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"( ) In that section, after subsection (3C) (as inserted by subsection (9) above) insert—
"(3D) The regulations may also include provision for the resolution of disputes as to the terms of any proposed section 28C arrangements, and in particular may make provision—
(a) for the referral of the terms of the proposed arrangements to the Secretary of State or National Assembly for Wales; and
(b) for the Secretary of State, or Assembly, or a person appointed by him or it, to determine the terms on which the arrangements may be entered into.""

On Question, amendments agreed to.

Clause 173, as amended, agreed to.

Clause 174 agreed to.

11.15 a.m.

Clause 175 [Persons performing primary medical and dental services]:

Earl Howe moved Amendment No. 460:

    Page 94, leave out lines 16 to 18.

The noble Earl said: In moving Amendment No. 460, I shall speak also to Amendments Nos. 461 and 462. New Section 28W relates to primary medical and dental services and the lists that restrict and define the practitioners eligible to provide those services. The amendments are probing amendments, and I should be glad if the Minister could comment on them.

Subsection (4)(e) of the new section refers to the declaration of interests, specifically financial interests. It would be helpful to know what interests other than financial a person will have to declare, to whom he will have to declare them and whether such declarations will be published. Will a de minimis provision apply? My fear is that we will go overboard in asking professional people to declare every conceivable interest, however insignificant, and that the process will not only become cumbersome but will cause real discontent among doctors and dentists. We do not need that.

I should be grateful for the Minister's confirmation that subsection (4)(g) is intended to cover the possibility of, for example, fraud or gross malpractice by a practitioner, in a case in which it might be considered inappropriate for that person to remove himself or be removed from the list until such concerns had been resolved one way or the other. I cannot see any justification in other circumstances for keeping someone on a list against his will, but, perhaps, the Minister can clarify that.

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Finally, the purpose of subsections (5) and (6) is not clear to me. Subsection (6)(a), in particular, is a complete mystery. What sort of conditions might be imposed to meet the requirements of subsection (6)? Should not those requirements be in the contract, rather than the list of practitioners? I beg to move.

Lord Warner: Many of the provisions continue existing practices. I turn first to Amendment No. 460. It is crucial that, once a practitioner has been admitted to a PCTs list, that practitioner complies with certain requirements. The requirements include notifying the PCT about criminal investigations and charges or other investigations. That continues existing practice.

With regard to the declaration of gifts and financial interests, there must be consistent rules throughout primary care. The provisions simply place in their proper context the existing regulation-making powers. There is nothing new about that. The powers were previously inserted into Sections 29 and 36 of the National Health Service Act 1977 by Section 23 of the Health and Social Care Act 2001. The provisions will ensure that gifts and financial interests are dealt with openly and honestly.

We recognise the special relationship that exists between practitioners and their patients and realise that patients will occasionally want to provide tokens of gratitude. We do not want to make practitioners refuse gifts, but we need transparent procedures to prevent abuse. If we did not have that provision, we would have inconsistency between some primary care practitioners, on the one hand, and other NHS employees, such as hospital clinicians, on the other. For example, hospital clinicians are required to declare gifts.

Common sense about the scale of the gifts must prevail. There is a world of difference between a box of chocolates and a foreign holiday. The onus is on the practitioner to recognise sensibly which gifts should be declared. I hope that that clarifies matters for the noble Earl.

I turn to Amendment No. 461. Doctors and dentists whose conduct or performance are under investigation by PCTs are prevented withdrawing from the list until the PCT has decided the matter. That continues the present arrangements.

Amendment No. 462 would have the effect that a doctor or dentist who was under investigation by the PCT or had been suspended or given a notice of intention to remove him would be able to avoid removal from a list simply by withdrawing from that list. That, in turn, would enable the doctor to apply to other PCTs, without having to declare what had happened. That is continuing present practices in that area.

In broad terms, the noble Earl is right. We are largely talking about—certainly from my own experience when I chaired a family health service authority—serious malpractice or financial irregularities. I am struggling to think on my feet of other circumstances that I have experienced in this area. I will check and if there are others I shall write to the noble Earl.

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Clause 175 is slightly delphically worded in the sense that we are continuing a longstanding practice; namely, there are particular aspects of the way in which, for example, a doctor conducts himself, but there is scope for remedial action. I am choosing my words with care. Occasionally, a doctor may go through a bad stage in his life—for example, he may have a little problem with alcohol or whatever—but it is a temporary phenomenon. Providing there is a clear plan to tackle the problem, and it is not so serious that services to patients are adversely affected, common sense prevails. Rather than lose a good doctor, conditions are imposed on the way in which he or she practises. We are talking about, and the provision in the legislation is dealing with, that kind of circumstance. I hope that that gives some reassurance to the noble Earl.

Earl Howe: Indeed, it does. I am grateful to the Minister for that, as I am for the explanation he gave with regard to my other amendments. From his remarks, I am not entirely clear, as regards the declaration of interests, to whom a doctor must declare his interests, how, in practice, that will operate and whether such declarations will be published as public knowledge. If the noble Lord can enlighten me further, perhaps he will write in due course. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 461 not moved.]

Lord Warner moved Amendment No. 461A:

    Page 94, line 23, leave out "by a Primary Care Trust or Local Health Board"

On Question, amendment agreed to.

[Amendment No. 462 not moved.]

Clause 175, as amended, agreed to.

Clauses 176 and 177 agreed to.

Clause 178 [Special Health Authorities]:

On Question, Whether Clause 178 shall stand part of the Bill?

Earl Howe: What is the intention that underlies Clause 178, which makes provision for a strategic health authority to carry out the functions of a PCT in respect of dental services? The Explanatory Notes are silent on this matter. My understanding has always been that a strategic health authority would never be a commissioner of services of any description and that its role is entirely supervisory. It would be helpful if the Minister could explain what kinds of circumstances might arise which would trigger the making of regulations under the clause.

Amendment No. 476 proposes that the abolition of the Dental Practice Board should not take place until the matter has been debated in both Houses of Parliament under the affirmative resolution procedure. It appears that the Dental Practice Board,

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when abolished, is to be replaced by a special health authority, but there is little in the Explanatory Notes that sheds light on how it will operate.

The reason for asking for the affirmative resolution procedure is simply that when a major reorganisation of the NHS takes place, Parliament needs the guarantee of being able to scrutinise the detail of what is proposed. Special health authorities are a convenient device which enable the Government to rewrite how the NHS is run. They can be created with relative ease from an administrative standpoint, yet their functions can be complex and of the highest significance. I hope that the Minister will look constructively on the proposal, notwithstanding any resistance her officials may suggest she should offer.

Baroness Andrews: I am completely impervious to resistance from officials. I do not think that I need to say that. There is great cynicism on Opposition Benches about headlines that say "Reject" and "Resist". I can assure noble Lords that we are at one with our officials about these matters.

The noble Earl asked: what is the point of the clause? Perhaps I could give him the brief explanation, which is purely the legal explanation and then answer his questions in relation to functions. I hope that we can come to agreement on that. Currently, Section 16B of the 1977 Act provides for regulations to provide for prescribed functions of PCTs to be exercised by a special health authority. The provision is needed to enable the rights and liabilities of PCTs—for example, financial rights and liabilities—to be transferred by order to the new special health authority established as a successor body to the DPB. That also enables us to allow for transferred functions to be transferred back by order if and when necessary.

For example, the general dental services contract may provide for payments to dentists under such a contract to be made by the special health authority rather than a PCT. The clause would allow an order to provide for the special health authority to take on the PCTs' contractual responsibility for the payments it makes. Subsection (2) makes similar provisions in relation to the local health boards in Wales.

Perhaps I may describe in more accessible language what we are expecting; that is, why we need a special health authority rather than the Dental Practice Board and what we want it to do. At the moment, the DPB is responsible for the payment or remuneration of general dental practitioners who provide general and personal dental services under the pilot scheme. It also approves higher costs and proposed treatments and fees in relation to certain services that are not specifically provided in the statement of dental remuneration. Therefore, it approves associated charges. Recently, it has also been directed, under Section 122A of the 1977 Act, to recover charges and other payments.

It is established under Section 37 of the 1977 Act, and the legislation also states, that the chair must be a dentist, as must be the majority of its members. At the time that the legislation was written, that made a great

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deal of sense: the board itself was making clinical decisions about proposed treatment. The board no longer concerns itself with clinical issues. Indeed, it has dentists on the staff who provide the clinical advice. Therefore, the board no longer needs that in-built dental majority.

The problem with the current structure is that it is inflexible. It cannot take on the additional functions that do not relate to general or personal dental services because its functions are set down in primary legislation. Therefore, it is difficult to match the capacity of the organisation to changing functions. It does not make best use of its staff. A more modern and flexible foundation for the DPB is long overdue. This is the opportunity for that.

Clause 177 provides for the abolition of the PCB and for the special health authorities to be established under Section 11 of the 1977 Act by the Secretary of State and the Assembly. It is a cross-border SHA and will undertake functions both in relation to England and Wales. As an SHA, it is capable of having functions transferred to it by directions.

The DPB has an enviable reputation of paying dentists correctly and on time. The profession draws confidence from that; we aim to maintain that confidence during the transitional period. We are discussing how best to achieve that with the relevant stakeholders. We also know that it plays an important role in verification of patient charges. Even under local contracting it will be important to ensure that the correct charge is being calculated and collected. We spoke a little about that issue in the early hours of Tuesday morning.

The continuing role of the DPB and the special health authority will maintain that important national perspective. Subject to consultation, the assets, liabilities and staff would be transferred, under Section 11 powers, to the new SHA. In addition to the payment function, the SHA will undertake monitoring and quality assurance—an area we want to see developed.

In terms of the transfer of functions, it may help Members of the Committee if I outline the timetable that we envisage. The DPB will continue to pay dentists on behalf of all PCTs from April 2005 at least through the transitional period, which is likely to run to 2008. However, we shall use the transitional provisions set out in the Bill to enable it to carry out functions in relation to the new contract. We anticipate that the special health authority will be established during 2005 and that it will gradually take on the functions of the DPB until the point at which all those functions have been transferred, when it will be abolished.

We have not yet set a date in 2005 for that, so there will be an element of overlap while the transition is completed. Obviously, funds for primary dental services will be allocated to PCTs in the usual manner. The new SHA will pay out moneys on behalf of PCTs, much as the DPB is doing now. That is how we envisage the timetable for the transfer process.

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I turn now to Amendment No. 476, which seeks to make the commencement of Section 177 covering the abolition of the DPB the subject of debate in both Houses under the affirmative procedure. As I have said, for operational reasons the SHA will need to be established before the DPB is abolished. I suggest, therefore, that the amendment would not be appropriate since a debate on the regulations under the affirmative procedure at the point of the imminent abolition of the body would be less appropriate than the opportunity we have now to consider the implications. A debate at the point at which the regulations are laid would take place rather after the fact.

For that reason, and given the explanations I have put before the Committee, I hope that the noble Earl will feel able to withdraw his opposition to Clause 178 standing part of the Bill.

11.30 a.m.

Earl Howe: The noble Baroness has made a very beguiling point and I am tempted to succumb to it. I apologise to the Committee for having inadvertently misled it by referring to a strategic health authority rather than a special health authority. I am grateful to the Minister for the useful explanatory background to the process.

However, I still feel that, given the current position of the dental majority moving to a membership and a remit that is not yet clear, there is an important role for Parliament to examine the new arrangements. Perhaps the noble Baroness is right to say that it would not be appropriate to do that at the point at which the old arrangements are abolished. However, I shall have to reflect on the matter and, if necessary, return to it at a later stage.

Clause 178 agreed to.

Clause 179 [Charges for dental services]:

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