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The noble Baroness said: My Lords, we debated this amendment on 21 May. It is set out in detail in col. GC 539 of Hansard of that date. I presented many reasons and comments and do not intend to repeat them, because time is valuable. Anyone who followed the debate or would like to know more can look those up.

In her very helpful reply, the Minister said:

She goes on to say that the Government already have the flexibility to do this through secondary legislation.

Since then, I have seen a letter written by the president of the General Dental Council, dated 12 June. It is quite unbelievable that it should be so contrary to what the Minister has said. The letter was sent to someone who was strongly supporting my case. It says:

this is the bit that impressed me—

He goes on to say:

again, I stress this—

He finishes by saying:

To me, that is unbelievable. Here we have an opportunity—that is why I have tabled this amendment—and the General Dental Council is saying it cannot possibly do it. For years, it has hidden behind the cloak of not being able to do it because doctors have the legal power and dentists do not. As I said in my previous moving of this amendment, doctors and solicitors remain on the register when they have retired honourably. The only people who are not on the

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register are those who have been struck off. Why are dentists second-class citizens? Why should they be different from all other healthcare professionals?

The noble Baroness, Lady Murphy, commented on how important it was that all healthcare professionals should be treated in the same way. That is absolutely true. At the moment, if someone wants to cease practice through illness, maternity leave or any other reason, they are removed from the register. To me, that is extraordinary. I do not accept that it is not in the public interest to retain retired dentists’ names on the register. I do not mind in what way it is done: it could be on a separate list, or as part of the same list. The essential point about any of these registers, whether for doctors or dentists, is whether they have an annual practising certificate. If you have a practising certificate, you can practise. If you do not have a practising certificate, you cannot practise. Surely that is a clear enough distinction. I do not see why anything more is required.

Why would dentists be treated as second-class citizens, which is what is being done in this case? As I mentioned at the last hearing, an extraordinary number of posts and positions are filled by dentists who have to remain on the register, even though they are not practising. They have to pay the full £400 registration fee and do all this continuing professional development, even though they are not going to touch a patient. They are in teaching or lecturing professions, or writing journals, or doing all sorts of other things, but they still have to be on the register. Yet they do not really require practising certificates because they are not practising.

It is very important that dentists should not be treated differently from other healthcare professionals. I think that there is value in that. Some dentists wrote to me this week to say that another good reason for retaining on registers doctors, dentists and all sorts of other people is that, if there was any sort of national emergency, you would immediately have a list of people to go to who, although they may not be currently practising, would have knowledge that might be useful in those circumstances. There are many reasons in the public interest why this should be the case. I thank the Minister for making clear in the past that it would be very simple for the Government to do it. Whereas in the past I believed that it would be possible and did not need to be put aside, when I now see that letter, which states that there is no opportunity to legislate, I cannot allow this opportunity to pass. It is very important that we seriously consider adding this to the Bill to avoid the suggestion of so many years of waiting before any possibility of legislation. My amendment was only intended to be enabling legislation, not to force the General Dental Council to do this, but I really worry when I see the council’s attitude. I beg to move.

Lord Walton of Detchant: My Lords, I appreciate the concern expressed by the noble Baroness. I wonder whether she is aware that retired doctors have been notified by the General Medical Council. I have been exempt for 21 years from payment of the annual registration fee and am still fully on the register. However, the GMC has taken legal advice on anti-age discrimination

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legislation and has been informed that any doctor wishing to remain on the register, even if retired, must pay the full annual registration fee. The situation for doctors has very much changed and all of us in that position will be invited in August this year to decide whether we wish to stay on the register, even if we are no longer practising. There have been occasions, even in your Lordships’ House, when I have been required quite informally to give medical support and advice when a crisis has arisen. The question is: do I require still to be on the register to do that? I will have to consider whether to stay on the register and pay the fee, or take voluntary erasure. The GMC is now recommending that next year, it will try to introduce a list of people who are registered but retired, and with no licence to practise. It is a complicated matter.

Baroness Howarth of Breckland: My Lords, if you are a social worker, you do not remain registered unless you keep up your practice and get your certificate. If you do not have that, you are removed from the register. Anyone looking to treat professionals similarly will have to look at social workers as well, because, not for the first time, they are left out in the cold on this issue.

Baroness Tonge: My Lords, the remarks of the noble Lord, Lord Walton, made me realise that the same thing is going to happen to me in the autumn. I am comforted by the fact that, if I choose not to pay the fee and am therefore struck off the medical register, I shall be in the company of such illustrious retired doctors.

Lord Colwyn: My Lords, I, too, support my noble friend. As a dentist who has retired and does perhaps two or three hours’ work a month, I still pay the full registration fee. For this reason, I support the noble efforts of my noble friend to make this change.

6 pm

Baroness Thornton: My Lords, I had not quite realised that this was such a hot issue. I know that the noble Baroness, Lady Gardner, has been struggling with it for some time; we have had several discussions about it and she knows that I am sympathetic to her view.

The noble Baroness tabled an identical amendment in Committee and we listened with interest to her concerns then and again today. Amendment No. 56C would amend the Dentists Act 1984 to allow retired dentists to remain on the dentists register on the payment of a reduced fee. It also makes provision for such dentists to be restored to the register on payment of a fee if the reason for their erasure was non-payment of that fee.

As I said in Grand Committee—and I know that the noble Baroness welcomed this clarification—it would not require primary legislation to make such a change. I am puzzled by the letter that she quoted. We are absolutely confident that our advice is correct and that this could be done through secondary legislation. Obviously, timescales would have to be considered if

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the General Dental Council approached this. I would be very happy to write to the noble Baroness in detail if she would find such a letter useful. She could then clarify the position with her colleagues at the General Dental Council.

I emphasise again that I recognise that removal from the register signifies a great deal more to a dentist than the fact that they no longer practise. The House is grateful for the noble Baroness’s expertise and for bringing these concerns to the Chamber. The General Dental Council’s position is that the dentists register exists to serve and protect the public rather than the profession. Its current position is that no public benefit has been identified in maintaining a list of inactive former dentists and therefore the General Dental Council does not support this amendment. I feel sympathy for the two distinguished dentists in the Chamber whose proud record in serving their profession for years would not be recognised.

I should also mention that the White Paper on working groups on revalidation for all professionals will need to consider the wider issues around semi-retirement, retirement, career breaks and the ability of professionals to make use of or provide expert opinion to others. Until these groups have concluded their deliberations, it would not be appropriate to make the change proposed by the amendment. However, the implementation of any recommendations from these groups will be discussed with all the regulatory bodies, including the General Dental Council. I hope that that provides another option for the noble Baroness.

In conclusion, it is the Government’s view that should the General Dental Council decide, in the light of the revalidation working groups, that it wishes to change its position, it may well find that it is pushing at an open door. As the changes proposed in the amendment could be made through existing secondary legislation, and in the light of the General Dental Council’s current position, I hope that the noble Baroness will feel able to withdraw her amendment.

Baroness Gardner of Parkes: My Lords, I thank all those who have spoken in this debate. As the noble Lord, Lord Walton, was not in Grand Committee on 21 May when I quoted from GMCtoday, I think that I must repeat that part on the position of doctors. I said then that the article states:

The article goes on to ask:

The answer, the article states, is:



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The dental situation was changed in 2004 and instead of paying £65, dentists over a certain age had to pay either the sum of almost £400 or nothing. There was no alternative. Doctors have been exempt from all charge but now it is suggested that there will be a charge. But this article contains no suggestion that they will not have the right to continue if they pay a certain charge. Dentists would certainly have been happy to pay about £100 a year, instead of £400. They would not have kept up the continuing professional development that is required. But at that time the General Dental Council threw away 2,500 dentists, losing a nice little income of £250,000.

The debate on this issue has made it clear to me that, although I am happy to withdraw the amendment now, I shall bring it back again at the next stage, not just for dentists but for doctors, social workers and all healthcare professionals. It would be very progressive if we put in the Bill an enabling provision, although it would not in any way force the General Dental Council to do this. If the dentists decide that they do not want it, that will be up to the General Dental Council. But the points that have been made by social workers and by the noble Lord, Lord Walton, today show that things are changing and that there should be an enabling provision in the Bill. This would be in the public interest; it would be valuable to have a list of people available in case of a national emergency or any other situation.

I warn the Minister, who has been so helpful in this matter, that the issue has just become much wider. I will bring forward an amendment at Third Reading with totally different wording to include in the Bill an enabling provision for all healthcare professionals. Emphasis has been placed today on the fact that all should be the same. Meanwhile, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 108 [The Council for Healthcare Regulatory Excellence]:

Earl Howe moved Amendment No. 57:

“(e) to commission independent information and advice services to assist members of the public considering reporting or reporting a concern to any of the bodies listed in subsection (3), and those who go on to become witnesses under the procedures of the Office of the Health Professions Adjudicator.””

The noble Earl said: My Lords, I bring us to an issue that has not so far been a feature of our debates on the Bill: the absence of any independent source of advice for patients or members of the public who have concerns about a health professional and want to know how they should set about reporting those concerns. Currently no service is funded to do this. Making a complaint about a doctor is a big step and a daunting task to all but the most feisty and determined among us. Many patients, because of age or infirmity, are in no way feisty, nor, often, are they able to draw on the emotional reserves necessary to enable them to stand up for what they believe is right, simply because that requires effort and courage. For emotionally vulnerable

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people of this kind, going to the GMC for advice is by no means an easy thing to contemplate. They need someone, at least at the outset, who can talk them through the process in a completely objective and unintimidating way.

The other aspect of the problem is the opposite situation. There are many complaints made to the GMC every year which are a complete waste of time. Many of them are not the concern of the GMC at all and would be more appropriately dealt with by other bodies. The result is that the GMC is landed with a huge amount of unnecessary work in assessing and redirecting complaints of this sort. It would be much better if there were somewhere people could turn to for advice before launching into a complaint that otherwise might be wholly misdirected.

The need for advice and assistance was highlighted by the Shipman inquiry. There is now quite a widespread feeling that this need should somehow be met. The amendment would make it a duty of the CHRE to commission independent advice and information services to assist members of the public who have concerns about the fitness to practise of a health professional: first, to enable them to decide whether to report that concern to a regulatory body; and, secondly, if they decide to do so, to assist them in that process.

The CHRE sent me a note voicing concern that the proposal contained in the amendment might compromise its independence. I do not see why that should be, if we are talking about the CHRE commissioning a service, which it then oversees, and which is largely devoted to giving advice on process. In another place the Minister was broadly sympathetic to the aim of a very similar amendment but said that it was not necessary because the CHRE already had powers to provide a service of broadly this kind. That was encouraging, but the trouble is that, without appropriate funding, the CHRE will find it impossible to implement such a service. It would be very helpful if the Minister could provide some more concrete reassurance today about this idea and tell us whether and to what extent the Government’s thinking has developed on these matters. I beg to move.

Baroness Thornton: My Lords, Amendment No. 57 would require the CHRE to commission independent information and advice services to assist members of the public considering reporting a concern to the healthcare professional regulatory body and to those who appeared as witnesses in cases adjudicated by the Office of the Health Professions Adjudicator. The amendment inserts this into the list of the CHRE’s general statutory functions. The willingness of members of the public to make their concerns known to regulators is vital. This is fully understood by the regulatory bodies.

Although I have sympathy with the spirit of this amendment, we want to keep this responsibility firmly with regulators who have the responsibility for investigation and presenting the cases at hearings. The role of the CHRE is to oversee the performance of the regulatory framework, not to become part of the fitness-to-practise process. Such direct involvement in complaints as this amendment proposes would undermine this hugely important oversight role. Clearly, the CHRE agrees with the Government on this.



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It may reassure noble Lords to know that information and advice is already provided by the regulators themselves on how a member of the public can make a complaint and the procedures to deal with it. For example, the General Medical Council has published A Patient’s GuideHow You Can Refer a Doctor to the GMC and the General Chiropractic Council published How to Complain About a Chiropractor: Telling the General Chiropractic Council About Your Concerns. These publications tell the public about the role of the organisation, what information they will need to provide about a complaint, the process followed after a complaint is made and what the outcomes might be. All the healthcare profession regulators publish similar information for members of the public and patients. Support for patients, complainants and witnesses is not limited to leaflets. The regulators provide telephone advice on making complaints and on whether the matter might be better dealt with locally than by a national regulator. They also provide detailed information and advice to members of the public who appear as witnesses in a fitness-to-practise case, such as the layout of the hearing room and an explanation of the hearing process.

The Government are confident that the GMC and GOC will continue to provide the necessary information and support to witnesses OHPA’s hearings. In addition, the Bill requires the OHPA to ensure that the public are informed about its functions, as provided in Clause 102.

While we think that the regulators should provide this detailed advice, I can assure noble Lords that it is very much the role of the CHRE to consider whether the information and advice that regulators provide is satisfactory from the patient’s perspective. If it is not, the CHRE can raise this issue in its report to Parliament on the performance of the regulator, which is a clear mechanism for triggering any specific improvements needed. The Government are still looking at local complaints resolution, and I hope to be able to say more about complaints at Third Reading.

The CHRE already provides on its website information about other organisations that can provide support to patients. On this basis and in the light of my explanations and the fact that we will be looking again at local complaints resolution, I hope that the noble Earl will be able to withdraw this amendment.

Earl Howe: My Lords, that was a very helpful reply. The House may like to know that I was prompted to table the amendment by Action for Victims of Medical Accidents (AvMA), which has a natural interest in this area. I totally accept that the main role of the CHRE is to oversee the performance of the regulatory process. I would not dissent from that for a moment. It is true that the CHRE has been clear that this amendment is a departure from its current role. My puzzlement, however, stemmed from the fact that the Minister in another place said that the CHRE already had the power to provide the service I was talking about, which rather suggests that it is not such a major departure from their current role. However, much of what the Minister said is very reassuring, and I and others will look forward to anything she is able to tell

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us at Third Reading about the complaints process. This has been a useful exchange. I beg leave to withdraw my amendment.


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