HC Deb 16 March 2001 vol 364 cc1355-8

Order for Second Reading read.

2.14 pm
Ann Clwyd (Cynon Valley)

I beg to move, That the Bill be now read a Second time.

I was No. 13 in last year's ballot, and I am No. 8 this year. I am slowly climbing the ladder; I hope that by next year I shall be nearer the top three.

I am grateful for the opportunity at least to talk briefly about the Bill. Its purpose is to ensure that private dentists are brought into line with other private health services within the remit of the National Care Standards Commission. One in four adults have private treatment, either by choice or because they cannot find a national health service dentist. Often patients are unclear whether their treatment is NHS or private, and many have a mixture of the two.

It is therefore right that patients who use private dentists should expect protection similar to that enjoyed by patients who use other private medical services. At present, private patients may not even have access to a complaints procedure. Surgeries do not have to comply with formal standards.

Those who want to complain about work done privately have no recourse to an independent complaints procedure or other forms of statutory redress. As a result, many people who want to complain about their private dental treatment have found that the only formal options are either to complain to the General Dental Council, which deals only with cases of professional misconduct, or to sue the surgery or dentist concerned.

I shall refer briefly to two examples. Jonathan Cowie felt a sharp pain in one of his teeth the afternoon after he had had a dental check-up. He contacted his private dentist, who said that his teeth were probably still sensitive after being cleaned by the hygienist and that he should rub dentine on his gums. However, the following morning he was in severe pain, so he went back to the dentist, who took an X-ray of the tooth and told him not to worry and that it would settle down. The pain continued, so he made another appointment. This time, the dentist said that there was a crack in his tooth, which he filled. Three days later the filling started to come out.

Still in pain, Jonathan visited another dentist for a second opinion. He was told that the tooth had split from top to bottom and that the filling had pushed it apart, further exposing the nerve and allowing the tooth to become infected. It was removed and, two days later, the pain went.

Mr. Cowie complained to his health authority about his dentist's repeated misdiagnosis, but was told that there was no statutory complaints procedure for private dental treatment. He contacted the General Dental Council, which said that the allegation could not be described as serious professional misconduct, so the matter was outside its remit. Jonathan is still disputing the matter with the GDC. He feels that it is not following the Dentists Act 1984, which provides that the GDC should

promote high standards of … professional conduct". Another case was that of Audrey Read, who last year was told by her dentist that she needed a bridge to replace a broken tooth, and that that had to be done privately at a cost of more than £500. The bridge was uncomfortable and looked horrible. A second bridge was fitted, but it was no better. She asked for her money back and the dentist refused.

As the work had not been done on the NHS, Audrey Read could not use the complaints system, even though the dentist also did NHS work. When the dentist would not agree to a refund, her only option was to sue. A dental negligence lawyer arranged for an independent dentist to inspect the work. He found that the tooth had not been properly pulled out and that 90 per cent. of the root was still present. Even if it had been properly extracted, the permanent bridge should not have been fitted for at least three months, to allow the gum to shrink. Finally—this happens in most cases but there are some where it does not—the dentist settled out of court and she received £6,500.

It is important that in the present climate patients should be reassured that the highest standards of care will apply to all areas of health care. The Bill would give greater legitimacy to the thousands of excellent private dentists who perform to high standards.

The Consumers Association brought the issue to my attention. For several years, it has campaigned for higher standards of private and NHS health care. The House may know that I have long campaigned for better regulation of all private health care services, including cosmetic surgery; it took me seven years before the new system was introduced. More people are using private dental services, not necessarily by choice, but I shall not go into that now. Dentistry is one area of private health care that must not be permitted to continue to operate without proper safeguards for patients.

The Minister of State, Department of Health, my hon. Friend the Member for Barrow and Furness (Mr. Hutton), has told me that private dentistry has not been brought under the National Care Standards Commission from the outset because the General Dental Council is committed to introducing a scheme for the investigation and resolution of complaints about private dentistry. Frankly, I am unhappy about that because, as we have seen with doctors, professional self-regulation alone is not sufficient.

There is still a pressing requirement to pull private dentists under the provisions of the Care Standards Act 2000, to ensure that complaints procedures are in place and that private dentists work to certain standards and provide good quality and safe care. Patients are just as vulnerable in the dentist's chair as they are at their GP's surgery. It is widely accepted that there is a need to regulate private GP practices, so why not dentists, especially as more people have private dental care than private GP care?

I should like to say more, but I would like to hear what other Members have to say. I am grateful for the support of Members on both sides of the House for the Bill, which is an important step in safeguarding the interests of patients who use private dentists. I appreciate that parliamentary time may not be available this side of the general election, but I should like the Under-Secretary of State for Health, my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart), to commit the next Labour Government to implementing measures similar to those in my Bill. That would protect patients, whether they are in a GP's surgery or a private dentist's chair.

2.22 pm
Mr. Desmond Swayne (New Forest, West)

The hon. Member for Cynon Valley (Ann Clwyd) has clearly identified a problem for which a remedy is required. We understand why she has introduced the Bill and why it has the support of the Consumers Association. It is unacceptable that the only remedy open to private dental patients—and most adults, of necessity, have to become private dental patients—is recourse to law or, if there is a case of professional misconduct, the General Dental Council.

We therefore accept that a remedy is required. We support the creation of a formal complaints procedure for private patients. Indeed, the Health Act 1999 gives the Government the power to create one. The British Dental Association believes that that should be a Government priority, but we are still waiting for action on that front. I quite understand the frustration that led the hon. Member for Cynon Valley to introduce her Bill. Last September, the Government published "Modernising NHS Dentistry—Implementing the NHS Plan", which deals with quality issues. I should have thought that that provided an opportunity to widen the scope and address the issues facing private dental patients, given that so many of them—and increasingly so— are also NHS dental patients. We are interested to learn the Government's response to the Bill.

The National Care Standards Commission has the remit of regulating private dental treatment under general anaesthesia, but dental treatment of the sort described by the hon. Lady was specifically excluded. The Government are currently reviewing the NHS complaints system. Many of us who function as ordinary Members of Parliament with casework would say that that is long overdue.

Our approach to the Care Standards Act 2000, which would be amended by the Bill, was summed up in Standing Committee G by my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond): The primary function of the Secretary of State for Health is to ensure a safe environment for all patients, irrespective of whether they choose to be treated privately or by the NHS, including those who are moved into privately provided facilities at the expense of the NHS—a practice that will become increasingly common. Patients are entitled to expect an equal standard of care. The Secretary of State, acting in the public interest, should ensure that a proper framework of safety measures is in place to regulate a patient's environment."—[Official Report, Standing Committee G, 6 June 2000; c. 47.] It follows from that that it would be preferable to have one set of regulatory and inspection criteria and a complaints procedure covering all provision of health care. Our difficulty with the Bill is that it perpetuates the system of two separate forms of inspection and regulation and complaints procedures for patients who move seamlessly between the NHS and the private sector, particularly in respect of dentistry.

The Bill will give rise to a practical problem, because the dentists who are to be regulated and inspected, and about whom complaints are to be investigated, carry out both NHS work and work in the private sector. They would consequently end up being subject to two different regimes. We are interested to hear the Minister's comments on the Bill.

2.27 pm
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)

I congratulate my hon. Friend the Member for Cynon Valley (Ann Clwyd) on introducing the Bill. I take note too of the remarks of the hon. Member for New Forest, West (Mr. Swayne). He reminded me of the debates that we had in Committee on the Care Standards Bill. The hon. Member for Runnymede and Weybridge (Mr. Hammond) ended up saying that he would go home and wrap a cold towel round his head, as he could not follow the discussion. I hope that the hon. Member for New Forest, West does not have to do the same.

My hon. Friend the Member for Cynon Valley has an honourable record. I am delighted that her determined campaign on cosmetic surgery was successful. I hope that in time she will look back and see that her present campaign was equally successful. There is no disagreement between us about the objective of her Bill. The matter for discussion is how that will be achieved.

People should expect to receive high quality health care, provided by doctors or dentists in whom they have complete confidence—practitioners who are well trained, up to date with good practice in their discipline, and mindful of the ethical standards set by their professional body. A constant theme of the Government's policies for improving the quality of health services has been the strengthening of the regulation of health care professionals.

In 1999 we secured enactment of the Health Bill, which included provision to amend, by order, the uni-disciplinary Acts governing the main health care professions—the Medical Act 1983, the Dentists Act 1984 and the Nurses, Midwives and Health Visitors Act 1997. Last year we used that provision after the conviction of Harold Shipman for murder to amend the Medical Act to provide for the immediate suspension from the medical register of doctors charged with serious offences. We also gave the General Medical Council wider ranging investigatory powers where complaints have been made about a doctor's conduct.

During the current parliamentary Session we have sponsored a Health and Social Care Bill which provides health authorities with tight controls over the four independent contractor professions—general medical practitioners, general dental practitioners, pharmacists and opticians. When the Bill is passed, health authorities will be empowered to refuse to register practitioners whom they judge unsuitable, to suspend practitioners on their own authority, without having to apply to the NHS tribunal, and to place conditions on their registration, such as prohibiting dentists from treating patients under general anaesthetic. We are currently working on a second order, to be laid under section 60 of the Health Act 1999. The order will empower the General Dental Council to strengthen the regulation of dentistry. It has two main elements to do with the constitution of the council—

It being half-past Two o'clock, the debate stood adjourned.

Debate to be resumed on Friday 23 March.