§ 11.55 a.m.
§ The Parliamentary Under-Secretary of State, Department of Health (Lord Warner)
rose to move, That the draft regulations laid before the House on 15th October be approved [28th Report from the Joint Committee].
§ The noble Lord said: My Lords, the House's agreement is sought to proposals to increase the registration fees paid by dental auxiliaries to the General Dental Council from £25 to £68.
§ Two classes of dental auxiliary are covered by the regulations: dental hygienists and dental therapists. They may practise only if they are registered with the General Dental Council. Their annual registration fee is, in effect, a licence to practise. By virtue of Section 45(7) of the Dentists Act 1984, Parliament is required to ensure that increases in fees are justified.
§ There are some 3,900 practising dental hygienists. Working under the direction of a dentist, they can clean, scale and polish teeth; provide local infiltration analgesia; apply prophylactic materials such as fluoride gels and fissure sealants; and give oral hygiene advice. Until recently, dental therapists have had a lower profile. Currently there are only about 370 in practice, and, like hygienists, they work under the direction of a dentist.
§ Dental therapists may extract deciduous teeth, do simple fillings, give local anaesthetics, undertake cleaning, scaling and polishing and give oral hygiene instruction. Originally, dental therapists could work only in hospitals and community dental services, but, in June 2002, we removed that restriction. As a result they may now work in all fields of dentistry, including NHS and private high street dental practices.
§ In essence, the fee increase is required to contribute to the costs incurred by the General Dental Council in modernising the regulation of dentistry. The GDC has two main objectives: the introduction of an effective fitness to practise regime for dentists and dental 1047 auxiliaries; and the extension of regulation to other classes of dental auxiliary, including dental nurses and dental technicians.
§ Unfortunately, those necessary reforms are costly. Half a million pounds is required for the development of computer systems to keep records on the new registrants. More administrative staff are needed to oversee the registration process, and the GDC must engage lawyers for hearings of conduct cases or appeals when a decision is challenged. As in other fields such as law and architecture, membership of a profession with major public responsibilities carries an overhead due to the cost of regulation.
In his report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary, Professor Sir Ian Kennedy said:
An effective system of professional regulation must be owned collectively. Further it needs an independence from the professions and from government which allows it to act in the public interest".
§ The General Dental Council's reforms should be seen in that context.
§ We are working on an order under Section 60 of the Health Act 1999 to amend the Dentists Act. It will specify that the main objective of the General Dental Council is the promotion of high standards throughout the profession and in education and training. The order will also empower the GDC to register the other classes of dental auxiliary, including dental technicians and dental nurses. Registration will make it a statutory requirement for those staff to obtain formal qualifications and empower the GDC to investigate and intervene where fitness to practise is in question.
§ We hope to publish a draft of the Section 60 order for consultation before the end of the year so that, subject to Parliamentary approval, it may come into force during 2004. The proposals before the House are necessary for the modernisation of the regulation of dentistry. I recognise that those are significant increases and that they exceed the rate of inflation since 1999. But it is not only the dental auxiliaries who are charged higher fees; the registration fee for doctors has increased from £80 to £290 since 1999 and that for dentists has increased from £135 to £300.
§ Dental auxiliaries earn less than dentists, and that is still reflected in the lower fee that they are charged. However, they are not immune from the regulatory reforms necessary to protect the public, and it is right that they should contribute to the cost of those reforms. I hope that my explanation has been helpful and that noble Lords will approve the regulations.
§ Moved, That the draft regulations laid before the House on 15th October be approved [28th Report from the Joint Committee].—(Lord Warner.)
§ Baroness Noakes
My Lords, I thank the Minister for introducing the order this morning. Before commenting on its specifics, I wish to make it plain that these Benches support the work of the General Dental Council. We believe that effective professional 1048 regulation is important to give assurance to the public about the practitioners with whom they deal—that they are professionally qualified and that complaints are dealt with correctly. It goes without saying, therefore, that we believe that the General Dental Council should be properly funded for that work.
The concerns that I shall raise are about the level of the fees that we are being asked to approve and the way in which the fees are being introduced. I will start with the level of the fees. Today, a dental auxiliary pays £25 in annual registration fees. In 2004, that will rise by a pretty significant 172 per cent to £68. Although it is not covered by this order, the GDC intends to raise the fee to £75 the year after, which will mean an increase of 200 per cent over two years. The Minister already mentioned that that is in excess of the general inflation rate. If we apply that rate and allow for the fact that there has been no increase in the fees since 1999, dental auxiliaries might have expected something of the order of £28. If we allow this order to proceed, the figure will be nearly two and a half times, which is a significant amount.
That increase is in stark contrast to what will happen to dentists' fees over the same period. The Minister said that they would increase from £135, but they currently pay £300. Over the next two years they will suffer increases—46 per cent over that £300 level by the end of 2005. In monetary terms, therefore, the increase over two years will be relatively much less significant than for dental auxiliaries. What steps have the Government taken to satisfy themselves that the increases proposed in the order are reasonably calculated? At first sight they indicate a lack of financial planning, given the very steep rate of rise. What inquiries has the Department of Health undertaken to ascertain the reasonableness of the underlying expenditure projections supporting these increases?
There are also issues of equity. Many dental auxiliaries work part time and many are women combining home and caring responsibilities with part-time work. When dental therapists do work, their average income is only £11 an hour. That puts into context the steep rise in these fees. What inquiries have the Government made to the GDC to ensure that the way in which the fees are set reflects equity between the different components of the dental profession? Do the Government believe that the way in which fee increases have been shared out reflect ability to pay and fairness?
The Minister told us this morning that the GDC needs extra money for modernisation—which is, as we know, one of the buttons to press to get new Labour approval. Part of that modernisation includes extending the regime to dental nurses and dental technicians for the first time. Will the fees paid by today's dental auxiliaries pay for the regulation of new sections of the profession? If so, the correct treatment would be for the new group of professionals to bear those costs, spread over a number of years perhaps if significant up-front costs were involved. The Minister quoted some costs this morning for the total modernisation package. My question focuses 1049 specifically on the extension of the arrangements to the extra groups. Have the Government ensured that the fee increases are not in fact a hidden cross-subsidy between today's dental auxiliaries and the new ones that will be brought on board?
Lastly, we come to the issue of consultation. Government Ministers often stand at the Dispatch Box and proclaim their allegiance to proper consultation, so today I should like to explore that. The Explanatory Memorandum to this order stales quite categorically that the GDC consulted professional bodies representative of dental auxiliaries about these increases and the fee increases "were generally supported".
Our own researches with the Dental Hygienists Association revealed a real concern about the fee increases, for precisely the economic reasons that I outlined earlier. What inquiries have the Government made about the quality of the consultation carried out by the GDC? Are they satisfied that the views of the people who will actually have to pay these fees have been taken into account?
It is not the custom of this House to oppose statutory instruments and I shall not be doing so today, but the Minister said that the Government intend in future that such fee increases will be subject to the even less effective negative procedure. I have a real concern about that based on my researches for today's debate. I am not at all sure that the interests of fairness and justice for the elements of the dental profession that inevitably wield little power are served by that. As a result of today's debate, I hope that the Minister will, if nothing else, look again at whether the arrangements within the GDC warrant the proposed weakening of parliamentary scrutiny.
§ Lord Addington
My Lords, the noble Baroness confirmed one matter for me. She mentioned an increase of 172 per cent. That is also what I made it. The noble Baroness's skill at maths is probably a little better than mine, so I was quite reassured. The figure is the nub of the whole matter. It is a huge increase. There is an expanding number of people in a new field of dental work that is probably beneficial to society as a whole and we want those people to be regulated.
I would not disagree with any of the questions asked by the noble Baroness—so this will be a comparatively short speech. However, can we have some assurance that this level of increase is a one-off? How was the figure calculated? Is it justified? Are the professionals themselves driving this increase or the Government? Paying a fee of £68 per year to be able to carry out a profession may not be crippling, but a couple of other increases of 100 to 200 per cent on top of that may stop people entering the profession, especially if they have to come up with the money all at once. We need assurance that such a thing will not happen in the future and that there is a regular way of calculating increases. That would ensure that degrees of worry would be removed. Other than that, we have no real objection to the order.
§ Lord Warner
My Lords, I understand the concerns expressed by the noble Baroness and the noble Lord 1050 because they were my concerns when I was being briefed to deal with the order. I can tell the noble Baroness that we have seen the detailed workings of the General Dental Council. These issues are always difficult for the Government in the sense that, although we are satisfied that the increases are justified, we must remember that the General Dental Council is accountable not to the department but to the Crown via the Privy Council. Successive governments have accepted that the GDC should be self regulating.
One of the checks and balances in the system is that dentists and dental auxiliaries vote members on to the General Dental Council. If they do not like the job that they are doing and the cost incurred in doing it, they can vote them off, so there is a degree of self regulation. It is a self-regulating system. We have looked at the workings and we believe that they are reasonable.
I mentioned that the General Dental Council is— and this is almost inescapable—trying to modernise its procedures, particularly through investment in better IT systems. To some extent, whenever one invests in IT systems, the cost is up-front, before future generations benefit. That is an inevitable consequence for all of us. It is not easy to have a system that deals with just one bit of the profession, rather than another bit of the profession. There is probably a degree of step change in the level of investment.
They are not easy judgments. We have examined the workings. It is worth bearing in mind that we have not had an increase in fees since 1999. With hindsight, one might think that it was better to keep the fees more up to date than to leave them for a time and then have large increases. The General Dental Council might like to consider that thought for the future. The noble Baroness asked me about next year's fees. I cannot comment on them. The General Dental Council has not submitted any proposals for next year, so we have not seen the workings. I cannot comment on that.
I may be able to give the House some reassurance on consultation. There is a dental hygienist and a dental therapist on the General Dental Council. When the increases were first proposed, those two members were asked to canvass the views of their colleagues. Their responses were that the need for the increase in fees was generally accepted and that the increase in status that would result from registration was welcome. I do not claim that every member of the two professional bodies, the British Association of Dental Therapists and the British Dental Hygienists' Association, was in favour. I cannot believe that, in the circumstances, anybody said, "Hip, hip, hooray! Higher fees!". It appears that, when approached directly, people accepted that the pay and status considerations were important and that a fee increase of the kind proposed was justified.
I cannot do more than that, other than to say that we would not have laid the regulations before the House if we did not believe that the fees were justified. It is an uncomfortably large increase, but, as I said, it is all about professional self-regulation. The profession is taking steps to modernise its procedures for registering 1051 applicants and is preparing itself, to some extent, for a future in which more dental auxiliaries will be subject to registration and the kind of disciplinary processes that have long applied to dentists.
With that explanation, I hope that we can agree the regulations.
On Question, Motion agreed to.