Queen’s Speech

Lord Colwyn Excerpts

Monday 9th June 2014 Lords Chamber

[Lord Colwyn (Con)]

My Lords, for the past 20 years I have been able to use the debate on the gracious Speech as a vehicle for my comments on the state of the NHS and dentistry. I hope that noble Lords will forgive me for extending that personal tradition this evening.

Progress towards the introduction of a new, more preventive, contractual basis for dentistry has been welcomed. Work continues on contractual reform, which forms a key component of the vision for the direction of NHS services. In April, my noble friend Lord Howe attended the BDA annual conference and announced the Government’s intention to move to a more advanced stage of reform, with selected practices—prototype pilots—testing whole variants of a possible new system, preceded by an engagement exercise. This exercise, aimed primarily at the dental community, is an opportunity to widen understanding of dental reforms within the profession and for it to contribute to the shape of the prototype pilots planned to start during 2015-16 and manage expectations about the pace and scale of change to be expected. He stressed the need to “get it right”. At first, different elements will be adopted by a select number of practices, with a view to rolling them out later on. He also stressed the importance of improving access and quality, and the need to take this into account. Capitation will be a central part of remuneration together with some payment for quality, related to activity in order to deliver a balanced system.

The pledges made to dentists and dental patients by successive Governments must now be confirmed and the final stages of contract reform completed. The work of the task group launched in 2012 to look at care for vulnerable and hard-to-reach patients must also be implemented. Care in settings such as residential homes and through reaching out to those who might not otherwise avail themselves of dental care is vital if we are serious about reducing the oral health inequalities that persist in this country. A focus on preventive treatment may not only yield long-term savings but improve the quality of life across the country. NHS England has a legal duty to commission dental services to meet local needs. More than 29.9 million people were seen by an NHS dentist in the 24-month period ending on 31 December 2013.

Searching questions have also been posed this year by the dentistry call for action. This consultation, which closed on 16 May, was intended to stimulate debate about how we could achieve the necessary transformational change if debate about the NHS is to go forward fit for the future. Vital in delivering that future will be the dental students of today, a group facing difficult challenges in recent years. The department must take the necessary steps to ensure that 2015 does not see a repeat of what has become the annual shortage of dental foundation training places for new graduates. This problem, which year after year denies new dentists the chance to pursue careers in the NHS, must be a priority.

Levels of pay for dental foundation trainees must be sorted out. It has been deeply worrying this year to see a proposed 8% reduction in the salaries, a proposal first ventured as one of a number of efficiency savings being sought by NHS England at the start of April 2014. The BDA moved quickly to condemn the proposal, warning that it would be seen as an attack on the most vulnerable members of the profession. Despite that warning, the Department of Health has signalled its intention to press on with the cut. The dental profession will be stressing in the strongest possible terms that the proposal is absolutely unacceptable. Cutting the salary for those beginning DFT in September 2014 is particularly unfair to those who have already accepted their place, expecting a higher salary than they now stand to receive. Dentists themselves face a postcode lottery on their earnings. An independent review body’s call for an across-the-board 1% rise for salaried and hospital dentists was rejected. Recent years have seen support for salaried primary care dentistry ebb away, with staff posts not being filled and facilities left to decline.

The workforce of consultants in dental public health requires strong positive action. In Answer to a Question that I put down on a possible extension of the current 12-month fixed-term contracts, answered as HL7006, my noble friend Lord Howe announced that Public Health England has commenced,

“a review of the number of dental public health consultants required to meet its statutory and non–statutory functions”.—[Official Report, 13/5/14; col. WA 476.]

Public health issues are crucial in the fight for improved oral health. Water fluoridation—a measure recognised among the dental community for its ability to improve oral health and narrow inequalities—is one whose full potential remains untapped, with many communities in England that might benefit from its introduction still going without it. It is important that we also reaffirm our commitment to the fight against oral cancers. There is growing recognition among the dental community of the value of extending vaccination against HPV to boys, and I encourage the Government to listen to that advice.

My time is up but the BDA agrees with the principle of business regulation. There must surely be a stronger role for the GDC in the regulation of bodies corporate. Since 2010, much progress has been made in the field of oral health and dentistry; that momentum cannot be allowed to falter. A new contract, a focus on prevention rather than cure and appropriate regulation could be essential in delivering a cost-effective and patient-focused dentistry, with stronger health outcomes for the British people.