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I spent 30 years in a profession that has parallels with this one and I should like to draw the House's attention to some parallels that might help the Minister. In my time as a lawyer, I looked at the changes that the Law Society wanted to bring about when it considered introducing continuous professional development for older members of the profession. Instead of putting 35 hours in place immediately, the number of hours was
slowly ramped up over a five-year period. The scheme did not just enable people to have out-of-office time; study time in the office and in the evening counted as well, which was helpful. I suggest the Minister looks at that system. We need to look at a modular approach for exams and at distance learning. As one of my hon. Friends pointed out earlier, we need to look at qualifications that are relevant to the business the individual is practising.
I wholeheartedly support the comments that have been made about experience and the idea of grandfathering. I was formerly a professional mentor, and with the European Mentoring and Coaching Council I looked at how we might develop qualifications and accredit people already in a profession. We looked at a framework model that enabled people to qualify when rules changed. I certainly commend that to the Minister.
The point about the big bang in 2013 when everything will change is absolutely right. That is not an appropriate way forward. I hope the Minister recognises that the businesses we are talking about are microbusinesses. Costs are crucial. Fees for IFAs have gone up by 4.8% this year, and I hope he is not thinking about the national financial advice service, at a cost of £50 million to the industry, replacing in any way the financial advisers who will undoubtedly fall out of the system.
9.41 pm
Chris Leslie (Nottingham East) (Lab/Co-op): I congratulate the hon. Member for Wyre Forest (Mark Garnier) on initiating this well-subscribed and, so far, very moderate and well-tempered debate on behalf of the 33,000 independent financial advisers in the industry. Clearly, the matter is of concern. I suspect the Minister is thanking his lucky stars that we do not have a votable motion at the end of tonight's portion of the debate, as we did in the earlier section on banking reform.
The Financial Services Authority started the retail distribution review many years ago. A consultation paper came out in 2009. Earlier this year, we had the proposals, although they will not come into force until 2012, so this is a useful period when the House should debate and consider them. It is a matter of regret that too few of these crucial regulatory issues are subject to parliamentary scrutiny, as Government Members have observed.
Some extremely legitimate points have been made about the need for sensible transition-if we are to have change-to new arrangements, which, in the words of the hon. Member for South Derbyshire (Heather Wheeler), do not throw the baby out with the bathwater. That is one of the phrases in the debate that particularly comes to mind, but a number of points were very well made, especially when we think about the comments of the chief executive of the FSA. Is it really acceptable that between 10 and 20% of the profession could leave as a result of the retraining requirements, shrinking the availability of independent advice? The hon. Member for West Worcestershire (Harriett Baldwin) rightly questioned what would happen if a Minister were to stand at the Dispatch Box and announce the demise of a similar proportion of an industry.
It is important that we take a pro-consumer approach to regulatory change-as the Opposition certainly do. Undoubtedly, it is necessary from time to time to look at the framework within which consumers get that advice, and I do not begrudge the FSA's moving in that
direction. However, there are some serious questions. On balance, it is right that we move away from fee structures that are, to a certain extent, hidden in the margins, where sometimes commission may not be transparent for customers and products are recommended even though it does not necessarily say on the tin how much of the fee will be returned to the adviser, but-
Mr Graham Stuart: Will the hon. Gentleman give way?
Chris Leslie: I just want to make a point about the ending of the commission system and the placing of the fee, perhaps straightaway, in an up-front form for the consumer. There may be risks that are similar to those related to the argument about up-front tuition fees, because people may be deterred from taking the advice in the first place. They may feel that the system is too difficult. As my hon. Friend the Member for Barrow and Furness (John Woodcock) said, we have to ensure that any fees are disbursed throughout the period of the product.
Mr Stuart: There will always be some form of bias in the system, at least conceptually, regardless of how we reward IFAs. Whether or not there is a fee-based system, they will still be more likely to receive a fee if they propose the sale of a product. Does the hon. Gentleman believe that getting rid of commission is the right way to go? Why not regulate from the product end? Why not get rid of 10% commission, if that is felt to be a gross abuse? Why not limit the size but allow commission, which the public understand and quite like if it does not force them to pay up front, which it seems from surveys they do not wish to do?
Chris Leslie: As I say, this is a good time to debate those matters. There are options that must be explored. We have not bottomed out the debate. Perhaps the Financial Services Authority can consider not necessarily the hon. Gentleman's suggestion in particular, but why commission changes are not being made across the wider financial services sector. There have been historic problems with mis-selling of products, not solely from an IFA perspective, and I can see why many people feel that these changes are necessary.
I would not counsel hon. Members to take issue with every section of the RDR-many of those who spoke in the debate did not. It is right, for example, that there should be proper clarity between independent and restricted market advisers, and that rather than waiting for the customer to inquire, there should be full disclosure on that up front.
Chris Leslie: I have only a couple more minutes.
The crux of the matter must be the issue of qualifications-the A-level equivalent threshold for financial advice. Although I understand the move to a QCF level 4 standard, which seems entirely fair, it is sensible that there should be a mechanism to allow some sort of conversion of existing qualifications or existing experience to that new level 4 qualification. I cannot believe it is beyond the wit of the FSA, Ministers and others to find some way of doing that. Hon. Members such as the hon. Member for Meon Valley (George Hollingbery)
spoke about how we should look at the grandfathering issue and what options there might be. It is important to move that forward.
Chris Leslie: I should like to conclude because I want the Minister to be able to explain in a way that he did not necessarily do in the first flush of debate on the topic in Westminster Hall, and possibly reflect the views of the vast number of Conservative Members. I am still perplexed that the Financial Secretary to the Treasury chose that McDonalds diploma analogy. Perhaps he will reflect on that and recognise that some IFAs were slightly astounded by that reflection on their professional integrity. He might want to choose his words more carefully.
It is important that parliamentary accountability should be voiced. The more I reflect on these financial services policy issues, the more it strikes me that there is a democratic deficit. No, we do not want to be embroiled in the day-to-day operational issues of regulation, but policy is policy and we are accountable for that. Perhaps, as my hon. Friend the Member for Leeds East (Mr Mudie) suggested, we can return to the issue when we come to the FSA reform Bill and discuss amendments to that. Hon. Members will log and remember today's debate and we can come to that later on in the day.
It is a shame that there is no motion tonight on the issue. It would have been useful for Members to express the formal position of the House of Commons on the matter. This is a time for the Minister to listen to the debate and perhaps reflect carefully on the measured and worthwhile comments that have been made by hon. Members across the Chamber.
9.48 pm
The Financial Secretary to the Treasury (Mr Mark Hoban): I congratulate my hon. Friend the Member for Wyre Forest (Mark Garnier) on the way in which he opened the debate this evening. He gave a balanced perspective on the changes that we are trying to make to improve standards for consumers, how that sits with the IFA sector and some of the challenges that a change in standards will create.
It is worth reflecting for a moment on the responsibilities of Parliament and of the FSA. Parliament set out the framework by which the FSA operates. The Financial Services and Markets Act 2000 sets out its objective, powers and how it goes about exercising its responsibilities. For example, there is a requirement to consult. As we know, there has been a long process of consultation on the RDR since the previous chairman of the FSA raised the matter in 2006. There have been a number of iterations and debates about consultation documents and discussion papers. Consumer groups, product providers, IFAs and their trade bodies have participated in a very lively debate, but the FSA is rightly responsible for implementing day-to-day regulations, and I know that it takes very seriously parliamentary scrutiny of its role. I spoke to the chief executive this morning about the Treasury Committee's scrutiny last week and the debate this evening, so the authority is well aware of parliamentarians' concerns. It is right that the FSA gets on with its job but listens to the issues being raised.
I counsel caution, however. It is all very well to think that we should engage in the regulatory regime when we think we are going to help one group or another, but there are times when regulators make difficult decisions on behalf of Parliament and our constituents, so we need to think very carefully about where the balance is struck. It might be very attractive in the context of this debate for Parliament to take more responsibility, but hon. Members might feel it less appropriate at other times.
Mr Graham Stuart: Will my hon. Friend give way on that point?
Mr Hoban: No, I will not give way to my hon. Friend, because I have- [ Interruption. ]
Mr Hoban: I have about nine minutes to respond to quite a long debate in which a number of points have been made, and I want to take the opportunity to address some of those issues.
Let me put on the record the importance that I place on independent financial advisers. They play a key role in helping people make financial product purchases and financial choices. High-quality, independent financial advice is vital in ensuring that people are encouraged to save and plan for the future and make the most out of their money. I have used independent financial advisers and been happy with the service I have received, because they have provided me with good-quality advice.
I cannot overstate the detriment to consumers from poor and biased advice. Indeed, the FSA estimates the detriment to consumers from inappropriate advice to be £200 million per annum, and it thinks that the figure could be significantly higher. Consumer detriment has led organisations such as Which? and the consumer panel that advises the FSA to support the measures in the retail distribution review. We need to get that balance right and to address some of the issues that undermine consumer trust in the IFA sector, and the FSA has sought to do so through the RDR.
I have become very conscious-in particular, over the past six or seven months as a Minister-of the financial services sector's increasing complexity, and consumers must be confident that IFAs are fully up to date and that their advice is underpinned by good technical knowledge. There can be few hon. Members who do not support that stance or recognise the benefits that increased professionalism can bring. Indeed, the FSA finds a clear link between increased qualifications for financial advisers and improved consumer outcomes. Under its reforms, consumers will be confident that their adviser has a minimum level of understanding and expertise that is maintained each year through continuing professional development.
We should also recognise that a number of IFAs already comply with those standards. Just under half of IFAs already hold the required qualification and, indeed, many go beyond QCF level 4. Some 89% of advisers already meet the required hours each year for CPD, and we need to recognise the progress that has been made since examinations were introduced in 2008.
I recognise the strength of the debate about grandfathering, and it is an important debate to have, but we need to think about how much experience is sufficient for people to be grandfathers, and about how we can ensure that that experience covers the range of products necessary to provide whole-of-market, independent advice. We ask people to advise on a range of products, such as pensions, insurance bonds and ISAs, and they need such technical knowledge to do so. Consumers are entitled to know that their adviser has a high standard of technical knowledge, and a minimum qualification standard should deliver that.
The increase in standards will not discriminate against those who have kept up to date with market developments, and they should not have to commit a significant amount of time to study. As I have said, 90% of advisers already undertake the required number of hours for continuing professional development, and I think that over the next two years the measure can be used to fill any gaps between existing and revised standards. As a consequence of lobbying by the IFA community, the FSA has relaxed the regulations, so there will be non-exam-based alternative assessments, rather than formal written exams. That is an important move forward that the FSA has already made, but high standards of technical knowledge will be crucial to help IFAs navigate their clients through the increasingly complex choices that they have to make.
I want to touch on the issue of adviser charging. I am strongly committed to increased transparency in financial services; it is important that consumers-whatever they are buying, be it advice or a product-understand the charges and the returns that they are likely to get. That underpins a whole range of work that we are doing at the moment in the Treasury.
Currently, financial advisers can earn different amounts as commission payments, depending on which product they recommend and from which provider. How much they earn is not always transparent; indeed, Which? found that 82% of advisers failed either to explain the "key facts of cost" document or have a meaningful discussion with their clients about how their advice would be paid for. It is important that remuneration arrangements for advisers work in the best interests of consumers and promote independence of advice.
A number of IFAs have already moved away from commission to a fee-based approach. I know that AIFA, the trade association for IFAs, is helping IFAs change their business model. I do not doubt the integrity of the vast majority of advisers, but no one can doubt the financial detriment caused to consumers as a consequence of mis-selling scandals of the past. Following the FSA's pensions review in 2002, 1.7 million consumers received compensation totalling £11.8 billion due to pension mis-selling alone.
Advisers should welcome changes in remuneration as a clear way of building consumer trust in the sector. Consumers already pay for advice, as commission is deducted from their premiums or initial investments. Advice is not free; that money comes out of the contribution that consumers make to their pensions, their investment bonds or their savings for the future. However, it is important that both the cost and the value of advice is clear to consumers. These reforms will provide clarity on price and service and that will promote competition. Just as we want transparency on interest rates paid on ISAs to promote competition among ISA providers, I
believe that transparency on IFAs' remuneration will also promote competition and provide a better understanding of the value of advice. It will increase consumers' confidence in that area.
We want to broaden the range of advice available. A number of hon. Members have raised the annual financial health check that CFEB is going to organise. Let me be clear. The cost of that will be borne by a social responsibility levy that will be paid by institutions from Goldman Sachs through to the high street insurance broker. The cost will not be borne by independent financial advisers alone. The biggest firms, such as Goldman Sachs or Barclays, will make the biggest contributions, and they will make a far bigger contribution than IFAs. Furthermore, consumer credit organisations have also been brought into the scope of this; they will also have to pay their share towards the annual financial health check. It is important that the burden should be shared.
Mr Stuart: Will the Minister give way on that point?
Mr Hoban: I wish to conclude my remarks so that my hon. Friend the Member for Wyre Forest, who opened the debate, can conclude.
We want a more responsible savings culture in Britain, in which people can plan confidently for their futures and are better able to realise their plans. Financial advice has a key part to play in that, and I want to see improved levels of expertise and knowledge and much greater clarity over transparency. It is important that the FSA should work closely with IFAs to get to that point. This evening's debate has helped the FSA understand the concerns of Members of Parliament. I am grateful to my hon. Friends for securing this debate.
9.58 pm
Mark Garnier: I am conscious that I have just over one minute to sum up this incredibly useful debate. There has been an extraordinary amount of unanimity on both sides of the Chamber; the debate has been completely unpolitical. We have talked about financial inclusion for those who need help and about protecting smaller businesses. We have questioned why the RDR was necessary and talked about grandfathering. IFAs are singular in the sense that they are not allowed to be grandfathered; long-stopping is something else that they are singularly affected by. We have talked about pushing savers into the hands of the banks, even though the banks have a worse track record than IFAs.
Importantly, we have also talked about the fact that we need more time to address this issue. I completely appreciate that we have already had six years, but we are entering a period when European legislation will be affecting these matters as well. We are also seeing the FSA moving into areas covered by the Consumer Protection and Markets Authority and the Prudential Regulation Authority. There are ongoing changes that give us an opportunity to extend the period.
I hope that three things have come out of the debate. First, Parliament has not had a chance to do this before because it is the first time that we have had such a Back-Bench debate, so will the FSA please listen following this new development? We have the feeling-
10 pm
Motion lapsed (Standing Order No.9(3)).
Business without Debate
Estimates
Motion made, and Question put forthwith (Standing Order No. 145),
That this House agrees with the Report [24 November] of the Liaison Committee. -(Bill Wiggin.)
Committees
Mr Speaker: With the leave of the House, we will take motions 3 to 7 together.
That George Freeman be discharged from the Communities and Local Government Committee and Mark Pawsey be added.
That Jessica Lee and Anna Soubry be discharged from the Justice Committee and Ben Gummer and Elizabeth Truss be added.
That Mark Menzies and Julian Smith be discharged from the Scottish Affairs Committee and Mike Freer and Simon Reevell be added.
That David Rutley be discharged from the Treasury Committee and Mr David Ruffley be added.
That Richard Graham and Sajid Javid be discharged from the Work and Pensions Committee and Andrew Bingham and Brandon Lewis be added. -(Geoffrey Clifton-Brown, on behalf of the Committee of Selection.)
Dental Practitioners
Motion made, and Question proposed, That this House do now adjourn. -(Bill Wiggin.)
10 pm
Sir Paul Beresford (Mole Valley) (Con): I am particularly glad, Mr Speaker, that you are here this evening. I am also glad that my hon. Friend the Minister is on the Front Bench. I hope that he remains my hon. Friend by the end of the evening, but I have had some moments of doubt.
As my hon. Friend is aware, I have a declarable interest in this subject. I am a very part-time practising dentist. I am a member of the British Dental Association, the British Dental Bleaching Society and the British Academy of Cosmetic Dentistry, and I have a link with Lockton, a dental indemnity insurer.
Many of us in the real world of business had great hopes of the new Government, especially in the area of deregulation. Quangos were to be removed, or at least diminished in size, and bureaucracy was to be cut back. Indeed, many Departments have been spectacularly successful in this respect. The Minister's Department has shown an early positive approach, with plans to remove primary care trusts. Sadly, the Care Quality Commission, which was set up by the previous Government, has slipped through the net. This organisation is now displaying a cancerous bureaucratic growth that I would have expected from the combination of the previous Labour Government working hand in hand with some overbearing Labour council.
In response to early consultation, members of the dental profession, particularly through their organisations, accepted that there should be regulation of the dental profession-they ought to, because there is plenty of that already-but they did not expect the monster that is now descending upon them. All dental professionals will be required to register with, and be regulated by, the CQC by April next year. The profession is being encouraged to do this online. The commission has made some efforts in that they undertook to warn dentists, and they even gave some dentists a registration number. Many dentists did not receive the notification; I am one of those. There are two stages that dentists need to complete. First, there is the enrolment form. To my mind, this form was relatively straightforward, but attached to it were barrel-loads of instructions-page upon page of confusing do's and don'ts that were excessive and confusing. After registration is accepted, registrants need to complete the CQC permission and validation form.
Included in the second stage is a requirement for a Criminal Records Bureau check. Members of the dental profession are not required to obtain a standard CRB check but have to obtain an enhanced CRB check. This is the first example of the enormous bureaucracy and unnecessary duplication involved. It costs money and time to acquire. Forms have to be obtained, filled in and processed through one of the 100 or so Crown post offices. The Post Office is paid for the service by the dentist, as is the CRB. From time immemorial, the General Dental Council has kept a legal watchful eye over dentists in judicial matters. Any dentist who is convicted of a criminal charge is reported to the General Dental Council-that is simpler and involves only those very few members of the profession who are criminally convicted.
As a dentist and MP, I witnessed the uproar that the last Government caused among the dental profession with the change in the contract for NHS dentists. I have to warn the Minister that the CQC is causing the same uproar. The difference now is that the condemnation by individual dentists and by every organisation related to dentistry is universal. These range from the British Dental Association and all the other similar professional organisations through to, curiously, a group of solicitors called the Dental Law Partnership. The intriguing thing is that the Dental Law Partnership is a group of solicitors with dental training who specialise in suing dentists-but they are on side this time.
To quote Susie Sanderson of the British Dental Association, the CQC is currently seen as overbearing, inconsistent and duplicatory. The Health Department's impact assessment of the regulation of primary, medical and dental care providers, on which the proposed regulation of dental professionals by the CQC was based, failed to identify any sound evidence to support the proposition that the existing regulation of dental professionals or the systems in which they work in England, were ineffective. There is no reliable evidence base for the proposition that the current regulation of the dental profession by the General Dental Council, among others, fails to regulate the system of dental care, nor is there any reliable evidence that failings of the GDC place patient care at risk.
The attitude of the CQC at its explanatory road shows around the country and at meetings has been seen by those who have attended-I do not include myself-as overbearing and dictatorial. To make matters worse, its responses to questions at those meetings and on its helplines have been inconsistent. There is an apparent lack of understanding of dentistry and the dental profession. Perhaps that was most clearly emphasised at a lecture, when one of the CQC's senior members of staff failed to understand the difference between the British Dental Association and the General Dental Council.
Even more maddening is that most, if not virtually all, of the proposed outcomes or targets set by the CQC are duplicated in the existing regulations set out in the General Dental Council's "Standards for Dental Professions" of May 2005. To exemplify that, I will list some of what the CQC calls outcomes-targets by any other name. Outcome 1 covers respect for individuals, outcome 2 is about consent to care and treatment and outcome 3 relates to fees. Those outcomes duplicate the GDC's existing regulations: standards 1, 2 and 3 of "Standards for Dental Professionals" of May 2005, standards 1, 2 and 3 of "Principles of Patient Consent", and standards 1, 2 and 3 of "Principles of Patient Confidentiality". The same applies to the outcomes relating to personal care, treatment and support, safeguarding and safety, and to outcomes 7, 8, 9, 10 and 11-all are covered by the GDC. The same also applies to the three CQC outcomes on the suitability of staff quality and management.
Outcome 14 requires practitioners to demonstrate that ongoing training is taking place. However, the GDC already regulates the professional development of dentists and other dental care professionals. Continuing professional development is compulsory for registered dentists and dental care professionals to remain registered with the GDC and be permitted to practice. Dentists must complete 250 hours of CPD every five years, of which 75 must be verifiable.
Outcome 17, on complaints against dentists, was a favourite of the Labour Government. It requires that there is a complaints and comments system, that there is support for complainants and that action is taken to address complaints. The General Dental Council also requires a practice to have a complaints procedure, so private practices and NHS practices are covered. An offshoot of the GDC, the Dental Complaints Service, deals specifically with patients' complaints, whether in the national health service or private.
Outcome 10, on the safety and suitability of premises, duplicates matters under the jurisdiction of the Environment Agency, water companies and the Health and Safety Executive. The HSE has the power to enforce the requirement for practices to have a risk assessment. It also has jurisdiction over equipment and its use to ensure that it is properly maintained and serviced. I am sure that the Minister will have done some homework for tonight and will be aware that the fire prevention regulations also fall under CQC outcome 10.
The Minister of State, Department of Health (Mr Simon Burns) indicated assent.
Sir Paul Beresford: The Minister is nodding sagely so perhaps I will believe him. The fire prevention regulations are enforced by the local fire authority and any CQC interest in that area is duplication. To my amazement, there is even duplication in the CQC requirements, some of which are addressed many times. For example, evidence that practices have appropriate confidentiality protocols in place must be provided to satisfy outcomes 1, 2, 6 and 21.
Dental providers must comply with 28 standards, but there is no guidance on what the CQC requires as evidence of compliance. Furthermore, it is unclear who the auditors of the process will be. To give an example provided by people who have lobbied me, the NHS Partners Network and the NHS Confederation state that generally, their members have been subject to mixed messages and unclear instructions from the CQC about what to expect from it. They say that in the current financial climate, such uncertainty is particularly difficult for their members and runs the risk of adding significantly to costs without yielding safety and quality benefits. The ultimate guillotine is having one's practice shut down for failure to comply with a potential deadline of April next year, which is causing deep concern in the dental profession.
Finally, I turn to costs. The current situation is that there is no fee for CQC registration. In contrast, my fee to be paid this month to the General Dental Council is £576, the same as for the majority of dentists. However, the CQC is consulting on proposed fees, which it wishes to divide up depending on the size of a provider. The fees proposed are disproportionate, as the lowest fee is to be £1,500, for a provider with one location, such as my own small, part-time surgery, whereas £48,000 is to be charged for a provider with 101 or more locations.
One of the most glaringly ludicrous points is the extreme jump in fees from one level to another. For example, if a dental firm has 100 practices it will pay £24,000, but if it merely adds one more practice, its fees will double to £48,000. The situation has to be dealt with, and it is in the hands of the Minister and his colleagues to do so. The CQC is charging ahead blindly,
apparently with little knowledge and with no response to concerns that have been expressed. It has finally agreed to sit down with the General Dental Council in the next week or two and discuss the potential duplications in registration costs.
I understand that there are organisations similar to the CQC in Wales and Scotland, and both appear to be working closely with the GDC without duplication. The result is that the annual cost to Welsh dentists for their organisation is not between £1,500 and £48,000, but probably in the region of £80 and certainly less than £100.
There is an opportunity for Ministers to act before it is too late, and before too much money is wasted. If necessary, the forthcoming Public Bodies Bill will enable Ministers to remove the CQC from its role of regulating dentists. I remind the Minister that all the problems that it is having with dentists, and dentists with it, are likely to be repeated, and more, in the case of general medical practitioners. They are next on the list.
I await the Minister's considered response, and I hope that he will take a step back and promise to consider the points made by me and, in particular, by the many organisations that have lobbied on the matter. It would be helpful if there were a serious meeting between Ministers, the GDC, the CQC and the BDA. It is overdue.
10.12 pm
The Minister of State, Department of Health (Mr Simon Burns): I begin by congratulating my hon. Friend the Member for Mole Valley (Sir Paul Beresford) on securing this debate on an issue that I know is of some concern to him and other dentists throughout England. He said at the beginning of his comments that he was a friend of mine and hoped that he still would be by the end of my speech. I echo that, because I, too, hope that we are still on friendly, and hopefully speaking, terms by the end of the debate.
My hon. Friend will know that the coalition Government do not believe in regulation for the sake of regulation. However, there are areas in which regulation is important for the interests of vulnerable people who are less able than others to defend their own interests. The provision of health care and adult social care services is one such area, and since 1 April 2009, the Care Quality Commission has been responsible for regulating those sectors under the Health and Social Care Act 2008.
The Government support the role of the CQC in ensuring that providers of health care and adult social care provide services that, at the very least, meet the essential levels of safety and quality that every patient and service user has a right to expect. I am sure that my hon. Friend would not argue with that, or with the enforcement powers that the CQC can use when providers fail to meet essential levels of safety and quality. He will be aware that the Government are committed to strengthening the CQC's role as an effective regulator of health and adult social care services in England.
At the moment, NHS and private health care providers are registered by CQC under the 2008 Act, as are providers of adult social care. From April next year, providers of primary dental care and private ambulance
services will also be registered. From April 2012, providers of primary medical care will be brought into the registration system.
There are a number of reasons why it is right to bring primary dental care providers into registration and to require them to meet essential levels of safety and quality. First, the current regulatory systems for dentists focus on the competence of the individual. However, how organisations and systems are managed is just as important in protecting the safety of patients. CQC registration will provide the framework to ensure that the provider, as well as the individuals within it, meet essential levels of safety and quality.
Secondly, increasingly complex treatments are being provided in primary care settings. For example, it is likely that more oral surgery will be carried out in primary care in future, and the General Dental Council has seen an increase in complaints about harm caused to patients by the placing of dental implants. Those developments make it even more important to ensure that providers have adequate systems in place to protect the safety of patients. Registration with the CQC will allow potential problems to be identified and addressed before they result in harm to patients.
Sir Paul Beresford: The Minister mentioned the GDC and complaints about dental implants. There has also been an increase in poor endodontic work, all of which can be dealt with adequately by the GDC. The situation does not need a huge, monolithic organisation such as the CQC.
Mr Burns: I am very grateful to my hon. Friend for making that point. If he will bear with me, I will, at a slightly later stage in the course of my remarks, address whether working together can minimise the level of overlap so that there is no unnecessary duplication.
Thirdly, registering primary dental care providers will ensure that the same levels of safety and quality are met irrespective of where care is provided. One patient could be treated in hospital where the quality and safety of their care is regulated by the CQC, while another receives the exact same treatment elsewhere without that same guarantee. Wholly private dental providers, treating some 7 million patients, are currently subject to no formal scrutiny of the service that they provide.
Finally-I know that my hon. Friend has raised this subject in the past-registration will provide greater controls on the decontamination of used dental instruments. Guidance on decontamination is set out in "Health Technical Memorandum 01-05". Although that has no legal standing, the CQC can monitor whether providers, including those in the independent sector, meet its requirements by enforcing the cleanliness and infection control registration requirement.
It is the view not just of the Government that the registration of dentists will bring benefits; that view is shared by the dental profession. Responding to the consultation on registration of dental providers with the CQC in June 2008, the GDC said:
"We broadly welcome the establishment of the Care Quality Commission...Whilst we are responsible for the registration and regulation of the whole dental team, whether they work in the private or public sector, there has been no additional means of
regulating wholly private dental services...up until now. We believe that this role can be covered by the CQC and would further enhance patient protection".
The British Dental Association was equally supportive, saying:
"Wholly private providers are currently unregulated (beyond individual professional regulation) and we believe it is essential for this to be addressed."
Sir Paul Beresford: I actually touched on that at the beginning of my short address. The Minister has to realise that the consultation came before the CQC moved into the area of dentistry, before the BDA realised what the CQC was going to do and before the monolithic and, what I called, almost cancerous growth of this organisation.
Mr Burns: I am grateful to my hon. Friend for that intervention. As far as I know, however, the BDA was aware at the time that dentists were going to be registered under the CQC, and as I see it, the comments on the consultation process were made in the knowledge of that information.
I know there has been concern among dentists about the potential impact of registration with the CQC, and my hon. Friend made an interesting and vigorous case highlighting what he perceived to be some of the problems. However, I have some sympathy with those dentists concerned that the process of registering with the CQC will be onerous and time consuming. I can assure him, however, that for the majority of dentists-those who already provide high-quality services-there will, to my mind, be no difficulty in meeting the essential levels of safety and quality.
The experience of HTM 01-05 demonstrates this point. Before the introduction of the guidance, dentists raised concerns about the burden that complying with it would place on them. Only today, we have published the results of the dental national decontamination survey, showing that when HTM 01-05 was published in November 2009, about 70% of practices were already meeting the essential quality requirements for decontamination, with approximately a further 20% of practices very near the essential quality requirements. The remaining small minority of practices were not.
This experience will, I believe, be repeated with CQC registration. Most dental providers already give their patients a high-quality service and will find that they already meet the registration requirements. In those relatively small numbers of cases where dentists do not meet essential levels of safety and quality, registration with CQC will force them to improve. This is the purpose of regulation, and such an outcome would result in safer and better dental care for patients.
My hon. Friend has spoken about the potential for overlap in the role of the CQC and the General Dental Council in the registration of dentists, and he raised it again in his first intervention on me. I would like to address that point now. I read with interest the recent letter from a number of dentists in The Daily Telegraph making the same point as him. The CQC and the GDC are working closely to ensure that the roles of the two regulatory bodies are closely co-ordinated. Indeed, the two regulators have agreed and set out a memorandum of understanding that explains how they will co-ordinate their activities and share information to ensure that
they do not duplicate actions and therefore create any risk of double jeopardy. It is vital that CQC registration complements the professional regulation of dentists by the GDC. The important word there is "complements".
Sir Paul Beresford: I spoke to the president of the GDC last week, and she said they are having a meeting to discuss this for the first time. So the Minister's information might have gone a little awry.
Mr Burns: I take on board what my hon. Friend says. However, the information I have been given, as I said earlier, is that the two regulators have agreed and set out a memorandum of understanding explaining how they will co-ordinate their activities and share information to ensure that they do not duplicate actions. I trust that that action is correct, I trust that they work closely together to achieve that aim, and I will certainly get back to him if-despite what I have been led to believe-that is not the case.
My hon. Friend also referred to the proposed level of registration fees for dental providers. As he is aware, the Care Quality Commission is currently consulting on its proposals for annual registration fees, which will apply to all providers, including dentists, from April next year. I would like to emphasise that they are proposals for consultation. I would certainly urge all dentists in England to make their views known to the CQC through the consultation process as soon as possible, and certainly before it ends, on 17 January. I heard what my hon. Friend said, and I have seen the consultation document. I can only repeat-and repeat quite vehemently-that it is important that all dentists take part in the consultation process and ensure that the CQC is fully aware of their views before it ends. I should also add that the CQC's final fees scheme is subject to the consent of the Secretary of State. It would obviously be wrong of me to prejudge the consultation process or what will happen at its conclusion. All I can do is advise my hon. Friend and the profession to ensure that they lobby the CQC as part of the consultation, so that it is left in no doubt about the views and concerns of dentists on the issue.
My hon. Friend also mentioned Criminal Records Bureau checks, which I know have been a particular issue for some dentists. CRB checks are important to ensure that those responsible for the delivery of services are fit to do so. In earlier registration rounds, CRB checks have revealed convictions that were not otherwise declared. Those dentists who already have a CRB disclosure countersigned by their primary care trust can use it for CQC registration. I know that there have been practical problems with getting the required CRB checks carried out, and I understand the frustration that this has caused for some dentists. As a result, the CQC has increased to 100 the number of post offices that can process CRB disclosures on its behalf. That will go some way towards helping to deal with some of the practical difficulties experienced in getting a CRB check. The CQC is also exploring with Post Office Ltd the possibility of extending the service to the entire post office network.
Although there is a degree of anxiety among dentists about CQC registration, I hope-although I am not convinced-that I have reassured my hon. Friend that the majority of dentists, who already provide good services, have no need to fear CQC regulation. For the
small number who do not provide a safe service, registration will provide an effective mechanism to bring about improvements for patients. Indeed, that is the very purpose of regulation.
In spite of the concerns, I am pleased to have been told by the CQC that the registration of primary dental care providers is so far proceeding smoothly. More than 7,000 dentists, including nearly 1,600 who operate solely in the private sector, have enrolled in the CQC's registration process. The CQC has now invited those primary dental care providers to submit applications. I understand that the first completed application was returned to the CQC
within three hours and that more than 400 applications for registration had been returned by the end of last week. With what I believe has been a good start, I am hopeful that the task of registering dental providers with the CQC will be completed on schedule by 1 April 2011, and that patients will have the assurance that whichever dental practice they use, whether NHS or private, they will receive care that meets essential levels of safety and quality.
10.29 pm
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