Fourth Standing Committee
on Delegated Legislation
Wednesday 8 May 2002
[Mr. Win Griffiths in the Chair]
Draft Dental Auxiliaries (Amendment) Regulations 2002
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I beg to move,
That the Committee has considered the draft Dental Auxiliaries (Amendment) Regulations 2002.
The Chairman: With this it will be convenient to consider the draft Dentists Act 1984 (Dental Auxiliaries) Order 2002.
Ms Blears: I welcome you to the Chair, Mr. Griffiths. I am pleased that we are to consider the two instruments together. They are interrelated and it makes good sense to do so.
The Government have embarked on a serious programme of trying to ensure high quality, fast and effective health services. Amendments to the regulation of the professions are designed to modernise them to enable them to encompass a wider range of skill mix. That will involve the entire national health service, not only the dental profession, and will help us increase the capacity of staff throughout the service.
Last November, we debated an order made under section 60 of the Health Act 1999 that empowered the General Dental Council to modernise the constitution of its council and make continuing professional development mandatory for dentists. The regulations on dental auxiliaries are the next step necessary in the implementation of the regulatory section of the dental strategy, modernising NHS dentistry and implementing the NHS plan. It is an incremental process of putting in place the legislative framework that enables us to deliver that ambitious plan for NHS dentistry. The dental strategy committed the Government to increased investment in NHS dentistry, better access to NHS dentists and improvements in the quality of dental care. The instruments are relevant to all three objectives. They are designed to facilitate team working—or multi-skilling as it is rapidly becoming known.
At a visit to the dentist, we will usually see a dental surgeon, a dental nurse and, possibly and increasingly, a dental hygienist. However, there are other, less visible members of the dental team, including dental technicians, who work mainly in dental laboratories, and dental therapists, who at present are permitted to work only in hospitals and community dental services.
Of those staff, only dental hygienists and therapists are required to complete an approved training programme that leads to enrolment and registration with the General Dental Council. We are committed to providing for the registration of all members of the dental team within a framework that permits as much
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flexibility in the delegation of duties as is compatible with the safe treatment of patients. It is important to get that balance right and to enable people to extend their skills, but always to bear in mind the safety of patients, which is at the forefront of our considerations.
We are working on a second section 60 order, which will bring about the registration of all professions complementary to dentistry, and we plan to lay that before Parliament later in the year. These draft statutory instruments provide a means of extending the role of dental hygienists and therapists using delegated powers in the Dentists Act 1984. We therefore have an earlier legislative opportunity for dental hygienists and therapists than for the other professions, which will be covered in the section 60 order later in the year.
The intention of the instruments is to enable hygienists and therapists to undertake a much wider range of duties, subject to varying degrees of supervision by dentists. We also want to try to permit dental therapists to work in all branches of the profession, rather than under the artificial community service restriction that applies now.
The Dental Auxiliaries (Amendment) Regulations 2002 amend the principal regulations, the Dental Auxiliaries Regulations 1986. They deal first with dental hygienists. The main duties of hygienists are to scale and polish teeth and advise patients on how to achieve and maintain good oral health. Regulation 3 extends the scaling power to enable a hygienist to treat patients who have previously had a course of treatment and who, after the swelling in the gums has subsided, are found to have excess cement around their teeth. In future, the hygienist will be able to clean that up using a rotary burr, as well as the scaling instrument that they would usually use. That will extend their skills so that they will be able to use different instruments for further work.
We will also extend the skills of dental hygienists to the taking of impressions. We have in mind those used for study at the outset of a course of orthodontic treatment, such as for teeth braces and similar procedures. That is a good example of a duty that a dentist can safely delegate to a dental hygienist.
We will also extend their skills to the administering of local infiltration anaesthesia, which numbs the teeth on the top part of the jaw before treatment. The bone on the top part of the jaw is less solid, so the injection goes in above the tooth. On the lower jaw, it is necessary to use something called inferior dental anaesthesia, because the injection has to go into the nerve at the back of the jaw, which is a more complex procedure requiring a deeper, more precisely located injection, usually with a longer needle.
I want to emphasise the requirement in regulation 23 (6) that the dental hygienist shall only be allowed to administer such inferior block anaesthesia under the direct supervision of a dentist on the premises. That is an example of how we want to enable the delegation of such powers to people who can do the job, while maintaining the supervision of the dentist, so that
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when procedures are more complex, there is a good overview and dentists actively support the other members of their team.
There is also a power in the regulations to replace crowns. That is a very practical measure. Currently, if a hygienist is conducting a scale and polish and finds that a crown is dislodged, all that they can do is ask the patient to come back and see the dentist at another time. That does not make sense. We want to let the hygienist replace the crown temporarily, until the patient can return to see the dentist, so that the patient is not left waiting.
Regulation 23(7) addresses people who are in fear of the dentist, and whose fear cannot be dealt with by local anaesthesia. Since the beginning of this year, general anaesthetic for dental treatment can be given only in hospital, where there is a full range of critical care facilities, in case anything goes wrong. However, more patients are having conscious sedation, which enables them to undertake their treatment without fear or pain. As that is becoming increasingly popular, the regulations allow a hygienist to carry out a scale and polish on a patient who has been sedated for treatment—so that, yet again, patients can have all the work at once, rather than having to come back at a later date.
We have gone a little further for dental therapists. There are not many of them at present; there are about 429 on the General Dental Council's roll. However, I am sure that their number will increase as a result of today's orders. Until now, they have only been allowed to work in the community dental service and the hospital service. We have removed that limitation. We think that it is right that therapists are able to exercise their skills in general dental services, as they can provide a significant contribution to the work of dental teams.
We also propose to extend dental therapists' skills to enable them, under regulation 4, to carry out work on the pulp of teeth, which is below the enamel in the area of the roots. Allowing dental therapists to do such work will enable them to carry out almost the full range of dental services that children need. Traditionally, dental therapists have developed their practice by working with children—often those with special needs who might particularly fear the dentist and need to be reassured and have their anxiety addressed. Dental therapists are experts in that area. Giving them that extra ability to exercise their skills will mean that dental therapy will be an attractive part of the profession.
In future, I hope that we will work towards creating a system in which, instead of a list of particular treatments that therapists can undertake, there will be general competences, and people can really begin to expand their practice. If that happens, the contribution that dental therapists make will be tremendous. We have asked our work force confederations to take on board the increasing numbers who will train to become dental therapists in the provision of training places and commissions.
When dental therapists were first envisaged, they were viewed with some trepidation by the profession,
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but they have proved their worth. Even though it has taken us some time to introduce the statutory instruments, I am delighted that they will allow dental therapists to start to play a real role in the dental profession.
Of the two instruments before the Committee, one will extend the skills of hygienists and therapists, and one will disapply the restrictions on the practices of dental therapists which limited them to a particular section of dental practice. The two orders are signs of the Government's commitment to modernising the profession. We must work with the profession and patients to ensure that we free dentists to do more complex work, and take advantage of the skills of hygienists, therapists, dental technicians and dental nurses. Such practitioners are increasingly working together to provide a first-class national health service dentistry service.
Mr. Simon Burns (West Chelmsford): I congratulate the Minister on her speech. Many of us—particularly wimps like me—dread visiting the dentist, as I did last Wednesday. It is a visit usually filled with agony and expense. I congratulate the Minister not only on the enthusiastic way in which she outlined the purposes of the two statutory instruments, but on describing fairly complex and, I suspect, nasty treatments as though they were painless and fun. That is no mean task.
I do not intend to repeat what the Minister said, as she outlined the orders comprehensively. Having studied them and consulted with interested parties, I can say that there is no opposition to what she described as the next step in a modernisation that will improve and enhance the quality of dental care. Nobody would disagree with her on that. I am pleased that the orders are being introduced, and that we can use the Dentists Act 1984 to fast-track them into law. It is important that they enhance and increase the opportunities for staff in the dental service.
I fully understand that the explanatory notes to a statutory instrument are not part of the order, but I would like a point cleared up about a reference in them to the Dentists Act 1984 (Dental Auxiliaries) Order 2002. The notes mention dental auxiliaries who carry out work
''in the course of providing national health services.''
Does that refer to the national health service that provides health care in this country, or to a service that is provided nationally? If the answer to the former is yes, the order will be restricted to practitioners and staff who work in the NHS. I assume that that is not the intention, and that it will apply across the board to both NHS dentistry and the private sector. I would like the Minister to confirm that.