January 20, 2006
I am very concerned about what is happening in the NHS and what it means for Hillingdon residents. Let me give you a sample of what is bleeping loudly on my radar screen.
I am very concerned about what is happening in the NHS and what it means for Hillingdon residents. Let me give you a sample of what is bleeping loudly on my radar screen. The North West London Strategic Health Authority wants to close Harefield Hospital and the Mt Vernon Cancer Centre. Is this agenda driven by clinical evidence or the wishes of patients or local communities? No- it is driven by the need to reduce the number of beds in North West London in response to a financial crisis. The Hillingdon PCT is cutting services. Why? Because they have overtraded and now have to manage the second biggest deficit in the NHS system. Hillingdon patients will pay the price of this mismanagement. The redevelopment of Hillingdon Hospital and Northwood Pinner Community Hospital are frozen. Seven out of ten dentists in Ruislip and Eastcote say that they intend to quit the NHS. I am probably not alone in wondering how we have got to this state of affairs in Hillingdon when close to £90 billion a year of our taxpayers money is swilling around the NHS. Many of you will wonder like me what impact this shambles will all have on the morale of those working in the NHS. This year sees the 25th proposed reorganisation of the NHS since 1982. Can you imagine working in a company that asked employees to live with that degree of permanent change? What have we got to show for it? When the Primeminister said in 1997 that we have ‘24 hours to save the NHS’ , what did he mean? The harsh truth is that politicians and bureaucrats have too often been the problem and not the solution. And so we must brace ourselves for yet another fight to preserve and enhance the local health services that are fundamental to the quality of life in this community. "
January 10, 2006
Nick Hurd makes a speech highlighting concerns about underfunding in NHS dentistry, the ability of the local Primary Care Trust to manage new responsibilities and the future of orthodontics.
Mr. Nick Hurd (Ruislip-Northwood) (Con): I respect your desire for brevity, Mrs. Humble.
Last Friday, all three Members of Parliament who represent the London borough of Hillingdon met members of the local dental community and the message could not have been clearer: in the words of the chairman of the local dental committee, the contract as it stands is a disaster. Many of the themes will be all too familiar to the Minister, and I am sure that they will be elaborated on in Front-Bench exchanges.
I would like to focus on three issues that particularly concern local dentists. The first is chronic underfunding of dentistry; the second, to pick up the comments made by the hon. Member for Stroud (Mr. Drew), is the ability of the local primary care trust to handle new responsibilities; and the third, to pick up the comments made by the hon. Member for Richmond Park (Susan Kramer), is the future of orthodontics.
On funding, a 46-year-old dentist made the point that his fee for fitting a crown on a posterior tooth was higher when he qualified than it is now. The point was also made that there is no London weighting in the contract. I would be grateful if the Minister explained whether consideration was given to London weighting and the reason for the apparent dismissal of that option.
Another major concern over funding is loss of the ability to charge for failed appointments. I have read the Minister’s response on that and have not been convinced. If payment is to continue on the basis of payment for units of dental activity and if a dentist does not have the opportunity to deliver a UDA because a patient does not turn up, the dentist loses UDA points and income through no fault of their own.
I note the Minister’s willingness to review the situation in the event of what is described as a sudden and dramatic change in the pattern of appointments and cancellations. It would be helpful to have some clearer parameters of what constitutes sudden and dramatic change.
The second area of major concern in Hillingdon lies in the PCT’s ability to manage the change. That concern is reinforced by the PCT’s announcement in August that no new orthodontic referrals to Hillingdon hospital would be paid for. The background of that decision-if that is what it is-is the severe financial difficulties of the PCT. It is not alone in that and is wrestling with a £31 million deficit. Cuts are the order of the day, and orthodontic referrals come first because they are deemed to be low priority and are lumped together with treatments such as homeopathy.
There was no consultation on the announcement, nor any apparent effort to understand the true nature of such referrals. Around 250 people are involved and we are not talking about cosmetic orthodontics. They are referred to Victor Crow because he does work that no one else in Hillingdon can do. I have seen pictures of the burdens that his patients must carry around and they are horrific, involving terrible facial deformities, clefts and so on. The message to those patients from Hillingdon PCT and the system it fronts seems to be to put up or pay up. That could be an irreversible decision if Hillingdon hospital responds to the drop in funding by closing a department that is recognised as doing unique and excellent work in the area. When it has gone, it is unlikely that we will get it back.
What is the saving to justify that loss of service? An estimated net £40,000 a year. That is false economics in the context of a £31 million deficit. This is not a local, parochial point. Hillingdon MPs have received representations from outside Hillingdon expressing concern that this is setting an alarming precedent for cash-strapped PCTs throughout the system, thereby doing irreversible damage to the future of orthodontics in this country. I urge the Minister to make inquiries about that initiative to ensure that any decision is fully informed, supported by cost-benefit analysis and taken with due regard to statutory procedure.
The wider point is that the initiative by Hillingdon PCT reinforces concerns about the ability of the PCT to handle new dental responses in just three or four months from now. If it can make such a mess over the £80,000 for which it is responsible today, what will it do with £10 million and what will happen to that money once the three-year ring fence is over? Just three or four months away from implementing new contracts, the leadership of the PCT is distracted by financial problems and has a short-term outlook, governed by uncertainty as to its own future. It appears not to have taken steps to access the expert advice needed to help it to shoulder that responsibility.
For my constituents who rely on NHS dentistry, the implication is bleak. The problem here is that the discontent is not the voice of Government employees. Dentists are independent agents over whom Government have few levers in a market with so much private provision. In truth, they will continue to migrate from the NHS. National statistics bear that out-dentists are leaving the NHS in roughly the same numbers as the Government are recruiting them. We are running very hard to stand still, but for me the local evidence is building.
The chairman of the Hillingdon local dental committee recently took a straw poll of 10 surgeons in my constituency who provide NHS care for patients. Seven of the 10 stated that, as of 1 April, they would be withdrawing from the NHS, leaving just three surgeries to cope with all the pressure from the PCT. How long before those three are also forced to go private? I expect the voice of my constituents to be raised then, asking exactly what the Government meant in saying that they were
“firmly committed to making high quality NHS dentistry available to all who want it by September 2001”.
In commenting on the reform, Dr. Lester Ellman, chairman of the BDA general dental practice committee, said:
“This is the Government’s last chance to get this right: there will be no second chance for NHS dentistry.”
Based on the evidence that I see in Hillingdon, the Government are getting it wrong.