NHS patients are cheated by 100m pounds a year extra for their dental work

Patients are being ripped off by more than 100million a year thanks to the Government's 'botched' reforms to NHS dentistry, figures suggest. Loopholes in a new contract for dentists are being exploited so that patients are effectively being charged twice for what should be one course of treatment, critics say. Dentists are accused of recalling healthy patients for checkups and splitting up courses of treatment unnecessarily. The Department of Health admits there is evidence that the tactic has become widespread since the introduction of the contract in April 2006.

Now data obtained from every primary care trust shows patients could have saved up to 109million in incorrect charges - almost a quarter of the 475million paid every year. And without the loophole, up to 6.5million appointments could have been freed up for people who currently do not have a Health Service dentist.

The Tories have calculated that the overcharging works out at an average of 7.77 pounds a year per patient, almost a quarter of the average annual charge of 33.80.

A deal drawn up by the Government means dentists can claim twice as much by spreading treatments across different appointments or calling patients back for unnecessary check-ups. NHS guidance, stating that no patients should be called back to their dentist for a check-up or have courses of treatment split up within a three-month period, appears to be being widely ignored.

Shadow Health Secretary Andrew Lansley, who obtained the figures, said: 'Labour's management of NHS dentistry has been appalling. Not only have millions been left without a dentist, but now we learn that those who do have one are often being charged more money than they should be. 'The blame here lies with Labour's botched dental contract, which incentivises dentists to increase the number of charges to patients and has led to such drastic cuts in the number of people being able to find an NHS dentist. 'The Government urgently needs to admit that the dental contract has been a monumental failure, get a grip and put an end to these practices immediately.' Dentists' leaders insist there is no evidence that anyone is playing the system.

But last week, the Government effectively admitted that its reforms have backfired when it announced an independent review of access to treatment. Health Secretary Alan Johnson appointed a team to investigate why 1.2million people have lost their NHS dentist since the changes were implemented.

Average dentists' earnings stood at just over 96,000 in the first year of the deal - a rise from 87,000 from the year before. For the top-earning dentists who own their own practice, income rose by a third to 172,494.

A decade ago, the Government pledged that all patients would have access to treatment on the Health Service within two years. But surveys suggest one in 20 patients is resorting to DIY treatment, in some cases pulling out their own teeth. And one in five says they have gone without treatment because they could not meet the cost.

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Quality medical care for the poor?

Not in the public hospitals of the Australian State of New South Wales

Registered nurses will be replaced by cheaper, less-qualified nurses and unqualified assistants, in the latest round of cost cutting by the State Government. The plan to substitute university-trained registered nurses with enrolled and trainee nurses contradicts a $1.2 million study commissioned by NSW Health last year, which found that increasing the proportion of less-qualified staff in hospitals caused a range of preventable complications and deaths.

Hospital managers have been ordered to save $32 million within four years by downgrading nursing cover at small and rural hospitals. The ratio of assistants-in-nursing will increase to 50 per cent of the combined registered and enrolled nurse numbers. Assistants-in-nursing have no minimum level of education and are not regulated by any nursing body. Some are students and others have a TAFE certificate in aged care. Since 1993, registered nurses have been university trained.

NSW Health says the cuts are justified because many hospitals are, in effect, working as aged-care facilities due to a shortage of nursing home places. But the lead author of the Glueing It Together study, Christine Duffield, said the plan flew "in the face of the evidence that shows the more RNs you have, the better the patient outcome". The three-year study used data from 27 NSW hospitals and found that a higher proportion of registered nurses produced lower rates of bed sores, intestinal bleeding, sepsis, shock, pulmonary failure, pneumonia and death of patients from a hospital-acquired complication. "In the mini-budget [the Government] said no frontline services will be cut, but nursing is a frontline service," said Professor Duffield, from the Centre for Health Services Management at the University of Technology, Sydney. "They're just doing it to save money."

Area health services have been identifying registered nurse positions that can be replaced since August, pre-empting the $32 million edict in the mini-budget last month. A leaked memo shows Greater Southern Area Health Service will turn 53 full-time equivalent registered nurse positions into enrolled nurse roles, each saving about $20,000 a year in salary, for a total of $800,000 by June. Karen Lenihan, the director of nursing and midwifery at Greater Southern, said most registered nurses would be lost through natural attrition, not redundancy. "It's not really about saving money; it's about being efficient."

But the president of the NSW Nurses Association, Brett Holmes, said the modelling used to devise the skill mix was "based on budget, not patient need". He had serious concerns about patient safety and nurses' workload. Less qualified nurses did not have the training to deal with critical emergencies and trauma, such as car accidents, he said. The Opposition health spokeswoman, Jillian Skinner, said the changes would put lives at risk.

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