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Lord Colwyn: Obviously, that is a helpful, long and explicit answer, for which I am grateful to the Minister. There is possibly no reason why the reasonable and local need amendments could not exist together. However, if there is a national bench-marking system in place, it might be redundant. The issue is whether the bench-marking system would be treatment-based—specifying the types of treatments that must be purchased—or whether it would be outcome-based, which is specifying the general level of dental health that must be achieved in each PCT area. The latter type of bench-mark might mean that any reference to local need is redundant. Once again, I thank the Minister for that long answer. At this stage, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 431 to 436 not moved.]

Clause 166 agreed to.

Clause 167 [Dental public health]:

3.15 a.m.

Earl Howe moved Amendment No. 437:


The noble Earl said: We see in Clause 167 that PCTs are to be given new statutory functions in relation to dental public health, including oral health promotion, surveys and school screening. At least, that is my assumption. It is good news, but the British Dental Association feels strongly that the Bill needs to spell out those functions or, at the least, the Government need to make clear how they are to be delivered.

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The existing duty for dental treatment and dental education in schools will cease to have effect under subsection (2), so it is important that there should be clear policy guidelines on dental public health issues, not least setting out how oral health inequalities are to be identified and tackled, and how a more preventive approach to dentistry is to be encouraged. Amendments Nos. 437 and 438 cover that point.

Moving on to Amendment No. 440, bearing in mind that these will be brand new PCT functions and that there is very little detail on the face of the Bill with as yet no published guidance, I believe that it is not unreasonable to propose, as I do in my amendment, that the regulations governing Clause 170 should be introduced via the affirmative procedure. The Minister will know that, notwithstanding the support of the BDA, which I acknowledge, there is intense unease, bordering on scepticism, about the ability of PCTs to deliver fully-fledged dental services for their patient populations. That is not only because PCTs know next to nothing about dentistry, but also because the money being devolved to them is likely to prove woefully insufficient for anything more than emergency cover. That money will not even be ring-fenced.

Many dentists fear that these changes have put paid to any hoped-for renaissance of a proper national dental health system. We could see a repeat of what has happened in education. Over time, practices will be starved of funds by PCTs, which will blame central government for not paying them enough. Central government will claim that they have paid the money and no one will quite know where it has gone.

However, accepting that PCTs are to be given the job of commissioning dental care in their local areas, what mechanisms will be in place to ensure that, locality by locality, dentistry is not squeezed out by other priorities? How will the Government see to it that dentistry across the country as a whole is receiving an appropriate share of the health budget?

The mystery to me is how the Government think that the new payment scheme for dentistry is going to improve access to dental healthcare or ensure that more people benefit from regular dental check-ups than is currently the case. There do not seem to be any incentives in the system to encourage dentists to increase their productivity. I believe that all these concerns merit a full debate when the new regulations are laid. It would be helpful if the Minister could say when she expects that to take place. I hope that she will look constructively on my amendment for the reasons that I have given. I beg to move.

Baroness Andrews: Perhaps I may begin by addressing the questions put to me by the noble Earl, particularly with regard to how we expect the payment scheme to encourage access to dental services. I shall cite one of the ways in which we expect this to happen. At the moment we have one contract for all dentists with payments geared essentially to the number of treatments. That increases activity; higher fees are paid for the greatest

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activity and so forth, while there is no incentive to take on preventive work or to offer different kinds of treatment. For example, within that framework is a provision for six-month check-ups for people who do not need check-ups every six months, along with a whole range of routine work which essentially fills a dentist's diary and generates the income.

One of the reasons for introducing individual contracts that are more flexible and geared to the real health conditions and needs of people is that dentists will be able to decide on the clinical pathway for people who require dental support and therefore will not have to see every patient once every six months; rather they will be able to tailor appointments according to an individual's health needs. This will create more freedom for additional patients to be taken on, for example, and for dentists generally to offer a different kind of service and to expand their practices in different ways. That is one suggested answer to the question.

We do not have a precise date for publication of the regulations but it is full speed ahead. I can assure the Committee that there is tremendous enthusiasm in the Department of Health for developing and achieving these provisions now that we have come so far.

The amendments raise very important issues and make the same provision in relation to both England and Wales. They attempt to ensure that the dental public health functions which are currently undertaken by the community dental services in both countries are included in the regulations setting out the new dental public health duties of PCTs and local health boards.

The Community Dental Service is currently provided by primary care trusts and some NHS trusts to ensure that people who might not otherwise seek or receive NHS dental care—such as patients with special needs—can receive it. The CDS also has dental health functions in relation to oral health promotions, school screening and dental health surveys. These functions are set out in the guidance HSG(97)4. The major change we are making is for dental public health functions to become the functions of PCTs and included in regulations because they are obviously an important part of the contribution made to dental public health locally.

So the changes we propose are designed to strengthen the work of the current CDS. First, Clause 167 seeks to insert a new Section 16CB into the 1977 Act. Subsection (1) provides for regulations to confer those dental public health functions directly on PCTs. It is indeed intended that the functions will include oral health promotion, school screening and surveys to plan and manage dental health services locally.

Secondly, the primary dental services provided by the PCTs under new Section 16CA(2) will be equivalent to the treatment function of the CDS. That is in line with the recommendations in Options for Change. PCTs may act jointly in discharging this

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function and they can involve other agencies, such as dental practices, in addition to primary dental services.

The Government set out their intention to review the school dental screening programme in the "Improving Oral Health" chapter of Modernising NHS Dentistry. We said in the letter that we sent to all noble Lords that the child health subgroup of the National Screening Committee is awaiting the outcome of the research into child dental health screening and the regulations made under subsection (1) will reflect its advice, when published. I would expect to see other functions added as well.

As regards Amendment No. 437, it would not be wise to have unnecessary detail, which may ultimately prove to be inappropriate or inflexible, imposed by amendment on the Bill. This could hinder the movement of services between these population-based dental public health functions and the patient-based preventive services under the GDS contracts.

We regard all these dental public health functions as extremely important objectives for the reasons I have given. I know that the noble Earl will be disappointed, but we consider that the affirmative resolution procedure is too heavy for this regulation-making power. For the sake of consistency, we should also reflect on the fact that regulations made under the provisions in Part 4 will be subject to the negative resolution procedure in keeping with the existing equivalent powers—for example, The NHS (Functions of Health Authorities)(General Dental Services Incentive Schemes) Regulations and so on.

Amendment No. 440 seeks to bring the regulation-making power in relation to dental public health functions conferred on PCTs and LHBs within the affirmative resolution procedure. But, as with the previous amendment, that does not give us the flexibility that we need. Amendment No. 438 relates to LHBs in Wales.

We are serious about these functions. I hope the noble Earl will understand my explanation of why we find it difficult to accept his amendments and that he will feel able to withdraw them.

Earl Howe: As ever, the Minister has been most illuminating, and I am grateful for the trouble she has taken to respond in such detail to my amendments. I am, of course, a little disappointed that she was not able to look more favourably on them, but she has explained some of the darker corners of these provisions very helpfully.

My reason for seeking a slightly more robust parliamentary procedure on the face of the Bill is, as I have said, because we are looking at an empty box at the moment—there is no published guidance. In those circumstances, I think there is justification for Parliament to be guaranteed debating time on the regulations.

Nevertheless, I take note of what the Minister said and will reflect further. I beg leave to withdraw the amendment.

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Amendment, by leave, withdrawn.

[Amendment No. 438 not moved.]


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