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Earl Howe: My Lords, the House will be grateful to the Minister for his clear and helpful explanation of the order, which we welcome.
The contents of the order have been the subject of extensive consultation and I understand that the British Dental Association supports it fully. It seems to me that the order is deserving of a wider welcome, given that its general thrust is to make the General Dental Council more responsive to the concerns of patients and to ensure that the quality agenda in healthcare applies as much to dentists as it does to doctors and other health professionals. That is surely the right direction in which the profession should be moving.
When the Health Act 1999 was debated in this House, we realised the good sense of being able to amend the regulatory arrangements for the health professions by statutory instrument. The advantage of doing so is that of speed. Previously, the only way of making changes of this kind was by primary legislation. It was for that reason that the previous Conservative government found themselves unable to respond to the requests put forward by the General Dental Council in 1996.
This order, which provides for a professional majority on the General Dental Council, preserves the important principle of professional self-regulation. However, that fact and the unamendable nature of statutory instruments create an obligation to ensure that the profession itself is content with the arrangements proposed. We know that that is the case so far as concerns dentists; but it is a point that applies more generally to all the relevant professions, and one to which we shall return as we debate subsequent orders under the 1999 Act.
However, given that the main advantages of the order-making power in the 1999 Act are speed and flexibility, I must ask the Minister why it has taken nearly two and a half years from the passing of the Act to the laying of this order. The dentistry profession has understandably been keen to move forward with these changes as rapidly as possible. Discussions about them began in the summer of 1999. Even allowing for the need to consult, I do not understand why we could not have been debating this order a year ago.
I say that not to be awkward, but to flag up my anxiety that the other measures, which I know the General Dental Council is keen to see approved by Parliament, may not see the light of day for some time to come. I hope I am wrong about that, but it would be helpful to hear from the Minister that progress on the questions of the performance review scheme for poorly performing dentists, misconduct procedures, regulation of the professions allied to dentistry and of dental bodies corporate, and other issues, will be expedited as rapidly as possible.
It is a pity that it has not proved feasible to incorporate all these measures into a single order. But since it has not, I hope that the Government will accept
the case for maximum speed in introducing the remainder of the reform programme, consistent with the need to secure a wide professional consensus.
Lord Clement-Jones: My Lords, I, too, thank the Minister for his clear exposition. I welcome the order. It is worth noting that this is the first use of the powers in the Health Act over which we laboured two years ago. I am sure that this is a useful precedent. I hope that the orders that come before this House in the future are as uncontentious. I suspect that that will not be the case, but we certainly welcome the order before us today.
I have listened with care to the Minister's remarks and I have read the fairly extended discussion on this matter in the First Standing Committee on Delegated Legislation in the other place. There has been a fair working over of the issues set out in the order. Generally in the profession the order is supported on all sides. As the noble Earl, Lord Howe, said, the aims of the order must be supported by us all in terms of not only a smaller and more effective governing body but also in terms of an increase in lay representation, which is clearly going in the right direction. The compulsory professional development of dentists as a precondition for registration is important. On these Benches, we always like the phrase "life long learning". That must surely be a step in the right direction.
We look forward to the forthcoming orders which will reform procedures further. I refer, for example, to the introduction of new complaints systems and the regulation of the professions complementary to dentistry. But will the Minister say what is the time-scale for the orders? It seems that the fitness to practise order is being drafted at present. But the precise nature of the orders is important.
I understand from the debate that took place in another place that only this order is subject to the affirmative resolution. The next set of orders will be subject to the negative procedure. The Minister in another place said that they were orders of the Privy Council. I am not aware of exactly why there should be a difference. If there is a difference, and the negative procedure is used, the point made by the noble Earl, Lord Howe, is important: in circumstances where we do not have the opportunity to question the Minister directly on the orders, consultation is of great importance. That is a minatory note. These orders need airing. We need to have a discussion and make sure that all parties are able to contribute.
Lord Colwyn: My Lords, I am grateful to Minister for the way in which he has explained the order, identified the issues and confirmed the fact that it is the first in a series to modernise the regulation of dentistry. I declare an interest as a practising dentist. I, and the profession, welcome the proposed legislation which will formalise the GDC's current initiative for continuing professional development—life long learning.
This will be phased in from 1st January 2002. The dental profession is solidly behind the GDC initiative. Some 13,000 have already registered voluntarily under
the scheme. That bodes well for the future of dentistry. Compulsory continuing professional development, as a condition of registration, will help to maintain and improve standards in the dental profession, and to enhance public confidence.The GDC is to be congratulated on having assembled a steering group in 1999, gathering together representatives of all the major stakeholders in the profession in order to take forward the council's proposals with a solid consensus. The proposed changes in the composition of the GDC will make it more manageable and more able to operate responsively and in a strategic way. The proportion of lay members will be tripled. The increase in the membership and participation of the professionals complementary to dentistry is appropriate to pave the way for proposed future registration of nurses and technicians who will join the hygienists and therapists.
The greater separation of the GDC's investigative and prosecuting function from the actual hearing and determination of cases is a crucially important one. The current lack of separation between the prosecution and hearings roles of the council undermines the appearance of fairness. The council's proposals are to create three distinct functions which will fall within the ambit of "fitness for registration". They are: health, conduct and performance.
While declaring my interest as a former chairman of Dental Protection Ltd, I think that the third category is a very positive step. It gives the council a valuable third option, which would allow an under-performing dentist to be assisted with a clear and structured personal development plan in order to allow that dentist to be a safe and useful member of the profession again; as opposed to the present situation, where the dentist is either subjected to severe disciplinary penalties, including suspension and erasure from the register, or where on occasions a decision is postponed, allowing the dentist further opportunity—perhaps a year later—to demonstrate that he or she is fit to practise safely. During this time the dentist tends to be left to his or her own devices.
Under the new arrangements, a performance committee would have a much wider range of constructive options available to it; but only the conduct committee itself would have the power to suspend or erase, or to impose conditional registration. This would appear to be a considerable improvement on the present situation.
Finally, I recognise that this is only the first in a series of orders to which the Government are committed. Subsequent orders covering poor performance, patients at risk, registration of the entire dental team, the introduction of a new complaints system—separated from the GDC to enable patients to seek independent resolution of disputes—and measures to improve the regulation of dental corporate bodies will be introduced early next year.
The modernisation has started. I hope that it can be completed very soon. I welcome the order.
Lord Prys-Davies: My Lords, I, too, welcome the order. I note that the noble Lord, Lord Colwyn, a practising dentist, has given it his complete support. To justify my brief contribution, perhaps I should say that a long time ago I was involved in the NHS for a number of years. I was much concerned about the adequacy of lay representation within the NHS machinery.
The order is a short order of seven pages, but to describe it as such does not reflect its importance to the dental profession and patients in the United Kingdom. I am especially pleased that it paves the way for a strong lay element in the composition of the General Dental Council, and that it will ensure that England, Wales, Scotland and Northern Ireland will have representation and a voice on the council.
The order is therefore a significant improvement on the present position. It is a major milestone in the dental profession's history. It contains some model provisions that could be adopted by other professions within the NHS. I greatly appreciate all the work by the General Dental Council and the departmental team. A great deal of effort has gone into the preparation of the order.
I end with two questions for the Minister. First, when will the retraining scheme come into effect? Secondly—here I end where I began—the order does not contain a job description for a lay member. I did not expect it to do so, but can the Minister confirm that it is not intended that a member of the medical or nursing profession will be deemed to be a lay member for the purpose of the order?
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