First Standing Committee on
Wednesday 14 November 2001
[Mr. Alan Hurst in the Chair]
Draft Dentists Act (Amdt) Order 2001
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I beg to move,
That the Committee has considered the draft Dentists Act 1984 (Amendment) Order 2001.
I am delighted to serve under your chairmanship, Mr. Hurst, on my first Standing Committee as a Minister. I am pleased that it concerns an important aspect of policy, the future of dentistry.
We all share the vision of creating a health service that provides high quality and professional services to patients in a fast and responsive way. To do so, we need clear and high national standards across the piece, which is why we set up the national service frameworks for cancer, heart disease and mental health. We need strong external reviews of the quality of national health service care, which is why we set up the Commission for Health Improvement to inspect and monitor quality. The third essential element of our vision is modernising the regulation of health care professions.
Parliament has intervened in the regulation of health care professions for nearly 150 years. It has established statutory frameworks for the range of professions whereby they regulate themselves. The purpose of professional regulation is to establish a countrywide, professionally set, independent standard of training, conduct and competence for each profession to protect the public and to guide employers. Those standards benefit from the input of lay members of the different regulatory bodies, as well as the professional perspective. The two points of view are merged.
Standards are underpinned by the personal accountability of practitioners for maintaining safe and effective practice wherever they are employed. Regulatory bodies need the power to take effective measures to deal with the minority of individuals whose continuing practice represents an unacceptable risk to the public or otherwise renders them unfit to be registered members of the profession.
The internal workings of the regulatory bodies have not always kept pace with the changes taking place across the NHS. As a result, a damaging perception can arise that the existing arrangements sometimes place professional self-interest before the interests of patients. Many of the processes and rules of professional regulatory bodies are bound by primary legislation that pre-dates the modern era of openness and responsiveness. The Government have addressed that problem by taking powers in the Health Act 1999 to modernise legislation more rapidly and easily than was previously possible.
The order empowers the General Dental Council to reconstitute itself as a smaller body with a higher proportion of lay members. I am delighted that the British Dental Association welcomes and fully supports the order. The order also provides for the reform of the council's committee structures and introduces new provisions to make dentists' continuing registration dependent on their regular participation in continued professional developmentin other words, lifelong learning for dentists.
The first issue that the order tackles is the composition of the council. The current situation is unsatisfactory because schedule 1 to the Dentists Act 1984 prescribes that the council comprise 44 members, of whom 37 must be registered dentists. There is only one dental auxiliary and six lay members. The present council is too large to be a fully effective executive decision-making body, and the lay representation is far too small to ensure the fair balance of patient and consumer interests.
Articles 3 and 4 of the order empower the council to reconstitute itself. The exact composition will be the subject of an Order in Council that will require the approval of the Privy Council. The GDC's current thinking is to have a council of between 25 and 30 members, of whom one third would be lay people. The remainder would be dentists and professionals complementary to dentistry. In the short term, the professions complementary to dentistry who are described in the order as dental auxiliaries will be dental therapists and dental hygienists, but we plan to make a subsequent order that will provide for the registration of additional classes of complementary professions, including dental nurses and dental technicians.
Michael Fabricant (Lichfield): I agree with everything that the Minister has said so far. By the way, I congratulate the hon. Lady on her promotion, and on presenting her first statutory instrument. She said that the order is a first step. Is she aware that the General Dental Council envisages making a series of changes over the next few years, and what how long does she think the reform of the GDC will take?
Ms Blears: I am aware of the GDC's desire to work closely with the Government in reforming the profession. In my early meetings with members of the profession, I was extremely impressed by their wish to embrace new ways of working and to make rapid progress in reforming the profession. The Government have tried to do their part by making the order as early as possible, and I shall ensure that subsequent orders are introduced as quickly as possible. We shall obviously need the necessary parliamentary time; we shall have to consult with the wider community, and we must make sure that we get the orders right. However, I am impressed by the desire of all parties to move forward quickly.
Dr. Evan Harris (Oxford, West and Abingdon): Once the composition of the GDC has been decided, how will the order making the amendment be made? Will the Minister clarify whether it will be done by affirmative resolution, like today's order, by negative resolution or by an Order in Council?
Ms Blears: I shall deal with that matter later.
Article 4 provides for the council to elect a president from among its number. The method of election and any conditions for eligibility for election will be a matter for the GDC. We await its views on whether the rules should prescribe that the president be a dentist. The matter is still open.
Article 5 provides for the rationalisation of the GDC's committee structure. Not surprisingly, the proposal that the education committee be abolished was greeted with incredulity. However, I assure the Committee that it is a technical amendment. The education committee does not possess statutory powers. There will be continuing need for a powerful education committee, but if it is not a statutory committee it will have the flexibility to draw on a far wider range of interests to ensure that its work is more relevant to the profession's education needs.
Finally, I turn to the other main feature of the orderthe provisions for continuing professional development and lifelong learning. Continuing professional development programmes will allow dentists to keep their practices up to date, so that they can provide the highest quality services to their patients. Good education and training, reinforced by the statutory provisions of the order, will ensure that all dentists are able to maintain their registration.
I am told that the commitment to lifelong learning is deep rootedan unfortunate phrase in relation to dentistryand the Department of Health allocates more than £6 million a year to the National Centre for the Continuing Professional Education of Dentists to provide training courses and distance learning and to ensure that all dentists are able to undertake professional development. The order provides for dentists to undergo 50 hours of continuing professional development each year to update their skills. That is a considerable time, but I understand that only 15 hours has to be accredited externally, and the other hours can be completed by distance learning and a variety of more flexible methods; we are conscious that dentists need to continue their practices while updating their professional skills.
The GDC is concerned that the requirements for continuing professional development must be easily understood by dentists and that any sanctions should be applied fairly. Article 8 therefore provides for the GDC to make rules on the operation of the recertification scheme, including the conditions that dentists who have been erased from the scheme have to meet to be restored to the profession. It is essential that the system is fair and transparent and that it provides natural justice to the professionals involved.
During the consultation, queries were raised about how dentists who had been erased from the register would be able to be recertificated and restored to the register by undertaking continued professional training. Clearly, they would not be able to carry out that training on real patients, because they would have been erased from the register. I am told that in such cases dentists are able to work on phantom heads, which provide an accurate means for them to keep their training up to date. Phantom heads resemble mannequins and tailors' dummies rather than any human body parts and are an appropriate way for dentists to carry on with their training.
Article 9 empowers the GDC to make rules on procedures to be followed by the continuing professional development committee and the rules of evidence that the committee would have to observe, as well as the rights of appeal and of representation by counsel or a solicitor and the right to a private hearing. The provisions to protect dentists' interests are extensive, but by ensuring that dentists are bang up to date, we protect the interests of patients.
The Government and the GDC are committed to modernising the profession. The order is a first step in a programme of reform that will extend the powers of the GDC to assess dentists' fitness to practise and provide a wider range of sanctions where a dentist's performance falls below requirements. We have been very encouraged by the responses to the consultation process, which has involved professions, voluntary organisations and community health councils. The proposals have enjoyed broad support. In my view, the provisions of the order are compatible with the convention rights as defined in section 1 of the Human Rights Act 1998, and I commend the order to the Committee.