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Lord Skelmersdale: My Lords, that leads me very nicely to my question. Will the late lamented CHIMP, now re-christened CHIM (the Commission for Health Improvement)--because "CHIMP" sounded a bit silly--be studying schizophrenia treatments of this kind, and will the Government encourage them?

Baroness Hayman: My Lords, the role of the commission will be to monitor the performance of health service providers in providing high quality care. One of the matters that it will look at is the guidelines that are being implemented and the adherence to accredited advice. One role for the commission is to look at the national service framework and to monitor, through clinical governance and inspections, how that is being implemented. There is also a role for the National Institute for Clinical Excellence in looking in particular at the cost-effectiveness and clinical effectiveness of the new treatments as they come on stream.

Lord Thurlow: My Lords, while I warmly welcome what the Minister has said about the prospect of a new national framework for guidance, which I believe can make an enormous difference, is she aware that 91 per cent of psychiatrists would like to prescribe the new atypical drugs but are virtually rationed, and that to treat all new patients with them would increase the total bill for mental health medication by only 1 per cent?

Baroness Hayman: My Lords, I am aware of considerable support among the mental health professional community, although we should not regard this as a panacea. The new anti-psychotics are very effective in some patients but not necessarily more effective than standard treatment; nor are they necessarily without side effects compared with present treatments. I return to the evidence base on which funding decisions should be taken. That is why we believe that the guidelines, which we hope will be published later this year, will be very important in ensuring that we all work from a common set of data.

Lord McNair: My Lords, is not one of the lessons to be learned that the side effects of the drugs prescribed are a major cause of the problem to which the report refers? Does the Minister accept that there is a growing interest among users of mental health services in alternative and complementary methods of treating mental illness symptoms, in particular as regards nutrition? Does she agree that that may provide the opportunity for the cost savings which the questioner seeks?

Perhaps I may recommend that the Minister reads the article, Complementary therapies, in the 10th June issue of Mental Health Care, Volume 2.

Baroness Hayman: My Lords, I thank the noble Lord for that suggestion; I shall look at the article.

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The noble Lord is right to highlight that we cannot consider individual issues in totally self-contained compartments. The noble Lord, Lord Williamson, made that point. A range of treatments may be effective. That is why we specifically asked for the guidelines to consider non-drug as well as drug treatments.

Earl Howe: My Lords, can the Minister assure the House that when the range of anti-psychotic treatments is examined by the national institute for clinical excellence the issue of affordability of newer types of drugs, as distinct from their clinical or cost effectiveness, will play no part whatever in its deliberations?

Baroness Hayman: My Lords, we have not yet announced the programme of work for the national institute for clinical excellence. I should not like to pre-empt that. We have stated clearly that that organisation will look to provide advice based on the issues of cost effectiveness and clinical effectiveness.

Dental Clinics: Standards

2.51 p.m.

Baroness Gardner of Parkes asked Her Majesty's Government:

    What authority will be responsible for the maintenance of standards of dental treatment provided for patients in the mixed private and National Health Service dental clinics now opening in large retail premises and whether controls and consumer rights will differ between the NHS treatments and those provided privately.

Baroness Hayman: My Lords, large retail premises are no different from any other mixed dental practice. The General Dental Council is responsible for both the professional conduct and fitness to practise of all dentists in the United Kingdom. Additionally, health authorities and the Dental Reference Service of the Dental Practice Board are responsible for the maintenance of standards of treatment for consumers within NHS dentistry.

Baroness Gardner of Parkes: My Lords, I thank the Minister for that reply. As an elected member of the General Dental Council I discovered that its responsibility is to issue the educational curriculum and to pick up problems which have reached an impossible point, perhaps then having to take someone off the dental register. Does the Minister believe that there is a great gap between those two areas? Does she agree that an independent assessment system should be available--either run privately or provided by the Government at a cost? Many individuals now have private dentistry treatment either because they cannot obtain such treatment under the National Health Service or because they choose to do so. They should have some

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means of being assessed independently. Few patients have any idea technically whether they are being treated well, badly or indifferently.

Baroness Hayman: My Lords, the noble Baroness pinpoints an important issue. As are several other regulatory bodies, the General Dental Council is concerned that its powers and abilities are not as wide or sensitive as it would wish. It has proposed a number of amendments to the Dentists Act, including proposals for a private complaints procedure, which I think would be helpful, and a performance review scheme. That could be achieved through the order-making power to strengthen professional self-regulation in the Health Bill, which returns to your Lordships' House this week. There are opportunities for improvement there.

We shall shortly issue a consultation document on regulating private and voluntary healthcare. We shall seek views on whether the current exemptions from regulatory arrangements, including exemption for premises primarily used by dentists for treatment, should continue. I think that there are opportunities for improvement in this area.

Lord Bruce of Donington: My Lords, is the Minister aware that the issue is being overshadowed by the fact that the dental service is rapidly becoming a two-tier service under the present national health arrangements? Some attention will have to be given to that fact. Hard choices are now having to be made by people who can least afford to make them.

Baroness Hayman: My Lords, my noble friend is right to point out that we inherited a situation which was the result of the promises of the former government, who did not invest in dentistry and allowed the rundown of dental services. That led to the inequalities and difficulties which are highlighted in some parts of the country. We have taken positive and successful action to tackle some of the worst areas by investing in dentistry and through personal dental services pilots. Twenty-four new pilots were announced as part of the Government's vision of a more flexible, accessible and convenient health service.

However, there is a great deal to do here. It would be wrong to suggest that we can put the matter right overnight. I hope that the strategy which we shall publish later this year will take us further along that road.

Lord Clement-Jones: My Lords, the Minister referred to drop-in centres that were announced recently. The noble Baroness, Lady Gardner of Parkes, referred to retail developments. Are not these taking place in somewhat of a vacuum? The Minister referred to the strategy document being published later this year. The original intention to have a strategy was referred to in April 1998. Is it not high time that the strategy paper was published--and very soon?

Baroness Hayman: My Lords, I hope that we shall publish it before too long. But the most important aspect

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is to get the strategy right. We need to ensure that that strategy reduces inequalities in oral health status, improves access to NHS dental services, builds on the success of investing in dentistry and personal dental services, guarantees high quality services, and ensures that all members of the dental team can make the fullest contribution to improving services for patients. The major job is to get the strategy right, if we are to cover all those areas effectively. As I have said, I hope that the document will be published later this year.

Lord Rix: My Lords, is the Minister aware that according to the Office for National Statistics survey of 1997, 96 per cent of all non-disabled children attended for an annual oral check while only 72 per cent of children with a learning disability did likewise? Similar figures apply to adults with and without learning disability. What safeguards and standards are being set for the new-style clinics in regard to the reception, treatment and encouragement to attend of people with a learning disability, both adults and children?

Baroness Hayman: My Lords, the noble Lord highlights that in our strategy we need to make sure that we reduce some of the inequalities in oral health status which apply to different groups in the population, including the learning disabled, and in different areas of the country. We have to look overall at access to dental services from different groups which have particular difficulty. Community dental services in some parts have done good work in that field. I shall make sure that the points the noble Lord raises today are taken into account in consideration of the issue.


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