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Lord Clement-Jones: Will the Minister clarify those important words? Is he saying that NHS paybeds are covered by the Commission for Health Improvement; and that the reviewing body will be the commission? Will national service frameworks apply to NHS paybeds? Will the NICE guidelines be applied by the CHI when it is inspecting those paybeds? That is implied in the Minister's statement that the full regime as applied to the NHS will apply to its paybeds.
Lord Hunt of Kings Heath: That must be right because those beds are part of an NHS trust hospital. What applies to that hospital must apply to all the beds within it.In conclusion, I say to the noble Earl, Lord Howe, that I refute the muddle which he suggests we have fallen into. I reiterate the fact that NHS paybeds are already covered by clinical governance and that therefore there is no need to have them further
regulated by the care standards commission. On that basis, I invite the noble Lord, Lord Clement-Jones, to withdraw his amendment.
Earl Howe: I am grateful to the Minister for clearing up much fog and uncertainty that have descended upon the issue. He has done so extremely clearly. We have had a helpful short debate and at the appropriate time I shall not move my amendments.
Lord Clement-Jones: I thank the Minister for clearing up one confusion. However, in clearing one fog another has descended. As was said by the noble Lord, Lord Jenkin, as some of the NHS paybeds closely equate to independent sector healthcare beds perhaps they should be regulated in the same way. However, as others, such as maternity units, closely equate to NHS beds, a common inspection regime should apply.
The common message is that a single set of regulations should apply across the board. The Minister repeated the distinction he made on Second Reading between the regulation of the independent healthcare sector and the management of the NHS. However, in many respects, it is a distinction without a difference. A common review and inspection system would be feasible, still leaving the regulation of the private care system within the commission. Future amendments are designed to achieve that.
We have had an interesting and well attended debate and I thank all Members of the Committee who have taken part. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
3.45 p.m.
Lord Clement-Jones moved Amendment No. 5:
- Page 2, line 23, after ("hospital") insert ("or any undertaking by one or more persons)").
A Consumers' Association report in Health Which?, published in August 1999, found that patients using private GP call-out services may not be adequately protected. One of the problems is that, because they are domiciliary services and are not based in a clinic-type setting, they may not be covered by the Bill. The amendment makes it clear that private call-out services must register under the proposed regulations.
I turn to Amendment No. 6. Arguably, dental care is the most common private healthcare service used by patients. While it is good that premises providing general practice services are covered under the Bill, we are concerned that only those dentists who provide treatment involving general anaesthetic will be regulated. We do not believe that that is adequate. Therefore, we propose that the dentists who do not
provide general anaesthetic should also be covered. They can undertake invasive and high-risk procedures and therefore, like GPs, should be regulated. I beg to move.
Lord Hunt of Kings Heath: The purpose of Amendment No. 5 appears to be to seek to regulate medical practitioners who do not work from a specific establishment. We are concerned to ensure that the new regulatory system protects patients and have therefore decided to extend regulation to private primary medical care premises. We regard it as being extremely important that such premises, which include private walk-in clinics such as medi-centres, operate to clear standards and are properly and regularly inspected. Our aim is to ensure that all such premises are regulated without regard to their ownership arrangements.
Amendment No. 6 seeks to bring all private general dental practice within the scope of the commission's regulatory powers. I understand the thinking behind the noble Lord's proposal, but I believe that such an extension of regulation is unwise. First, most dentistry, whether practised in the private or public sectors, does not present a great risk to patients. The great exception is in relation to dentistry under general anaesthetic, which has tragically resulted in deaths.
We are determined to regulate such property, and the Bill makes provision for the commission to regulate premises where that work is undertaken. Furthermore, Clause 37 will allow such treatment to be regulated under the existing legislation even before the commission comes into existence, so concerned are we to take action.
However, I must say to the noble Lord that it is a big step from regulating this aspect of dentistry to regulating the whole of private dentistry. We consulted on the issue last year and carefully considered the results. We concluded that it would not be right to extend regulation in the way proposed, not least because of the need for proportionality in our approach and the need to avoid unnecessarily increasing the regulatory burden on small businesses. That said, we stated clearly in Regulating Private and Voluntary Health Care that we shall keep the matter under review and consider whether at some stage we should extend regulation to that and other sectors.
The noble Lord, Lord Clement-Jones, raised a specific issue concerning call-out services. All wholly private GPs will be covered. Therefore GPs would be covered wherever they were practising. We did not regulate only the premises. It is worth making the point that private GPs will also come under the regulatory provisions of the General Medical Council.
Baroness Gardner of Parkes: I should like to pass some comments on the Minister's remark that he does not believe that much dental hazard exists except in cases involving dental anaesthesia. As a dentist who has used thousands of general anaesthetics I believe that the general anaesthesia issue has gone over the top
at present. I feel strongly about all the poor children who have to wait three months before they may have anything done.There is a further aspect to the matter. At the time when I was in practice the National Health Service was very much stronger than it is now. I deplore the transfer of dentistry away from the National Health Service. I was a member of the London local dental committee, and a procedure existed whereby we used to inspect any surgery or premises where there was any doubt whatever about the standard of cleanliness or hygiene. Today, when sterilisation is a most important feature of life in terms of transmission of infection--particularly HIV, although hepatitis is perhaps even more transmissible--it is important to ensure that all dental practices have adequate facilities in terms of autoclaving.
In my day when one started one used to mix up one's solution in a bottle of water and add the tablets. Nowadays people would be horrified by that. Unfortunately, disease has progressed to the extent where it is terribly important that one has a sealed individual capsule and an individual needle. The Minister might believe that practices do not act in such a way, but I recall clearly, when I sat on the disciplinary committee of the General Dental Council, the case of a NHS practice--it could now be a private practice--where the forceps were merely dipped under the tap after each extraction. The dentist concerned had a turnover of £1 million per year and was disqualified by the General Dental Council. Think of how many patients he had treated without sterilising anything. He had one set of forceps for four surgeries which he would dip under the tap and then run on to the next patient. The hazard of that to the patient is almost unbelievable.
Therefore, I cannot go along for a minute with the view that the only hazard in dentistry is general anaesthesia. It is important to consider this question. If I could find fault with the amendment tabled by the noble Lord, Lord Clement-Jones, it might be that to specify dental practitioners is not enough and that the amendment should refer to premises used by anyone in any allied profession. I do not know what the hazards are in an osteopathic or chiropractic practice. Perhaps the terms of the amendment are not wide enough, but it would certainly be a good thing to include dental practitioners, unless the Minister can assure me of some other form of examination being carried out to assess standards in private dental practice.
Baroness Masham of Ilton: Will the Minister tell the Committee whether, where line 24 of Clause 2 states, "by medical practitioners", nurse practitioners are included?
Lord Hunt of Kings Heath: I believe that the answer must be no.
It is a foolhardy Minister who tries to talk about dentistry when the noble Baroness, Lady Gardner, is in the Committee. She made some extremely valid points. I hope that I did not, by saying that the particular focus here relates to anaesthesia, give the
impression that other issues do not need to be considered in relation to safety and hygiene within dental premises. The substantive point that I was trying to make is that this is an area of particular concern. I note the noble Baroness's comments as to whether too much is made of the anaesthesia issue. Certainly we in government have been concerned about the number of cases identified where use of anaesthesia has led to deaths in dental surgeries. The noble Baroness may well be aware that we are currently undertaking a review of that matter.
To move from regulating that aspect of dentistry is a large step and it seems to me sensible to focus on that area. In relation to the more general issues about dentistry raised by the noble Baroness, we hope to publish a strategy on dental services in the future as part of our efforts to try to ensure that those who wish to have NHS dentistry may receive it. Of course, GDS regulations exist in relation to NHS dentistry which are one component of the relationship between the NHS and dental services. We are keen to encourage such practices as continued education for dentists in order that we may update them and ensure that they keep up with current thinking and trends.
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