HC Deb 11 May 2004 vol 421 cc1-22WH

Motion made, and Question proposed, That the sitting be now adjourned.—[Ms Bridget Prentice.]

9.30 am
Richard Younger-Ross (Teignbridge) (LD)

Mr. Deputy Speaker, today's debate revolves around the words of my constituent, Mrs. Thresher from Teignmouth, who said: Why should I have to give up my heating to get my teeth fixed? She was interviewed in theSunday Express on 8 February, following a survey by my hon. Friend the Member for Sutton and Cheam (Mr. Burstow), who is with us today. She also said: There are no NHS dentists where I live that are taking new patients. I've been told to go to one in Torquay, which is 14 miles away, but I don't see why I should be expected to travel miles. I've paid my tax and my national insurance all my life and I'm entitled to free dental care but I can't get it. She went on to say that the Government had generously given her £200 to pay her heating bill. If she has to go to a dentist in Torquay or to a private dentist with Denplan, however, that £200 will go towards dental care not heating.

Mr. Anthony Steen (Totnes) (Con)

Will the hon. Gentleman give way on that point?

Richard Younger-Ross

It is very early to be giving way, but I shall do so.

Mr. Steen

I congratulate the hon. Gentleman on securing the debate, but I must tell him something that I am sure he will find interesting. National health service dentists in Torquay are not taking patients either. If his constituent had gone there, she would have wandered around and seen that wonderful resort, but she would not have found a dentist.

Richard Younger-Ross

The hon Gentleman is ahead of me. If he is patient, I will come to the fact that there are no dentists in Torquay or Paignton. Over the past year, people have been directed to those towns, and they are now being directed to places such as Barnstaple, Plymouth and further afield. I shall come to that later.

The essential question is why my constituent, who has been given extra money for heating to ensure that she does not suffer hypothermia, should be expected to put her health at risk by cutting her heating bills to pay for her dental treatment. The Government talk of giving people choices, but that is not the sort of choice that they should be encouraging.

This is not a new problem; we had a similar one in the early 1990s, when no NHS dentists were taking on new patients in Teignbridge. As hon. Members may remember, we had a Conservative Government in those days. The crisis continued for some time, and the health authority told my predecessor that it would deal with the matter. It made provision for an emergency dentist in Newton Abbot hospital, and the arrangement was heralded as a success at the time. However, as most people will know, emergency dentists do not provide ordinary dental care but deal only with emergencies and patients in pain. Furthermore, although the hospital still has an emergency dentist as a consequence of the authority's decision, people in wheelchairs cannot gain access to the hospital and must still go all the way to Torquay for emergency dental treatment.

Relief did come when new dentists decided to set up practices in Teignbridge. For a short while, it was fairly easy to register with a new dentist. There is a certain bitter irony for local people in that many of those new dentists who set up have now de-registered as NHS dentists. That is part of the reason for the current crisis in the south-west, Teignmouth, and especially Teignbridge. The Minister will no doubt tell us about the action plan for the south-west peninsula—we have an action area because we have a crisis area. I hope that the Minister's response will take into account my comment, which I am sure will be echoed by other hon. Members from Devon, that we have a crisis that needs urgent and rapid action.

I shall concentrate for a moment on my area, which is primarily covered by the Teignbridge primary care trust. In June last year, 46 per cent. of the population of 109,000 were registered with national health service dentists. The Minister and hon. Members will know that that is below the national average of 48.6 per cent; we were already doing badly last June. The crisis began in February last year and has continued, with the figure for April this year falling to only 42.12 per cent. That is a disgrace and a sad reflection on the state of the Government's policy on dental care in the south-west. For those who are statistically minded, that is a decrease of 8 per cent. The figure for under-18s is better—56 per cent.—but the figure for the over-18s, which is a true reflection of the situation of the elderly in my constituency, is 39.49 per cent.

The national figures often quoted in newspapers are for the number of dentists per thousand of the population, and I am horrified at how few dentists there are in some areas. However, that figure does not tell the whole story. In Teignbridge we have 44 dentists; there are 56 NHS contracts in 20 practices. However, we must consider how many patients they take on. Of those 44 dentists, only three have more than 2,000 NHS patients, which is the UK average. Fifteen of the 44 dentists have fewer than 500 NHS patients, and five have fewer than 50. The number of dentists per thousand of the population is a meaningless statistic. We must consider the number of people who can register with an NHS dentist.

We started writing to the Minister at the beginning of last year, saying that we again had a growing crisis. The Minister helpfully wrote a letter to one of my constituents on 21 December last year. In it she said: On 18 September I announced additional funding of £65.2 million to support change and help improve access, quality and choice for patients. The funding will be targeted at those PCTs where access is a real problem. There is also a further £1 million now to help PCTs, local dental committees and dentists to prepare for the change in the way dental services are commissioned. In 2004–5 an additional £15 million revenue funding will be made available to PCTs. Those are fine words, and I would hate to accuse the Minister of spin because I suspect that it is not, but since the Minister said that that money was being made available, 7,000 more patients in Teignbridge have been de-registered as five dentists have retired or gone private and have not been replaced.

Dentists are entitled to retire—we all reach that stage at some point, or at least most of us hope to do so—but they are fed up with the current contract. Peter Zeltmann, of Salisbury Villa dental surgery, is one of the dentists who moved into the area in the mid-1990s and was a saviour. In a letter to his patients, he says: For several years now we have postponed making any changes in the hope that the situation would improve but unfortunately there is little sign that it will. Consequently I have concluded that it is no longer feasible to continue seeing adult fee paying patients under the NHS.

Mr. Zeltmann concluded that he could no longer continue, and recommended that his patients go to Denplan. As the Minister knows, many people cannot afford to do so. Mrs. Thresher, whom I mentioned, is on income support and cannot afford it. She cannot afford many luxuries, and dental treatment has become a luxury to her.

Mr. Hugo Swire (East Devon) (Con)

In Brent, East the Liberal Democrats produced £100 vouchers to give back to everyone in council tax. Having heard their leader on the "Today" programme this morning, I believe that that is no longer their policy. If the Liberal Democrats had stuck to that pledge, however, the hon. Gentleman's constituents would be £100 better off. Would not that have put Mrs. Thresher in a better position to afford dental treatment?

Richard Younger-Ross

I am not sure whether the hon. Gentleman is actually following the debate. I thought that we were talking about dental provision in Devon. He wants me to go down a route that I am sure you would not wish me to follow, Mr. Deputy Speaker.

Mr. Deputy Speaker

You are quite right.

Richard Younger-Ross

I am grateful for your guidance, Mr. Deputy Speaker.

When the PCT considered the community consultation, which was conducted by the district council in 2002, it found that dentistry was the first health priority for local people. Currently there are no NHS dentists in Teignbridge. I do not think that there are any in Exeter. I note that the hon. Member for Exeter (Mr. Bradshaw) is not here. Nor are there any in Torquay, South Hams or south-west Devon. People are still being told to go to Plymouth. The hon. Member for South-West Devon (Mr. Streeter) is indicating from a sedentary position that there is no NHS dentist in Plymouth.

Mr. Gary Streeter (South-West Devon) (Con)

I shall enlighten the hon. Gentleman later.

Richard Younger-Ross

The hon. Gentleman will enlighten us later should he catch your eye, Mr. Deputy Speaker.

People are being advised to go to Barnstaple. It is easy enough for people to say, "Why not Barnstaple? It's in the same county. It's not far, is it?" Those who suggest such things know very little of Devon's geography. Barnstaple is 50 miles away from Teignmouth. It takes two train journeys to get there, and one would have to take a taxi at the other end to find the dentist's, having taken a taxi to the railway station in Teignmouth in the first place. The cost of such a journey is high and unacceptable. It is not a journey that an elderly or frail person should be expected to take. Surely, the elderly, the infirm and those on income support or on low incomes—in fact, everyone—deserve to have a dentist within fairly easy reach.

Another constituent wrote to me to say that he had two children. His dentist had gone over to Denplan. He was told that he could go on to Denplan and that if he did, the dentist would continue to treat his two children, who were aged 10 and 12, on the national health service. Clearly, that is a form of blackmail. It was made clear to my constituent that if he did not sign up to Denplan, his children would no longer be accepted for NHS treatment at that practice.

That put my constituent in a difficult spot—an unacceptable spot, some may say. He was given a hard choice: should he take up Denplan at £17 a month or leave that dentist and take his children out of school to travel to Torquay, where a dental practice was then available? The hon. Member for Totnes (Mr. Steen) should note the time span. Today, my constituent would have to take his children to Barnstaple, and how long would that journey take? A visit to the dentist which would take most of us out of work or school for an hour or two would have taken a whole day by the time he had got to Torquay and back again.

I hope that the Minister will not say that everything is rosy in the garden—I am sorry; that was an unintended pun. I hope that she will not say that everything is well and that the world will be all right because the Government understand the problem. There is a crisis, and action is required now. One dentist in my constituency has made a planning application to expand a practice and bring in some foreign NHS dentists. What can the Minister do to help dentists to do that?

I hope that the Minister will tell us not just that money is available, but that it is available now to aid the bringing in of dentists from abroad. The national papers yesterday were saying that Britain was well down on the dental league table and that we needed about 5,000 new dentists. Will she tell us what she can do to provide dental hygienists and nurses, because there is also a shortage of those? Will she address the concerns of those in the industry who are worried about the new contract? I have been told that there is inadequate information about it. Can she shed some light on that? In particular, will she address the rumour that the start date of April next year will be put back?

Teignbridge district council, which is not statutorily required to assist, carried out a survey that showed that, given the opportunity, 10,000 constituents in its area would go back to a national health service dentist. That would mean that we were close to the average figure of those registered with NHS dentists rather than being dramatically below it. I commend the district council for its work in highlighting a concern outside its responsibility and for its work in partnership with the primary care trust. I also commend the fact that it has made available funds to help to establish some dental practices in Teignbridge. I hope that its generosity and quick action and reaction is matched by that of the Minister.

I could go on at length quoting my constituents, who feel bitter about the situation. However, I shall finish with a quote from a doctor. When doctors start writing to MPs regarding lack of provision, we know that something is seriously wrong. He wrote: I write to express my worry that several of my vulnerable, low-income patients, including one with cystic fibrosis, have had problems with securing national health service dental services". When doctors worry, we should all worry, as we should when constituents such as Mr. Brookes have to make 340-mile round trips to Bridgend, because that is where they used to go to the dentist, and they have continued to do so. Similarly, last Saturday, when canvassing, I met a constituent who had moved to Teignbridge three years ago and was still going back to Berkshire for dental treatment. There is a crisis in dental provision in Devon. I hope that the Minister will tell us how she intends to address that crisis now—not in six months or a year or two years' time. What can she do in the next month to help to provide dental services in Devon?

Several hon. Members


Mr. Deputy Speaker

I want to help the Chamber. I intend to start the winding-up speeches by calling the Liberal Democrat spokesman at 10.30 am. I hope that the four Back-Bench Members seeking to catch my eye will bear that in mind.

9.51 am
Mr. Anthony Steen (Totnes) (Con)

I congratulate the hon. Member for Teignbridge (Richard Younger-Ross) on being such a model of a modern Liberal Democrat MP. Jumping on bandwagons is one of their specialities, and sitting on them so comfortably is another. More seriously, this is a problem for the whole of Devon, and I pay tribute to him for taking the trouble to raise the matter, as do south Devon colleagues who are concerned about it.

Richard Younger-Ross

I thank the hon. Gentleman for his kind words. I carried out my first dental survey in Teignbridge in 1992. I do not think that that constitutes a bandwagon—there was not one rolling at the time.

Mr. Steen

If the hon. Gentleman is not aware, I was in touch with both the Torbay and the South Hams and West Devon primary care trusts about the matter last August, and my hon. Friend the Member for East Devon (Mr. Swire) raised the matter in this Chamber some months ago. I am not trying to gain brownie points, but the Liberal Democrats do not, thank goodness, have a monopoly on dentists.

On 11 November last year, I received a letter from the chief executive of Torbay primary care trust, who said: From April 2005 the PCT will be responsible for commissioning and contracting with dentists. In developing our approach, we will be consulting with the profession and public as to the best approach to ensure improved access. This may result in us recruiting dentists to work in a salaried post, or directly contracting with dentists for NHS sessions. This should enable us to secure a more consistent level of provision than at present— you can say that again— where with three months notice large numbers of patients can be disenfranchised.

The situation has been well rehearsed by the hon. Member for Teignbridge. In a letter dated 17 February, the chief executive of South Hams and West Devon primary care trust—not Torbay; I have two or three PCTs in my area—wrote: South Hams & West Devon Primary Care Trust (PCT) has been struggling with dental access for a number of years. During the past months the situation has worsened with practices in the area de-registering large numbers of NHS patients. The fact that South Hams & West Devon PCT is very rural means that every time an NHS practice decides to de-register a patient, if they are able to find a practice accepting NHS patients they must travel a considerable distance to access the service. It is rather like the middle ages, when people travelled by horse and cart throughout the county to find a dentist. The only practice that currently accepts NHS patients in South Hams and West Devon is in South Brent on the edge of Dartmoor, which has a bus service once a day and which no one can reach conveniently. Incidentally, South Brent has the highest levels of radon gas in Devon. I am not sure whether that is a relevant factor—it is just an aside.

The chief executive goes on to say that dentists are independent contractors—we know all about that. He then wrote: The PCT has very limited influence", which worried me a bit, on NHS dental practices operating under the NHS contract". He goes on to say: There is a national shortage of UK qualified dentists who wish to work within the NHS. Increasingly established dentists are moving into private practice. Although in past years Dentists have been attracted to the UK from Scandinavia and Denmark, this supply now seems to have halted. I am told that qualified dentists from outside Europe are put-off by the amount of bureaucracy they have to go through to enter the UK to work. Well, who is responsible for that? Is it the EU, the Government or the dental practice? The Minister needs to deal with the matter. I have a letter from the chief executive saying that dentists from outside Europe are put-off by the amount of bureaucracy.

Having dealt with the numbers, let me help the Minister and the Chamber. In the past three years, 4,000 full-time students have been on undergraduate courses in dentistry in Great Britain. That is a large number. However, in 2000–01 only 618 graduated. In 2001–02, 591 graduated and in 2002–03, 549; those figures are for England only. The figures that I was given show that in Great Britain there are 4,000 full-time students but roughly only 600 or fewer graduate in England alone. I do not know quite why that is, and I do not know why they are not interested in staying in the national health service. However, dentists are clearly not taking any notice of the Government. I am amazed by the numbers.

Do the Government wish us to believe that the answer is outside the EU? I remember a market in Marrakech in Morocco, where there is a stall that boasts a man with assorted pliers, who will pull out teeth for a modest fee. Is that what we want here? Is that what the Minister is going for: not a farmers market every Saturday, but a local artisans market where our teeth are wrenched out with pliers?

The Minister of State, Department of Health (Ms Rosie Winterton)

indicated dissent.

Mr. Steen

The Minister shakes her head, but I would like to know what my constituents are supposed to do if they do not and cannot find an NHS dentist.

We know that dentists are leaving the NHS in droves. There is now a stampede. They are abandoning the NHS ship, which has been scuppered by the Government and is going nowhere but the seabed. The Government have an interesting answer to that, and I want to read it out. The Minister herself gave me the following answer, which is full of wonderful words: On 18 September 2003 we announced new investment totalling £65.2 million for dentistry. Well done! It continued: This consisted of £35 million capital for dental access and quality, £30 million for dental information technology"— I am not sure that we want information; we merely want dentists— and £200,000 for developing dental leadership. I wonder what dental leadership is? Is it the molars? There has been £200,000 given to that. She goes on to say: This was on top of revenue funding we announced in August of £9 million for targeted support on dental access and £1 million for organisation development. That is wonderful bureaucracy, but the proof of the pudding is that we have no dentists in south Devon. None of that money is going to south Devon.

The Minister adds: The £30 million investment in IT will facilitate integration of dental practices with wider NHS information technology systems and will support local contracting." However, we do not have any local contracting. She continues: The IT investment and solutions for dentistry consistent with other NHS information technology initiatives are being taken forward within the national programme for IT."—[Official Report, 23 February 2004; Vol. 418, c. 274W.] She then goes on to talk about the balance of £59 million, and this and that—but it is a lot of garbage. It is hogwash. These are enormous sums but, as far as we can see, none of it is coming to our area. That money is available for a wonderful list of things, but not for dentists in south Devon.

You rightly pointed out, Mr. Deputy Speaker, that many of my colleagues wish to speak about such problems in their constituencies. I shall therefore touch on only two cases. The first is a single mother who lives in East Prawle, a wonderful but God-forsaken place that is difficult to get to. It is in the middle of nowhere; it is one of those remote villages that people aspire to go to until they find that there is no means of transport other than the car.

The single mother has two children, aged five and seven. They are patients of a dental surgery in Kingsbridge. In February, the mother arranged the six-monthly appointment for the family, but she was telephoned on the day of the appointment to be told that it would have to be rescheduled. She then received a letter from the owner of the surgery advising patients that a new dentist would be taking it over.

No one telephoned the mother to rearrange the appointment, and although she had contacted the surgery a couple of times to get a new date, it was in vain. However, she received a letter from the primary care trust on 7 April advising her that a new dentist, Mrs. Stembridge, wished to give notice that she was ending the arrangement for providing dental care on the NHS from 28 June. What that single mother was told is simple: unless she registered with the dentist privately, her two children would not receive treatment. That is a form of dental black mail. As a result, she can get dental treatment for her children only if she, a single parent of restricted means with no means of transport, can get to Kingsbridge and have private treatment for herself. That is not acceptable.

The next case is equally unacceptable. Another constituent of mine has a 90-year-old father and a 92year-old mother living in Brixham. However, there are no dentists in Brixham, Paignton or Torquay—nor, as the hon. Member for Teignbridge said, in that town. My question to the Minister is, what are those people supposed to do if they do not have the money? We do not choose to have teeth. Some of us think that it is rather bad planning that we should have teeth, but we all have them and we all need to have them seen to.

Are the Government suggesting that we should go to the dentist rather as we take the motor car to the garage, and that just as we pay for our MOT certificates and car repairs, so we should pay for repairs to our teeth? I would have nothing against that if it were the Government's policy, but the Government say that it is not their policy. They say that their policy is to provide free dental services, but the policy is failing.

What the Chamber wants to hear is not how much money the Government are putting into the dental service nor how many people are being trained, but why dentists in the entire swathe of south Devon—probably in the whole of Devon—are not prepared to work for the NHS. We want to know why hundreds of thousands or even millions of people are going around with substandard teeth and suffering pain and discomfort. It affects their work, their jobs and their relationships, and it is inexcusable. I hope that the Minister will not give a trite response but will say how to deal with that serious problem.

10.4 am

Linda Gilroy (Plymouth, Sutton) (Lab/Co-op)

The hon. Member for Totnes (Mr. Steen) entered into the debate with characteristic gusto, but I think that he had a degree of selective amnesia. The roots of the problem go way back to the early 1990s when there was a contract that resulted in a very unsatisfactory position that has undermined dentists' confidence in providing care under the NHS. I will return to that in a moment.

The hon. Gentleman also accused the hon. Member for Teignbridge (Richard Younger-Ross), whom I congratulate on securing this debate, of jumping on a bandwagon. None of us is jumping on a bandwagon. We are all seeking to represent the interests of our constituents and to raise a serious issue with the Minister. I hope that her response will show that we are at long last pointed in the right direction in terms of how we provide for NHS dental care in the 21st century.

Like other hon. Members, I have found that the problems are reflected in my casework at both ends of the age scale. Just yesterday a mother with four children aged two to 14 came to me. She was desperate for care for the two-year-old. She has had to turn to Derriford hospital for help. She moved to Plymouth two years ago. The person I most recently saw at the other end of the age scale, whom I met when I was out and about in Efford, also moved to Plymouth recently. Like many people, she has experienced problems with her dentures, which are probably past their sell-by date and need attention. She cannot find an NHS dentist who is willing to take her on that side of town. Like many older people, as the hon. Member for Teignbridge pointed out, she would have difficulty in travelling any great distance even within Plymouth, let alone facing the challenges that some people in rural constituencies face.

Richard Younger-Ross

Will the hon. Lady give way?

Linda Gilroy

I am sorry, but I will not give way. I have a lot to say and I want to stick within the time limit.

Those are two of the many problems that have been brought to me. It may have come a little later to Plymouth than to some of the rural areas, but there are other ways in which I have a sense of the problem escalating in Plymouth. I see it in the number of people who seek my help as their Member of Parliament; GPs report increased numbers of patients turning to them for help with pain and gum disease; the primary care trust reports increased numbers of calls on dental matters and, whereas the evening paper would cover the occasional story, there is now regular coverage of problems with dental services. Most recently, in a particularly alarming case a dentist dumped 7,000 NHS patients. That was one of the more recently qualified dentists. There is still a strong commitment among longer qualified dentists to try to engage with the NHS. We need to find a way forward with the Minister's help today.

The first sign that there might be light at the end of the tunnel is the work, to which the hon. Member for Teignbridge did not refer, which is going on across the local authorities in the area. As I understand it, each local authority scrutiny committee is bringing together and taking evidence from the players in dental care about the way forward. There was a joint conference at St. Mellion in February bringing dentists and others together with people from the primary care trust to explore the problems and the options for dealing with them. It is always a good sign when people recognise that the way forward is not one to which anyone has the sole or monopoly answer. The Government cannot have that: it will take everyone getting together to resolve the problem.

The problem goes a long way back. One of the big hurdles that we have to overcome is that dentists distrust the present set-up. They distrust the NHS and the new proposals as well as the new money that is on the table. A lot of confidence-building is needed. Dental schools have been closed. There is a lack of understanding about how the new contract will work. There may be a lack of information from the Department of Health on that or it may not be getting through. I understand that there has been a delay in the time taken for funding streams to reach the PCTs from the NHS. The incentive scheme money that was promised last year has yet to reach Plymouth, and I ask my hon. Friend to look into the matter.

There are proposals for the new contract and there is new money, which was announced in the debate secured by the hon. Member for East Devon (Mr. Swire) in Westminster Hall on 11 February. In Plymouth, there is an oral health programme. The board was set up under the first wave of health action zones, and it has been running for five of the seven years for which money is committed to it. It is a catalyst that has led to several schemes being set up, including free tooth brushes in some of the poorest communities, and, importantly, the programme for vocational dental training in Plymouth. There is a dental access centre in Plymouth and in Cornwall, but other PCTs have not set them up and as hon. Members have said, there is considerable pressure from elsewhere on the dental access centre in Plymouth.

Plymouth is an "Options for change" field site; it is a testing ground for the new way forward on contracting locally with dentists. I understand from the primary care trust dental lead that two practices are moving to the new service agreement this month and several more will follow shortly, which will have advantages for dentists. It will bring them a steady and predictable income throughout the year, and because it is based more on patients than treatments it will reduce the bureaucracy that was built into the disastrous contract developed in the early 1990s. It has the potential to enable the PCTs, which will take responsibility throughout the country from March next year, to focus support on preventive health care, which will be a considerable help to certain communities. At present, any dentist, anywhere, who is willing to do NHS work is very welcome.

In Plymouth, there are 41 dental practices, with 86 general practitioners working as NHS dentists, carrying between 50 and 1,500 patients each; that is the scale of the challenge. In Devon, the average list size has decreased by 31 per cent. since the disastrous 1992 contract. Some people who have lost their dentist have gone private, a few happily but most reluctantly. The chair of the Plymouth health scrutiny panel, Councillor Mary Aspinall, told me that a recent survey in Plymouth suggested that between 6 and 10 per cent. of adults were not registered with a dentist. Some of them are just allergic to dentists, but some are the sort of people I described earlier. About 20,000 people in Plymouth are not registered, which is a matter of considerable concern. If 2,000 patients per dentist is the right figure, it means that about 10 dentists are needed in Plymouth alone.

What is being done to get the dentists we need? As my hon. Friend the Member for Falmouth and Camborne (Ms Atherton) argued in the previous debate, we urgently need to consider setting up training in the far south-west of the peninsula, as an outpost of the nearest dental school at Bristol, or as part of the new peninsula medical school. When people are trained in an area, at least 25 per cent. stay there. That would help to increase the number of dentists, just as it helped to increase the number of doctors. We knew that we were under-doctored when we argued for the peninsula medical school, because, per thousand young people, there were not enough to come forward as doctors. I suspect that the same is probably true in respect of dentists.

In the mean time we need to try to attract dentists from abroad. I understand that there are people in Poland in particular who are keen to come and work here under the accession agreement. Is that true? What is the Minister doing to encourage that? Does she agree that that would have a particular relevance for Plymouth, which has a strong historical link with Poland, through the population that came over in the second world war?

What can we do to secure the position of those who are fortunate enough to have an NHS dentist? What is the way forward for the vocational dental service? It is funded until 2005 through the workforce development confederation and is an essential tool to encourage people to train and work in the area. Its continuance beyond 2005 is essential. We need to ensure that primary care trusts have the resources and back-up to give current NHS dental practitioners the confidence to continue.

The good will of dentists is strained to the limit and they lack confidence. I believe that most want to ensure that those who need NHS dentistry can have it, and that they are willing to play their part. Localising the commissioning of NHS dentistry and engaging dentists through membership of the executive committee of the primary care trust will enable local stakeholders to play their part. I look forward to hearing what the Minister has to say about what the Government will do to assist them in returning confidence to a vital part of the health care system.

10.16 am
Mr. Hugo Swire (East Devon) (Con)

I congratulate the hon. Member for Teignbridge (Richard Younger-Ross) on being lucky enough to secure this debate. It follows on from a debate that I instigated on 11 February, so I am not quite sure why the debate is taking place. Perhaps in the intervening period the Minister will have come up with some answers. I am sure that she will do better than her colleague, the Under-Secretary of State for Health, the hon. Member for Welwyn Hatfield (Miss Johnson), did in February.

The issue is the stuff of headlines. It is a problem not only for Devon or East Devon. The headline in theDaily Express of 18 February was "Government must act as dentist crisis begins to bite." This crisis is a byliner's dream. Under the headline, "A kick in the teeth", the Daily Mail of 10 May reported: The critical shortage of NHS dentists has been dramatically exposed by an international study. Research ranks Britain last in terms of dentists per head of population. Greece has nearly three times as many, while in France and Germany it is almost double. TheExpress and Echo, a local newspaper reporting on another local problem, used the headline, "Chloe told to wait as dentist crisis rages". In Torquay, theHerald Express announced: Experts get teeth into dentist crisis when it reported in February that an estimated 700,000 people in Devon and Cornwall do not have access to any dental services and that local councils have decided to join forces to tackle the problem.

We know what the problems are. These reports come on the back of pledges made time and again; for example by the Prime Minister at the Labour party conference in September 1999.The Times reported on 29 September that he pleased activists with a pledge that everyone would have access to an NHS dentist within two years.The Independent on Sunday reported on 13 August 2000: In stating that Blair's pledge on dentists was impossible to meet the Chairman of the British Dental Association Dr. John Renshaw stated: 'The Prime Minister went and shot his mouth off without speaking to us. He didn't ask us whether we could deliver on the promise he was making. The target is very, very difficult but with the timescale it makes it impossible'". The article continues: 'The BDA believes that all the dentists who have left the NHS, or have only tiny numbers of non-paying patients, need to be attracted back to the public sector"' and adds: Dr. Renshaw on outlining this requirement commented: 'I don't believe that the Government has any intention of even trying.' He went on to conclude: 'We have had enough of talk. We are sick of it. We are fed up with listening to the talk. We need some action'.

What did we get? More talk and no action. On 17 May 2000 at Prime Minister's questions, the Prime Minister said: We have set the date for the end of next year to make sure that everyone who wants access to NHS dentistry can have it"— [Official Report, 17 May 2000; Vol. 350, c. 331.] On 19 June 2002 he said: The changes that we have made mean that anyone who wishes to do so can contact NHS Direct or other NHS services and get the name of an NHS dentist whom they can visit."—[Official Report, 19 June 2002; Vol. 387, c. 276.] On 26 February 2003 at Prime Minister's questions, the right hon. Gentleman said: The reason we are putting so many additional resources into the national health service is precisely in order to ensure that people get proper access to it."—[Official Report, 26 February 2003; Vol. 400, c. 257.] On 15 October 2003 he said: We have made huge attempts to make sure that people can get access to NHS dentistry."—[Official Report, 15 October 2003; Vol. 411, c. 106.]

Mr. Deputy Speaker, you may think that I attempted a trivial diversion earlier when I intervened on the hon. Member for Teignbridge to talk about pledges, but I believe that the collapse in people's support for the political parties and interest in politics has something to do with broken pledges. Despite all the pledges made, by people from the Prime Minister down, my constituents and others in our part of the world are fed up. It is another case of being let down by Labour.

I alluded to the Liberal Democrats doing a complete volte-face on their promise to give everyone £100 back on their council tax; they are now changing their policy on that. It is about time that we were more honest. Perhaps the Minister will admit this morning that the Government are unable to deliver on the Prime Minister's pledges, and we can consider together a way of dealing with the problem. Little has changed since my debate in Westminster Hall on 11 February. If anything, the situation in East Devon has got worse since Bernard Jones retired last week: an additional 2,500 patients are now looking for an NHS dentist. There is a continuing problem since Mr. Alistair Danby's attempt to secure premises on Rolle road was rejected by East Devon district council because of a highways problem.

The situation is bad and was highlighted excellently by my local newspaper theExmouth Journal: I congratulate it on its "plug the cavity" campaign, which seeks to attract more dentists to east Devon and which has attracted 1,044 signatures. I have, nothing further to add, although I am surprised that we are having this debate. There is an element of the Liberal Democrats jumping on the bandwagon, but I want to leave the maximum time for the Minister to answer some of the questions that have been raised, both in this debate and that in February.

10.22 am
Mr. Gary Streeter (South-West Devon) (Con)

I can be blisteringly brief, because much of what I wanted to say has been covered. I pay tribute to the hon. Member for Teignbridge (Richard Younger-Ross) for securing the debate, which is important and timely and builds on the debate inspired by my hon. Friend the Member for East Devon (Mr. Swire) earlier this year.

Whether it is the right policy that every person who wants access to an NHS dentist should have it is a matter that we can debate. However, as has already been said, it is this Government's policy. It was spelled out by the Prime Minister in his party conference speech in 1999 and put into the NHS plan in 2000; it is a clear Government pledge and commitment that anyone who wishes to have access to NHS dentistry can have it. As hon. Members have heard, in our part of the world, as in other parts of the country, that is not the case. I am the first to admit that the problem pre-dates 1997 and has been an issue for a number of years. However, the Prime Minister made his commitment in 1999—five years ago—and the Labour party has been in government for seven years. As I shall demonstrate with some correspondence, the situation is not getting better in my part of the world: it is getting worse, week by week and month by month. The Government have made a firm policy commitment and promise, and are failing to deliver. Many people are suffering and are becoming distressed as a result, and I look for and to the Minister dealing with that important point.

It has not been said yet, but I pay tribute to the many NHS dentists in Devon who are continuing with NHS dentistry, often at personal expense to themselves, working under extreme pressure and not enjoying the same rewards as those taking the independent route. From time to time we should say, "Thank you and well done" to them. My concern about the matter has been rumbling on for a number of months. It has been exacerbated, as the hon. Member for Plymouth, Sutton (Linda Gilroy) mentioned, and as the local newspaper reported, by a practice crashing recently and 7,000 people being told that that they could no longer have NHS dentistry. That was in my constituency in Plympton, and the situation has caused major concerns.

I shall quote from a letter from the South-West Peninsula strategic health authority. I often write my initial inquiries not to Ministers—they have plenty on their plates—but to the chief executives of the SHAs who are administering the primary care trusts. I received a letter quite recently, on 28 April, from the chair of the local SHA, who said: With the exception of one surgery in Tavistock which was registering NHS charge exempt patients all the others shown on the list"— she had previously sent me a list— were only registering children as NHS patients. Unfortunately there were, and are,"— here is the killer phrase— no dental practices in the Plymouth area registering charge paying adults for NHS treatment.

I do not want an NHS dentist myself. For many years I have, rightly or wrongly, been on a Denplan arrangement, which has cost an arm and a leg. My wife and I pay about £50 or £60 a month for cover, which is a lot. My wife has very bad teeth—I should not have said that, but now it is on the record. If anyone sends her a copy of theHansard report, they will be in big trouble with me. Paying between £50 and £60 a month, or even £20 and £30, is simply not within the reach of some of the people on low incomes whom we have heard about today. That is why the issue is so important to such people. There are people who, on a point of principle, insist on NHS dentistry. That is what they have always had, what they have paid into over the years—they think—and what they still want. We should meet that demand, and the Government have promised to do so. Many others simply cannot afford any alternative treatment.

It is not only in the Plymouth area and in the city where there is a massive and growing problem and where constituents are distressed. A constituent came to my surgery about three weeks ago. She was a single parent. She brought along her three lively and lovely children to explain that she, too, had received a letter about a practice in Kingsbridge, which my hon. Friend the Member for Totnes (Mr. Steen) mentioned, and a Mrs. Stembridge, who is no longer taking on NHS patients. The letter reads: However, after that date you will no longer be entitled to emergency cover, or treatment provided by your current dentist under the NHS. Unfortunately at the time of writing this letter there are no NHS Dentists accepting new patients in the South and West Devon area. That is a pretty big area, but there are no dentists accepting new NHS patients there. My constituent asked me, "What can I do when the time comes for my children to receive their regular check-up? I can't afford to go private and they won't be accepted under the NHS." I suspect that there have been many children over the past two or three years who have not received their regular dental check-ups, and that many will miss them in years to come. We are storing up a health hazard for the future.

The problem is hugely important. The Government have had long enough to put in place changes that should by now have worked through on the ground. I recognise and accept that we are talking about the individual choices of dentists about how they wish to organise their practices. However, the Government must also accept that they have made promises. They have had long enough to introduce arrangements that can work on the ground. If the Minister cannot satisfy us that patients in our part of the world will soon have access to NHS dentistry, we shall have yet another example of failure to deliver by a Government who have promised so much.

10.28 am
Mr. Paul Burstow (Sutton and Cheam) (LD)


Mr. Deputy Speaker

Order. May I make a plea to the Liberal Democrat spokesman and to the spokesman from Her Majesty's Opposition to allow adequate time for the Minister to reply?

Mr. Burstow

Thank you, Mr. Deputy Speaker. I thank the hon. Member for South-West Devon (Mr. Streeter) for keeping his remarks brief and to the point. I congratulate my hon. Friend the Member for Teignbridge (Richard Younger-Ross) on securing a debate lasting an hour and a half on the important issue of the supply and availability of dentistry in Devon, because it enables us to explore the issues that have led to the crisis there, but which apply also to many other parts of the country.

It is to my hon. Friend's credit to have secured the presence of a Minister of State, because in the half-hour debate in February we had only an Under-Secretary. On that occasion, the hon. Member for East Devon (Mr. Swire) raised a number of important issues concerning East Devon's dental services and the difficulties that his constituents were experiencing. However, I fear that it is a little churlish to suggest that a Member who has persistently pursued dentistry issues and consistently surveyed the availability of dentistry in his constituency since at least 1992 is on a bandwagon. If he is on a bandwagon, it is one that he built and which he has been on for a long time.

The debate has demonstrated that there is a serious problem with the supply and provision of dentistry in Devon. There is a parlous state of supply in Teignbridge and in the constituencies of other hon. Members who have spoken today. I was interested to hear the remarks of the hon. Member for Totnes (Mr. Steen), particularly those about the availability of radon gas, although I am not certain that they play directly into today's debate.

Yesterday, we saw some interesting reports, which graphically demonstrate the shortage of dentists throughout the UK and tell us that Britain has fewer dentists than Poland. It is important to understand what has happened with dentistry in the past few years, and how we reached the current situation. It is worth bearing it in mind that, according to a parliamentary written answer that I received earlier this year, over half of the population in England are without an NHS dentist. I believe that the hon. Member for East Devon referred to an article in theDaily Express that published that parliamentary written, answer to the world. It is essential that we reverse the trend of people being deregistered and losing access to dental services. South-west peninsula residents are undoubtedly among the least well served when it comes to dentistry services, but that problem is not confined to that part of the world.

Two key decisions had a serious impact on dentistry, and brought us to where we are today. The first was the decision to introduce the 1990 contract and, more importantly, the unilateral decision of the Department in 1992, to cut—first by 23 per cent., and then by 7 per cent.—the fees that it was paying to dentists. That unilateral decision, more than anything else, undermined the dental profession's confidence in what the Department was about and whether it was really committed to sustaining a universal service of free dental care. It accelerated dentists' disengagement into an exodus from NHS provision. Rather than delivering the hoped for focus on prevention, it sped up the treadmill that so many dentists talk about: the drill-and-fill state of affairs—no time to talk, no time to prevent dental decay. The second important decision was the closure of three dental schools, which undoubtedly had disastrous implications for the long-term viability of the work force.

My hon. Friend the Member for Teignbridge ably documented the impact of that mismanagement in the 1990s on the oral health of his constituents, as have other hon. Members. Is there any comfort on the horizon for our constituents? Will dental services improve? Since 1997, a host of initiatives has been introduced—I am sure that the Minister will rehearse them for us today—but in 2001, the Select Committee on Health recorded its view that the Government had a quick-fix approach, which did not go to the root of the problem.

What is next? We now have legislation that provides for primary care trusts to pick up responsibility for commissioning. That is the biggest shake-up for a quarter of a century. A new base contract is being developed and piloted, which will move dentistry away from drilling and filling and toward promoting prevention.

Access to NHS dentistry is a serious problem because dentists are doing less NHS work and we have poor work force planning. What assessment has the Minister made of the British Dental Association's estimate that the number of new dental students needs to increase by 25 per cent. to meet demand? Does she agree with John Renshaw, the chair of the BDA executive board, that we do not have enough dentists?

That brings me to what is, from my review of parliamentary answers and other literature of late on this issue, the key question: what do the Government mean by "shortly" as in, "We will publish a report shortly"? In 2001, the Department announced the first review of the dental work force since 1997, which was completed last autumn—another of those vague terms. In a written answer on 2 February, I was told that the report would be published "shortly". Will the Minister tell us in which month the report was completed and, more importantly, when it will be published? That report must be the basis on which we will move forward the development of the work force.

With changes to the contract due in April 2005, clarity on work force issues and the direction of travel has to be essential to bolstering the confidence of which the hon. Member for Plymouth, Sutton (Linda Gilroy) spoke. We have 13 dental schools—this relates to a point that the hon. Member for Totnes made—and, UK-wide, 800 extra dentists coming in every year. We imported 456 dentists from overseas last year.

It will be difficult for the Government, if they intend to grow our own dental work force, to do so without knowing the current position of the work force. The report has not yet been published, and it is therefore difficult to ascertain whether there is the right mix of training places, and whether the training "pipeline" is adequate to produce not only dentists, but therapists, nurses and others complementary to dentistry. Those questions need to be answered now, because if those extra dentists and others do not come through the training system, we will not be able to deliver the quality service that we should all expect for our constituents, in Devon or anywhere else in the UK. Can the Minister therefore tell us what "shortly" means in this context, and when we will see that report and the necessary action to turn its recommendations into reality?

At the BDA's conference on 6 May the Minister made an important speech, and was asked a number of questions by members of the association, not least about the timing of the implementation of the new contracts. The Minister said that she would examine that matter in the weeks subsequent to the conference. Can she tell us whether the Government are minded to amend the timing and, if so, in what way? W ill she also tell us whether there will be further announcements about additional funding to underpin the PCTs' capability to implement their new roles as commissioners? When will that money be announced, and when will it reach the front line, so that it can have an impact?

The dentistry sector has been neglected for so long that it has, in many areas, lacked the necessary investment in infrastructure. How will the infrastructure—premises and equipment—be improved for those who have slogged along and stayed with the NHS? What are the Government's plans in that area?

My hon. Friend the Member for Teignbridge has done the House a service by initiating this debate so that the Minister can respond to the concerns of hon. Members. NHS dentistry is in poor shape. There is a growing underclass of people who do not have access to NHS dentistry; for them it is a pipe dream. The scale of the task is clear, but the Government's response is still too vague. Can the Minister give us confidence that we will begin to see a dentistry service fit for the 21st century, fit for the people, and free on the basis of need?

10.37 am
Dr. Andrew Murrison (Westbury) (Con)

I congratulate the hon. Member for Teignbridge (Richard Younger-Ross) on introducing the debate, and also congratulate my hon. Friend the Member for East Devon (Mr. Swire) on initiating a similar debate in February. The debate today is an opportunity for the Minister to give us a progress report on the response made by the Under-Secretary of State for Health, the hon. Member for Welwyn Hatfield (Miss Johnson) in that earlier debate.

However, I believe that the glass is half full rather than half empty, and that many dentists would take exception to some of the remarks made by the hon. Member for Sutton and Cheam (Mr. Burstow). It is true that there are problems in accessing NHS dentistry—that is the subject of the debate, and rightly so. However, we should recognise the huge strides that have been made in dentistry over the past couple of decades. It is important to bear it in mind that part of the current problem of access to NHS dentistry is related to the standards that we expect today, which did not apply 20 or 30 years ago.

Nevertheless, we have seen what might be described as the decline and fall of NHS dentistry which, ironically, has occurred since the Prime Minister made a categorical statement at his party's conference in September 1999 on access to NHS dentistry for everyone. It was a brave thing to say but, in the fullness of time, that policy has been seen to be undeliverable. I hope that the Minister will respond to that point in her concluding remarks.

Some 1.5 million fewer people are now registered with NHS dentists than in 1998, which is a huge decline. There has also been a reduction—from 4.4 per cent. to 3.1 per cent.—in the proportion of the health budget devoted to dentistry. I fully accept that the NHS budget has expanded, but that proportional decline gives some indication of the priority given to dentistry within the NHS. Will the Minister comment on that matter? The BDA seems to think that the proportion of total NHS spending on dentistry is declining even further.

The analogy that my hon. Friend the Member for East Devon drew between the Liberal Democrats' pledge of £100 during the Brent, East by-election and the Prime Minister's remarks in 1998 was spot on. We need to restore trust in politics. The Prime Minister making promises in 1998 and failing to keep them, and other parties making wild pledges during by-elections and then rescinding them, does none of us any good.

The BDA is clearly concerned about "Options for change". We have great hopes for "Options for change", as I am sure the Minister does. The measure will apparently revolutionise dentistry. I think that the BDA started by being quite positive about "Options for change", but it appears that it changed its mind, as so often happens, when it read the small print. We have seen time and again that when organisations read the small print of things that Ministers say, they often have second thoughts. A recent MORI poll suggests that 57 per cent. of dentists now oppose "Options for change", 15 per cent. support the measure and the rest simply do not know. Perhaps they have not been sufficiently apprised of the implications of that revolutionary measure that will apparently change their lives. I find that deeply worrying.

I received a letter recently from a general dental practitioner who is deeply concerned about "Options for change". We heard that the Liberal Democrats view the contract that was introduced in the early 1990s as a disaster. Well, we all need a little humility in politics, and we have to accept that in retrospect that may have been the case, but I hope that Ministers will reflect on what is going on at the moment, so that they do not make the same mistakes. Clearly, the gentleman who wrote to me feels that they are about to make similar mistakes. His comments are well put. He says: Put bluntly, dentists can expect to do 50 per cent. less work and still expect to receive their previous gross. They will work fewer hours, take more holidays, attend more courses, spend more time with each patient and carry out minimum invasive treatment. They will not touch a patient whose treatment plan involves high laboratory costs. The losers will be social classes D & E whose dental needs are the highest. They will be confined in ever increasing numbers to access centres, community and hospital services … The reform is guaranteed to exacerbate existing dental inequalities.

I find that particularly difficult, given that the Under-Secretary of State for Health, the hon. Member for Welwyn Hatfield, in her response to the remarks by my hon. Friend the Member for East Devon in February, made great play of addressing dental inequalities. I should be interested to hear from this Minister whether, in the months that have passed since, she has given further thought to how we might best do that. Indeed, I should be interested in her reflections on how dental inequalities may have been exacerbated since 1997.

This debate is about dentistry in Devon, but the problems that have been experienced there, which hon. Members have eloquently described, reflect problems in the country as a whole and particularly in areas where the population is relatively sparse. Devon has an elderly population. It is a rural area, with all that that implies for transport and access. The number of dentists in Devon seems to have declined significantly since 2000, and the dental work force is apparently quite elderly.

In that context, it is important to ask again, as several hon. Members have, when we will see the dental work force review that we have been promised for so long. It is important to know where we are going. I have said before in the House that many of the problems stem from the 1970s, and I believe that to be the case. We failed to predict adequately then what our dental needs would be now, and we are suffering the consequences. The review is welcome and we need to have it urgently, without any more delay. I hope that the Minister can shed some light on that. Given that we want her to have sufficient time to respond to the important questions that have been posed, I shall call it a day at this point.

10.44 am
The Minister of State, Department of Health (Ms Rosie Winterton)

I congratulate the hon. Member for Teignbridge (Richard Younger-Ross) on securing this debate. I realise how important the subject is for his constituents. I certainly will not give the impression that everything in the garden is rosy, but I hope to show how we are tackling the long and short-term problems. My hon. Friend the Member for Plymouth, Sutton (Linda Gilroy) eloquently put her finger on the button in saying that we have inherited the problem from the previous Administration, who introduced a deeply unpopular contract, closed not three but two dental schools and cut dentists' fees. That was when dentists started walking away from the NHS and we are dealing with the consequences of that.

The hon. Member for Sutton and Cheam (Mr. Burstow) spoke about some of the difficulties, not just in Devon but across the country, and drew attention to the report published yesterday. I do not deny that there is a problem, but that report was misleading because it did not take into account the number of hospital or community dentists. The fact is that there are more dentists than ever before. The problem is that fewer of them do work for the NHS. To address that, we are negotiating with the British Dental Association over the introduction of a new contract. It has told us that dentists have difficulties with the treadmill effect of the current contract. They find it bureaucratic and say that it does not allow them clinical freedom to work with patients, so we are changing it. I take on board the comments of the hon. Member for Westbury (Dr. Murrison) about a particular dentist who feels that that is not the right way forward. However, a lot of effort has gone into negotiations with the BDA to try to find a different style of contract to suit dentists better.

Secondly, we ire devolving the money that is currently held centrally. By next year, that will be about £1.5 billion. The hon. Member for Westbury asked about the proportion of NHS funding spent on dentistry. The difficulty is that if an NHS dentist withdraws from providing NHS treatment in an area, the money that they would be paid returns to the centre. Therefore, that money cannot be made available locally and offered to other dentists. We will devolve the money held centrally so that local commissioners can properly plan with local dentists for the provision of dentistry in the area. That is the way forward.

Many hon. Members asked about the start date for the new contract. The BDA has said that it needs more time to conclude negotiations. We have listened to the points made by the BDA and I will make decisions on that after further discussions.

My hon. Friend the Member for Plymouth, Sutton raised the issue of work force training and she is absolutely right. My hon. Friend the Member for Falmouth and Camborne (Ms Atherton) made the point in the previous debate about how we can get trainees into an area and keep them there. It is a point well made and something that I am examining. It can be difficult to force people to go to a particular area, as they take lots of things into account when they move somewhere. However, I want to see whether there are ways to persuade people, because many people tend to stay around the dental schools instead of moving elsewhere. It is an issue that we need to consider.

The hon. Member for Totnes (Mr. Steen) spoke about international recruitment and his experience in Marrakech. To a certain extent, he cannot have it all ways. We want to consider increased international recruitment, but it is also important to ensure that practising dentists are of a high standard. That is dealt with by the General Dental Council, which requires some candidates to take exams. I suspect that that is the bureaucracy that he mentioned, but those checks are important in ensuring that dentists are practising to the highest standard.

Dr. Murrison

The Minister needs to recognise that it is the European Commission that is holding up the registration of many professionals from the European Union accession states. Will she admit that, and not just blame the regulators of dentistry and other professions?

Ms Winterton

I will come on to some of our discussions about that point. While ensuring that we can recruit from other European countries, we must ensure that we are not denuding another country's health service. We are undertaking discussions on that.

I will turn to Devon, as I know than that is what hon. Members have come to debate, but before that, I want to touch on the dental work force review, as it was raised by several hon. Members. We will be publishing the review in the not-too-distant future, but I want to ensure that we not only analyse the problem but come up with the solutions. That is why I have been keen to have all the questions answered before we publish. It is true to say that several conclusions have emerged, but I want to ensure that we can also define the solutions.

The long-term work involves what we are doing with the new contract, commissioning locally, the dental work force review and increasing; training. Some immediate access problems remain at a local level, to which many hon. Members have referred today. The PCTs throughout Devon have been working hard to develop a range of local solutions and I shall run through some of them before I talk about what more can be done.

The north-east Devon dental access centre opened in 2001 and now has three centres fully operational in Exeter, Crediton and Barnstaple. That scheme has recently been extended to Exmouth, where a drop-in arrangement is now in place. There is a salaried community and emergency dental service based in Newton Abbot in Teignbridge. There is also one in Torquay, which is due to expand will additional central funding. For the past three years, a mini personal dental scheme has been running in Tavistock to treat unregistered patients who are in pain and need emergency treatment. In Plymouth a walk-in dental access centre opened in December 2002 to offer a wide range of services and specialist support, including same-day treatment for patients in pain and emergency cover during weekends and bank holidays. Those are some of the schemes that are up and running to tackle the dental access issues that hon. Members mentioned.

The whole of Devon is part of the "Options for change" peninsula field site. Hon. Members have mentioned the fact that the BDA says that there is not enough information about how the new system will work. We have been setting up field sites and pilot sites for five years to ensure that the new system builds on the best practice that has been developed at such sites when it is introduced. It is important that Devon is part of that process, which will enable practices to move to the new system before next year, remove the uncertainty that some dentists face and provide an opportunity to influence the changes and achieve a secure income.

We have ensured that there is a project co-ordinator in Devon working for the Modernisation Agency. The co-ordinator, Andrew Harris, is based in a PCT in Devon and provides dedicated support to local dental practices and local PCTs to facilitate the move to the new system. Eighteen practices in Devon and Cornwall have adopted the new contracts under "Options for change", and we are looking to 20 more to move to do so in the next couple of months. That means that up to 45 dental practices and 100 dentists in the south-west peninsula will be part of the new system by July.

I have tried to make sure that the Department works closely with local NHS organisations to ensure that there is appropriate support.

Mr. Burstow

Will the Minister give way?

Ms Winterton

No, I cannot. Last week, officials from the new special health authority for dentistry met representatives of all the PCTs in Devon and Cornwall to discuss the progress that has been made in expanding the field site and to consider the PCTs' dental action plans. A specific meeting also took place with Teignbridge PCT, and the moves that are being made were discussed.

Additional funding has meant that PCTs are now in a position to develop plans for the future. Some £1 million of national access funding, which I announced last year, will be used in Devon to support capital developments to increase capacity. PCTs are developing dental action plans setting out how they will use that additional funding. I take on board the point made by my hon. Friend the Member for Plymouth, Sutton about whether the funding is getting through. The funding is there, and it has been confirmed that PCTs will have it. That is why the dental action plans are being developed.

On international recruitment, we have had discussions not only with Poland but with Spain, Denmark and Germany, where we are building on established links to recruit additional dentists to the NHS. We will be working with strategic health authorities to target international recruits at areas with the most acute access problems. I can confirm that Devon will be one of the first areas to receive new recruits when they start to arrive later this year.

So, there are some immediate problems, but I hope that hon. Members will accept that we are looking for a viable longer-term solution to the difficulties that we have inherited. We are also taking action to address the immediate, short-term problems that hon. Members have raised. The package that we have put together, which we have worked out with the profession, will lead to better working lives for dentists and improved services for patients.

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