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Lord Clement-Jones moved Amendment No. 439:

"( ) A general dental services contract must require the contractor or contractors to provide for this or their patients—
(a) information about treatment charges;
(b) access to dental records;
(c) alternative local provision and the complaints procedure; and
(d) other such information as may be determined."

The noble Lord said: The Minister will notice that once again, we are so enthusiastic about Amendment No. 439 that we have put it down twice. We obviously expect the Minister's response to be twice as long as she would normally feel obliged to give.

We strongly support the OFT's recommendation that dentists should provide consumers with clear information on indicative prices for common treatments, detailed treatment plans—together with information on any other options and estimates of the likely costs—access to dental records and complaints procedures. This kind of information is fundamental to the delivery of a patient-centred service and to any notion of patient choice.

Existing guidance to dentists from the General Dental Council—the GDC—already covers much of this, yet it is clearly not being observed by the majority of dental practices. It is therefore crucial that appropriate mechanisms are put into place to strengthen the requirements in this area and ensure compliance.

Additionally, we on these Benches strongly support the idea that dentists must also inform consumers about the availability and likely cost of NHS care and how to find an alternative dentist offering NHS treatment if they cease to offer this.

Consumers tend not to look for a different dentist, even if their usual dentist stops providing NHS care. This was confirmed by research by the Consumers' Association earlier this year; it found that 48 per cent of Scottish consumers currently registered with a private dentist had stayed with the same dentist when they switched to providing private-only care. Without even this most basic information, consumers are likely to be a captive audience and unable to exercise an informed choice. Stipulating this key information provision as part of the contract should go some considerable way to addressing this, backed up by enforcement from the PCTs and CHAI. I beg to move.

Lord Colwyn: I support the amendment. Information about local dental services is absolutely fundamental. It is quite true that most people do not really know where to get the information about their local service. This amendment is very important for that reason.

Baroness Andrews: I am sorry to disappoint the noble Lord, Lord Clement-Jones, but I think my

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speaking notes on this amendment are about half as long. We are at one on this and we welcome the support of noble Lords to the commitment to improve the information available to patients. All the evidence—and this is well documented—suggests that the current system is not good enough by any standard.

Of course patients need to be able to make informed choices in all the instances that the noble Lord detailed. Our experience over five years of piloting personal dental services is that that is best done through national requirements and national criteria. We propose to take the necessary provisions in proposed Section 280(2) under Clause 168 rather than proposed Section 28L and Clause 167 where these amendments replace them. We are also committed to the field sites that are being set up by the Modernisation Agency. The 15 or so field sites are pioneering new ways of doing everything from remuneration to information. A number of them are concerned with testing ideas to improve the patient experience.

Fully tested information from the sites will become available over the next two years. We want to incorporate those into the GDS contract as they evolve in the transition period and beyond. That is best done through a national contractor requirement, and we believe that the provisions set out in new Section 28 are already sufficient. For example, new Section 280(2)(f) already provides for,

    "rights of entry and inspection (including clinical records and other documents)".

I hope that we can meet the information needs and requirements that the noble Lord set out, and that it will be successful.

3.30 a.m.

Lord Clement-Jones: I thank the Minister for her reply. If it were a different time in the morning, I might get excited about pioneering field sites, but I cannot quite raise enough enthusiasm. I am sure that tomorrow morning I shall feel a whole lot different about the nature of those field sites.

I believe that I heard the Minister say that the regulations published under Clause 166 would essentially contain the same elements as set out in the amendment. If that is the case, I would be only too pleased with that. However, it must be made quite clear that there are certain key elements, whether the provisions are in the primary legislation or the regulations. Those are the elements that the OFT has specified, and the ones that I set out in my introduction to the amendment, which should be included if there is going to be "improving patient experience", as the Minister called it. If that is to happen, those elements must be contained within it. On that basis, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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Lord Colwyn moved Amendment No. 439A:

    Page 82, line 7, at end insert—

"( ) A Primary Care Trust will include a qualified dentist on any professional executive committee or equivalent committee, and secure consultant level dental public health advice, to secure the discharge of its functions in relation to dental public health.
( ) A Local Health Board will include a qualified dentist on any professional executive committee or equivalent committee, and secure consultant level dental public health advice, to secure the discharge of its functions in relation to dental public health."

The noble Lord said: The amendment would ensure that there are dentally qualified staff at PCT and LHB level to properly commission, manage and co-ordinate local dental service delivery.

While dentists and the British Dental Association are keen to work closely with PCTs and LHBs to ensure that the new commissioners understand issues of dental and oral health, that is no substitute for the presence of appropriately qualified staff within the PCTs and LHBs themselves. The transfer of responsibility for dental commissioning in PCTs does offer some exciting opportunities for co-ordinated and consistent delivery of dental services tailored to specific local needs.

In order that these opportunities are not squandered, there is a need for proper understanding of the complex issues involved. Dental public health is a wide area and its scope includes more than just screening, for example. It covers both the full range of dental public health activities and the links between dentistry and issues such as diet, nutrition, and tackling health inequalities. It is important that professionals who understand those issues and links are involved in the commissioning of services.

Ideally I should like assurances that there will be a dentist on the professional executive committees of all PCTs and LHBs. The BDA would also like there to be a dentally qualified dental public health adviser, who fully understands the issues of dental and oral health, available at consultant level to the PCT or LHB. The terms of this amendment are worded more generally, however, to take into account any changes or variations in terminology that may arise. Again, the Minister kindly referred to the matter in his letter to me, and I feel that he will be sympathetic. I beg to move.

Lord Hunt of Kings Heath: I have a great deal of sympathy with the noble Lord's comments. The problem with the amendment is that it sets a precedent. If the measure applies to dentists, why should it not apply to nurses? If it applies to nurses, why should it not apply to pharmacists? If it applies to pharmacists, why should it not apply to members of the allied health professions? If you go down that route, the primary care trust ends up with very little discretion about appointments to its board and the professional executive committee.

Given that all Members of the Committee have expressed themselves utter devotees of devolution, we should leave PCTs with enough room to manoeuvre. That said, I hope that my noble friend will be able

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to answer the substantive point that the noble Lord raised. If we are really to make a success of the new contract, and if we are to get dentistry back in alliance with the NHS, it is essential that there is dentistry leadership at the PCT level, whether it is a public health dentist or a dental officer who has been appointed. Perhaps between now and Report my noble friend will give further consideration to ways in which we can strengthen the dental profession working alongside primary care trusts. Over many years there has been a disengagement not just between the health service and dentists but also in the vast reduction in the capacity of the NHS to engage with local dental committees.

These clauses are great news for patients who wish to receive NHS dental services. The contract and the discussions with the BDA offer great promise for the future but it is essential that primary care trusts have the ammunition and the expertise to take forward these programmes effectively.

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