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Lord Clement-Jones moved Amendment No. 462A:

"(b) for the manner in which patients should be informed about charges;"

The noble Lord said: I shall be very brief on this subject. Amendment No. 462A is similar in nature to Amendment No. 441A which we debated during the small hours the other day. I think that the Minister accused me of calling him a creature of the night; I would not dream of saying such a thing, but I daresay we could all be so accused. The debate this morning feels rather like the lull after the tempest, which is a far preferable way of considering these issues.

Put simply, it is important to ensure that patients are informed about dental charges as a matter of course. There should be transparency in this and in a number of other related aspects so that they know what their treatment is going to cost. The Minister confirmed that and gave us certain assurances when we debated Amendment No. 441A. I beg to move.

Lord Skelmersdale: Our Amendment No. 464 has been grouped with this amendment. However, before I speak to it, I wish to point out that, in my view, the

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proposal to leave out line 13—that is, the provision for calculating the amount of any charge—and replacing it with,

    "the manner in which patients should be informed about charges",

is a little strange. I much prefer the second amendment tabled by the noble Lord, Lord Clement-Jones, which would retain the original wording and add his additional form of words.

I turn now to Amendment No. 464. The Explanatory Notes on clauses explain that under Section 79A of the 1977 Act, the arrangements under the existing regulations provide for dental charges to be calculated on an item of service basis, which is what I suspect the new regulations will do as well. However, the notes go on to say:

    "The existing system may act as an incentive for the dental practitioner to maximise the items of treatment provided to a patient to maintain income".

That is quite a charge to make, and to say the least it is a little vague. While it does not say that such practices are going on, it suggests that they could. Clause 179 therefore inserts a new section and schedule into the 1977 Act. My problem is this: how will such possible overcharging by dentists be avoided under the new scheme?

A further point occurred to me while looking at the new arrangements. First, presumably new Schedule 12ZA is to be amended by the regulations to be laid under Clause 179(1). I say "presumably" because it is certainly not made clear in the drafting of the clause. Secondly, as I have said already, if I am right and it is intended to have regulations at some point in the future to amend exemptions, then it is quite unsatisfactory to do so by negative statutory instrument. It should be done using the affirmative procedure, a point that I made over and over again at some time between midnight and half-past two on Tuesday morning.

Baroness Andrews: We all had something of the night about us on Tuesday morning, although I thought that we were heroic in our efforts. However, it is nicer to debate these matters when one is feeling relatively more awake.

Let me put the noble Lord's mind at rest on the various questions he raised. Under the current law, Section 79A of the 1977 Act provides for the charges paid by a patient for dental treatment under general dental services to be based on the remuneration paid to the dentist. As the noble Lord pointed out, the present regulations provide for such charges to be calculated on an item of service basis.

The first problem with this system is that patients, dentists and representatives from the Audit Commission have all said that it is very unclear. Dental charges are difficult to understand and raise concerns about the potential cost of treatment, and blur the point at which treatment provided under the NHS moves across, as it were, into private treatment. According to a recent survey undertaken by the British Dental Health Foundation, some two-thirds of people

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are ignorant about NHS dental charges. We want first to clarify exactly what people are paying for, thus answering clearly the question: how much will NHS treatment cost when I go to the dentist?

In future, dental charges will continue to bear relation to the level of service provided, such as a charge per course of treatment or per visit, but they will not be limited to whether one has had scaling and polishing treatments, or those involving fillings and so forth. We are breaking the link between what the dentist charges per item and his remuneration. It will also be based on volume, quality of service and costs, which is much more sensible.

The noble Lord also asked how we know that the system has operated unsatisfactorily and that there has been a degree of over-treatment. Evidence provided by the BDA suggests that dentists themselves have described the system as a "treadmill": the more treatments they offer, the more they are paid, and thus a perverse incentive base is built into the process. That is why, for example, patients who do not require treatment reviews every six months are nevertheless called in, simply to be told that they are all right. There is consensus that the system needs to be changed.

The new system will avoid such overcharging because it is to be based on a more sensible and strategic framework of charging so that people are treated for what they need rather than what dentists provide. Further, the new arrangements will apply nationally. They are not intended to increase the level of charges, but to ensure greater clarity.

Within this process we shall follow the advice which will be generated by Harry Cayton, the director of Patient Experience and Public Involvement. The majority of people on that body are patient representatives who provide consumers with professional advice. They are considering the charging regime, as the Audit Commission recommended, and we are awaiting their findings, which we expect early next year.

The point about exemptions is very important. I stress that there will be no changes to the current exemptions and that it is not our intention to increase charges. Those two important matters need to be on the record.

Clause 179 replaces Sections 78A, 79 and 79A of the 1977 Act with one streamlined section, proposed new Section 79. Amendments Nos. 462A and 463 seek to make clear on the face of the Bill that regulations made under Section 79(1) may include arrangements under which patients are informed about dental charges. Like the noble Lord, Lord Skelmersdale, I am not entirely sure why the noble Lord, Lord Clement-Jones, seeks to remove the reference to the calculation of charges. It is extremely important—it goes to the heart of the provisions—and should remain in the Bill.

As I said in an earlier debate in relation to Amendments Nos. 439 and 441A, I can confirm our commitment to improving patient information. As I said then, we want that to be set out in national contractual requirements to ensure uniformity and to ensure that these issues can be properly and fully

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addressed within the regulation-making power under Section 280 rather than within the proposed new Section 79 regulation-making powers. I am unable to accept the amendments for that reason.

Amendment No. 464 seeks to make the regulation-making power for the recovery of charges for dental treatment subject to the affirmative procedure. The Delegated Powers and Regulatory Reform Committee made no recommendation in relation to this, but I understand the concerns that it is a large and wide regulation-making power. The kind of issues raised by the noble Lord are related to other issues in regard to the power itself. We shall look again at the provision to see how the regulations might be made subject to additional scrutiny.

Lord Skelmersdale: This is one of those occasions when, from the point of view of the noble Lord, Lord Clement-Jones, it is slightly unfortunate that these three amendments are grouped. Be that as it may, I was delighted to hear in the noble Baroness's long explanation that there is no intention—certainly at the moment—to make any changes to the exemptions. I am also delighted that the department and her noble colleague have decided to look again at the whole subject of regulation-making powers—which is what I understood her to say—from Part 3 onwards through the Bill. Is that what the noble Baroness said?

Baroness Andrews: I was referring specifically to the regulations governed by the clause.

Lord Skelmersdale: I may therefore have to retract on Part 3. But, certainly so far as concerns this clause, I am delighted with the noble Baroness's response.

Lord Clement-Jones: It gives me great pleasure to see the noble Lord, Lord Skelmersdale, in such jovial form in response to the Government's response, so to speak, compared to some of his contributions at an earlier hour.

Far be it from me to disagree with the Minister. I entirely agree with both her and the noble Lord, Lord Skelmersdale, in regard to line 13. I am delighted that her response to Amendment No. 462A is consistent with the Minister's response to Amendment No. 441A. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment Nos. 463 and 464 not moved.]

Clause 179 agreed to.

Clause 180 agreed to.

Schedule 11 [Part 4: minor and consequential amendments]:

11.45 a.m.

Lord Warner moved Amendments Nos. 464ZA to 464ZG:

    Page 148, line 21, at end insert—

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