First Standing Committee
on Delegated Legislation
Thursday 30 October 2003
[Mr. Peter Atkinson in the Chair]
Draft Dental Auxiliaries
(Amendment) Regulations 2003
The Minister of State, Department of Health (Ms Rosie Winterton): I beg to move,
That the Committee has considered the draft Dental Auxiliaries (Amendment) Regulations 2003.
It is a pleasure to see you, Mr. Atkinson.
The proposals, with the Committee's agreement, would increase the registration fees paid by dental auxiliaries to the General Dental Council from £25 to £68. The regulations cover two classes of dental auxiliary: dental hygienists and dental therapists. They may practise only if they are registered with the GDC. The annual registration fees are, in effect, a licence to practise. By virtue of section 45(7) of the Dentists Act 1984, Parliament is required to ensure that increases in the fees are justified.
There are some 3,900 practising dental hygienists. Working under the direction of a dentist, they can clean, scale and polish teeth, provide local infiltration analgesia, apply prophylactic materials, such as fluoride gels and fissure sealants, and give oral hygiene advice. Until recently dental therapists had a lower profile. There are only around 370 in practice and, like hygienists, they work under the direction of a dentist. Dental therapists may extract deciduous teeth, carry out simple fillings, give local anaesthetics, undertake cleaning, scaling and polishing and give oral hygiene instruction. Originally they could work only in the hospital and community dental services, but we removed that restriction in June 2002. As a result they may now work in all fields of dentistry, including both national health service and private high street dental practices.
The fees increase is required to contribute to the costs incurred by the GDC in modernising the regulation of dentistry. More specifically, that income is required to introduce an effective fitness-to-practise regime for dental auxiliaries and to extend regulation to other classes of dental auxiliary, including dental nurses and dental technicians.
In his report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary, Professor Sir Ian Kennedy said:
''An effective system of professional regulation must be owned collectively. Further, it needs an independence from the professions and from government which allows it to act in the public interest.''
The GDC reforms should be seen in that context. They form part of the Government's programme for the modernisation of the regulation of the health care professions.
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We are also working on an order under section 60 of the Health Act 1999 to amend the Dentists Act. It will make it specific that the main objective of the GDC is the promotion of high standards throughout the profession and in education and training. The order will also empower the GDC to register other classes of dental auxiliary, including dental technicians and dental nurses. Registration will make it a statutory requirement for those staff to obtain formal qualifications and will empower the GDC to investigate and intervene where fitness to practise is in question. We hope to publish the draft order for consultation before the end of the year so that, subject to parliamentary approval, it can come into force during 2004.
The proposals are necessary for the modernisation of the regulation of dentistry. The GDC has reported no opposition to the fees increase, and there are no implications for the NHS as dental auxiliaries remit the fees directly to the GDC. I hope that my explanation has been helpful and that the Committee will approve the regulations.
Mr. John Baron (Billericay): It is a pleasure to see you in the Chair again, Mr. Atkinson. Without detaining the Committee for too long, I will raise two or three issues. I hope that the Minister can answer my specific queries about the scale of the increase.
The statutory instrument increases the registration fees that hygienists and therapists pay for membership of the GDC, which is obligatory for them to practise. The increase is from £25 to £68, which is about 170 per cent. in one go. We are aware that the GDC needs to raise more money, but we question whether that huge increase should be introduced all in one go. It is unreasonable, especially for dental therapists, who often have a limited income. The registration fees are the same whether the dental auxiliary is working full-time or part-time. That is somewhat unreasonable and the Government should consider it. Therapists' incomes are often about half that of hygienists: the average wage for dental therapists is approximately £11 per hour. That does not seem to have been considered when the scale of the fees increase was decided.
At the end of her speech, the Minister said that nobody has objected to the increase. The explanatory memorandum states:
''The GDC consulted professional bodies representative of dental auxiliaries about these increases and they were generally supported.''
However, the bodies that I spoke to were not aware of a proper and exhaustive consultation exercise, and their members certainly did not support that huge increase. The two main bodies that would need to be consulted are the British Association of Dental Therapists and the British Dental Hygienists Association. I have a message from Sue Skinner, the president of the BDHA, which states:
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''Many of our members are concerned at the level that these fees may be set as many hygienists work part timesome only one day a week. Dental hygienists can only work (treat patients) under a written prescription by a registered dentist and the fees should be set accordingly''.
As that seems to contradict what the Minister has just told us, I will put some questions to her. Will she give the Committee more information about the results of that consultation? How many dental professionals were consulted and what were the responses? What have the two main representative bodies said about the fees increase? Will the Minister address the fact that the huge increase highlights a severe lack of planning by the GDC? Why is the increase so large? Why could not it have been introduced incrementally over the last few years or over the next few years? Why is it being introduced suddenly, in one go?
The increase will severely dent the incomes of many practising dental auxiliaries, some of whom are not as well-paid as the Minister obviously believes them to be. Will she address the specific questions that I have asked?
Mrs. Patsy Calton (Cheadle): I, too, welcome you to the Chair, Mr. Atkinson.
To follow on from the questions that have been asked, I, too, am concerned by the large increase from £25 to £68, an increase of 172 per cent. Parliament is required to see that the increase is justified, and I am interested by the Minister's comment that she regards the change of purposethe necessity for modernisationas the reason for the increase. I cannot think that the original parliamentary requirement allowed for changes of purpose to increase the fees. Will the Minister therefore say whether the measure is either a simple increase or an increase for a different purpose from the original one?
I understand that a further increase is planned for next year, which will take the registration fees to £75, so will the Minister also address that? We are beginning to see a large amount expected from people who, as has been said, sometimes work full-time and sometimes part-time, and who are not particularly well paid. When such massive increases are introduced, it is important that they are understood, that the consultation that is supposed to take place is carried out fully and that people's concerns are properly acknowledged. I am concerned that very little information has been forthcoming on that front and I should be pleased to see the results of the consultation, which have been requested.
What additional services will dental auxiliaries expect in return for the massive increase? Finally, I have concerns about the wide variation in registration fees and costs for different medical and dental professions. They seem to reflect not ability to pay, but the number of registrants in each profession: that is, the more registrants, the lower the fee. That seems extremely odd, so it would be helpful if the Minister could address that and the other issues.
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Ms Winterton: Obviously the hon. Members for Billericay (Mr. Baron) and for Cheadle (Mrs. Calton) have raised a number of issues to do with the scale of the increase. Some of the questions were to do with why the Department of Health does not restrain GDC expenditure, so perhaps I should explain that the GDC is accountable not to the Department, but to the Crown via the Privy Council. Successive Governments have accepted that the health care professions should be self-regulating. Dentists and dental auxiliaries vote members on to the GDC, so, frankly, if they do not like the job that it does or the fees that it suggests, it is always open to them to change the leadership.
In answer to what the GDC will use the extra income for, there is a need both to employ more administrative staff to oversee the registration of the additional groups that will come within its remit and for more computers to maintain that register. The council will also have to engage lawyers for hearings of conduct cases or appeals when a decision is challenged. As in law and architecture, for instance, membership of a profession with such major public responsibilities carries an overhead, owing to the cost of regulation.
The hon. Member for Billericay asked about part-time workers, and I understand that the GDC will review that in future years as the issue has been raised previously. In answer to who was consulted, the GDC consulted both the British Association of Dental Therapists and the British Dental Hygienists Association, and I shall certainly see whether their formal responses can be made available to members of the Committee.