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Building on the Best specifically commits the Department of Health to tackle inequalities in palliative care provision. This is the objective of our end-of-life care programme and was one of the key objectives in the £50 million programme we have already discussed.
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Your Lordships will also be aware that we have published a number of national service frameworks. All of these, particularly those for children, for renal services, for long-term conditions and for older people, stress the importance of palliative care and end of life care and the importance of cultural diversity. Many of the initiatives we have taken in the field of cancer, including the training of district nurses that I have mentioned and the supportive and palliative care guidance published by NICE, will be of benefit to patients with other conditions as well as to those with cancer.

A number of noble Lords mentioned palliative care for children. I do not want to dwell on that too long, other than to say that we recognise the need to make progress in this area. The National Service Framework for Children has set standards for local authorities and others to ensure that children's palliative care services provide high-quality and sensitive support.

We are not complacent about this progress and we know that more needs to be done. A number of noble Lords have reminded us of our general election manifesto commitment and we are working closely with all who impact on its delivery. A great deal of work will be taken forward in the coming weeks. I pray in aid that since the election we have been in office for only two months. We are entitled to a little time to work in partnership with others in developing the arrangements for implementation.

I know we are a government in a hurry and a government that make progress on their commitments, but we need to work with people such as Mike Richards, with the voluntary sector and with Marie Curie Cancer Care to develop the way forward on that commitment. We will honour the commitment and take matters forward.

As many noble Lords will know, the Government have announced that they will be holding a major public engagement exercise on consulting the public about services outside hospital. This will enable us to address some of the end of life concerns that people have.

I thank noble Lords for their contributions to the debate. I end by quoting the excellent article in the Guardian today by Tom Hughes-Hallet, the chief executive of Marie Curie Cancer Care. He said:

That is our mission in this area.

Baroness Finlay of Llandaff: My Lords, I am most grateful to all noble Lords who have spoken in the debate. I am particularly grateful to the noble and learned Lord, Lord Lyell of Markyate, for having chosen this debate for his maiden speech, which we all enjoyed enormously. I am also grateful to the Minister for outlining what the Government are already doing to ensure that state-of-the-art palliative care is rolled out faster. His recognition of its importance and the need to do more will hearten all those working in hospice and palliative care.
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The way in which society responds to human tragedy in every form, shoulders its responsibility and works tirelessly is a reflection of its dignity and its values. I beg leave to withdraw the Motion for Papers.

Motion for Papers, by leave, withdrawn.

Dentists Act 1984 (Amendment) Order 2005

4.43 pm

Lord Warner rose to move, That the draft order laid before the House on 26 May be approved [2nd Report from the Merits Committee].

One The noble Lord said: My Lords, this is an order about patients. It will improve the way that the General Dental Council protects patients and increase patient choice by, first, setting standards for the profession and taking action when a dentist falls below those standards; secondly, by regulating the whole dental team; and, thirdly, by introducing compulsory indemnity cover.

More than 70 individuals and organisations responded to consultation, the vast majority supporting the proposals. The order is part of the Government's programme to modernise the regulation of health professions. It updates the legal framework for dentistry in line with the model for other professions and has been developed with the General Dental Council.

Amending legislation, such as this, can be hard to follow. We have therefore supplied a version of the Dentists Act "as it would look". I will summarise the main changes that the order brings about.

The first concerns indemnity cover. Article 16 introduces a legal requirement to have such cover. That is important for patient protection. At present, regulators tell professionals that they need to be adequately insured, but may not find out that someone is uninsured until after the event, leaving the patient without compensation.

The next change concerns fitness to practise. This updates how the General Dental Council deals with an allegation that a dentist's fitness to practise is impaired. Our policy is that the same legal approach ought to apply to a problem with any health professional. These changes take that agenda forward. The General Dental Council can currently deal with misconduct or health problems. It has difficulty dealing with poor professional performance—the ability to do the job—and the order will resolve that.

The GDC has limited options to deal with impaired fitness to practise: it can strike someone off, suspend their registration or do nothing. The order will provide an additional option: to impose conditions on registration such as the requirement to undertake further training, or be chaperoned when with a female patient. The final change is regulating professions complementary to dentistry. Currently two groups, dental therapists and hygienists, are registered under
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enrolled status. The order will bring the regulation of those two groups to a comparable footing with the regulation of dentists. It will also allow the General Dental Council, with parliamentary approval, to bring other groups, such as dental nurses and dental technicians, into regulation. That will allow redesign of care around patient need. Professions complementary to dentistry will be subject to rigorous standards of training, conduct, health and performance and these are set out in this section.

These are worthwhile reforms that will make a real difference to patients. I beg to move.

Moved, That the draft order laid before the House on 26 May be approved [2nd Report from the Merits Committee].—(Lord Warner.)

4.47 pm

Earl Howe: My Lords, this order is welcome and I am grateful to the Minister for setting out its meaning and effect so clearly. The General Dental Council exists to promote high standards of professional practice and to protect the public. The changes that the order makes to the structures and procedures of the council will, I am sure, be conducive to those ends.

Especially welcome are the provisions relating to the new patients' complaints scheme and those that establish for the first time mandatory insurance or indemnity cover for dentists and dental care professionals. On that issue, I am aware that there are differing views about whether a contract of insurance from a commercial provider is preferable to an indemnity from a mutual, not-for-profit organisation. I have discussed the issues extensively with representatives from both camps.

My conclusion, with which I hope that the Minister will agree, is that there are advantages to both approaches but that, provided the mutual has prudent levels of reserves, the suggestion that a discretionary indemnity arrangement is inappropriate or unsafe for dentists and patients is misplaced. Indeed, there are respects in which a discretionary indemnity can be more responsive and flexible than a contract of insurance.

The Minister will know that dentists have voiced concern about three main issues. The first relates to erasure from the dentists' register. Article 17 states that when erasure takes place, it must be for a minimum term of five years. The immediate question that arises from that is why the Government feel it necessary to be so prescriptive. If we believe in the principle of self-regulation for the dental profession, why should not the council have discretion to apply whatever term of erasure it deems appropriate to a particular case?

The Government's answer appears to be that there must be consistency across all the medical professions. Doctors and nurses, for example, are subject to an identical minimum term of erasure. The difficulty with that argument of symmetry is that, at least in one respect, dentists are not like the other self-regulated professionals. To be a proficient dentist, you absolutely have to keep your hand in. That means more than just maintaining your level of theoretical knowledge; it
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means crucially maintaining manual dexterity and practising the techniques of dentistry. If dentists do not use their skills, they lose them pretty rapidly. To erase a dentist from the register for five years would be equivalent to erasing him for the rest of his life, in practical terms. It would be virtually impossible for him to reskill.

We need to ask whether that is fair or right. The order cannot be amended today, of course, but I hope that the Minister will agree to sit down with the representatives of the profession and talk the issue through further. To be saying, in effect, that a rule is a rule is to avoid the real argument.

Article 25 has given rise to another worry. When an allegation against a dentist is received and referred to the investigating committee, certain people have to be informed straight away. If a health body is informed, an alert letter may have to be issued. One can see why that requirement should have been thought necessary. After all, we are dealing with the protection of the public—no one questions that. But what if the allegation were malicious or otherwise poorly founded? What if the committee looked at the allegation and quickly decided that there was no case to answer? If employers and others have already been notified that there is a question mark hanging over the dentist's good name, the damage will in part have been done.

I therefore think that we need to know that the GDC will refer to the investigating committee only those cases that it believes have potentially serious implications for the dentist's fitness to practise. In other words, the GDC should make sure that some preliminary sifting takes place to separate the more serious allegations from the less serious ones.

The third main area of concern relates to Article 39 and the provisions surrounding dental bodies corporate. The worry there is that, as drafted, the measures do not represent adequate protection for the public, because they do not include a robust regulatory mechanism. There is a power to investigate and fine a body corporate or director for various misdemeanours, but where a body corporate has acted wrongly but not in a manner serious enough to require erasure, there ought to be a power open to the GDC to take action in cases that might lead to suspension or the imposition of conditions.

Equally, there is no power for the GDC to issue guidance to dental bodies corporate. Nor is it clear what information the GDC can require a body corporate to supply to it whereby it can be effectively regulated. Will the Minister reconsider those issues?

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