Mike Penning winds up the debate on behalf of the Conservatives and outlines the importance of access to NHS dentists, especially for children.
Mike Penning (Hemel Hempstead) (Con): It is a pleasure to sum up on behalf of Her Majesty’s Opposition on such an important debate, which has taken up so much of my time since I became a Front-Bencher. As we have heard, dentistry does not take up the largest part of the NHS budget—some £2.7 billion of some £110 billion is spent on NHS dentistry annually in this country—but it is something that affects nearly everybody in this country, whether or not they go private. I shall return to the comments made by the hon. Member for Carlisle (Mr. Martlew) about where I go for my dentistry in a moment, although I must say that he clearly does not know me very well.
The shadow Secretary of State summed up very well the problems within NHS dentistry, which explain why this debate has been chosen by Her Majesty’s Opposition so quickly after the summer recess. That was done—I shall come on to this in more detail in a moment—because we welcomed the Steele review, which the Government accepted in full. During the debate, I asked the Under-Secretary whether she accepted it in full, and she said yes. The Steele review is there, and I welcome it. I have spoken to Professor Steele since he published his review and I think that it was a very important way to look forward. It is visionary—it has similarities to Lord Darzi’s review in that respect—although it perhaps does not have the detail that we were looking for about how we should implement some of those ideas. We have those ideas, and the shadow Secretary of State laid them out earlier.
I want to touch on some areas to do with our policy on dentistry that we did not have a chance to discuss earlier and I also want to make comments on the contributions made by each individual Member who has spoken in the debate this afternoon. This has been a sensible debate. I have to admit that some of the comments that I have heard about how brilliant the availability of NHS dentistry around the country is seem to be anomalous to the letters and correspondence that I get and the comments I hear from dentists. As we heard earlier, provision is patchy and in some parts of the country it works well whereas in some parts of the country it is appalling. How can that be right in an NHS in the 21st century?
Let us consider some of the comments that were made during the debate. I have been on the platform many times with the hon. Member for North Norfolk (Norman Lamb) to discuss dentistry. I was slightly surprised when he said that he did not quite know whether we were going to get rid of the contract, keep it, twist it or do whatever else with it. I have stood on the platform with him many times and said that the contract in its present form is unworkable, that it is a damaged brand and that it needs to be phased out. We intend to phase in the new contract alongside it. We will pilot the hours—the pilot is important—but we will not ignore the pilot, as the Government did in 2006 and appear to have done again now, and force something on dentists.
Norman Lamb: I am grateful for that sort of clarification. It was merely that the hon. Gentleman said that he accepted Steele’s recommendations, and Steele says that we should build on the existing contract framework, develop it and, if necessary, make some changes to regulations. Essentially, he says that we should build on what is there at the moment. Is the hon. Gentleman saying that that is not the approach that he would take?
Mike Penning: I have said that there are very good things within Steele, but that how we implement what he is saying is much more difficult than simply saying, “I have a vision.” We do not feel that one could leave the contract in this form, discredited as it is within the profession and around the country—it is discredited not only with patients but with dentists too. It is absolutely right to say that if we came in on day one and scrapped it, there would be chaos—there would. There is chaos in parts of the country now, but there would be more chaos. The new scheme needs to be phased in and to be piloted and dentists need to know from day one where we are going and we need to work with them, unlike what is happening at the moment.
Let me touch on the school inspections, which have been commented on by my hon. Friends the Members for South Cambridgeshire (Mr. Lansley) and for Mole Valley (Sir Paul Beresford). If we only do school inspections and nothing else—if a dentist merely walks into a school, looks at a child’s oral health and walks back out again—there is no point doing it. That is not what we are proposing. It has to be based on education, and on training for people in the schools and for the nurses in the schools. We also need to look inside that child’s mouth—in many cases, sadly, they will never have had any oral expert look at their oral hygiene at all.
I say to hon. Members and to people around the country—I have said it to the British Dental Association, too, so it is no secret—that if they think that it is acceptable for children in our schools today to have abscesses and rotting teeth at such an early age and for us to do nothing about it, they should come up with another idea—
Mr. Martlew: Fluoride.
Mike Penning: I hear a comment from a sedentary position that it is just about fluoride. It is not just about fluoride. There has been enough fluoride in toothpaste in this country for many years.
Mr. Martlew: Will the hon. Gentleman give way?
Mike Penning: No, thank you. The hon. Gentleman has said enough from a sedentary position.
If school inspections are so wrong, how come one in seven primary care trusts in this country still carry them out? They have made the decision to put their money where their mouth is and to still do that. That is very important.
I also listened carefully to the hon. Member for Staffordshire, Moorlands (Charlotte Atkins), with whom I served on the Select Committee. I congratulate her on convincing the Committee to look into dentistry. I would have thought that it would have been an easy process—I would have thought that all Members of the Committee would have realised what a crisis there was.
The important part of the hon. Lady’s speech was her understanding of the problems with the unit of dental activity. The Select Committee saw the problems in having such a small group of bands. It is not good for the patient, because they do not understand exactly what they are paying for when they hear of someone who had a lot less treatment paying exactly the same. The bands have to be expanded, as we have said, but they also exert a perverse influence on dentists. What should they be interested in when they look inside a person’s mouth—oral hygiene, or how much money the job will cost and how much they will get? I know that the Health Committee looked at that, because it was one of the biggest worries expressed by dentists.
It cannot be right that dentists get paid the same to do one filling, or six. The money has to be based on the activity that is undertaken. Earlier, and again from a sedentary position, the hon. Member for Carlisle made it clear that he was worried that more extractions than fillings are carried out these days. In fact, there has been a 45 per cent. reduction in the amount of root canal work done in this country since the new contract came in.
Mr. Martlew: Will the hon. Gentleman give way?
Mike Penning: No, you have had your opportunity already. There are more extractions and fewer fillings now: those are the facts, as given in evidence to the Health Committee. That Labour-dominated Select Committee produced a devastating report about dentistry in this country.
Mr. Martlew: Will the hon. Gentleman give way?
Mike Penning: If you want to get on the Health Committee, I suggest that you talk to your Whips. Then you can contribute in a better way.
Mr. Speaker: Order. May I just say to the hon. Gentleman that I know that he will not want to use the word “you” again?
Mike Penning: Thank you very much, Mr. Deputy—I am sorry, I mean Mr. Speaker. Perhaps “Deputy” is another word that I should not use too often.
My hon. Friend the Member for Mole Valley knows so much about dentistry that sometimes it is very difficult for me to talk to him about these matters. He probably knows more about them than anyone else in the House, and I was very interested when he said that dentists were less worried about what happened when they ran out of UDA than they were about the money that is then clawed back. Although they may want to treat the new patients that come to them, the fact that they do not have enough UDA means that they are not able to.
It is astonishing to me that, in the past nine months, we should have had two debates about the types of contracts that are out there yet hon. Members and the public still do not realise that, unless they are having treatment, they are not registered with an NHS dentist. In his report, Professor Steele made it absolutely and categorically clear that registration was crucial. He said:
However, you cannot have such a relationship if the dentist is not responsible for continuing care. If you only go to him when you have problems, he is not responsible for your continuing care. That is why registration is so important, and why we need to make sure that dentists, like GPs, are responsible for people’s preventive care.
Earlier, the hon. Member for Carlisle said, again from a sedentary position, “I bet he’s always gone to a private dentist,” but—
Mr. Martlew: On a point of order, Mr. Speaker. That is not true. I did not say that about the hon. Gentleman.
Mr. Speaker: I am grateful to the hon. Gentleman, but I suspect that that represents a point of debate to which the hon. Member for Hemel Hempstead (Mike Penning) may or may not wish to respond.
Mike Penning: Where people in this country go to the dentist is a matter for them, and I happen to be lucky enough to have an NHS dentist. In fact, most of the time my dental hygiene was looked after Her Majesty’s armed forces. That care was not private either.
In many parts of the country, people do not have the choice to go and see an NHS dentist. There is no point in being delusional about the fact that NHS dental provision is good in some parts of the country and bad in others. Sadly, the current system is fundamentally failing millions of people who would prefer to have an NHS dentist looking after their continuing oral hygiene needs.
My hon. Friend the Member for New Forest, East (Dr. Lewis) defended local democracy to the hilt. He read out the relevant correspondence and my hon. Friend the Member for South Cambridgeshire, the shadow Secretary of State, set out our party’s position on these matters. However, one specific thing would help to ensure that an awful lot more children got to see an NHS dentist—the removal of the ban that the Government introduced that prevents children from being seen only on the NHS.
In a perfect world, NHS dentists would be available to everyone who wanted to see one, but the crisis is most serious when it comes to children. For a large proportion of the adult population, the damage has been done already, but children’s dental care is the crisis area and that is why we would allow NHS-only contracts for children. That would have the important effect of encouraging dentists back into the NHS. We do not have a shortage of dentists in this country: what we have is a shortage of dentists willing to work in the NHS. Those are the facts.
We train huge numbers of dentists. In his opening remarks, the Minister told the House how many dentists are being trained in this country at the taxpayer’s expense, but as the hon. Member for Staffordshire, Moorlands said, they may not even stay in the NHS. We train them very well, with some of the best—probably the best—training in the world, but once they have done that training, they can walk away from the NHS and the taxpayers who pay for it. We must ask them to stay at least partly within the NHS; it is important that we do so. This has been an important debate. I am pleased that so many Back Benchers have—
Mr. Mike O'Brien: Will the hon. Gentleman give way?
Mike Penning: No.
Mr. O'Brien rose—
Mike Penning: I have said no. I have indicated the position of my party throughout the debate. There has been a long time for everybody to participate. With a minute to go, I shall defend the statement that the NHS must be there for everybody. NHS dentists must be there for those who wish to have an NHS dentist. That is not the position today, but it will be under a Conservative Government.
6.45 pm