§ 7.36 p.m.
§ Lord Filkin
rose to move, That the draft regulations laid before the House on 25th April be approved [28th Report from the Joint Committee].
The noble Lord said: My Lords, in moving the draft regulations, perhaps I may speak to the two draft statutory instruments together. The Dental Auxiliaries (Amendment) Regulations 2002 contain the substance of the changes we wish to make to extend the role of dental hygienists and therapists. The Dentists Act 1984 (Dental Auxiliaries) Order 2002 provides that a particular restriction imposed by the Dentists Act on the range of duties and the fields of dentistry in which dental auxiliaries may work shall not apply to dental therapists.
As the House will know, the Government are committed to modernising the regulation of the healthcare professions. That includes the dental health professions. Last November we debated an order made under Section 60 of the Health Act 1999 which empowered the General Dental Council to modernise the constitution of its council and made continuing professional development mandatory for dentists. This draft legislation governing dental auxiliaries is the next step necessary for implementation of the regulatory section of our dental strategy, Modernising NHS Dentistry—Implementing the NHS Plan.
The draft legislation provides a means whereby we can extend the role of dental hygienists and dental therapists using delegated powers in the current Dentists Act. Our intention is to enable these staff to undertake a wider range of duties subject to varying 219 degrees of supervision by the dentist/team leader. We also wish to permit dental therapists to work in all fields of dentistry.
I turn first to dental hygienists and the detail of the amending regulations. Regulation 3 of the amending regulations extends the scaling power to enable a hygienist to treat a patient who has previously undergone a course of treatment and who, with the reduction in swelling of the gums, is found to have excess cement around teeth that have been crowned. A rotary instrument is a burr fitted on a drill which the hygienist can use in addition to a scaling probe.
Next, we want dental hygienists to be able to undertake some impressions in dental work. The impressions we have in mind are those taken for study models at the outset of a course of orthodontic treatment.
We also think it right that dental hygienists be able to undertake inferior dental nerve block anaesthesia used in the lower jaw where a deeper, more precisely located injection is needed. However, a dental hygienist will be allowed to administer only inferior block anaesthesia under the direct supervision of a dentist on the premises. We believe that they should have the power to replace crowns when they become loose in the course of an examination.
Lastly, the proposed new Regulation 23(7) would allow a hygienist to carry out a scale and polish on a patient who had been sedated for a more invasive dental treatment. It would save the dentist from carrying out work that could be delegated and enable the patient to receive the full programme of treatment on one occasion without, one hopes, feeling any pain.
I turn to dental therapists. Regulation 4 of the amending regulations amends Regulation 27 of the principal regulations which relate to dental therapists. Under the 1957 Dentists Act, therapists were allowed to work only in dental hospitals and community dental services because those were the only places where they were direct NHS employees—mainly clinics for the dental care of children and for people with special needs. Therapists cannot work in the general dental services because although these are NHS services they are delivered by self-employed independent practice owners. Nor can they work in private dental practices. We believe that that should be changed. The omission of paragraph 27(2)(a) of the principal regulations (under Regulation 4(3) of the amending regulations) will permit dental therapists to work in all fields of dentistry—the NHS general dental services, private practices or elsewhere.
In many other respects the amendments in Regulation 4 provide for dental therapists the same range of extended duties provided for dental hygienists in Regulation 3. I should draw your Lordships' attention particularly to paragraph (1)(ec) inserted into Regulation 27 of the principal regulations relating to the pulp of the tooth which is below the enamel in the area of the roots of the tooth. This would enable, therefore, dental therapists to perform virtually all 220 types of fillings required by young children with primary or, as they are sometimes known, deciduous teeth. The other amendments will enable them to make a substantial contribution to the dental care of adults, thereby using their training and skills to the maximum.
As the House will know, the General Dental Council has been extremely helpful in this respect and has promoted these changes which the Government are pleased to support. I beg to move.
Moved, That the draft regulations laid before the House on 25th April be approved [28th Report from the Joint Committee].—(Lord Filkin.)
§ Earl Howe
My Lords, I thank the Minister for his clear explanation of the orders which we very much welcome. I believe that they are in the interests of patients and that the extension of the duties of dental therapists and dental hygienists will enable them to make the most of their skills and experience and thus benefit the whole of the dental team. The Minister will know that the General Dental Council is currently in the process of reform through orders made under Section 60 of the Health Act to amend the Dentists Act. Perhaps I may ask the Minister one question in that context. As part of the GDC's programme of reform the council published last year its proposals for the extension of professional regulation to the whole dental team. As the noble Lord will know, the proposal is to register professionals complementary to dentistry (PCDs) via a single PCD register. That will enable all members of the dental team to make the best use of their skills in the interests of patients.
I understand that PCDs will register by protected titles, based upon their qualifications and experience, thereby ensuring that the public can distinguish those who are properly qualified from those who are not so qualified. Registration of the entire dental team will mean that all PCDs will be subject to the public protection measures that professional regulation offers, not least approved courses of training and robust fitness-to-practise procedures.
I wonder whether the Minister is in a position this evening to give the House any indication of when such orders might come forward, and of how far the preparation for them has now progressed. I repeat my welcome for both the order and the regulations, and thank the Minister again for his introduction to them.
§ Baroness Harris of Richmond
My Lords, I, too, thank the Minister for so clearly outlining the content of these measures. This is a very new area for me, but I was most interested to hear his introductory remarks. Noble Lords on these Benches consider these provisions to be very sensible, and are very happy to support them.
However, I should simply add that the training area is a subject upon which we should like to hear a little more. It would be most helpful if the Minister were able to enlighten us in that respect. We wholeheartedly support both the order and the regulations.
§ Lord Filkin
My Lords, I thank the speakers from both Front Benches opposite for the welcome that they have given to the legislation. I believe that there is a general recognition that this is part of a sensible process of deregulation and of developing good teamworking, while being prudent in ensuring that there is adequate supervision of delegated work to "dental auxiliaries", as they were formerly called. It is part of the modernisation of the dental service in general, which I know from previous debates the whole House wishes to see.
I turn to the question posed by the noble Earl, Lord Howe, about the progress on the second Section 60 order. I can tell the noble Earl that it is in preparation, and that it will provide for the registration of all classes of professionals complementary to dentistry. It will also empower the General Dental Council to introduce a more flexible regime for defining the duties that the PCDs can undertake. Instead of a list of duties, like the one that we have just debated, the intention is that the PCDs will be able to carry the full range of duties for which they have been trained, and in which they are competent. Dental therapists and hygienists will benefit from those changes through further amendments to the legislation that we have discussed today.
I am pleased to say that we intend to consult on the order in July. After the proper process of consultation, the order will no doubt be placed before the House either at the end of the year, or at the start of next year. I believe that progress has been made in that respect.
On the subject of training, I very much agree that the training of dental therapists is most important. We must ensure that there is an adequate supply of dental therapists to allow for the effective delegation of work from dentists. That was one of the Government's earlier concerns as regards not moving too fast in this area. That is why dental auxiliaries undertook a very helpful survey of the potential take-up of such training. There are currently 54 training places available each year for dental therapists across dental schools. Most therapist courses offer dental hygienist qualifications at the same time.
However, I have to say "no" to the further question raised in that respect. We shall look to developing those services and monitoring the generation of adequate supplies to go with the increased delegation for which this order provides.
On Question, Motion agreed to.