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Health and Social Care Bill

My Lords, never have I had more extensive or better briefing on a Bill from a very wide range of interested parties. Others have dealt with the important points covered. As a former dentist, I have a particular interest in this aspect of healthcare, and because of limited time, I shall deal mainly with dental topics. I declare a non-pecuniary interest as a dentist in general NHS practice for 35 years. I was a member of the General Dental Council, elected by general practitioners. Former members of the GDC meet annually. I know that many feel strongly about the registration issue, as I do. I describe myself as a former dentist because the opportunity of calling myself a ““retired dentist”” or a ““non-practising dentist”” was taken away from me in 2004, when I was told that the age-related reduced fee of £65 was abolished and that, unless I paid the then new fee of £388, which represented an increase of 122 per cent, I would be struck off the register. It was estimated that 2,500 dentists were struck off at that time, although most of them would willingly have paid £100 to remain on the list. These lost fees would have given the General Dental Council an extra quarter of a million pounds. It also soon became obligatory to carry out continuing professional development involving courses and study, even if one never wished to treat a patient again. The General Medical Council is entitled to hold a list of non-practising doctors on its register. It makes very clear whether a practitioner has a past record of good practice. In 2004, when the change in dentistry took place, the GMC made no charge to the retired doctors on its list—I do not know whether it remains free. One could be struck off the dental register either for misconduct or simply because one no longer wished to continue in practice. This lack of distinction between the honourable and the dishonourable absence from the register is invidious and upset many dentists. I took it up with the GDC at the time of my leaving and again last week. I am told that it no longer sends letters stating you will be ““struck off””; it now says that ““your name will be removed from the list””. It is possible the GDC may not wish to have such a list, and if so, has been hiding behind the lack of legal powers as an excuse. The person to whom I spoke raised the point that dentists who wish to remain on the list as not practising may be doing so for their own personal reasons and not in the public interest. It is a good point. I know that I have a personal interest. I recall my father, who was believed to be the world’s only Minister for Health and Motherhood—in the New South Wales Storey Government—paying his registration fee as a pharmacist to the day he died. I was interested in the health and pregnancy grant. I would like to hear more from the noble Baroness, Lady Murphy, about her point on that. There is a public interest in non-practising dentists remaining on the list, as many non-practising dentists continue to work on boards, trusts, charities and other bodies, public and private. If they claim to have been dentists with an honourable record, it should be verifiable. I was vice-chairman of North East Thames Regional Health Authority and later chairman of the Royal Free Hampstead NHS Trust after I had ceased dental practice. Had the age-related registration which I enjoyed not applied at that time, no one would have had any idea of my dental status. The General Dental Council might also wish to consider some difference in fee for those dentists who do not wish to practise at all, but who are employed in some capacity that requires them to retain registration. At the very least, people who carry on little if any dental treatment for patients should be allowed to pay in instalments rather than having to produce the full £438 at the beginning of the year. It is surprising that there is no mention of dentistry or the Dentists Act 1984 in the Bill. It brings to mind the Sherlock Holmes dog that did not bark. The president of General Dental Council referred in his winter message to a, "““new look, smaller, fully appointed Council with an increased lay membership””—" emerging when a, "““Section 60 Order—amending the Dentists Act 1984—is published, hopefully in 2008””." I am sorry to see that a fully appointed council is proposed as I thought it very healthy and desirable that a number of dentists were elected by their fellows. I am disappointed that the General Dental Council does not appear in the Bill, when the General Medical Council and the General Optical Council do so. I have always been told that the General Dental Council lacked the legal powers, which exist under medical legislation for the GMC, to have non-practising dentists on a separate list. The dental legislation was claimed to be defective. As I doubted the accuracy of that remark, I wrote to the Department of Health, which confirmed that a change in the law would be required. Looking at the changes proposed under Clause 60 of and Schedule 8 to the Bill, I am convinced that, had the GDC wished to make changes, it could have applied at any time under Clause 60 of the Health Act 1999. I intend to bring forward an amendment in Committee. With these powers, the GDC would have the right to make a decision, which it claims is presently denied to it. Is it just hiding behind the Government and a legal technicality? In his winter message in the GDC Gazette, the president mentions that from 1 August continuing professional development will be compulsory for all dental care professionals. He states: "““Patients can now expect the whole dental team to maintain their knowledge and skills””." This must be good, but it is important that some flexibility is applied. I took the point made by my noble friend Lady Cumberlege. Until the first registration date, anyone who is working as a dental nurse is entitled to registration on the basis of their experience, but, after that, they will have to have a qualification. When I was in practice, dental nurses, then known as chairside assistants, were trained on the job. The dentist was always fully responsible for his or her staff and their actions. Some went to evening classes and got extra qualifications, but they were optional, not mandatory. Running a dental practice is like running a small business, and there are always holidays and sickness periods when additional cover is needed. There were instances when some of my children, on school or university holidays, stepped in to fill these gaps. Now the BDA News tells me that even if a receptionist covers only lunch breaks amounting to two hours a week, they will still need to be registered and that the registration fee is more than £90. Some practices use probationary periods, but they will all have to pay a registration fee. I can remember when there was full employment and it was extremely difficult to get anyone to work as a chairside assistant—it is not a job that has an instant appeal and it is quite hard work. I am concerned that the time might come when it will be hard to attract enough applicants. To have proper well trained dental nurses is good for everyone: for the nurses who will have achieved a high standard, for the dentists they work with and for the patients. How can we ensure that we have enough of these qualified nurses? I suppose that agencies play a part, but that is not the ideal answer. The dentist has a medico-legal requirement not to treat patients unless another adult is in the surgery with them, because they can be accused of attacking the patient, for which I have seen dentists struck off. What will the dentist do if his nurse is ill and there is no one to step in? Will he simply send the patient away, even though he or she is in great pain? There must be some degree of flexibility in these things. Sixth formers came to our practice for work experience. Indeed, the splendid dentist who looked after me last week decided on her dental career after such an experience. What legal provision will there be for young people to work in a dental surgery or any other health field as work experience to see whether they would like to enter these professions? I have run out of time so I shall not continue. I served on a GDC disciplinary committee, and I served as a national health adjudicator. I welcome the fact that now dental treatment, private or national health, will be able to be inspected, as we saw cases where there was wonderful national health work done, but we could not comment on the atrocious private work done by someone—who admittedly was dying; so I hope it was not typical of his work. It meant that for people doing private work, no patient had any way of seeing whether they were right or wrong. I agree with the civil level of proof that has been mentioned. I thought that the noble Lord, Lord Carlile, made a very interesting case for legal or non-legal chairmanship. The noble Lord, Lord Walton, made a particularly important point in saying that wherever a case is being heard someone with specialised knowledge of that particular aspect of medicine should be on the board. I know of cases currently under way where that is not the case. The GMC is conducting cases without anyone specialising in the field alleged against a particular doctor. It is always good to move to a higher level in standards and training, but there must be flexibility. I hope that the Bill will operate effectively and do much to help patients and their families. The Healthcare Commission, when referring to Clause 16, said that, "““the scope of regulations should cover all services posing significant risks to patients and not create unnecessary burdens for low-risk activities””." I think that that summarises my view.