Committee of Public Accounts


Press Notice No. 30 of Session 2004-05, dated 14 July 2005


THIRTIETH REPORT: DEPARTMENT OF HEALTH: REFORMING NHS DENTISTRY (HC 167)

Mr Edward Leigh MP, Chairman of the Committee of Public Accounts in the previous Parliament, said today:

"It is well and good that 12 year old children in England have healthier teeth than their European counterparts. But the wide variations in oral health within this country are dismaying, with adults in northern England twice as likely to have no natural teeth as those in the south. And people all over the country - according to current estimates, a staggering two million - are involved in the fruitless quest of trying to register with an NHS dentist.

"The Department of Health has once again postponed implementation of its ambitious programme for reforming NHS dentistry, to April 2006. Some details of the programme are finally starting to emerge - proposed patient charges were put out to consultation last week after a long delay - but time is fast running out to develop a system to which all parties can agree. Whether Primary Care Trusts, given the responsibility of managing the new contractual arrangements, have enough time to acquire the right expertise and resources must also be open to question.

"These are far-reaching changes and there is still much work to do to reduce uncertainty and to win over a sceptical dental profession. If this fails, the Department's attempts to cure NHS dentistry may turn into something that seriously damages its health."

Mr Leigh was speaking as the Committee published its 30th Report of the 2004-05 Session, which examined the progress made by the Department in implementing its challenging programme for reforming NHS dentistry. In particular it examined whether the significant risks identified in the report were being managed, including the mismatch between supply and demand for NHS services, primary care trusts' ability to commission services, and variations in oral health.

The Committee found that in areas with high levels of social deprivation there are relatively few dentists, while in more affluent areas many adult patients experience difficulties in registering for NHS treatment. The Department's 2003 workforce planning exercise indicated a need for 1,000 new dentists and it has introduced various initiatives, including recruitment from abroad and increasing the number of dental training places, to tackle these access problems. The new contracting arrangements together with new guidance on dental recall periods, which recommends that recall periods should be based on clinical need (of between 3 and 18 months) rather than the standard recall period of six months, are also expected to increase dentists' commitment and ability to provide additional NHS services.

Indicators of oral health show that twelve year old children in England have lower levels of decay than their European neighbours, and an increasing percentage of five year old children have no dental decay. There are wide variations in oral health levels across the country however, with children in some parts of northern England having, on average, twice the level of decay of children in other parts of the country. Likewise adults in northern England are twice as likely to have no natural teeth as those in the south.

Dentists remain concerned that the proposed commissioning arrangements will still not release dentists from the "treadmill" of being paid for treatment provided rather than focussing on prevention. The delay in publishing the details of the revised patient charges regime, and the lack of experience in primary care trusts of commissioning dental services, add to concern about the NHS's ability to implement the reforms effectively. Following the Committee of Public Accounts' hearing, the Secretary of State for Health announced that the timetable for implementation would be delayed until April 2006 to enable public consultation on key aspects of the new proposals, and to allow Primary Care Trusts to prepare for their new roles.


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