First Standing Committee on Delegated Legislation
Thursday 25 November 1999
[Mr. Joe Benton in the Chair]
Draft Dental Auxiliaries (Amendment) Regulations 1999
The Minister of State, Department of Health (Mr. John Hutton): I beg to move that the Committee has considered the draft Dental Auxiliaries (Amendment) Regulations 1999.
The measures, which have the support of dental auxiliaries and dentists, should be seen in the context of two key elements of Government policy: first, to improve the quality of public services, including the national health service; and, secondly, to deregulate, if it can be done without compromising the protection of the public.
The dental auxiliaries covered by the regulations are dental hygienists and dental therapists. When working under the direction of a registered dentist, dental hygienists may scale and polish teeth; in addition, dental therapists may extract deciduous teeth from children and undertake simple fillings.
The amendment to regulation 2 of the Dental Auxiliaries Regulations 1986—the primary regulations—would enable dentists and members of the public who choose to consult the rolls to identify those dental hygienists or therapists who have additional qualifications; at present, the register reveals only whether a person has the minimum professional qualifications. The change could help dentists to recruit auxiliary staff; it would also enable patients to select those dental practices that offer whatever special expertise might be required.
The amendment to regulation 4 of the primary regulations simplifies the procedure by which hygienists and therapists apply to remain on the rolls. The primary regulations require them to complete an application form, which has to be submitted with the retention fee. With the increased use of standing orders and direct debit mandates to pay regularly recurring charges, that form has become redundant. Receipt of the payment gives the General Dental Council sufficient notice that the hygienist or therapist wishes to remain on the roll, and fewer forms means less bureaucracy.
The amendment to regulation 6 provides for an increase in the fee for retention on the roll from £20 to £25, and for restoration to the roll from £5 to £10. The Committee will be aware that those fees have not been increased since 1996. The increase will allow the General Dental Council to continue to develop its standard-setting and investigatory role, in accordance with the Government's commitment to improving the quality of patient care.
The amendments to regulations 23 and 27 provide for dental hygienists and therapists to insert temporary dressings or temporary fillings. The reason for that minor extension in their permitted duties is that, when treating patients, hygienists and therapists sometimes find broken or missing fillings; if all the registered dentists in the practice are engaged in treating other patients, they have to advise the patient to return when the dentist is next free. That is obviously unacceptable. If a temporary dressing can be inserted, the patient is free to make an appointment to see the dentist at a mutually convenient time. I hope that my explanation has helped and that the Committee will support the regulations.
Mr. Philip Hammond (Runnymede and Weybridge): We are not always able to deal swiftly with delegated health legislation, but the regulations are unusual, if not unique, in being fairly uncontentious. As the Minister said, dentists and dental auxiliaries are comfortable with the changes, but another group has to be considered: the public. Therefore, I have a couple of questions for the Minister.
The amendment to regulation 2, which will permit the registration of additional diplomas appears to be a straightforward move. More information is always better than less; and for the benefit of the public and of other members of the profession, putting additional information on the roll is probably a positive move, but I wonder whether there is something more behind it.
Does the change relate to what I believe is known as ``denturism'', the growing separation of the practice of inserting dentures from that of dentistry itself? In many advanced countries, people with appropriate qualifications in denturism who are not dentists routinely fit dentures to otherwise healthy mouths. That is not the case in the United Kingdom.
In Canada, legislation is about to be changed so that even a fully qualified dentist will not be allowed to insert a denture unless he also has a separate qualification in denturism. Perhaps the recognition of that distinct professional qualification in this country is being prepared, so that dental auxiliaries as well as dentists may be recognised to have the necessary skills to practise denturism.
The General Dental Council set up a working party to consider changes in the scope of the work of dental auxiliaries and technicians. The working party recommended something similar to the practice in other advanced countries, but the GDC overturned its decision. That gave rise to concern among some sections of the professions complementary to dentistry that issues of protectionism are at work as well as those of proper professional definition.
Will the Minister give us an insight into the Government's thinking on that important issue and state whether the changes to the regulations have any bearing on the possible recognition of denturism as a separate skill?
As the Minister rightly said, the changes to regulation 4 recognise modern payment practice, and on that we agree with the Government's entirely appropriate recognition of the world in which we live.
The amendments to regulation 6 increase the General Dental Council's fees by 25 per cent. for maintaining a name on the roll and by 100 per cent. for restoring a name to the roll. The Minister told us that those fees were last raised in 1996, which represents a fairly dramatic rate of increase—25 per cent. on the main fee in slightly less than four years. At a time when management organisations throughout the national health service are expected to make something like 2 per cent. per annum efficiency savings, the justification offered for such an increase is that it will enable the GDC, which depends on the fees as its principle source of income, to meet its increasing costs.
What are those costs? What steps has the GDC taken to impose on itself the same disciplines as management throughout the NHS accept to achieve the Government's demanded efficiency savings? What audit have the Government undertaken of the GDC's practices to satisfy themselves that the increases are justified? What would be the Minister's response to an NHS management team that said, ``To meet the increasing pressures that we face, we need an increase of 25 per cent. on our 1996 revenues for management costs. We cannot deliver a 2 per cent. per annum saving, but we'd like the equivalent of a 6 per cent. or 7 per cent. per annum increase''.
It is easy for the Chancellor to exhort people to moderate their wage demands. It is easy to quote headline inflation figures of 1½ per cent. or 2 per cent., but in the reality of everyday life, ordinary people do not go to renew their professional body membership and find that cost has gone up by 1½ or 2 per cent.—it goes up in discrete leaps. That is not unusual, but is difficult to square with the Chancellor's justifiable demands for people to moderate their demands for wage increases to maintain our low inflation economy. How rigorously have the Government assessed the real need for such a dramatic increase?
The amendments to regulations 23 and 27, which make some significant and sensible changes to the boundaries of dental auxiliaries' practice, seem to us and to the professions concerned to address a real need for dental auxiliaries to be able to deal sensibly with an emergency emerging during the course of treatment.
In summary, we seek further information from the Minister on the provision to allow additional qualifications to be listed and on the provision for increases in fees.
Dr. Peter Brand (Isle of Wight): I should like to ask the Minister a third question. The regulations are sensible, but I should like clarification on the amendments to regulations 23 and 27. Those amendments make tremendous sense, extending the ability of dental hygienists and therapists to carry out work, but I am slightly concerned that it may open the way to their working as first-line dental treatment practitioners.
We all know the tremendous difficulty the general public face in finding dental care, especially under the national health service. I hope that the regulations will not permit a system of dental hygienist clinics working independently, doing a temporary patch-up and then expecting people to find a dentist, which in my part of the world may take three to six months. Such work would constitute not a temporary filling, but permanent treatment. I should like an assurance from the Minister that the regulations will not open up the way to dental hygienists and dental therapists working totally independently and giving general dental care.