§ 7.4 p.m.
§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath) rose to move, That the draft order laid before the House on 30th October be approved [8th Report from the Joint Committee].
§ The noble Lord said: My Lords, as part of the Government's modernisation programme for the NHS, we seek to modernise and make more robust the system of professional self-regulation of the healthcare professions. The order before your Lordships' House today is an important first step towards that aim.
§ Many of the processes and rules of professional regulatory bodies are bound by primary legislation which pre-dates the modern era of openness and responsiveness. The Government have addressed this by taking powers in the Health Act 1999 to modernise this legislation more rapidly and easily than was previously possible.
§ Section 60 of the Health Act 1999 enables amendments to be made to primary legislation dealing with the regulation of healthcare and associated professions by Order in Council. The order before your Lordships House today concerns dentistry, and I should like to pay tribute to the role of the General Dental Council. Under the presidency of Professor Nairn Wilson and his predecessor, Dame Margaret Seward, the council has pursued a policy of modernisation since at least 1995. This order will place dentistry among the first professions to make life-long learning a mandatory requirement. But it is just the first part of a programme of reform, and work has already begun on a second order which will cover the fitness to practice of dentists.
§ The first issue addressed by the order is the composition of the council. The current situation is unsatisfactory because the council is too large to be a fully effective decision-making body and the lay representation too small to ensure a fair balance of patient and consumer interest.1306
§ Articles 3 and 4 of the order empower the GDC to reconstitute its council. The exact composition will be the subject of an Order in Council which requires the approval of the Privy Council. The GDC's current thinking is to have a council of between 25 and 30 members, of whom one-third would be lay people and the remainder dentists and professionals complementary to dentistry.
§ Article 5 of the order provides for the rationalisation of the GDC's committee structure. This provides for the creation of an additional continuing professional development committee and the abolition of the education committee. There has been a misunderstanding in the profession about the education committee proposal. This is a technical amendment. The GDC will continue to have such a committee, with strong representation from the educational institutions to advise on its duty to set educational standards and accredit training institutions, but it will no longer be a statutory committee.
§ The abolition is proposed because, in contrast to the council's other statutory committees, the education committee has no statutory powers; it cannot suspend or erase a dentist. Removing the committee from primary legislation would therefore give the GDC more flexibility should the composition of the GDC committee responsible for education need to be altered.
§ Finally, I wish to turn to the other main objective feature of the order, which is about life-long learning for dentists. Continuing professional development programmes are the means by which dentists ensure that their practice is up to date with developments in medical and dental science.
§ Article 8 of the order empowers the registrar of the GDC to erase from the dental register the name of a dentist who has not met the council's re-certification requirements. However, the GDC recognises that these requirements have to be easily understood by dentists and any sanctions applied fairly. Article 8 also provides for the GDC to make rules on the operation of the re-certification scheme, including the conditions which dentists who have been erased would have to meet to secure restoration to the register.
§ To provide further assurance that the scheme is fair to dentists, the order provides a right of appeal to a newly-constituted continuing professional development committee for dentists who have been notified that they are to be erased for non-compliance with the council's re-certification scheme. A further right of appeal will then be available to the Privy Council.
§ Article 9 empowers the GDC to make rules on the procedures to be followed by the CPD committee and the rules of evidence that the committee would have to observe.
§ I believe that the proposals before the House today are sensible and very much underpin the modernisation of regulation within the profession of dentistry. I commend the order to the House.1307
§ Moved, That the draft order laid before the House on 30th October be approved [8th Report from the Joint Committee].—(Lord Hunt of Kings Heath.)
§ Earl Howe
My Lords, the House will be grateful to the Minister for his clear and helpful explanation of the order, which we welcome.
The contents of the order have been the subject of extensive consultation and I understand that the British Dental Association supports it fully. It seems to me that the order is deserving of a wider welcome, given that its general thrust is to make the General Dental Council more responsive to the concerns of patients and to ensure that the quality agenda in healthcare applies as much to dentists as it does to doctors and other health professionals. That is surely the right direction in which the profession should be moving.
When the Health Act 1999 was debated in this House, we realised the good sense of being able to amend the regulatory arrangements for the health professions by statutory instrument. The advantage of doing so is that of speed. Previously, the only way of making changes of this kind was by primary legislation. It was for that reason that the previous Conservative government found themselves unable to respond to the requests put forward by the General Dental Council in 1996.
This order, which provides for a professional majority on the General Dental Council, preserves the important principle of professional self-regulation. However, that fact and the unamendable nature of statutory instruments create an obligation to ensure that the profession itself is content with the arrangements proposed. We know that that is the case so far as concerns dentists; but it is a point that applies more generally to all the relevant professions, and one to which we shall return as we debate subsequent orders under the 1999 Act.
However, given that the main advantages of the order-making power in the 1999 Act are speed and flexibility, I must ask the Minister why it has taken nearly two and a half years from the passing of the Act to the laying of this order. The dentistry profession has understandably been keen to move forward with these changes as rapidly as possible. Discussions about them began in the summer of 1999. Even allowing for the need to consult, I do not understand why we could not have been debating this order a year ago.
I say that not to be awkward, but to flag up my anxiety that the other measures, which I know the General Dental Council is keen to see approved by Parliament, may not see the light of day for some time to come. I hope I am wrong about that, but it would be helpful to hear from the Minister that progress on the questions of the performance review scheme for poorly performing dentists, misconduct procedures, regulation of the professions allied to dentistry and of dental bodies corporate, and other issues, will be expedited as rapidly as possible.
It is a pity that it has not proved feasible to incorporate all these measures into a single order. But since it has not, I hope that the Government will accept 1308 the case for maximum speed in introducing the remainder of the reform programme, consistent with the need to secure a wide professional consensus.
§ Lord Clement-Jones
My Lords, I, too, thank the Minister for his clear exposition. I welcome the order. It is worth noting that this is the first use of the powers in the Health Act over which we laboured two years ago. I am sure that this is a useful precedent. I hope that the orders that come before this House in the future are as uncontentious. I suspect that that will not be the case, but we certainly welcome the order before us today.
I have listened with care to the Minister's remarks and I have read the fairly extended discussion on this matter in the First Standing Committee on Delegated Legislation in the other place. There has been a fair working over of the issues set out in the order. Generally in the profession the order is supported on all sides. As the noble Earl, Lord Howe, said, the aims of the order must be supported by us all in terms of not only a smaller and more effective governing body but also in terms of an increase in lay representation, which is clearly going in the right direction. The compulsory professional development of dentists as a precondition for registration is important. On these Benches, we always like the phrase "life long learning". That must surely be a step in the right direction.
We look forward to the forthcoming orders which will reform procedures further. I refer, for example, to the introduction of new complaints systems and the regulation of the professions complementary to dentistry. But will the Minister say what is the time-scale for the orders? It seems that the fitness to practise order is being drafted at present. But the precise nature of the orders is important.
I understand from the debate that took place in another place that only this order is subject to the affirmative resolution. The next set of orders will be subject to the negative procedure. The Minister in another place said that they were orders of the Privy Council. I am not aware of exactly why there should be a difference. If there is a difference, and the negative procedure is used, the point made by the noble Earl, Lord Howe, is important: in circumstances where we do not have the opportunity to question the Minister directly on the orders, consultation is of great importance. That is a minatory note. These orders need airing. We need to have a discussion and make sure that all parties are able to contribute.
§ Lord Colwyn
My Lords, I am grateful to Minister for the way in which he has explained the order, identified the issues and confirmed the fact that it is the first in a series to modernise the regulation of dentistry. I declare an interest as a practising dentist. I, and the profession, welcome the proposed legislation which will formalise the GDC's current initiative for continuing professional development—life long learning.
This will be phased in from 1st January 2002. The dental profession is solidly behind the GDC initiative. Some 13,000 have already registered voluntarily under 1309 the scheme. That bodes well for the future of dentistry. Compulsory continuing professional development, as a condition of registration, will help to maintain and improve standards in the dental profession, and to enhance public confidence.
The GDC is to be congratulated on having assembled a steering group in 1999, gathering together representatives of all the major stakeholders in the profession in order to take forward the council's proposals with a solid consensus. The proposed changes in the composition of the GDC will make it more manageable and more able to operate responsively and in a strategic way. The proportion of lay members will be tripled. The increase in the membership and participation of the professionals complementary to dentistry is appropriate to pave the way for proposed future registration of nurses and technicians who will join the hygienists and therapists.
The greater separation of the GDC's investigative and prosecuting function from the actual hearing and determination of cases is a crucially important one. The current lack of separation between the prosecution and hearings roles of the council undermines the appearance of fairness. The council's proposals are to create three distinct functions which will fall within the ambit of "fitness for registration". They are: health, conduct and performance.
While declaring my interest as a former chairman of Dental Protection Ltd, I think that the third category is a very positive step. It gives the council a valuable third option, which would allow an under-performing dentist to be assisted with a clear and structured personal development plan in order to allow that dentist to be a safe and useful member of the profession again; as opposed to the present situation, where the dentist is either subjected to severe disciplinary penalties, including suspension and erasure from the register, or where on occasions a decision is postponed, allowing the dentist further opportunity—perhaps a year later—to demonstrate that he or she is fit to practise safely. During this time the dentist tends to be left to his or her own devices.
Under the new arrangements, a performance committee would have a much wider range of constructive options available to it; but only the conduct committee itself would have the power to suspend or erase, or to impose conditional registration. This would appear to be a considerable improvement on the present situation.
Finally, I recognise that this is only the first in a series of orders to which the Government are committed. Subsequent orders covering poor performance, patients at risk, registration of the entire dental team, the introduction of a new complaints system—separated from the GDC to enable patients to seek independent resolution of disputes—and measures to improve the regulation of dental corporate bodies will be introduced early next year.
1310 The modernisation has started. I hope that it can be completed very soon. I welcome the order.
§ Lord Prys-Davies
My Lords, I, too, welcome the order. I note that the noble Lord, Lord Colwyn, a practising dentist, has given it his complete support. To justify my brief contribution, perhaps I should say that a long time ago I was involved in the NHS for a number of years. I was much concerned about the adequacy of lay representation within the NHS machinery.
The order is a short order of seven pages, but to describe it as such does not reflect its importance to the dental profession and patients in the United Kingdom. I am especially pleased that it paves the way for a strong lay element in the composition of the General Dental Council, and that it will ensure that England, Wales, Scotland and Northern Ireland will have representation and a voice on the council.
The order is therefore a significant improvement on the present position. It is a major milestone in the dental profession's history. It contains some model provisions that could be adopted by other professions within the NHS. I greatly appreciate all the work by the General Dental Council and the departmental team. A great deal of effort has gone into the preparation of the order.
I end with two questions for the Minister. First, when will the retraining scheme come into effect? Secondly—here I end where I began—the order does not contain a job description for a lay member. I did not expect it to do so, but can the Minister confirm that it is not intended that a member of the medical or nursing profession will be deemed to be a lay member for the purpose of the order?
§ Lord Hunt of Kings Heath
My Lords, I am most grateful for the comments that have been made. I welcome the support of the noble Earl, Lord Howe, for the order. He was right to say that it is broadly supported among the dental profession—and especially by the BDA, which has played an important role in enabling the profession to discuss the proposals. I agree that the GDC will emerge from the order as a more responsive organisation that will be even more committed to ensuring a quality agenda among the dental profession.
I have always been an admirer of the dental profession in this country. Its standards are high compared to those of many other countries. It is much to the profession's credit that it supports the proposals. I have no doubt that the public will be the winner in receiving an even further increased quality of care.
Noble Lords have assumed that this is the first order to be laid under the Health Act 1999. In fact, it is the second. About a year ago, we laid an order providing for immediate changes to the General Medical Council. I can promise many more orders as we go through the health professions one by one. What I cannot do—I express my regret to the noble Earl, Lord Howe, and the noble Lord. Lord Clement-Jones—is to 1311 give a precise timetable at the moment. I will endeavour to keep noble Lords informed of the progress of the various orders that must be laid.
I have noted the comments of the noble Earl, Lord Howe, about professional support for the changes. There has been extensive debate with all of the professions during the past 12 to 24 months, which has been lively. That has helped to inform the process. Each of the orders that will come before your Lordships will ensure professional confidence in the arrangements, but, at the end of the day, the public interest must be paramount.
The noble Earl, Lord Howe, chided me for delay in bringing the order before your Lordships' House. I must tell him that I am aware of the General Dental Council's anxiety that the orders be brought to fruition as soon as possible. When I met the GDC several times, it was clear about that message.
On timing, in May 2000, the GDC sent the department proposals for a Section 60 order along the lines of the order before us. We could not respond immediately, because we had to revise the agreement by which NHS dentists are compensated for loss of earnings through undertaking continuing professional development. We had to take account of the extra CPD required under the GDC's re-certification scheme. Agreement with the profession was not reached until November last year. We published the draft order for consultation on 27th April. That was then delayed by the election, and there was no time to arrange a debate before the summer recess. We laid the order as soon as practicable after Parliament returned in October. I accept that the noble Earl, Lord Howe, is right to press us on speed. I am as committed as he is to ensuring that we deal with the orders as soon as possible.
I was asked about future orders. The orders relating to the GMC, the nursing and midwives council and the Health Professions Council will all be affirmative orders to be debated in your Lordships' House as we are doing today. The orders that will not be affirmative are those that concern the actual membership. Today we are conferring the ability for changes in membership to be made. That will be subject to another order, which will not be an affirmative order.
§ Lord Clement-Jones
My Lords, in the other place, an honourable friend of the Minister responded to a question from the honourable Member for Oxford, West and Abingdon about how future orders will come before the House. I assume that that Minister was also talking about the orders on complaints and professions complementary to dentistry. She said:They will be subject to negative resolution because they will be orders of the Privy Council."—[Official Report, Commons, 14/11/01; col. 11.]Is the Minister saying that that refers only to the composition of the council?
§ Lord Hunt of Kings Heath
My Lords, when my honourable friend said that, she was referring to what we may call the subsidiary orders contained in the dental order before your Lordships' House. The 1312 substantive issues relating to dentistry that will be addressed in the second order will be debated in your Lordships' House under the Section 60 provision. As I said, the orders dealing with the other professions will be dealt with in a similar way.
I turn to the comments made by the noble Lord, Lord Colwyn. He is a distinguished dentist in his own right, and I welcome and agree with his comments about the fairness of the regulatory procedures. He asked what matters were to be contained in a further order. Taken together, the orders place dentistry in a good position. It will be leading the way in regulation. I am convinced that, together with the change to the GDC and the discussions taking place between the department and the dentistry profession, the orders lay an excellent foundation for the future.
My noble friend Lord Prys-Davies spoke about his experience of NHS dentistry. I agree with him about the need to increase the number of lay members on the GDC and other regulatory bodies. I can confirm that the order's principle of increasing lay membership will be followed through with the other regulatory bodies.
On the question of when re-certification will commence, provided that the order is passed by your Lordships' House, and provided that the GDC can make its rules by 31st December, re-certification will be mandatory from 1st January 2002. My noble friend then asked how one defines a lay person, and whether it could include a doctor or a nurse. Yes, it could be a doctor or a nurse or, indeed, a Member of your Lordships' House. The definition of "lay" essentially is someone other than a person who could be appointed as a professional member of the GDC. It is right that the lay category should be as broad as possible. However, I also believe it is important that the people appointed to the GDC as lay members can reflect the lay person's view. Of course, great care will be taken to ensure that a high calibre of member is appointed.
I believe that I have responded to all the points that were made. I commend the order to the House.
§ On Question, Motion agreed to.