the new reforms will commence in April. They will test different models that will include patient registration, quality and capitation. The models are intended to lead to a new dental contract that will facilitate a more preventive approach to dental care. The pilots must be given time, they must be properly evaluated and their lessons must be learnt in dialogue with the dental profession.

The Government will need to tread carefully as they pursue each of these reforms, ensuring that a co-ordinated approach to dentistry is taken across all departments within the Department of Health. They must manage the various strands of reform that will contribute to the creation of new arrangements for primary care dentistry in England. What guarantees will the Minister provide that the work on the three strands that will impact on the delivery of primary dental care—the new contract, public health and commissioning arrangements—will be joined up and co-ordinated?

I conclude with a question that I was unable to ask earlier today. Will my noble friend offer any encouragement to patients and to the practitioners who use herbal medicine and who regard regulation—as recommended in November 2000 by the Walton committee, of which I was a member, and the Pittilo independent report set up by the Department of Health—as vital to the practice and continuation of their profession?