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Dentistry (Nottingham, North)

I was going to come to registration, but given that my hon. Friend has raised it, let me deal with it now. There is a demand from some dentists to reintroduce registration. If we look back at the history of that, dentists when my hon. Friend and I were young did not have registration as it existed after 1990, when dentists were paid to keep a register. That practice was ended, mainly because it did not seem to make much of a difference. Before 1990, and by and large—though not in all cases—since then, dentists have kept a list of patients. That enables dentists to keep their customers—dentistry is a business, albeit contracted to the NHS. It enables them to keep in contact with their customers—their patients—and ensure that they send regular notices to those patients to get them to come in for check-ups. Then the dentists can make the appropriate claim under the NHS dentistry contract. Whether we should pay dentists for doing what the vast majority currently do without payment is debated. Some people say that we should reintroduce registration, which would mean that dentists were paid a fee for doing what most of them already do, because some dentists do not keep a list. It appears, though, that the vast majority still do, and the evidence suggests that the numbers on the lists are similar to those when people were registered. It is difficult, because we do not have regular records, to be entirely sure about how many keep a full and proper list. Of course, because it is in some sense voluntary to do so, dentists who are anxious to run an efficient business for their patients keep in regular contact with them, but those who are less efficient or who have enough patients without lists may well not do so. However, I am not convinced at the moment that reintroducing a system of registration would be the best way of using NHS funding. We will look at the evidence—my mind is not entirely closed on the matter. The position is that the vast majority of dentists try to keep in contact with their patients, which is how they generate income under the NHS contracts. Nottingham City PCT has been paying dentists to apply fluoride varnish to children, in line with Department of Health guidance. There is a great deal more that we can do to prevent tooth decay in communities, but I accept that we also need to improve access to dental practices. As I said, access to NHS dentistry is already improving across the country. A recent Which? survey published in June showed that nine out of 10 people who tried to find an NHS dentist in the past two years were able to get one, but we need to go further to ensure that every person who wants an NHS dentist can have one. The 10 SHAs in England, with the 152 PCTs, have set themselves the task of delivering access for all who seek it by March 2011. In the year to June 2009, just over 64 per cent. of people in the Nottingham PCT area saw a dentist. Unfortunately, that figure represents a fall on preceding years. Nottingham City PCT is aware of that. We have been assured that it is carefully monitoring the situation. I think that it needs to do a bit more than that and to be proactive in dealing with the situation. The PCT has, however, conducted extensive research and consultation, including through focus groups and questionnaires, to understand why people in Nottingham are not going to the dentist and to find out which services they would use. As a result of the consultation, the PCT is opening two new dental practices, in Bulwell and Bilborough, with a mobile dental service to work flexibly across the city. In addition, it will be initiating a targeted communications campaign to promote uptake of dental services. Those initiatives will be backed by increased funding for dental services in Nottingham City, with £16.2 million allocated for the current financial year. The expanded national dental access programme is helping Nottingham City PCT to implement its dental strategy. The programme, led by Dr. Mike Warburton, supports the NHS to expand dental services rapidly where they are needed. It will work closely with Professor Jimmy Steele's independent review of NHS dentistry. Professor Steele's review is helping us to understand how dentists can deliver consistently high quality care while providing the right level of preventive work, as well as looking at how we can go further to reduce inequalities in oral health. The core of our dentistry reforms—that the dental budget is held locally and that PCTs commission dentists directly to deliver NHS care—is here to stay. We need to ensure that PCTs such as Nottingham City increase the work that they are doing to ensure that we get much more effective responses regarding dental care. Demonstrating that and echoing the national picture, the number of dentists in Nottingham City PCT increased from 138 in March 2007 to 143 in March 2009. The NHS is confident that it can achieve its aim of delivering access to a dentist for all who seek it within the next 18 months. We strongly welcome the level of commitment from SHAs and PCTs to tackle dental access while we have that ambitious time frame in place. It is going to take quite a lot of work to ensure that we hit the targets; we do not underestimate the challenge. The problems of access are considerable and they have grown over time, so they will not be turned around overnight or without significant effort. I assure my hon. Friend that the NHS in general and Nottingham City PCT in particular are committed to improving oral health and that the development of dental services in Nottingham is an integral part of the PCT's priorities for local health services. My hon. Friend raised a couple of other issues. First, he asked about an annual adult and child check for tooth decay and other oral health issues. He will know that there used to be a system of annual checks of children's teeth, which was done by the school dentist. It cost some £17 million, but an independent review found that it did not have any effect on improving oral health in deprived areas. What happened was that children would be looked at by the school dentist and be told that they had some decay, but they would not be taken to the dentist. That is a problem, because it is in deprived areas in particular that we need to ensure that we improve oral health. The question is what is the best way to spend that £17 million. The view is that a better approach is to target areas of significant deprivation and ensure that effective resources are put into a real programme to teach children and adults about the importance of dental health. The British Dental Association has considered whether we should have children's dentists, and it takes the view that that is not the best way to spend such resources. We have acted on independent advice, but I hear what my hon. Friend says and, in principle, the idea that both adults and children should have an annual check for decay or any other problems is a good one. I shall discuss it with my hon. Friend the Under-Secretary of State for Health, who has responsibility for dental service issues. My hon. Friend the Member for Nottingham, North also talked about the 2006 contract and how it has developed. Professor Steele's review of that contract is important and bears close examination. Issues did arise with the contract. It was not piloted, and we have lessons to learn from that. Indeed, in looking at Professor Steele's review we have decided that we do need to pilot his proposals so that we have a process for the introduction of changes to the contract that is broadly acceptable to dentists, the Government and the taxpayer. That process will also ensure that we do not create an over-complex contract by which we reward dental practices in a vast variety of ways. One of the problems with the old contract was its complexity, so we have tried to simplify it. We now need to examine the results of the independent review carried out by the team led by Jimmy Steele, and to ensure that the proposals in the document are considered carefully and properly piloted. If the pilots show that they are the best way of making changes, we should implement them as soon as possible. Nottingham City PCT and East Midlands SHA are committed to ensuring improved oral health for the residents of Nottingham and to improving NHS dental services in the area. The increasing number of dentists demonstrates a real commitment. I applaud my hon. Friend's presence today, despite his operation just a couple of days ago. It demonstrates his level of commitment to, and determination to serve, his constituents. His contribution today might have been painful for him, but I hope that it will at least prove worth while in raising the concerns of parents and children in Nottingham about the future of children's oral health. Question put and agreed to.