Previous Section Back to Table of Contents Lords Hansard Home Page

Lord Warner: I do not believe that we could accept the amendment as drafted even if we wanted to because it does not mention Scottish Ministers. It would mean that underpayments in England and Wales due to clerical error could not be recovered, but that similar payments in the Scottish scheme could. Having said that, I understand the arguments that the noble Lord makes. I am happy to agree to re-examine the issue. I make no commitment but the noble Lord and I shall cover this in discussions with colleagues and we shall see whether we can move forward on that issue.

Lord Skelmersdale: We have had six days of debate on this. How long does the Minister anticipate that the discussions will last?

Lord Warner: I have said that I would meet the noble Lord to discuss with him a variety of his amendments, particularly those on which he has some detailed concerns. I am simply sweeping up this matter into those discussions. At the same time I am saying to the House that we shall re-examine the issue and return to the matter on Report.

Baroness Blatch: The Minister is being very generous in his offer of meetings. I know that my noble friend Lord Hunt will welcome and appreciate that. I need to remind the noble Lord that only two days have been allocated for Report stage. With the number of matters that are now subject to meetings,

20 Oct 2003 : Column 1453

and which will give rise to more debates on Report, I hope that there will be a more generous allocation of time for discussion on Report.

Lord Warner: That is a matter for the usual channels. I would not rule out the fact that what we have to say may be so persuasive that there may be no problems when we come to Report.

Lord Hunt of Wirral: I do not know quite what to say. I have had so many generous offers. The only offer that the Minister has not yet made to me is office space within his department. He is now offering it. I am reminded of the words of Viola in Twelfth Night when she said,

    "Make me a willow cabin at your gate".

I shall not pursue this matter at a quarter to three in the morning. Once again I say that I am grateful to the Minister. In the circumstances, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 152 agreed to.

2.45 a.m.

Clauses 153 to 157 agreed to.

Clause 158 [Payment of NHS charges to hospitals or ambulance trusts]:

[Amendment No. 430D not moved.]

Clause 158 agreed to.

Clause 159 agreed to.

Clause 160 [Liability of insurers]:

On Question, Whether Clause 160 shall stand part of the Bill?

Lord Hunt of Wirral: Clause 60, which deals with the liability of insurers, is a new provision and, as far as I can tell, it did not feature in the 1999 legislation. I am not certain what prompted the Government to seek to include this provision for the first time for four years. It may be—I speculated to the Minister—that the Government were concerned about limits of indemnity on certain types of insurance policy, which of course would not be a feature in road accident cases.

If that were the Government's concern, I mentioned to the Minister that I would welcome confirmation that regulations to be made under this clause would not cause insurers to have to pay out in excess of the limits under their policies. I appreciate that this might mean a deduction from the damages that a claimant might otherwise receive, but I sense that insurers were understandably anxious that they should not be exposed to greater liability than policy limits provide.

20 Oct 2003 : Column 1454

In response, the Minister stated in a letter to me:

    "Where a liability to pay compensation is covered by insurance, it is our [the Government's] view that the corresponding liability to pay NHS charges should also be covered by the insurance policy. Clause 160 supplements clause 146(2) which makes it clear that liability to pay NHS costs falls upon 'the person making the compensation payment'. There is no provision to transfer that liability to a third party".

The noble Lord explained that,

    "Clause 160 ensures that this liability to pay NHS costs is made absolutely explicit".

The Minister went on to explain that the,

    "requirement was not necessary under the road traffic scheme which was concerned only with cases covered by compulsory motor insurance or its equivalent".

He felt that Clause 160,

    "reflects the fact that all kinds of personal injury will now be included in the scheme regardless of the insurance position, and that they may be covered by different types of insurance".

The Minister, however, stressed that,

    "the clause also enables regulations to be made to limit an insurer's liability in some circumstances. This might include . . . enabling a reduction in the NHS costs payable in cases where an insurer has only covered a proportion of the total compensation due as a result of a cap on the amount payable under the insurance policy".

I am very grateful to the Minister for his explanation, which goes some way to satisfying me. I am very grateful to him for giving me the opportunity of his reply in advance of this debate. I hope that I have set out his position as clearly as I can in my speech on Clause 160 stand part. Of course I should like to see more detail, and I recognise that he has already explained that his offer for further discussions includes this aspect. I readily accept that and am very pleased that he should have made that offer.

Lord Skelmersdale: If my noble friend Lord Hunt's explanation of the Minister's view is correct, does that mean that individuals are encouraged to insure up to the 33,000 cap? If so, the cost to individuals will rise exponentially.

Lord Warner: The outline of the Government's position given by the noble Lord, Lord Hunt, was completely accurate and I have nothing to add to it. I cannot prejudge the question posed by the noble Lord, Lord Skelmersdale. I should like to think a little more about it and will come back to him.

Clause 160 agreed to.

Clauses 161 to 165 agreed to.

Clause 166 [Provision of primary dental services]:

Lord Colwyn moved Amendment No. 430E:

    Page 81, line 21, at end insert—

"( ) Each Primary Care Trust and Local Health Board will publish a statement of what constitutes a reasonable level of service in its area."

The noble Lord said: We now come to Part 4, which covers provision of primary dental services. At this time of night, the Committee will be delighted to hear that I do not intend to see any patients tomorrow morning.

20 Oct 2003 : Column 1455

My amendment is intended to discover what the Government intend shall be a reasonable level of service when provided locally by primary care trusts. Most of the profession—the British Dental Association and the General Dental Practitioners Association—welcome the proposals in Agenda for Change that move towards local commissioning of dental services by primary care trusts. For many years—certainly since Sir Kenneth Bloomfield's report in the early 1990s—dentists have wanted to get off the treadmill of fee per item of service.

I have received a letter from the Minister, for which I thank him. He says that he agrees with the intention behind Amendments Nos. 430E and 434A. He also points out the Secretary of State's general duty under Section 3 of the National Health Service Act 1977, which states that he must provide dental services,

    "throughout England and Wales to such extent as he considers necessary to meet all reasonable requirements".

But what is reasonable? Reasonable may mean different things in different parts of the country. During Committee in the other place, it was noted during discussion of an equivalent amendment that the reference to local need was proposed because dental health varies considerably around the country and there was a perception that that was not recognised in the wording. It was intended as a reference to local needs, as opposed to local residents' needs, as commuter populations were also regarded as local.

The principle of local commissioning must be supported, but it is important that assurances be given about what constitutes reasonable levels of service. The PCTs must make clear what services will be available. Perhaps "reasonable" means the essential services that the public currently receive from the NHS dentistry. Will the Minister confirm that stakeholders, local dentists and the public will be consulted on that definition; and that, having defined "reasonable", the PCTs will ensure that they are accessible? I beg to move.

Baroness Barker: I shall speak to Amendments Nos. 431 to 436. Never in my life has dentistry seemed a more pleasing prospect. I simply want to add a few more strings to the bow of the argument advanced by the noble Lord, Lord Colwyn. We are trying to tease out what is determined to be an acceptable level of dentistry provision.

Amendment No. 431 is a probing amendment to enable us to ask the Minister exactly what will be the requirement placed on primary care trusts to determine and provide NHS dentistry. Amendments Nos. 433 and 434 set out our strongly held view that dental services ought to be based on need and, thereafter, on funding. Amendment No. 435 is important in that it draws into the definition of primary dental care such work as orthodontics and oral surgery, which are provided increasingly at local level.

20 Oct 2003 : Column 1456

Perhaps one of the most important provisions is the requirement to publish details of dental provision and complaints procedures. Members of the Committee will recall that, a few months ago, details of a new NHS dentist were kept hidden for fear that his surgery would be besieged, such is the scarcity of NHS dentistry in an increasing number of areas. NHS dentistry is becoming the profession that dare not speak its name, such is the demand in some areas. I am being flippant, as it is five to three in the morning, but it is a very serious issue, as many Members of the Committee, most specifically the noble Lord, Lord Colwyn, have highlighted.

Next Section Back to Table of Contents Lords Hansard Home Page