| Previous Section | Index | Home Page |
Lebanon
22. Mr. Jim Cunningham: To ask the Secretary of State for Foreign and Commonwealth Affairs what discussions he has had with the Government of Israel regarding the ceasefire in the Lebanon. [30865]
Mr. Hanley: During the conflict in Lebanon, we repeatedly urged all sides to reach a ceasefire agreement. Since the 26 April agreement was reached, my right hon. and learned Friend the Foreign Secretary and I have been in touch, by letter and telephone, with the Israeli Government about Lebanon, and kept in regular touch, in person, with the Israeli ambassador to the Court of St. James.
Mr. Cunningham: Has the Minister had any clarification from the new Israeli Prime Minister who says that he wants peace and security? What is the Minister's interpretation of that statement?
Mr. Hanley: I cannot but believe that it is in the interests of the new Israeli Government and their Prime Minister to continue the peace process. Peace comes with prosperity and prosperity comes with peace. It must be in the interests of all people in the middle east to pursue the peace process. Last weekend, and during the week, I visited five countries--Lebanon, Syria, Jordan, Egypt and Morocco--and in each of them I found constructive views and people willing to give the new Prime Minister of Israel the chance to show that he is dedicated to peace. I believe that the Arab world will do so and that Mr. Netanyahu will rise to the occasion.
PRIVATE BUSINESS
Australia and New Zealand Banking Group Bill [Lords]
Read the Third time, and passed, without amendment.
NHS Dentistry
3.30 pm
The Minister for Health (Mr. Gerald Malone): With permission, I would like to make a statement on the future of dentistry in the national health service.
Last April, I announced on behalf of all United Kingdom Health Ministers a package of reforms to the general dental services remuneration system. I can now tell the House that a year of constructive and detailed discussion with the General Dental Services Committee has resulted in agreement on that package. Implementation will start in September. This will do much to end uncertainty and to provide an atmosphere of stability and security for the dental profession. It creates a firm foundation for future work.
I wish to set out both an immediate and a long-term agenda. I will deal with the immediate agenda first.
The package has a number of elements, one of which is children's dentistry. At present, the treatment of children is funded through a monthly capitation payment to dentists, supplemented by weighted entry payments where significant additional treatment is needed. The new system retains capitation payments, and replaces weighted entry with a new set of fees for individual items of treatment. This will help ensure that children receive appropriate preventive advice and dental treatment.
For both adult and child dentistry, we will harmonise the registration period at 15 months. This will provide a period of continuing dental care following each course of treatment, while streamlining administrative procedures and reducing bureaucracy for dentists.
To help ensure that the public secure the best value for money from resources, we will introduce more rigorous prior approval for some courses of treatment from 1 December. This will ensure that all clinically essential services are available and are secured in the most cost-effective way. A joint working party between Health Departments and the General Dental Services Committee will develop our proposals further.
It is important to construct a remuneration system which encourages improvements in oral health. Our aim is to target substantial existing resources more effectively for the benefit of patients. We shall be working with the profession to monitor the outcome of the changes to the proposed fee scale to ensure that we achieve our objective.
I deal now with the longer-term agenda. I can now tell the House that we intend to pilot and evaluate a system of local contracting for primary care dentists in several areas around the UK. The chairman of the General Dental Services Committee has stated that it will work with us constructively. I welcome that approach. The pilots will require primary legislation, and it is the Government's intention to seek an opportunity to introduce a Bill. I hope that it will prove possible to publish a draft Bill for consultation this autumn. We want to make progress, with the agreement and commitment of the profession.
Such a Bill would provide an opportunity to tackle another agenda which has been set by the dental profession itself and which I have discussed recently with the General Dental Council. The council is charged under the Dentists Act 1984 with setting and maintaining professional standards for the benefit of dentists and patients alike. Last year, the council issued a consultation
document setting out its proposals to amend the Act to do away with a number of constraints to the development of the profession. I am now happy to announce that the Government are prepared to take forward their proposals.
First, the Government propose to set up new classes of dental auxiliaries and expand the range of work that they can do. That would allow the GDC to approve pilot studies of mixed-skill working. The aim is to allow dentists to manage their practices more effectively, provide more professional opportunities for hygienists and other dental auxiliaries and increase the amount of care available for patients. It will be necessary to ensure that those changes produce enhanced NHS services, targeted to need. The proposals will enable clinical dental technicians to practise legally in future.
Secondly, in cases of disciplinary proceedings, the Government propose to introduce conditional registration in addition to the sanctions currently in place. Another important component of that proposal would be the creation of a statutory career redevelopment scheme for dentists who do not demonstrate a sufficient level of competence. We also intend significantly to increase the lay representation on their council.
Thirdly, the Government propose to establish a complaints system for private patients, something that was urged upon me recently in a debate by my hon. Friend the Member for Cirencester and Tewkesbury (Mr. Clifton-Brown). That would enhance the GDC's powers to deal with complaints against dentists providing treatment outside the NHS.
Those proposals broadly mirror developments for the medical profession which were put to the House earlier this year and approved.
I recognise that, within a growing general dental service, there are some localised problems of accessibility. Health authorities are already able to apply to the Secretary of State to seek to appoint a salaried dentist and use the community dental services in areas where availability problems arise. In addition, we have been consulting within the NHS and the profession on an access fund for this year.
I am pleased to announce to the House that we shall shortly be seeking bids from health authorities in England for individual grants, in the region of £40,000, to enable them to fund local solutions to local problems of availability. An access scheme has already been successfully launched in Wales. We shall monitor the outcome carefully.
Another issue which has greatly concerned the profession is that dentists have been remunerated through a system with a balancing mechanism, whereby overpayments in one year were recovered in subsequent years. However, over a number of years, up to 1993-94, an overpayment amounting to some £16,500 per dentist arose. I have had many representations on the issue. I have listened to the views of my right hon. and hon. Friends, and also to Opposition Members, who have urged me to mitigate the burden of those overpayments.
In view of the agreement reached with the profession, I have decided not to pursue that course of action. Instead, I have decided to announce today a total waiver of the overpayments. As a consequence, I understand that the chairman and executive of the General Dental Services Committee will recommend that the dispute started in 1992 be called off.
NHS dentistry is a success story. Since 1992, the number of dentists on English health authorities' lists has increased by around 500, to nearly 16,000. The number of adult treatments has gone up by 50 per cent. since 1979. Expenditure on the general dental services is up by 57 per cent. over the same period. We now have an agreed way forward. In my statement, I have set out an exciting and challenging new agenda for the profession and for the NHS. I intend to pursue it with vigour, and I commend it to the House.
Mr. Henry McLeish (Fife, Central):
Does the Minister not accept that, against the background of the crisis now gripping NHS dentistry, his statement will be seen as muddled and misguided, and will be a bitter disappointment to the public, professionals and Parliament? Will he acknowledge that this package is further evidence, if any were needed, that the Government are determined to drive dentistry out of the NHS by promoting further privatisation of adult treatment and retaining a residual welfare service for children and people on benefit?
Is the Minister oblivious to the main problem: to ensure that adults get routine NHS general dental services throughout the country? On that issue, does he accept that, in London and the south-west, one in six of the population has difficulty finding an NHS dentist? Does he further accept that there has been a significant fall in the registration of young adults over the age of 18? Why does nothing in his statement address those issues?
No one will disagree with more assistance being given to children, nor with the proposals to maintain professional standards. The belated attempt to solve the payments problem is welcomed by most people, and the Government have belatedly accepted that there are localised difficulties in terms of access, but will the Minister explain the knee-jerk reaction to the crisis facing children in NHS dentistry?
Will the Minister confirm that the proposed amount to be spent is £10 million, and that it will in effect be transferred from adult dentistry? Will he also explain why the item-of-service payments, which have been reintroduced, provide dentists with more money for taking teeth out than for filling them, which will undermine preventive health care?
Does the Minister accept that the reduction in the registration period from 24 to 15 months--or, to use his words, to "harmonise" the phase of registration--could mean that millions of adults will be removed from NHS dentists' registers? I urge the Minister to tell the House whether 2 million, 3 million or 4 million will be removed at a stroke. Can he explain whether the new rigorous prior approval for expensive treatments--crowns and bridges--is designed to improve dental care or merely to provide the cash for transferring to children's treatment?
| Next Section
| Index | Home Page |