Queen’s Speech

Lord Colwyn Excerpts

Thursday 19th May 2016 Lords Chamber

[Lord Colwyn (Con)]

My Lords, I declare my interest as a retired dental surgeon and a fellow of the British Dental Association. I am sure that noble Lords will not be surprised to hear that in my remarks I am keen to turn the attention of the House towards the important but too often overlooked field of dentistry and oral health. As noble Lords will probably realise, the noble Baroness, Lady Benjamin, virtually made my speech word for word, but that is the problem with getting briefs from the same source.

Yesterday, I was disappointed to discover that the Government have yet again continued to kick the badly- needed reform of health regulation into the long grass. In the wake of the Francis inquiry back in 2013, the Prime Minster pledged to sweep away the outdated and inflexible legislation governing health regulators. Yet, despite repeated commitments to reform of the regulation of health professionals, three Queen’s Speeches later parliamentary time has still not been found to introduce a Bill which would simplify and modernise the regulatory framework for dentists and more than a million of their fellow healthcare workers in Britain. The complex, burdensome and frankly antiquated laws we currently have in place hurt patients and practitioners and cost time and money. Will the Minister set out a clear timetable for action in this area?

While there was no mention of improving health outcomes in the gracious Speech, statistics clearly show why oral health deserves much more attention this Parliament. One in four five year-olds in England has tooth decay, and the number of children facing hospital admission for tooth extractions under general anaesthesia went up by a quarter between 2010-11 and 2014-15. While data published last week by Public Health England show modest improvements in the oral health of English children, the pace of progress is significantly slower than in Scotland and Wales, where devolved Governments have introduced innovative preventive dental health programmes. Data also show that despite the small overall improvement, regional and social inequalities in oral health continue to persist. I welcome the proposed measures to establish a soft drinks industry levy to help tackle childhood obesity, and I support the noble Baroness, Lady Walmsley, in the use of fluoridation, which should be much more widespread than it is at the moment. I urge the Minister to show the same ambition and appetite for innovation as her colleagues in Holyrood and in the Senedd. The Childsmile and Designed to Smile schemes have cut NHS treatment bills and shown that dental disease and deprivation do not have to go hand in hand. Will the Minister consider learning from their success and investing in a similar national oral health programme to drive improvements in children’s oral health in England?

I am pleased to see that access to NHS dentistry continues to increase, with the latest data showing that more than 30 million patients were seen by a dentist in the 24 months. However, there are still many areas where access to a dentist remains a significant challenge and there is anecdotal evidence of constituencies where not a single practice accepts new NHS patients. I am sure the Minister will agree that this is largely due to the way NHS dentistry is currently commissioned, with the current dental contract putting a cap on how many patients each dentist can see in a year. This April marked the 10th anniversary of the introduction of the current contract, and to mark the occasion the British Dental Association conducted a survey of more than 1,200 dentists. Seven out of 10 said that the current contract prevented them being able to take on more national health patients.

Noble Lords will agree with me that a shift in focus from treatment to prevention is crucial if we are to ensure the long-term sustainability of the NHS, and this is as true in the area of dentistry as it is elsewhere in our health system. It is crucial that the new contract for NHS dentistry improves access and rewards dentists for keeping their patients healthy rather than for carrying out interventions, as is currently the case. Dentists and patients were promised a new contract back in 2010, but the Government are dragging their feet and the new arrangements are not expected to be rolled out earlier than 2018-19.

With a second round of pilots going live this spring, this time labelled “prototypes”, it seems increasingly likely that we might end up with little more than a watered-down version of the current system. The prototypes contain the tarnished structure of payment per unit of dental activity alongside payments for capitation and quality. That is a step back from the previously tested pilots, which moved away completely from rewards for activity. The BDA feels strongly that the options currently on offer are decidedly unambitious and thinks that all reward should be based on keeping local communities healthy, not on the number of procedures performed. How can a system improve oral health, deliver prevention and provide continuing quality care when the proposed contract continues to offer perverse incentives to treat instead of rewarding dentists for improvement in oral health? Both dentists and their patients deserve a contract with a square focus on prevention, and neither of the options being tested goes far enough in meeting that objective.

Lastly, I want to reflect on the recent hike in charges for NHS dental services. As many noble Lords will have heard, fees for treatment are going up above inflation, by 5% this year and a further 5% next year. I fear that this unprecedented increase will discourage patients who most need to see the dentist from going to see one, and will undermine the relationship between patients and practitioners. One in five patients already says that they had delayed dental treatment because of its cost, and this will only go up as the cost of NHS dental treatment continues to rise much faster than people’s earnings.

I am also concerned that the money raised this way is not ring-fenced to be spent on improving dental care or access to dental services. Dentists are being asked in practice to play the role of tax collector while their patients are singled out to subsidise the wider health service. Expenditure on primary-care NHS dentistry as a proportion of the total NHS England budget has gone down by 13% in cash terms over the past four years, while proceeds from dental charges were going up even before this latest surge in prices. Treating dental patients as a source of easy money is not fair and, as the increasing sums spent on hospital extractions show, it is also a false economy.

Much progress has been made in the field of oral health over the past few decades and that momentum cannot be allowed to falter. Adequate funding for NHS dentistry, investment in reducing oral health inequalities, a new regulatory framework and an improved, truly preventive contract are all essential components of not only delivering quality cost-effective dentistry but improving health outcomes for the British people.