Health and Social Care (Community Health and Standards) Bill

Public Bill Committee, 19 June 2003.

Standing Committee E

Clause 157 - Provision of primary dental services

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I beg to move amendment No. 635, in clause 157 page 74 line 21 leave out

'to the extent that it considers it reasonable to do so'.

Peter Atkinson (Conservative, Hexham)

With this it will be convenient to discuss the following amendments: No. 629, in clause 157 page 74 line 22 after 'provide', insert

'and promote the development of'.

No. 636, in clause 157 page 74 line 23 at end insert

'in accordance with identified local need'.

No. 639, in clause 157 page 74 line 26 at end insert

'and will ensure that provision that is currently available under the existing system, including the care of those with special needs, and services such as orthodontics and oral surgery, will be secured.'.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I am delighted that we are finally, at least in this clause, discussing the role of commissioning. The Minister is aware of earlier exchanges during which regret was expressed at the fact that a great deal of this piece of legislation is designed to change structures and systems relating to the provision of service. This generally very welcome clause recognises the importance of commissioning, particularly local commissioning according to local decisions.

The amendments seek to examine more carefully the basis upon which commissioning decisions will be made. Proposed new section 16CA(1) does not give enough priority to the importance of first assessing local need and then commissioning services designed to meet it. Instead, it simply allows primary care trusts to judge what it is reasonable to commission. I should be grateful if the Minister would explain how that qualification, and the basis on which local commissioners have a duty to commission dental services, compare to the commissioning of other services by health authorities or their replacements under the National Health Service Act 1977. The comparison seems to be a fairly loose one, and it may be more appropriate to place a requirement in the Bill to deal with local need.

Dentistry, the provision of dental services and the level of public dental health vary considerably across the country. That variation is too great, which implies that there are pockets of great need. Commissioners may decide to increase the level of provision to a degree that they consider reasonable given all the circumstances. However, if that level comes nowhere near meeting the identified need, or if they do not take

steps to identify the needs of public dental health, health promotion, access to dental care, access to screening services and access to emergency and elective treatment, the commissioners may fall short.

In tabling amendment No. 635, the Liberal Democrats have the support of the Consumers Association, which requested that we raise the issue with the Government. It too recognises that access to dentistry is poor and that dental services are under great pressure in many areas. We have also heard from the British Dental Association that the share of funding for dentistry under the national arrangements has fallen from about 5 per cent. to nearer 3 per cent. of NHS spend. That constrains the ability of dental services to obtain sufficient resources to keep up with the level of need or demand, which is why the Committee and the Government have faced the problem of poor access to NHS dentistry.

Providing the ability for local commissioners to commission services and to be responsible for making contractual arrangements with providers—a matter to be dealt with in later clauses—is a sensible move away from a nationally negotiated and nationally organised system of contracting with dentists, and I support the Government in their intention. However, reference to need will be important.

We are concerned at the continuing failure to provide the ability for people to register with an NHS dentist. The Government made a limited pledge to ensure universal access to dentistry as much as possible. However, that really meant access in emergencies and did not result in people registering with dentists, as was the case before the drift away from NHS dentistry to private dentistry.

Primary care trusts should be required to identify the need for people to be registered with a dental practitioner, just as they register with a medical practitioner in primary care. Without that, there will not be the holistic and preventive care provided by dental practitioners that is an important part of dental health care, but simply a dental sickness service that deals with problems as they arise. There will not be the continuity of care that registration with an identified dental practitioner gives, and patients will not receive the advice that regular check-ups provide. Whether the practitioner is salaried or on a contract is immaterial; the question is whether that holistic care will exist.

If the Government were minded to look kindly on amendments Nos. 635 and 636 and consider the necessity to identify and cater for need, they would find that there was more pressure on local commissioners to ensure that they provided not just a holistic and preventive service, but one that was actually cost effective. If more dental disease were prevented by advice and appropriate evidence-based, effective screening techniques, and by dealing with problems early rather than in an emergency, the cost of dental care would ultimately be lower than if people were allowed to drift into problems that a firefighting system would rectify.

The wording of the clause is far too loose, because a PCT might consider it reasonable to maintain the current level of services and registrations. After all, the

Government consider that level to be adequate because they claim to have met their access pledge to dentistry. Members on both sides of the House know from their constituencies that current dental provision is simply inadequate, especially the levels of holistic and preventive work that I mentioned. The Government are running the risk of ensuring that commissioners continue to view dentistry and related care as a lower priority than other areas, and it is unreasonable to allow that to continue.

Andrew Murrison (Conservative, Westbury)

The Government have lived up to their 1999 pledge on dentistry, but does the hon. Gentleman agree that they have only partly done so, as they have fulfilled their pledge on emergency dentistry and but not on the bulk of dentistry care?

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Yes, the hon. Gentleman is agreeing with my earlier point that their pledge was limited in that it ensured greater access to only emergency treatment. Registration with dentists continues to fall, yet most people consider that good dental care involves the ability to register with a dentist, as one does with a GP, to ensure access to joined-up services, preventive work and advice on screening. The Government seem to want to provoke a firefighting mechanism by ensuring that there is a requirement only to provide access to emergency treatment or treatment when the patient deems it necessary, rather than encouraging the normal teamwork relationship between a patient and their registered dentist.

I hope that the Government have heard that point. I also hope that they recognise that the current wording is insufficient to safeguard the need to increase dentistry care. If PCTs argue that the current dental provision that the Government consider adequate—for which the access pledge has already been met—is acceptable, it would be reasonable not to seek to increase the degree of registration.

The clause does not recognise the degree of variation in dental services and in need. There is huge dental need in certain areas. It is important to debate whether other preventive measures, such as fluoridation, may be appropriate, but it is probably not fitting to do so during debates on this Bill. That whole debate is predicated on the unevenness of treatment.

The British Dental Association advised my colleagues and I on amendment No. 639, regarding the provision of specialist services. It is rather surprising that the British Dental Association, which has been involved closely with the Government in the negotiation of the contract and which, like us, generally supports these clauses, still has concerns. In tabling the amendment, I seek to clarify what specialist and special needs services will be available under the new system, because the Bill makes no specific provision for securing services for patients with special needs, who are among the most vulnerable people in our society. Dentists working in the community dental services have considerable experience in that area: they, and we, need assurance

that such care will continue to be provided and commissioned by primary care trusts under the new arrangements.

Similarly, patients who need orthodontic treatment and oral surgery must be assured that such services will be available in the future within a primary care setting. The General Dental Council, which regulates the profession, has recently set up specialist registers of those qualified to provide such services, and primary care trusts need to recognise the contribution that such specialists can make.

The Department of Health, through a supplement of the chief dental officer's digest from May 2003, states:

''There will also be an opportunity to ensure that developing dental specialities are given the right incentives to contribute to patient care''.

Amendment No. 639 would seek to secure that. The Minister will know that access to orthodontics and oral surgery is poor. Waiting times for orthodontics were traditionally not measured under the Government's waiting time statistics inherited from the Conservatives, and, therefore, there were particularly long waiting times in that service, as there were for a few other services such as chiropody. Indeed, the term foot and mouth disease might well apply to the failure of the system to measure the waiting times in those specialities. Therefore, due to the priority given to meeting waiting time targets, dentistry, chiropody and some other areas have fallen through the net, and waiting times have become too long.

There are people with complex needs who often have significant other health needs of which oral health is a component. In particular, some patients with congenital disease require effective access to these services both in secondary care and in primary care settings, especially as more expertise develops in primary care and the Government seek rightly to shift services into primary care for reasons of quality and access. If the Government are going to be consistent in that, they must give an assurance that primary care trusts will have a duty not only to commission and secure the services that are currently available for these groups of people with special needs, but to improve those services.

We may be able to cover access to dentistry in other areas, so I will not go into detail on that because you, Mr. Chairman, may see fit to have a clause stand part debate. However, there are issues concerning access to dentistry for other parts of the population, and I hope that we will have an opportunity to debate at some point, though perhaps not under these detailed amendments, what the Government intend to do to secure better access to dentistry in prisons and detention centres, and for some other groups.

I hope that the Government will look kindly on this group of amendments. They are tabled in a constructive manner to seek to ensure that primary care trusts are given the incentives that they need to ensure that dentistry is no longer the Cinderella service that it has been under the current arrangements.

Simon Burns (Conservative, West Chelmsford)

I agree with the hon. Member for Oxford, West and Abingdon (Dr. Harris) that his amendments are a constructive way in which further information and guidance on the Government's intentions can be sought. I hope that the Minister will listen carefully to concerns, particularly as part 4 is an important and significant inclusion in primary legislation. To be accurate, the last work on this matter was done in 1977, so this is the first time in almost 30 years that a Government have taken a new approach to, and sought a greater insight into, the provision of dental services in this country.

It is apparent that since Nye Bevan set up the NHS in 1948, dental services have been a hybrid part of that service, and they have been greatly misunderstood by those who use them. In many ways Governments of all parties have used them as a whipping boy in the NHS, particularly when those Governments have experienced severe financial problems. That is why, by and large, the services have lost out.

I noticed that the hon. Member for Oxford, West and Abingdon mentioned briefly the question of access to the NHS. I am not quite as optimistic as he seems to be, because the pledge that the Prime Minister gave at the 1999 Labour party conference was not that access through registration with a local dentist would be ensured, but that within two years anyone would be able to ring up NHS Direct and be told the location of an NHS dentist in their area. That is very different from registering with one of those dentists, and the matter must be looked at.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I agree with the hon. Gentleman. I thought that I had made it clear that the Government's pledge on access to treatment was limited only to the accessibility of NHS dentists, and that that is not equivalent to ensuring that registration rates, which have been falling for years, turn the corner. Without registration one does not get, as I mentioned, the holistic and preventive care that is so important in avoiding dental problems.

Simon Burns (Conservative, West Chelmsford)

I am grateful to the hon. Gentleman, and as I am in a benign mood, I will go along with him and accept that that is what he said.

Apart from giving the Committee an opportunity to improve the Bill so that there can be no misunderstanding or lack of progress, the amendments, just as importantly, will flush out more of the Government's intentions. Amendment No. 635 refers to proposed new section 16CA(1) in clause 157, which basically states that a primary care trust will now have a vital and significant role in the commissioning and, in effect, the provision of dental services in its region. That is in keeping with the Government's professed aim to decentralise the health service and make it more accountable and responsive to the needs of local communities. I have no problem whatsoever with that principle, and I think that the sooner that politicians end their day-to-day interference in the provision of dental services and health care the better.

I am not, however, convinced that what the Government propose for other areas of the health service—I shall not expand on those so as not to fall

foul of the relevance rule—will decentralise services to the extent that Ministers maintain. New subsection (1) states that a PCT

''must, to the extent that it considers it reasonable to do so, provide primary dental services''.

The amendment seeks to remove the words:

''to the extent that it considers it reasonable to do so''.

I do not understand why the Government have put that phrase in the Bill, because there is a danger that it will allow the status quo partly to continue under a different commissioning and provision regime.

What exactly does

''considers it reasonable to do so''

mean? I would appreciate it if the Minister elaborated on that in his remarks, and I hope that he reassures me. In theory, that could be a cop-out clause for PCTs. If they could argue that they do not provide a service, or do not provide it to the level that the local population might believe, they would be able to hide behind that expression. That weakens what the Government are proposing to do. However, I suspect that the Minister does not intend that to happen.

Gary Streeter (Conservative, South West Devon)

Does my hon. Friend agree that another interpretation of the words

''to the extent that it considers it reasonable to do so''

is ''to the extent that it can afford to do so'', which lets off the hook not only PCTs but the Government? One can imagine that, for a PCT, a shortage of funding would be a good excuse for not making such a service available.

Simon Burns (Conservative, West Chelmsford)

I am grateful to my hon. Friend, who anticipates a point that I will discuss in due course. I have been made aware by the Minister's sedentary comments that the debate has the potential to degenerate rather than remain at an intelligent level. I am not confident that that level will continue once the Minister begins to speak. I will say—to pray in aid my case—that the Minister should be a little cautious before he begins his misrepresentation and his rant about funding, because the Government have been in power for six years. One cannot constantly live solely in the past: defining what has happened between 1997—

Peter Atkinson (Conservative, Hexham)

Order. I remind the Committee that we are discussing the provision of primary dental services. I would be grateful if hon. Members could bear that in mind.

Simon Burns (Conservative, West Chelmsford)

I am grateful for that guidance, which I accept. What I was eager to do, though wrongly, was to try to save the Committee from the Minister's rant, which I anticipate later.

Andy Burnham (Labour/Co-operative, Leigh)

Labour Members may find it strange that a certain party seems to want more money to be spent on primary dental services. Removing the qualifying phrase in subsection (1)—

''to the extent that it considers it reasonable to do so''—

would render it meaningless because it would simply state:

''Each Primary Care Trust and Local Health Board must provide primary dental services within its area, or secure their provision within its area.''

Simon Burns (Conservative, West Chelmsford)

I am grateful to the hon. Gentleman, but I do not accept his argument. The phrase could throw an element of doubt into the procedures or introduce a barrier or excuse that PCTs would be able to hide behind. I will not argue with the hon. Gentleman, because if he believes that the amendment would render the subsection meaningless, which I do not, then presumably, rather than include a phrase that causes doubt, we should strengthen the subsection to remove any element of doubt.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Perhaps the hon. Gentleman could point out to the hon. Member for Leigh (Andy Burnham) that amendments Nos. 635 and 636, which would insert the words,

''in accordance with identified local need'',

are supposed to be taken together to reassure him that although part of the clause may be taken out, needs will be identified and met. If, as he believes, the removal of the qualifying phrase would make the subsection unreasonable, that would make it meaningful again.

Simon Burns (Conservative, West Chelmsford)

I am very grateful to the hon. Gentleman, because again, like my hon. Friend the Member for South-West Devon (Mr. Gary Streeter), he has anticipated, in a different context, the point that I was going to make. Amendment No. 636—

Andy Burnham (Labour/Co-operative, Leigh)

Will the hon. Gentleman give way?

Simon Burns (Conservative, West Chelmsford)

I shall deal first with the previous intervention. Amendment No. 636 spells out that, among other things, it will be the responsibility of PCTs to provide a dental service in accordance with identified local need, which—

Andy Burnham (Labour/Co-operative, Leigh)

Will the hon. Gentleman give way?

Simon Burns (Conservative, West Chelmsford)

One minute.

Of course, that provision is crucial, because one of the main functions of PCTs is to identify local health needs or, in the case of this part of the Bill, dental health needs and to seek to commission treatment and care for patients.

Andy Burnham (Labour/Co-operative, Leigh)

In accepting the amendments proposed by the hon. Member for Oxford, West and Abingdon, is the Conservative party supporting the notion that, in certain areas, the public sector should pay in full for dental services according to need? That would be the effect of amendment No. 636, and it would go completely against what the hon. Gentleman's party did when in office. The amendment would require the PCT to pay for all dental services according to local need.

Simon Burns (Conservative, West Chelmsford)

The hon. Gentleman is absolutely right, and, as I said at the beginning of my comments, if one is to have a health care system that includes dental care, one must respond to local needs. In many ways, this is about changing the way in which dental care is commissioned in an area and by whom.

The Government are using this part of the Bill in an imaginative way to devolve power to local PCTs, which is absolutely right. Sadly, we have not heard from the Minister yet, so we will have to wait to hear how he envisages the measures will work. However, as my hon. Friend the Member for South-West Devon stated, we do not know what will drive these reforms. Of course, spending drives the health systems in this country, and we will be very interested to hear how the Government will implement their proposals for funding that expenditure. Do they, for example, expect this innovation to be funded by their existing levels of expenditure, or do they think that the responsibilities and systems that they are imposing on PCTs will, in fact, generate more funding requirements from the existing NHS budget, and will they adjust their funding mechanisms accordingly?

We also do not know when the proposals will be implemented. We are at a loss because we are not familiar with all the Government's intentions for the exact working of the system and when it will be introduced. Will that be in the next 12 months or in two, three or four years?

Andy Burnham (Labour/Co-operative, Leigh)

I hope that the hon. Gentleman will accept that Labour Members find it ironic that the Conservative party is making a major argument for huge expansion in NHS dentistry. Putting that aside, has the hon. Gentleman worked out how much the amendments would cost the NHS?

Simon Burns (Conservative, West Chelmsford)

The hon. Gentleman is not taking in what I am saying. I welcome the fact that commissioning for dental care will be devolved to PCTs.

I welcome the fact that it will provide services at a local level. That is not in the Bill, but the hon. Member for Oxford, West and Abingdon is seeking through his amendment to include that commitment in the Bill.

However, until we hear from the Minister, we are in the dark about exactly how he expects the system to work on the ground, and whether he expects the system to work under the existing framework and arrangement. Alternatively, does the Minister envisage an expansion in the provision of dental care as a result of the changes in systems? As we all know, dental care is very different from most of the rest of NHS provision. It is split significantly between those who use the private sector for a variety of reasons, and those who have to, or choose to, use solely the NHS. Of course, even those who use the NHS do not, in most cases, receive a service that is free at the point of use. To return to my original point, that is because dental services have, almost since the beginning of the NHS—although not from day one—included an element of charging for a proportion of the cost of treatment.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Before the hon. Gentleman goes down that path, I would like to recognise that the hon. Member for Leigh made some important points, which I would have appreciated responding to in my own speech.

It is important to note that amendment No. 636 does not use the words ''all identified need''. It is not an unlimited spending commitment, but it is a

commitment to spending more. Liberal Democrats support the fact that extra resources are being made available. We also want the PCTs to be elected and to have tax-varying powers to meet the needs that they want to prioritise. The hon. Member for Leigh's point is a fair one to put to the Conservative party—it is quite political—but I hope that he recognises that the way that the amendment is worded does not provide for an unlimited spending commitment, and that Liberal Democrats at least have a democratic mechanism to respond to that.

Simon Burns (Conservative, West Chelmsford)

The hon. Gentleman is absolutely right. The amendment is not talking about ''all'', but ''the'' local need. It is in that context that I am making my comments, because I have been very careful in the course of my remarks not to give any commitment in any shape or form on spending. It is not appropriate in the context of the discussion of these amendments for us to do so.

I think—I say this with a degree of kindness—that the hon. Gentleman's intervention was too hard. I welcomed the first part of his intervention. However, vis-à-vis the second part of his intervention, I knew that it was only a matter of time before he jumped on the bandwagon and tried to turn this debate into a party-political dogfight, rather than maintaining the higher standards of intelligent debate on the provision of dental services.

Jim Dowd (Labour, Lewisham West)

Will the hon. Gentleman give way?

Simon Burns (Conservative, West Chelmsford)

I will not, because I wish to make progress and to conclude my remarks so that possibly the hon. Gentleman himself could make an invaluable contribution to our discussions; clearly he has an interest in and knowledge of dental services from his work on the Select Committee on Health.

I conclude with two points. First, with this part of the Bill the Government seek to achieve a significant change from the status quo and, in many ways, an overhaul and update of a system that was put in place when the provision of health care was in a different situation. In doing so, in many instances the Government raise more questions than answers. It is important that we hear what the Minister has to say, because I suspect that he will have an opportunity with these amendments not only to put flesh on the bones of this part of the Bill, but to inform us more about the way in which the Government intend this part of the legislation to work.

In dealing with the amendments and his proposals, the Minister must share with us when he anticipates the proposals being introduced. Moreover, how does he anticipate that the reforms will impact on the provision of dental care and its cost?

Andrew Murrison (Conservative, Westbury)

Most of my constituents' principal concern is the patchy provision of dental services. Amendment No. 635 would help to remove the possibility of that patchiness continuing. It is certainly the case that one can get different services in different areas. For the new section 16CA(1) to contain the phrase

''to the extent that it considers it reasonable to do so''

means that the service will continue to be provided as it is at present, so it would help if that phrase were deleted. In subsections (5) and (6) we see that regulations may define primary dental services and those that would be provided by contractors. At a lower level, the primary care trusts pass judgment, or comment, on that level of regulated provision and tweak it to suit local need. That is very good in theory but in practice would mean that there would continue to be a patchwork of services across the country that would vary from one primary care trust to another, and that would be wholly undesirable. Therefore the hon. Member for Oxford, West and Abingdon was right to table amendment No. 635, which would delete the phrase

''to the extent that it considers it reasonable to do so''.

Primary care trusts would be allowed to concentrate on those primary dental services that have been mandated by regulation. That would lead to more uniform primary dental services across the country, which most of my constituents want.

John Hutton (Labour, Barrow and Furness)

First, I congratulate the hon. Member for Oxford, West and Abingdon on tabling the amendment. It has given us the opportunity to discuss what is, by common consent, a very important and significant part of the Bill. Those were the words of the hon. Member for West Chelmsford (Mr. Burns), and I agree with them.

It may have escaped the attention of anyone who was listening to the debate because of the words that were uttered, but part 4 of the Bill has been broadly welcomed. It is not the biggest shake-up of NHS dentistry in 30 years; it is the biggest shake-up since the NHS was established in 1945. It is a very important and significant area for the NHS. All of us know that our constituents experience problems in accessing NHS dental services, so it might be helpful for the Committee if I make it clear at the beginning that the clause is not about maintaining the status quo, but changing it. It is not about providing a covert mechanism for rationing, which is the usual approach of the hon. Member for Oxford, West and Abingdon to every such issue. It is about widening access to NHS dental services and providing a more up-to-date legal framework that will better allow primary care trusts to develop and plan those services strategically.

Part 4 makes several significant changes, and clause 157 is at the heart of those changes. The clause will place on primary care trusts and local health boards in Wales a new duty to commission dental services or provide them directly. There is no such explicit duty under the existing legislation, so existing legislation does not provide a robust-enough platform for developing NHS dental services. It is worth reminding ourselves, because no one has mentioned it yet, that section 35 of the 1977 Act merely requires primary care trusts to enable general dental services to be delivered when a dentist has agreed to provide such services. That is not a satisfactory basis on which to

develop the role of NHS dentistry to meet the needs of local communities.

No one is satisfied with the existing arrangements—we certainly are not. Thus, the new duty has been widely welcomed. Clause 157 will broadly shift the responsibility for commissioning NHS dentistry on to a basis similar to that of other medical services that primary care trusts are obligated to provide. This is an important new addition to the framework of NHS legislation.

The hon. Member for West Chelmsford said that he wanted to flush out my intentions. I am happy, if by doing so he can perhaps set aside some of the concerns that have been raised.

This group of amendments essentially addresses the concerns of the hon. Member for Oxford, West and Abingdon about the word ''reasonable'' in clause 157, which inserts new section 16CA in the 1977 legislation. It may be helpful to give a little background on this. The use of the word ''reasonable'' in new section 16CA(1) mirrors its usage in section 3 of the 1977 Act, which states:

''It is the Secretary of State's duty to provide throughout England and Wales, to such extent as he considers necessary to meet all reasonable requirements'',

a national health service. The duty in new section 16CA relates to the primary care trust area, and, as my hon. Friend the Member for Leigh made clear, without the test of reasonableness it would be difficult to interpret that provision succinctly. This is a new departure, so we must be as precise as possible. Given that, it would be unhelpful to inject an element of uncertainty into the precise parameters of the new duty.

With the greatest respect to the hon. Member for Oxford, West and Abingdon, his assessment of his own amendment is not accurate. It certainly was not helped by the clarification given by the hon. Member for West Chelmsford, who spoke in its favour.

Let me explain the fundamental difficulty with the amendment. Primary dental services are a description of what dentists do, rather than a service provided by the NHS itself. Therefore, his amendment would affect not only NHS dentistry, but private dentistry. It could be interpreted as meaning that the Liberal Democrats want primary care trusts to be put under a duty to promote the development of private dentistry. That may well be what the hon. Gentleman intends, but I suspect that he intended to provide a duty to develop NHS dentistry. However, that is not what his amendment proposes. This may well be a probing amendment, but I do not get the sense that it is.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I anticipated that the Government would take that approach. It is unfair to do so, because neither we, nor the Minister, oppose the ability of primary care trusts, and commissioning bodies in general, to commission services for the NHS from private dentistry. The Minister is saying that a need for private dentistry may be identified, and that it will somehow be the commissioners' role to ensure that people who feel a desperate need to pay privately

shall have that need met. That is not a fair interpretation of health need generally. I have never heard the Government mention, when they discuss health need in their many documents and consultation papers, the desperate need, and the right, of people to find services for which they can pay directly or through insurance. Therefore, the Minister's attack is a little unfair.

John Hutton (Labour, Barrow and Furness)

I am not trying to be unfair to the hon. Gentleman; I am simply telling him what his amendment proposes. There is a distinction between the two. As the hon. Gentleman well knows, we have no objection to encouraging a plurality of different health care providers—a concept to which the hon. Gentlemen is something of a late convert. It is a sensible way to maximise capacity and make it available to NHS patients, and it would be provided free at the point of use. That is not the issue. His amendment places a duty on primary care trusts to promote the development of private dental services.

Dr. Harris indicated dissent.

John Hutton (Labour, Barrow and Furness)

The hon. Gentleman shakes his head, but that simply confirms that he does not understand the purpose of the clause. If he were talking about general dental services, that would be a different story. However, he is talking about primary dental services, and that clearly includes private provision. I do not argue whether that is an appropriate way to provide treatment of NHS patients; it clearly is, and that is how it is currently provided. The question is whether that makes sense in terms of his proposals. It would be helpful if the hon. Gentleman would clarify whether or not this is a probing amendment.

He did not make that point in his introduction. We have to take the amendments at face value as a serious attempt to widen the commissioning responsibilities and duties of PCTs.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Would the Minister's claim that this seeks to promote private dentistry apply if amendment No. 635, which would delete the words

''to the extent that it considers it reasonable to do so'',

were rejected, and the words

''in accordance with identified local need''

were accepted? Would commissioners or providers be saved from having to secure and help the development of private dentistry by a test of ''reasonableness'', or by amendment No. 636, which talks about ''identified local need''? Perhaps if the Minister clarified that point the debate could progress.

John Hutton (Labour, Barrow and Furness)

My concern is about the use of the words ''promote the development of'' in amendment No. 629, not about the deletion of the word ''reasonable''.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

That amendment is in the name of the hon. Member for Woodspring (Dr. Fox), and it is not an amendment to which I spoke. I spoke strictly to amendments Nos. 635 and 636. I assumed that it was incumbent on the hon. Member for West Chelmsford to speak to amendment No. 629.

John Hutton (Labour, Barrow and Furness)

The hon. Gentleman is quite right, and I apologise to him. Together, the amendments would

have the effect of promoting private dentistry. I should be directing my remarks to the hon. Member for West Chelmsford.

Jim Dowd (Labour, Lewisham West)

I thank my right hon. Friend for showing the good manners that are so uncharacteristically lacking in his opposite number. The real weakness in amendment No. 636, which the hon. Member for Oxford, West and Abingdon seems to be advancing, is that it does not limit the number of people who could identify local need. The amendment does not restrict that role to the PCT, because it is so vague, it could mean that anyone in an area could identify local need, which the PCT would then be expected to meet.

John Hutton (Labour, Barrow and Furness)

I did address that point when I started to speak to the amendments, which feels like a lifetime ago. Amendment No. 636 would not aid the proper interpretation of clause 157 because it is so completely open-ended and, as my hon. Friend the Member for Leigh made clear, it would be difficult to determine the duty of PCTs.

I tried to say—for the sake of recalling the argument—that the hon. Member for Oxford, West and Abingdon was concerned about where the concept of reasonableness came from. I made it clear to him that it is broadly the Secretary of State's existing duty under section 3 of the 1977 Act. We are not importing an innovation or taking a back-door route to rationing. This is the current broad framework within which NHS services are commissioned and provided by the Secretary of State.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

The Minister read from section 3 of the 1977 Act. However, I would be grateful if he read it again so that, in my response, I can get the wording exactly right. The wording in the Act is not the same as that in the Bill, because section 3(1) talks about the ''necessary''—a word that is not in clause 157—steps to secure reasonable requirements, and it lists those requirements. There is a difference between taking necessary steps to secure reasonable needs and doing something reasonably without any reference to its being necessary or to what those needs are.

John Hutton (Labour, Barrow and Furness)

The hon. Gentleman is scraping the bottom of the barrel with that approach. There is no substantive difference. Typically, he is making a mountain out of a molehill. I have no doubt whatsoever that this is a broadly comparable provision. The hon. Gentleman should not be developing his arguments along those lines.

Amendment No. 636—regardless of who the author is, and we can have a debate about that—would not help. It would introduce unfortunate ambiguity into the parameters of the new commissioning duty, and we can do without that. The real difficulty with the amendment, which stands in the name of the hon. Member for Oxford, West and Abingdon, is that it suggests that PCTs should provide services in accordance with identified local need. We expect a PCT to have regard to the needs of persons resident in its area, but as the hon. Gentleman knows, dental services have always been provided on the basis of catchment area rather than residential area. That

means that the public can access the service where it is most convenient, and we want that to continue.

It is at least arguable—probably more so than in the case of the words chosen by the hon. Gentleman—that amendment No. 636 would limit the service to what was required to meet the PCT's local health needs. I assume that the amendment is intended to cover the local resident population, rather than to those who want to use it wherever they are resident. Therefore, for that reason alone, it is not—

Simon Burns (Conservative, West Chelmsford)

That is the Minister's assumption.

John Hutton (Labour, Barrow and Furness)

It is not my assumption; it is how the amendment can be reasonably interpreted. Even if I am wrong, it serves to illustrate the point that the amendment is not sufficiently well drafted.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Will the Minister explain the difference between catchment and resident population bases? It was not clear from his remarks. If he could do that, it might help me to respond to his interesting argument.

John Hutton (Labour, Barrow and Furness)

The catchment could be outside the PCT area, as is currently the case with NHS dental services. That is the difficulty with the amendment. Many commuters will register with an NHS dentist in Westminster because that is where they work and where they use services.

There is genuine difficulty with the amendment. I am not trying to make a mountain out of a molehill, but the new commissioning duty should be made as clear and simple as possible. I understand the hon. Gentleman's intentions; he wants PCTs to plan the provision of dental services, using their new statutory duties to commission in a way that meets the needs of local people. As I understand it, that is what the new commissioning responsibilities require them to do, so there is no issue. I say only that his amendment is unnecessary and its precise meaning is unclear. We do not know how it would affect historic patterns of registration with dental practitioners. I cannot support this group of amendments.

The hon. Member for West Chelmsford raised the subject of resources. With hindsight, he might acknowledge that that was not very clever, given that Labour Members know what happened to NHS dentistry when his lot were last in office. This refrain may sound familiar, but I am sure that he will understand why I use it: I do not think that anyone in the country believes that if the Tories were ever returned to power, they would suddenly reverse the changes that they made to NHS dentistry, or find that their policy was to spend significantly more on it. The hon. Gentleman will make no progress if that is the thrust of his argument.

The issue of resources is, however, important. It may help if I speak about that now, rather than being tempted to do so on every group of amendments. That would be tedious, although Labour Members would enjoy it. The changes to NHS dentistry in part 4 create a new legal platform within which those services can be provided. That is long overdue and widely welcomed. However, as I said earlier, we know that in some parts of the country it is difficult, especially for adults, to access NHS dental care. In some cases,

patients feel that they have to pay privately to see a dentist. That situation is not good, but we inherited it from the Conservative party.

Measures such as the establishment of personal dental services pilots, including dental access centres, have been taken to improve access to NHS dentistry, and they have done an excellent job in extending the range and reach of NHS dental services. However, more must be done. The proposals in the Bill underpin a modernised, high-quality primary dental service, provided through contracts between PCTs and dental practices. PCTs will have a duty to secure the provision of primary dental services, either through contracts with individual practices or by providing services directly. With those new responsibilities will come £1.2 billion of financial resources that are currently held centrally.

I make the important point that once the reformed system is in place, it will be possible, over time, to adjust NHS allocations to take account of the health inequalities that can only persist under the old system. I acknowledge that the existing funding arrangements are unsatisfactory. They reflect the varying willingness of dentists to treat, rather than the needs of the NHS to secure dentistry.

I can give the Committee the important guarantee that current spending will be protected. We will also take some short-term measures until the implementation of the Bill enables the NHS to address local historical anomalies, with additional funds being deployed to support PCTs as they get to grips with the new agenda.

In the longer term, allocations will need to take health needs into account, as general allocations currently do. In some areas that may mean that additional funding for dentistry will be available to PCTs so that they can begin to address the long-term oral health inequalities that many of them face. Clearly that would be taken into account in future allocations within the framework of the funding formula.

Simon Burns (Conservative, West Chelmsford)

I thank the Minister for such a detailed answer on this crucial matter, but can he advise us when the new system will come into force?

John Hutton (Labour, Barrow and Furness)

Yes. We hope to have the new GDS contract operational by 2005, and we intend to commence the implementation and operation of the provisions as soon as possible. Perhaps we can return to the matter at hand.

Alongside the practice-based contracts, I want to move to a more preventive approach to the provision of dental services in much the same way as the Health Committee's report on access to NHS dentistry recommended. The Bill will end reliance on the fee-per-item-of-service method of paying dentists. Also, clause 158 will, for the first time since the foundation of the NHS, give dental GPs the opportunity to focus on prevention and health promotion as well as treatment. Those are important provisions.

The amendments in the name of the hon. Member for Oxford, West and Abingdon are unfounded, they

are not well drafted and they would not add clarity to the duties that we are placing on PCTs. The amendment in the name of the hon. Member for West Chelmsford would take us into similarly uncharted waters and create ambiguity that the NHS can do without.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

The Minister asked whether these were probing amendments. I may not have the necessary experience, but I did not think that it was a requirement to say at the outset whether an amendment was ''merely'' probing. I would hope that all amendments were probing. I sometimes wait to hear a Minister's response before I decide whether to press an amendment to a vote.

I do not accept the Minister's counter-arguments, perhaps because I have not understood them. That may be due to my deficiency in understanding or his deficiency in explaining. We will leave others to judge when reading Hansard.

The Minister said correctly that this is partly about rationing. The hon. Member for Leigh made that point too. My position is clear—there will always be rationing in a publicly funded cash-limited health service. The question is not whether there will be rationing. There are two key questions. First, how much rationing will there be? In other words, what services that are not available on the health service, or not available without a charge, do the health professional and the patient together think would be of net benefit to the patient?

Secondly, how explicit will that rationing be? There is, and has been, far too much rationing, and I have supported greater funds for the health service to reduce it. The Government's latest comprehensive spending review details the funding that they plan to put into the NHS. We argue that it is five or six years too late, but we accept that the level of extra funding is about right. I am at one with the Minister on the degree of rationing.

It is the failure to be explicit about rationing that concerns me. People should know what they will not be able to have, and they should not have the wool pulled over their eyes with the pretence that a treatment would not be beneficial, when it would be beneficial but simply cannot be afforded.

Citizens, voters and taxpayers should be empowered, so that when they know that something is not available because of a lack of resources, they can vote for politicians who are committed to the expansion of the necessary resources. Otherwise, not realising how much is unavailable to them, they may be duped into voting for tax-cutting, expenditure-cutting parties. The Government should find common cause with us on that, for their electoral well-being as well as ours. We take a generally similar view on the quantum of funding, whereas the Conservative party does not.

Unfortunately, the framing of the clause leads to fog rather than to clarity on rationing.

Chris Grayling (Conservative, Epsom and Ewell)

May I have clarification about tax-cutting parties? I am under the impression that the hon. Gentleman has just

introduced a raft of policies that will involve cutting taxes.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Let me be a little clearer: this is about the quantum of resources and about how those resources are raised. The hon. Gentleman makes a fair point: in any tax-and-spend package, some taxes will be raised and others will be reduced. Our policy is to cut unfair taxes and to raise fairer taxes, so he is quite right. We are keen to cut unfair taxes. Let us not talk about tax cutting or tax raising, because one can get into silly arguments. The question is whether—

Peter Atkinson (Conservative, Hexham)

Order. That was good advice. I do not want a debate on tax cutting.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Quite so. The question is whether parties are committed to the quantum of resources, and the increase in resources, going into the health service. We voted for the rise in national insurance that the Government are using to fund the increase, but the Conservatives voted against it. That implies that the Conservative party is not in support of the additional resources. I hope that the hon. Gentleman accepts that that argument can be made and that there is, therefore, a question of rationing. How does one provide a greater level of services when one does not put in the resources?

As I said, the key issue with the amendment is whether rationing is explicit. If citizens, patients, consumers, voters and taxpayers are to understand what services are not available, it would help them if there was clear information on the level of need and on what services are provided. The next group of amendments provides the other part of that equation. This amendment seeks to ensure that primary care trusts look at identified need and then make decisions on what can be met, taking reasonableness into account. That is why amendment No. 636 stands on its own, in addition to whatever words the Government want to put in to ensure that there is a test of reasonableness—the rationing test—before meeting those resources. Amendment No. 636 ensures that any rationing becomes explicit.

The Minister was right to say that this is about rationing, and the hon. Member for Leigh was right to question the Conservatives about how they can support the amendments without at least supporting a significant increase in funding to give some scope for meeting—[Interruption]. Is the hon. Gentleman seeking to intervene?

Andy Burnham (Labour/Co-operative, Leigh)

I was wondering whether the shadow Chancellor of the Exchequer would approve of the Conservative Front Bench support for these amendments this morning.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

It is slightly easier to put that question as an intervention, because, given the acoustics, it is hard to hear what is being said from a sedentary position. The question needs to be answered, but perhaps not in this forum. The rationing issue is clear, and I want to state clearly that the amendment is predicated on the basis of achieving greater explicitness. The Minister said—he sometimes says this and sometimes does not—that I am a late convert in relation to the plurality of providers. I have challenged him and his colleague to find any

statement in which I am on the record as saying that that I am opposed in principle to the provision of NHS services by non-NHS providers. I have opposed an increase, at the expense of NHS provision, in privately commissioned services, private pay-as-you-go services or insurance-based services, especially those that are subsidised by NHS money, such as the system recently proposed by the Conservatives.

Moreover, I am opposed to private health care being delivered through NHS services when it is against the interests of NHS users, because to jump the queue is unfair. Should the Minister continue to make this allegation, I should be grateful if he could find anything I have said to suggest that I do not support the mixed-provider message.

My main difficulty with the Minister's rejection of amendment No. 635 is that he thinks that the meaning of the words in subsection (1)

''to the extent that it considers it reasonable to do so,''

in relation to the provision, or the securing of the provision, of primary dental services, is equivalent to the general duty on the Secretary of State as set out in section 51 of the National Health Service Act 1977. I think it is the same as in section 3 of the Act. I invited the Minister to repeat the reference, but he was unable to do so. There is a difference, because the wording in that section concerns doing what is necessary, and makes the qualification of ''reasonable'' only after saying that he must do what is necessary to secure what is a reasonable need.

John Hutton (Labour, Barrow and Furness)

The hon. Gentleman has misunderstood what section 16(6)(a)(i) provides. If he looks at it carefully he will understand that the primary care trust must provide those services that it considers reasonable so to do. The use of ''necessary'' that he is harking on about does not change that one iota.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

It may be that we must look at what the Minister has said and, at a later stage or in another place, table an amendment that has the exact wording that applies to the provision of general medical services. The Minister implied that the effect was the same and that to use the words that apply to the rest of the health service would make this clause unnecessarily complex. That is a debate that must take place when the wording is before the Committee. I accept that it is incumbent on Opposition parties to put those words in an amendment so that the Minister can argue with them.

Furthermore, the Minister argued that, because the wording was broadly comparable, we should not go down that path. However, when I have not been convinced by what he says, I am always sceptical when he urges me not to go down the path, because that suggests that he is not clear of his own ground.

John Hutton (Labour, Barrow and Furness)

I would be clearer about where the hon. Gentleman was coming from had he at any time during the passage of the Bill tabled an amendment to section 3 of the 1977 Act to make his point, but he has not done that.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

It is questionable whether an amendment would be in order. I should be grateful if the Minister could advise me on how I might do that, other than through a new clause. I accept that in order to deal fully with his response to this amendment and to test it we would have to bring back an amendment with the same wording as section 51—if that is the section to which he refers.

I did not understand the Minister's argument about catchment and resident populations, and I am not sure that he was convinced that that was a relevant argument. I am not sure from his two comments on it—one in response to my intervention—which arrangement exists now. Could the Minister clarify whether dental services are currently arranged on a resident or a catchment population basis? I should be grateful for his advice. I should also like clarity on the position of someone who comes to work at Westminster, lives in Westminster and wants to access an NHS dentist in Westminster. Will that person receive dental services on the basis of residency or catchment?

John Hutton (Labour, Barrow and Furness)

I made it clear that it is currently done on a catchment basis through reinvestments to general dental practitioners through the Dental Practice Board. The effect of this amendment—in crude terms—would be to prevent primary care trusts providing services on that basis. Instead they could provide them only to people who lived in their areas. That would be a retrograde step.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I now understand what the Minister is saying: catchment applies, by definition, to those who register with a dentist, rather than to a local resident population. School catchments imply a residency qualification, and that is why I was confused.

However, amendment No. 636 does not talk about local residents' needs, but local needs. As the Minister will know from other areas of the health service, many areas have a duty to provide health services for tourists. Indeed, such areas get extra funding under the weighted capitation allocations to meet the needs of tourists and commuters. He will also know that that is the case for Westminster, among other places. That is an example of local needs, but clearly not local residents' needs. Because the word ''resident'' is not in amendment No. 636, I understand his point, but I still do not think that it applies. It might have been easier to have the debate on wording that the Government have accepted in other areas of the health service. With that in mind, I beg to ask leave to withdraw amendment No. 635.

Amendment, by leave, withdrawn.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I beg to move amendment No. 637, in

clause 157, page 74, line 29, at end insert—

'including:—

(a) details of all NHS dental provision in the area;

(b) details of overall available provision in the area; and

(c) details of the complaints procedure.'.

Peter Atkinson (Conservative, Hexham)

With this it will be convenient to discuss amendment No. 638, in

clause 159, page 76, leave out lines 9 and 10 and insert—

'(2) A general dental services contract must require the contractor or contractors to provide, for his or their patients, information about treatment charges, access to dental records, alternative local provision and the complaints procedure, and other such information.'.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Amendment No. 637 also relates to clause 157. New section 16CA(3) reads:

''Each Primary Care Trust and Local Health Board must publish information about such matters as may be prescribed in relation to the primary dental services for which it makes provision under this section.''

I will deal with amendment No. 638 presently, which is an amendment to clause 159.

Access to information about local dental services is clearly fundamental to enable consumers or patients to find appropriate dental care locally. As MPs, we know that access to information about local services is a high priority for people who come to see us who simply do not know where to find an NHS dentist. The Consumers Association found that to be the top priority for its members and consumers in a consumer health survey conducted in May 2001. An Office of Fair Trading consumers' survey found that 60 per cent. of those surveyed did not know where to find information about local dental services, which confirms the existing research on this issue.

In June 2001, the Consumers Association examined how NHS Direct provided information about NHS dental services and found that it was extremely patchy and generally poor. The Consumers Association told me that it has noted that there is no obligation on NHS Direct to provide information about private dental services. The Government may feel that it is not the job of the Government or the commissioning body to ensure that information is available about private dental services, and the Minister may want to comment on that.

There is clearly a problem with information, but without information about what is provided, we do not have the other half of what is required for an explicit system of rationing to ensure that people—patients, voters and taxpayers—know what they are voting for when they get it. Amendment No. 638 is important because there is a problem with the failure to provide consumers and patients with the necessary information.

The Office of Fair Trading report is relevant. It recommended that dentists should provide their patients and the population that they serve 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 procedure. Such information is fundamental to the delivery of a patient-centred service and to any notion of patient choice.

One would expect this to be sensible and to be observed by all dental practitioners, but the Office of Fair Trading report found that that was not the case, and that is extremely disappointing. There is a strong argument that dentists should inform consumers about the likely cost of NHS care and how to find an alternative dentist offering NHS treatment if they cease to offer it. Consumers tend not to look for a

different dentist, even if their usual dentist stops providing NHS care. I have had constituents whose dentists have stopped providing NHS care. They have been told that they can join Denplan or Dencare, but they have not been given the name of an alternative NHS dentist. That is not too much to ask.

These are genuine concerns, not only for us but also for the Consumers Association and the Office of Fair Trading. It is particularly important in an area such as dentistry where, historically, care has been provided by people who also have a private practice and, therefore, have a tremendous incentive to increase the market for that private care, particularly given that the rewards are so significantly better than their NHS remuneration and are always likely to be so. It is also important that this information is available where, in this particular area of health care, there is so much co-payment and co-charging. That is why dentistry is unique and why it creates a greater need for information so that consumers and patients may be absolutely clear, and to be made available not only by those who commission it, but also, in these cases, by those who provide it. I commend the amendments to the Committee.

John Hutton (Labour, Barrow and Furness)

I obviously have a great deal more sympathy for the hon. Member for Oxford, West and Abingdon on these amendments than I did with the other group of amendments that he moved. All of us, when talking to our constituents, have come across a generally recurring theme: the information about what NHS dentistry services are available and how the public might access them is often pretty poor and frequently difficult to understand. That is why the Government, in bringing forward new section 16CA(3), are very much in favour of greater consumer information and choice being made available. These are new duties on primary care trusts and local health boards to make this sort of information available to the public. I am sure that it was an omission on the hon. Gentleman's part not to say that he greatly welcomed the introduction of this new statutory provision.

The question is not whether we provide this information, because we should; the question is how we do it, and how we do it in the most effective way. We are thinking about dealing with this, as the clause makes clear, on the basis of regulations rather than through the Bill itself. We can argue that fairly and reasonably on several grounds. The requirements will inevitably change over time as providers' abilities to provide information improves. For example, in the future, it may be a requirement to make available certain statistical information that providers do not currently record. We should therefore look at alternative ways of ensuring that that information flow remains up to date. The danger of putting anything into primary legislation in the way in which the hon. Gentleman proposes is that it tends to get stuck in time.

I agree with the hon. Gentleman about the need for the sort of information that amendment No. 638 lists to be made available to members of the public. It may be helpful to him and the Committee if I make it clear

that our experience from over five years of piloting primary dental services is that this sort of information is best provided through national requirements, which local contracts must then contain.

Proposed new section 28O, which we shall come to later, will allow the Secretary of State to make regulations specifying mandatory contractual terms. The information required in the amendment will be covered by that type of provision.

We are also committed to learning from the field sites, several of which are concerned with improving the patient experience. The Modernisation Agency is setting up some 20 sites to test ideas that we want to incorporate into the dental service contract as it develops.

Amendment No. 638 seeks to replace new section 28L(2), which allows regulations to describe services

''by reference to the manner or circumstances in which they are provided.''

For example, the regulations could state that certain services could be provided on week days, perhaps between the crucial working hours of 9 am to 6 pm. Amendment No. 638 deals with completely different territory. However, I am sure that it is not intended to remove the flexibility that proposed new section 28L(2) will give with the exercise of powers conferred by proposed new section 28L(1). It is not a restricted provision; it attempts to ensure that there is a power to make regulations in cases where it would be helpful to patients and consumers.

I agree strongly with the hon. Gentleman's sentiments, and I know where he is coming from. This information should be made available. Regulations will ensure that that information is relevant and up to date. We can also consider mandatory contractual terms as a further platform for progressing such information exchange. I have only one argument with the hon. Gentleman, which is where we do it, not how we do it. For the reasons that I have given, it is better done through regulations and new contracts.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

In the light of the Minister's positive response that this issue will be dealt with by regulations, and in some cases may go even further than that, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

Jim Dowd (Labour, Lewisham West)

Clause 157 largely enacts the provisions outlined in ''Options for Change'', and I want to examine some of the implications of the new commissioning regime. I was able to discuss the matter with the now Under-Secretary of State for Constitutional Affairs, my hon. Friend the Member for Tottenham (Mr. Lammy), when he appeared before the Select Committee on Health a few weeks ago as Under-Secretary of State for Health, a role which, sadly, from the Department of Health's point of view, he no longer holds. He was able to throw some light on how the system will operate, but I

should like the Minister to confirm a few points or let us have the Department's views on how it will operate.

The extensive discussion on PCTs and local health boards did not touch on how decisions will be made on what is reasonable with regard to the provision of private dental services. How much public consultation will there be? Will there be consultation with the broader public or will it be restricted to professional providers? Will an outline plan be published, on which consultation could be sought? Or will decisions on provision simply be taken and commissioned arrangements secured to support them?

I believe that the field test site programme is almost completely in place and that an implementation date for the new commissioning arrangements of April 2005 is still the aim. Will the Minister confirm that there are arrangements to allow that timetable to be met and that there is sufficient expertise available to people who are new to commissioning, not least the dentists themselves or those involved in the commissioning negotiation procedure? Would it not be better to have a simple default contract that could be negotiated rather than various PCTs having different contracts? I should be grateful to the Minister for an explanation of those issues.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I return to the issue that I flagged up earlier, which I hope the Minister will be able to address. How will the provision or commissioning of dental services by primary care trusts improve the services for certain vulnerable groups of people who are currently significantly underprovided for?

I do not have detailed briefing notes about the situation in the Prison Service, and I know that the Prison Service had a separate health care system from the NHS until recently when it was finally announced, after a long time, that there would be an effective merger. However, it has been generally acknowledged in various reports by the chief inspector of prisons that the provision of dental health care—and even access to emergency treatment, let alone preventive work—is appalling in prisons. There may be historical reasons for that: perhaps it was not felt unreasonable in the past that people in prison should suffer toothache. However, it is a miserable thing to have to suffer, and poor dental health has significant implications for infection, particularly systemic infections and infections of heart valves, and for the general health of the patient or person concerned.

There is now plenty of research that shows that the poor provision of dental health care in prisons creates major problems for people who have been in prison, and a significant financial burden on the NHS, which has to pick up the pieces. I should be grateful if the Minister would take the opportunity to assure me that there will be some thinking about that matter when primary care trusts take over responsibility for the provision and commissioning of NHS dentistry, and that either specific duties will be imposed on them with regard to prisons—there is very little lobbying of them by people in prisons—or there will be some other mechanism.

The second area that I am concerned about is people who are not in prison and are not criminals but who are otherwise in detention. In my constituency the Campsfield house immigration centre has a number of people detained, sometimes for very long periods even though that was not the intention. Some of them, not unsurprisingly, have dental health care needs, and I understand that the detention centre has only been able to avail itself of the services of one community dental practitioner once a fortnight because of the extent of rationing. I do not see how it is compatible with human rights for people to be left in that situation. I know this because people who have been in detention there have contacted me while in detention or after their release. How can it be compatible with basic decency for people to be left for weeks, shut off from the outside world, not having been convicted of an offence and unable to obtain access to the dental health care that they need? People in the outside world with relatively trivial complaints can simply go to the dental practitioner with whom they are registered or get access to some of the community dental services and personal dental services schemes that the Government have introduced.

This is something that I feel strongly about. I will not go into any more detail, but I seek an assurance from the Minister that he is aware of the problem and that it will be dealt with, not only through the Bill, but in general even before this measure reaches the statute book.

Simon Burns (Conservative, West Chelmsford)

As we have realised during discussions on this clause, we are talking about a significant revamping and overhauling of the provision of primary dental services. But there is one area that we have not really touched on, about which the BDA is particularly concerned, I think with some justification.

I should like to raise the issue of dental service staffing so that the Minister is aware of our thinking. As we shall discover as we progress through the amendments to this part, the Government envisage not simply overhauling the commissioning process but specifying an expansion in the duties and services provided. Such expansion, however, requires a sufficient number of properly trained dentists and dental nurses, hygienists and therapists. Will the Minister explain how he will plan for future staffing in the dental service to fulfil the Government's aims as set out in the clause?

Peter Atkinson (Conservative, Hexham)

Order. The hon. Gentleman is anticipating later clauses. Perhaps the Minister will bear that in mind when he responds.

Simon Burns (Conservative, West Chelmsford)

You are absolutely right, Mr. Atkinson, but it may help to flag up that concern now so that when we reach that stage of the Bill, the Minister will be aware of the issue and able to answer in detail.

Peter Atkinson (Conservative, Hexham)

That is ingenious.

John Hutton (Labour, Barrow and Furness)

I can assure the hon. Gentleman that I have come fully briefed for this debate; he need not worry about that.

My hon. Friend the Member for Lewisham (Jim Dowd) asked three important questions, and I shall try

to deal with each in turn. First, he asked about preparations for the new general dental service contract. As he knows, some 20 sites with approximately 100 dental practices will be involved in testing the contract. They are preparing to start on 1 October. I am assured that all arrangements are proceeding satisfactorily, and our intention is to begin to test those new arrangements on that date. The Government have made it clear that they want those provisions and the new contract to start in April 2005, and that remains our strong intention. It is the Department's job to ensure that that timetable is observed.

Secondly, my hon. Friend asked about the default contract. Clause 160 provides for that, and it is not optional; provision must be made for a default contract in the interim period. We shall activate that provision, so dentists need not worry in that regard. Thirdly, my hon. Friend raised the important issue of the PCTs' new commissioning responsibilities. He asked whether I thought it appropriate for PCTs or local health boards simply to make decisions and then publish their strategies. That would not be appropriate; it is the responsibility of PCTs to consult widely on their new commissioning responsibilities and to develop their local dental strategies in an open and transparent way.

For many years, the NHS has been a secret society wherein plans are made and announced, and people have to take them or leave them. That is absolutely not how the new NHS will operate. This is an opportunity for local PCTs to consult widely on the development of their services, particularly dental services. Section 11 of the Health and Social Care Act 2001 requires proper public consultation on any significant change to service delivery, and that will apply as much to dental services as to other parts of the NHS. Those are all significant gains for transparency and openness, and I hope that my hon. Friend is reassured.

I apologise to the hon. Member for Oxford, West and Abingdon for not referring to prisons earlier. The new commissioning responsibilities for PCTs will apply to prisons in their area, so they will have a responsibility to make reasonable provision in that regard. I am not aware of the particular problems at Campsfield detention centre, but I shall make inquiries and write to the hon. Gentleman if he has concerns.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I do not want to retread the ground of amendment No. 635, but does the Minister think that the current provision for prisons is reasonable? If it is not, could PCTs be criticised for continuing with the current provision rather than increasing it? I am talking in general terms. The problem lies with the use of the word ''reasonable''. PCTs may consider it reasonable not to offer much of a service to people who have fallen foul of the law. That is why prison health care is so appalling, as is commonly recognised. I hope that the Minister will state his view of the current state of dental health care in prisons.

John Hutton (Labour, Barrow and Furness)

It is for PCTs to make those determinations in their own area. I could not say whether dental provision in every prison and detention

centre is sufficient, and I would not want to volunteer an opinion about that. It is not in my capacity to do so. However, it is important that PCTs look carefully at their new responsibilities and plan accordingly. I do not doubt that there could be an improvement in dental provision in many parts of the Prison Service, and I look forward to that happening.

The hon. Member for West Chelmsford also raised some important issues. If we want to expand and improve NHS dentistry, we must ensure that there are dentists, hygienists and therapists to work in the NHS and support this policy, which we have outlined on previous occasions. He will be aware, as the BDA is, that we are currently reviewing the work force requirements for dentists and other health care professionals. We want to ensure that we have proper, strategic long-term planning.

The hon. Gentleman will be aware that we have already provided for an additional 150 training places for dental therapists to be established next year. That is the first instalment of the long-term approach that must be taken by the Government, the NHS and the higher and further education providers to make sure that we have an adequately skilled and sufficiently large group of workers to ensure that NHS dentistry can continue to play the role that we want it to play.

Simon Burns (Conservative, West Chelmsford)

The Minister will be aware that the work force review to which he referred was commissioned by the Department of Health in 2001. When does he anticipate that its results will be published?

John Hutton (Labour, Barrow and Furness)

I hope that we can do that soon. It depends on the work that is done and the progress that has been made. It is a very important piece of work. As the hon. Gentleman will know from his time in the NHS, work force planning has not been one of our greatest strengths. It is a complicated field, and we have never performed very well in the past, so we are now trying to plan effectively. I am sure that the hon. Gentleman is one of those who would counsel us to ensure that we get it right this time rather than rushing something out. That is how we used to do it, and it is not how we want to do things in future.

Question put and agreed to.

Clause 157 ordered to stand part of the Bill.

Clause 158 - Dental Public Health

Simon Burns (Conservative, West Chelmsford)

I beg to move amendment No. 630, in

clause 158, page 75, line 5, at end insert

'provided that these functions should include school screening as well as oral health promotion and local oral health surveys to help plan services.'.

Peter Atkinson (Conservative, Hexham)

With this it will be convenient to discuss the following:

Amendment No. 631, in

clause 158, page 75, line 7, at end insert

'provided that these functions should include school screening as well as oral health promotion and local oral health surveys to help plan services.'.

Simon Burns (Conservative, West Chelmsford)

I would like to make it plain from the outset that these are probing, but important, amendments. They were drafted by the BDA, and they give us an opportunity to discuss preventive dental care among children and young people. In the explanatory briefings that the Minister kindly made available to us on Tuesday, he pointed out that the Government's intention is that the regulations that will flow from this clause are likely to cover school screening, oral health promotion and local oral health surveys. I assume, therefore, that he will welcome the amendments because they directly reflect his intentions.

It is crucial that the regulations contain those elements when, at the appropriate time, they are drafted and published, because it is quite extraordinary that, although we live in what John Kenneth Galbraith described as ''the affluent society'', the health care, particularly the dental health care, of our children in this developed nation is deteriorating. One could argue at length about why that is happening, although I do not intend to do so today. Sadly, I suspect that it has nothing to do with funding or the fact that the service is provided by a Government body—the NHS. I believe that it has more to do with education and ignorance and with other problems associated with poverty in certain areas of the country.

It strikes me as odd and contradictory that, when standards of living in this country have been improving for many years, a section of the community is still failing to move with the times and to ensure the dental health of their children and, in many cases, themselves. That is why preventive initiatives designed to bring home to people the importance of basic oral hygiene are crucial.

Andy Burnham (Labour/Co-operative, Leigh)

The hon. Gentleman seems to be laying the blame for the poor dental health of children in some parts of the county at the door of parents. Leaving that aside for a moment, his amendments propose a duty of oral health promotion. Does he envisage that that might involve PCTs promoting water fluoridation, which has been proven to be the safest and most effective method of improving dental health?

Peter Atkinson (Conservative, Hexham)

Order. That question is too wide for the scope of the amendment.

Simon Burns (Conservative, West Chelmsford)

I am grateful for that guidance, because I do not want to go down that route today.

To ensure that there is no misunderstanding on the part of anyone who reads the report of the proceedings, I point out that the hon. Gentleman's statement that I blame parents gives a distorted view of the point that I was making. I am sure that he did not do that intentionally. I said that, sadly, through ignorance or lack of knowledge or for other reasons, too many people are not carrying out their responsibility as parents, either as well as they should or, in some cases, at all, to ensure that their children are familiar with oral and dental hygiene, and clean their teeth regularly each day. That fact struck me as ironic, given that we live in a society in which living standards, educational standards and the

awareness of health requirements have improved significantly over several decades. Something is failing: the message of the importance of oral hygiene and of caring for one's teeth is not getting across sufficiently to the population, and to certain sections of it in particular.

Dental health is not simply a question of how many fillings one needs before the age of 15; by having high standards of dental care and oral hygiene one can avoid, or detect at an early stage, other medical problems, which can be identified through regular dental check-ups. Far too many people do not fully appreciate that a dental check-up is not simply a procedure that one goes through to find out whether one needs a filling. It is also an opportunity for dental staff to identify potential mainstream health problems or further dental problems, or to confirm that there are no other problems.

That is why it is important to make the maximum effort to ensure that we raise standards through education, screening in schools and other community-based initiatives. We must get the message across to the many people who missed or did not appreciate its importance, which is that dental and oral hygiene and the care of one's teeth are crucial not only to avoid the pain of a tooth that needs to be filled, but because of the other health implications.

Andrew Murrison (Conservative, Westbury)

Although oral health is important in the preventative sense, it must be put into its proper context, which is that one can detect a finite number of oral diseases.

Who will be responsible for dental public health? Primary care trusts have directors of public health whose functions and, I suspect, priorities, are clearly defined. I fear that the priority that is accorded to dental public health will be limited, given that there is nobody obvious in primary care trusts who can develop dental health. My hon. Friend is correct to point out that there is widespread misunderstanding among the public at large about the importance of public health. However, I suspect that that is also true of the medical profession, which staffs public health posts. It is important that the Minister tells us how he envisages directors of public health developing programmes in dental public health.

John Hutton (Labour, Barrow and Furness)

I am grateful to the hon. Gentleman for tabling these amendments, because it gives me the opportunity to place on the record the Government's intentions.

Many of those duties are set out in section 5 of the National Health Service Act 1977. However, it specifically relates to those duties that are given to the Secretary of State that he then delegates to the primary care trusts. Clause 158 seeks to confer those duties directly to the primary care trusts, and that is in line with our policy of ascertaining where power and responsibility should properly lie in the NHS.

In changing the function from one that is delegated by the Secretary of State to one that is directly conferred on primary care trusts, we have chosen to draft those changes as regulations, rather than putting them in the Bill. I know that this is a wearisome argument, and I apologise in advance for making it,

but we have drafted those changes in that way not because we no longer wish to provide those functions—they are important in developing and maintaining high oral health standards—but because it gives us the flexibility that we need to ensure that the regulations reflect changes in practice, as well as advances in the development of services.

I do not have as rigid a view on this as I have on some of the other amendments. I am prepared to have another look at this matter to see whether it would make more sense to put it in the Bill. Flexibility means that it is better to include those functions in the regulations. I can at least confirm again—as I did on Tuesday afternoon, Mr. Atkinson—that if we decide to proceed with the regulatory-making power rather than converting anything onto the Bill, which would be my preference, those regulations would cover the matters that the hon. Gentleman's amendment raised; oral health promotion, school dental screening and local oral health service.

The hon. Member for Westbury (Dr. Murrison) raised a fair and important point about who will actually carry out this work, and mentioned the relationship between that and the wider public health functions of the primary care trusts. It is important to bear in mind that primary care trusts are now responsible for community dental services and the bulk of the public health function is carried out within, from and through community dental services. That will continue in one way, shape or form, either through primary care trust direct services under the Bill—which is another option—or as community dental services. We have a cohort of skilled oral public health practitioners who will continue to do that work.

It will be the job of the public health directors in the PCT to co-ordinate that work, and to ensure that it has been done properly and effectively. It is not the case that there is no one there to do that work; those functions are currently being discharged through the community dental service. I very much hope that those practitioners will continue to work under this new format, and I am confident that they will. Oral public health is a sector in which there is much professional expertise, and in which many skilled practitioners work. I hope that the new legal framework that we are creating for dental services within the NHS will boost oral public health; that is precisely what clause 158 is designed to do.

Simon Burns (Conservative, West Chelmsford)

I am grateful to the Minister for assuring us that he will look again at the issues thrown up by the amendments. I put on record that I fully understand that by having a look at the amendments, the Minister is making no commitments; he may change his intentions.

John Hutton (Labour, Barrow and Furness)

I am grateful to the hon. Gentleman for making that clear. That is the case, and I have expressed my preference.

With your indulgence, Mr. Atkinson, I wish to deal with a point raised by the hon. Member for Westbury. He asked who would carry out this function. An important aspect of the Bill is that, for the first time, general dental service practitioners will be allowed to

be involved in oral public health provision. I hope that that the hon. Gentleman, and other hon. Members, welcome that change.

Simon Burns (Conservative, West Chelmsford)

In light of the Minister's comments, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

In contrast to clause 158, subsections (5) and (6) of new section 16CA contained in clause 157 specifically provide for regulations, their purpose and scope. New section 16CB contained in clause 158 mentions prescribed functions in subsections (1), (2) and (3), but does not mention where the regulations that set out those functions are, or where the regulation-making power is. I assume that the Government are relying on a general regulation-making power somewhere in this part of the Bill, and perhaps there is a general provision in the Bill. I looked for it, but could not find it.

Given that the issues are similar—indeed, we have just debated what dental public services should provide—why does new section 16CB not include descriptive subsections about regulations equivalent to those subsections included in new section 16CA? New section 16CA(6) mentions ''the manner or circumstances'' in which some of the dental public health services might be provided. I hope that my question is clear, and that the Minister can answer it; if not now, then later.

John Hutton (Labour, Barrow and Furness)

It is important to bear in mind that all those amendments are insertions into the 1977 legislation. In this case, I understand that the regulation-making power is contained in the 1977 Act. The Secretary of State—or, where appropriate, the National Assembly for Wales—has the power to make those regulations.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I know that there are general regulation-making powers in this Bill and in the 1977 Act. Why has specific provision been made for regulations in new section 16CA but not in new section 16CB? Presumably such provision was not felt necessary, or perhaps it is redundant in new section 16CA. When a subsection mentions functions that may be prescribed, I check whether there is anything specific about the regulation-making power. The Government are not generally reluctant to give themselves specific regulation-making powers and descriptions of how those regulations are provided for. Why the distinction in the treatment of the two areas?

John Hutton (Labour, Barrow and Furness)

It relates to the specific circumstances of the two different duties. Subsection (6) of new section 16CA has been included because we want it to cover that ground. I gave an example of weekday services and the hours in which they are provided. Section 128 of the 1977 Act sets out a general regulation-making power, and I am confident that the powers to make regulations under the 1977 Act give us the necessary flexibility and reach. We included new section 16CA(6) because we did not have that power, and we feel that we were right to include it.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

On that basis, will the Minister consider whether—if he did not feel that the general powers were sufficient to provide for those proposed in section 16CA(6)—there are similar issues relating to the manner and circumstances by which dental public health services are provided, such as those listed in the amendments we have just discussed? If he agrees that there are, will he consider including equivalent regulation-making powers or qualifications to section 16CA(6) in clause 158, so that we can be certain that there will be the ability to make regulations that will

''describe services by reference to the manner or circumstances in which they are provided.''?

That is even more important in the provision of some of these services than in terms of primary dental services.

John Hutton (Labour, Barrow and Furness)

I am confident that we have sufficient flexibility under section 128 of the National Health Act 1977, but I assure the hon. Gentleman that we will have another look at it.

Question put and agreed to.

Clause 158 ordered to stand part of the Bill.

Clause 159 - General dental services contracts

John Hutton (Labour, Barrow and Furness)

I beg to move amendment No. 616, in

clause 159, page 76, line 25, leave out from 'professional' to 'services' in line 26 and insert

'who is engaged in the provision of'.

Peter Atkinson (Conservative, Hexham)

With this it will be convenient to discuss the following:

Government amendments Nos. 617 to 620.

John Hutton (Labour, Barrow and Furness)

The amendments make minor and technical changes to section 28M of the National Health Act 1977, ''Persons eligible to enter into GDS contracts''; in particular to the conditions that are to apply to those who may become contractors under a GDS contract.

General dental services may be provided by a dental practitioner, a dental corporation or a partnership including at least one dental practitioner, and any of those people listed in section 28M(2)(b)(i) to (iii). Amendment No. 616 changes the wording of section 28M(2)(b)(iii) to make clear that health care professionals who work for the health service in any capacity are eligible to seek GDS contracts as a member of such a partnership. The existing wording might have implied that they had to have a contract to provide services in the health service when, in fact, it does not matter whether they are working for the health service as employees, contractors or on any other basis. The important point is that they are engaged in providing services for the health service. That was always our intention and I hope that is now put beyond all doubt.

The amendments would add existing providers under a GDS or PDS contract to the list of potential providers of GDS contracts. Otherwise, it is possible that providers—such as practice managers, who are parties to GDS contracts—would not be able to seek

new contracts because they may not fall into any of the existing categories. We want to avoid that situation.

The amendment also makes provision to cover the situation where a person, such as a practice manager, was a provider of GDS, but that contract terminated before a new contract was agreed. The exercise of the power will allow such a person to enter into a new contract for a prescribed period—for example, three or four months or longer—after the ending of the first contract. That is notwithstanding the fact that he is not currently a provider, and is simply an avoidance of that provision.

Amendment No. 617 enables regulations to cover the situation where there is a change in a partnership whose members hold a GDS contract; for example, where one of the partners leaves or a new partner joins the practice. It is intended to avoid an unnecessary renegotiation of the contract.

Amendment No. 618 alters the definition of a dental corporation in line with that which appears elsewhere in the 1977 Act. That was an oversight. The purpose of amendment No. 620 is to adjust the definition of an NHS employee in relation to a GDS contract to ensure consistency with the same definition that applies in relation to primary dental services.

Amendment agreed to.

Amendments made: No. 617, in

clause 159, page 76, line 27, at end insert

'or—

(iv) an individual who is providing services under a general dental services contract or in accordance with section 28C arrangements or arrangements under section 17C of the National Health Service (Scotland) Act 1978, or has so provided them within such period as may be prescribed.'.

No. 618, in

clause 159, page 76, line 27, at end insert—

'( ) Regulations may make provision as to the effect, in relation to a general dental services contract entered into by individuals practising in partnership, of a change in the membership of the partnership.'.

No. 619, in

clause 159, page 76, line 29, leave out from 'which' to end of line 31 and insert

', in accordance with the provisions of Part 4 of the Dentists Act 1984, is entitled to carry on the business of dentistry'.

No. 620, in

clause 159, page 76, line 37, after 'NHS employee' insert

'has the same meaning as it has in section 28D above in the case of an agreement under which primary dental services are provided; and'.—[Mr. Hutton.]

Clause 159, as amended, ordered to stand part of the Bill.

Clause 160 - General dental services: transitional

Simon Burns (Conservative, West Chelmsford)

The effect of clause 160 is to set out the transitional arrangements for general dental services.

The clause gives the Government powers to make orders to ensure a smooth transitional period between

the systems. The orders are significant in their own right, giving opportunities for discussions on how the transitional arrangements are being organised and on the future system of dental services; all of them will be made under the negative procedures.

I shall not rehearse my arguments about the pros and cons of affirmative rather than negative resolutions again because the Minister has heard those arguments many times in various Committees in recent years. Those arguments, with which he is familiar, still hold good. However, given the importance of those orders and what they will do, will the Minister reconsider and make the orders subject to affirmative rather than negative resolutions, so that, when they are made, Parliament will have the opportunity to debate in detail the Government's proposals to ensure that they are getting it right?

John Hutton (Labour, Barrow and Furness)

I can give the hon. Member for West Chelmsford that assurance. We shall look at the matter and consider whether it is the right way to proceed. Clause 160 is an essential precautionary measure, designed to ensure continuity of services while reassuring dental practitioners about the future. I hope that we shall be able to proceed with the clause in that light. It is an essential safeguard and a necessary precaution, and I hope that members of the Committee will be assured about that.

Question put and agreed to.

Clause 160 ordered to stand part of the Bill.

Clause 161 - Persons Performing Primary Dental Services

John Hutton (Labour, Barrow and Furness)

I beg to move amendment No. 621, in

clause 161, page 80, line 9, at end insert—

'( ) circumstances in which a person included in a list may not withdraw from it;'.

Peter Atkinson (Conservative, Hexham)

With this it will be convenient to discuss the following:

Government amendments Nos. 622 and 623.

John Hutton (Labour, Barrow and Furness)

I hope that these amendments will improve the effectiveness of the primary care trusts and their ability to control their performance lists. Amendment No. 621 will enable regulations made under section 28Q(3) to ensure that, where a performer is subject to an inquiry into efficiency and fraud, that performer cannot circumvent the investigation by simply removing his or her name from the list. It would not be in the public interest for the Government to allow that to happen, and I hope that members of the Committee will sign up to that.

Amendment No. 622 makes it clear that the information disclosed about applications to be included on the list should include information about applications that have also been granted. That is a natural counterpart to information about refusals, and it will provide a fair and more evenly balanced system.

Amendment No. 623 makes it clear that information about applications for inclusion on a list may be shared with the Secretary of State, primary care trusts and local health boards. That is necessary in order to ensure that a performer, under sanctions

applied by one authority, can be quickly identified should a subsequent application be made to a different body. That, too, is in the interests of the profession and the patients.

Amendment agreed to.

Amendments made: No. 622, in

clause 161, page 80, line 20, at end insert 'grants or'.

No. 623, in

clause 161, page 80, line 35, at end insert—

'( ) Regulations making provision as to the matters referred to in subsection (3)(j) may in particular authorise the disclosure of information—

(a) by a Primary Care Trust or Local Health Board to the Secretary of State; and

(b) by the Secretary of State to a Primary Care Trust or Local Health Board.'.—[Mr. Hutton.]

Clause 161, as amended, ordered to stand part of the Bill.

Clause 162 ordered to stand part of the Bill.

Clause 163 - Abolition of Dental Practice Board

Simon Burns (Conservative, West Chelmsford)

I do not wish unnecessarily to detain the Committee, but I should be grateful if the Minister provided more detail. The clause is self-explanatory; it will abolish the Dental Practice Board. When and how does the Minister anticipate that happening?

John Hutton (Labour, Barrow and Furness)

The hon. Gentleman is quite right; that is precisely what clause 163 does. As I made clear in response to my hon. Friend the Member for Lewisham, West, obviously that will have to be done in a co-ordinated way as we move towards April 2005 and the new arrangements. I do not think that I could give a specific date for when that will happen, but it will be co-ordinated to take into account the operational objective of getting the new system up and running and in place by April 2005. Shadow arrangements will have to be put in place to ensure continuity and a smooth transition, but that is a matter on which I shall be happy to share further detail with the hon. Gentleman in the near future.

Simon Burns (Conservative, West Chelmsford)

I am grateful to the Minister. However, will he tell us how the Dental Practice Board is going to be abolished?

John Hutton (Labour, Barrow and Furness)

The board will be abolished by commencing this particular clause of the Bill. We will also create a new special health authority; I am sure the hon. Gentleman knows that, and we have tried to make it clear through our notes to the Committee to help them understand this part of the Bill. The Dental Practice Board's functions will be taken on by the new special health authority.

Question put and agreed to.

Clause 163 ordered to stand part of the Bill.

Clause 164 - Special Health Authorities

Simon Burns (Conservative, West Chelmsford)

I would appreciate it, as would the Committee, if the Minister cut through the technicalities of this clause and share with us exactly what it means.

John Hutton (Labour, Barrow and Furness)

I am very happy to do that. Essentially, the clause paves the way for a new special health authority to be established to take on the functions and responsibilities of the Dental Practice Board. These two new functions are needed to enable the new special health authority to be established as a successor body to the DPB to undertake the functions needed in relation to primary dental services.

Subsection (1) amends section 11 of the National Health Service Act 1977, under which a special health authority is established, having reference to the National Health Service (Primary Care) Act 1997. This will allow, very simply, for a new special health authority that replaces the DPB and takes on its functions in relation to primary dental service pilot arrangements.

Subsection (2) amends section 16(b) of the 1977 Act in relation to the exercise of functions by primary care trusts. An order may provide for the transfer to a special health authority of the rights and liabilities of a primary care trust under a general dental services contract, where the special health authority is to exercise functions on its behalf, and for their transfer back where the authority ceases to exercise those functions.

Subsection (3) makes similar provision in relation to local health boards in Wales. It proposes a simple series of technical provisions to allow the new special health authorities that will take on the work of the DPB to do that within a proper legal context. In that way, there will be no question marks over their jurisdiction and authority.

Clause 164 ordered to stand part of the Bill.

Clause 165 - Charges for dental services

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

The Minister will agree that this is an important clause. I wish him to explain some of the background to this clause—as he has just done for clause 164—which deals with charges for dental services. A new schedule has been incorporated into the clause, which, according to the explanatory notes, makes some changes to the existing charging arrangements. I should be grateful if the Minister clarified what those changes are and on what basis they have been proposed.

I should be grateful also if he explained, in as much detail as possible, what the significant changes are going to be, compared with the current charging arrangements by virtue of the change from an item per service. What are the Government's intentions in

relation to the range of charges and the income from those?

The Minister may be aware that NHS income from charges has increased steadily over the past six years; indeed, by just as much as it did in the six years before that. Making charges for NHS treatment is not consistent—generally speaking—with the commitment that the NHS should be free at the point of delivery. The two concepts are inconsistent. This is a case where NHS treatment is not free at the point of delivery. It is incumbent on the Government, from time to time, to defend their departure from that principle.

The Government should explain why, of the treatments that should be available on the NHS—as opposed to the treatments that are not considered to be worth having on the NHS—the Government consider it to be legitimate to levy charges for treatment for the mouth and teeth, but not legitimate to levy charges for treatments for other parts of the body. That requires explanation, particularly given that, in the Bill, they are bringing dental practitioners on to a similar—although not identical—basis to that of primary care practitioners on the medical side. That is unless it is the Government's intention not to rule out the possibility of extending co-payment to other areas.

I will not go into the detail of the concerns that have been raised about the Prime Minister's thinking when he referred, in a document, to more co-payment. The Government now say that in the foreword to that book, he was talking about education and not health as far as public services are concerned. It may reassure the Committee—it would certainly reassure me—if the Minister explained the general position on co-payment and in particular how that is changing with regard to dental care. I look forward to hearing what the Minister has to say about that.

John Hutton (Labour, Barrow and Furness)

The current law—section 79A of the 1977 Act—provides for the charge to be paid by a patient for dental treatment under GDS to be based on the remuneration paid to the dentist. In particular, the existing regulations provide for the charge to be calculated on an item of service basis. Patients, their representatives and others have told us forcibly that dental charges are unclear, are difficult to understand and raise concerns about the potential costs of treatment. A recent survey undertaken by the British Dental Health Foundation found that two thirds of people were ignorant about dental charges, and I would include myself among that body.

Even more worrying is the Office of Fair Trading's comment in its recently published report on the private dentistry market in the UK that poor price transparency can encourage potentially unnecessary treatment or treatment that is of a higher or lower quality than the consumer would wish. If that is true in the private market, it is equally true in the NHS. In the Bill, we are attempting to provide a regime that is clearer, more transparent and simpler to understand. In future, dental charges will continue to bear a relation to the level of service provided—such as a charge per course of treatment or per visit—but will no

longer be explicitly related to the dentist's remuneration.

The new arrangements will apply nationally. They are not intended to increase the level of charges but to ensure greater clarity for both dentists and the public about the cost of treatment. I will be establishing a working group, led by Harry Cayton—the director of Patient Experience and Public Involvement, who recently joined the Department from the Alzheimer's Disease Society—to undertake a review of the charging regime, as recommended in the recent Audit Commission report, ''Primary dental care services in England and Wales''. Decisions on the structure of the new charging regime will be informed by the findings; they are not specifically provided for in the Bill.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I am grateful for the Minister's explanation, and I interrupt him only to raise two issues. First, he qualified matters by saying that generally it is not the intention that existing charges will be higher under the new regime. Given the changes that are involved in moving away from an item of service payment to a national tariff, can the Minister guarantee that no course of treatment will be charged at a higher rate than at present?

I shall come to my second point after the Minister has responded.

John Hutton (Labour, Barrow and Furness)

I look forward to the second point.

There will be no new charges for NHS treatment. The Bill does not pave the way for increases in NHS dental charges. How much is raised by charges for particular treatments and so forth is a matter for regular review. The Bill makes no provision for increasing the charges for dental treatment faced by NHS patients. I should also make it clear to the hon. Gentleman that I have tabled a new clause that will produce a new schedule 10 to the Bill. During the review and preparation of legislation, I was advised that schedule 10 was not comprehensive enough, given the amendments to earlier legislation. That is why I have tabled new schedule 2 and new schedule 10.

The difficulty is basically in relation to new schedule 2, and we will come to that shortly. That new wording is designed to replace references to GDS and some references to personal dental services with the new terminology of PDS, primary dental services. In going through the vast volume of NHS legislation, we found that we had not corrected and tidied up all of those references.

In relation to dental charges, I can say little more than I have already said about how we intend the new regime to operate.

I have set out the general principles, and a detailed review of those provisions is about to start.

The hon. Gentleman asked me the wider question of why there should be NHS dental charges at all. Perhaps he will be able to enlighten us as to whether it is now Liberal Democrat policy that there should be no charges and where that money will come from. However, I shall return to his wider point in a second.

Andrew Lansley (Conservative, South Cambridgeshire)

I understand that the intention is not to specify the nature of the new charging regime but to allow that to

emerge from the review. To ensure that the structure of the legislation does not constrain the review, will the Minister confirm that, notwithstanding the exemptions for certain persons in schedule 12 of the 1977 Act, the charging regime, in shifting away from items of service, is not only capable of setting maximum amounts of courses of treatment or items of service but maximum amounts for individuals who may be receiving dental services?

John Hutton (Labour, Barrow and Furness)

I shall have to come back to the Committee on that point or perhaps write to the hon. Gentleman. It is quite a technical question, and I do not want to mislead him or the Committee.

Let me make one or two points clear about the wider question of NHS dental charges. My right hon. Friend the Prime Minister has made it absolutely clear that there are no Government proposals to extend co-payment. That was a bit of mischief-making from the hon. Member for Oxford, West and Abingdon, which we do not usually expect from him.

All I can say is that the view of successive Governments for over 50 years has been that it is appropriate for people who can afford to make a contribution to the cost of their dental treatment to be asked to do so. There is an extensive list of exemptions, to which the hon. Member for South Cambridgeshire (Mr. Lansley) referred. We ensure that people with limited means who are not in a position to make such a contribution are not asked to do so, and those exemptions will continue. This clause and the schedule, which we shall come to in a minute, will have no effect either on the groups that are currently exempted or on those who receive health costs under the low-income scheme.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I accept the Minister's question about our policy. On a clause stand part debate, it is reasonable for me to ask him about his policy. Does he accept the premise, for better or worse, that co-payments for those who can afford it for this type of NHS treatment are inconsistent with the argument that the NHS is free at the point of delivery for this treatment?

Does the Minister accept, as anyone who supports charges for NHS treatment must, that despite there being a range of exemptions—these are merely exemptions because there is no income-related sliding scale—this is regressive in two ways? First, it is regressive for people who fall just outside the exemption but are not very well off, and, secondly, it is regressive for people who have continuing dental health problems that require them to have more treatment than other people in the same income bracket who are blessed with better dental health. Will he at least accept the fact that those issues exist?

John Hutton (Labour, Barrow and Furness)

Of course I accept the fact that those issues exist; that is blindingly obvious. However, we must keep our feet on the ground during this type of debate. In my experience, the hon. Gentleman likes to come to Committees such as this and to other places and develop the argument that there should not be co-payments. However, as we all know from dealing with Liberal Democrat councillors on social services issues, Liberal Democrats come here and say one thing but

unfortunately they do completely the opposite when they are given an opportunity in power or authority to make actual decisions. [Interruption.] I detect a little support for that argument.

However, we are not talking about social services; we are talking, in the hon. Gentleman's language, the wider language of co-payment. As ever, he wants to pick and choose the argument that he wants to make, ignoring Liberal Democrat practice and instead focusing on Liberal Democrat rhetoric. That might work on some audiences, but I am glad to say that it will never work on a sophisticated audience such as the membership of this Committee.

Question put and agreed to.

Clause 165 ordered to stand part of the Bill.

Clause 166 ordered to stand part of the Bill.

Schedule 10 - Part 4: Minor and consequential amendments

Peter Atkinson (Conservative, Hexham)

With this it will be convenient to debate Government new schedule 2 and Government amendments Nos. 624 and 625.

John Hutton (Labour, Barrow and Furness)

When we published the Bill, as I made clear in the debate on the previous group of amendments, parliamentary counsel had the huge and laborious task of ensuring that all existing health legislation that identified references to general dental services and personal dental services on the statute book, and other financial and administrative references, reflected the new terminology and language contained in the Bill.

New schedule 2 will effectively replace schedule 10, which I hope that the Committee will remove from the Bill. I want to reassure the Committee that new schedule 2 contains minor technical and consequential amendments, which are needed to establish integrated primary dental services. The new schedule contains amendments consequential upon the new responsibilities for PCTs, in relation to the provision of primary dental services. The new dental public health functions are affected by clauses 157 and 158. As I said, the new concept of primary dental services needs to be reflected elsewhere in the statute book. That is essentially what my new schedule 2 seeks to do.

There are, however, three additional changes that I must bring to hon. Members' attention. I hope that my doing so will address the points made by the hon. Member for Oxford, West and Abingdon. First, in paragraph 19 of the schedule, the aim of the significant redrafting of provisions for the establishment and recognition of local dental committees in England and Wales was to improve clarity. Existing sections 44 and 45 of the 1977 Act have been subject to repeated amendment as we have pressed ahead with our reform of NHS legislation. I am glad to say, Mr. Atkinson, and I am sure that the Committee will agree, that the

establishment of an integrated primary dental service provided the opportunity for a rewrite. We have sought not to change the way in which dentists are represented locally but to align that with the way in which the new service will be delivered. Local dental committees will be representative of dentists who are providing services under a general dental services contract. Others who provide or perform services may also choose to be represented.

Secondly, paragraph 36 of new schedule 2 replaces existing exemptions for providers of primary dental services from the restrictions to carry on the business of dentistry, which will allow non-dentists to hold a PDS contract. There is also a new form of words to include providers under a GDS contract. If we are to encourage team working and are to extend the opportunity to be involved in NHS dental service provisions to other health care professionals, it is important that the change be made.

Finally, paragraph 52 contains a minor consequential amendment to a provision in the Education Act 1996 that relates to co-operation on school dental inspections. That amendment is needed because the Secretary of State's previous functions, by virtue of clause 158, will in future become a primary care trust responsibility.

Amendment No. 624 completes the repeals and revocations in schedule 12. Those repeals and revocations are consequential on the replacement of sections 35 and 36 on general dental services in the 1977 Act, abolition of the Dental Practice Board, the new dental charging regime and the updating of PDS legislation in order to make its delivery effective in the new world in which we live.

Amendment No. 625 simply improves the drafting of the Bill. Its provisions generally apply to England and Wales. However, where consequential amendments and repeals to the Bill are required under clause 180, that clause will provide that the extent of such an amendment will be the same as the original provision. That is usually desirable, but in the case of the National Health Service (Primary Care) Act 1997, which extends to England, Wales and Scotland, we must make it clear that any consequential repeals or revocations affect provisions in England and Wales only.

Question put and negatived.

Schedule 10 disagreed to.

New clause 19Arrangements under section 28C of the 1977 Act

New clause 19 - Arrangements under section 28C of the 1977 Act

New Schedule 2 - 'Part 4: Consequential and Minor Amendments

Schedule 12 - Repeals and revocations

Standing Committee E

Health and Social Care (Community Health and Standards) Bill

Chris Grayling (Conservative, Epsom and Ewell)

On a point of order, Mr. Griffiths, you will be aware that the amendments that the Government added at the last minute refer to the Public Health Laboratory Service board. I have not yet received a copy of the explanatory notes, and I wonder whether the Minister will be kind and pass me a copy, which I can read while he is speaking.

Win Griffiths (Labour, Bridgend)

Well, we have heard that.Schedule 12 Repeals and revocations

Schedule 12 - Repeals and revocations

John Hutton (Labour, Barrow and Furness)

I beg to move amendment No. 602, in

schedule 12, page 135, line 26, at end add—

Abolition of the Public Health Laboratory Service Board

Reference

Extent of repeal or revocation

Parliamentary Commissioner Act 1967 (c.13)

In Schedule 3, in paragraph 8(1) the words ''or by the Public Health Laboratory Service Board''.

House of Commons Disqualification Act 1975 (c.24)

In Schedule 1, in Part 3, the entry relating to the Chairman of the Public Health Laboratory Service Board.

Race Relations Act 1976 (c.74)

In Schedule 1A, in Part 2, the entry relating to the Public Health Laboratory Service Board.

National Health Service Act 1977 (c.49)

Section 5(4) and (5).

In section 127(c) the words ''(except the Public Health Laboratory Service Board)''

Schedule 3

Public Health Laboratory Service Act 1979 (c.23)

Sections 1(3) and (4) and 2.

Income and Corporation Taxes Act 1988 (c.1)

Section 519A(2)(h).

National Health Service and Community Care Act 1990 (c.19)

Section 4(2)(h).

In section 21(2), paragraph (c) and the preceding ''and''.

In section 60(7), paragraph (h) and the preceding ''and''.

Health Service Commissioners Act 1993 (c.46)

In section 2(1), paragraph (g) and the preceding ''and''.

Employment Rights Act 1996 (c.18)

In section 218(10), paragraph (c) and the preceding ''and''.

Government of Wales Act 1998 (c.38)

In Schedule 5, paragraph 39.

Freedom of Information Act 2000 (c.36)

In Schedule 1, paragraph 43.

International Development Act 2002 (c.1)

In Schedule 1 the words ''Public Health Laboratory Service Board''.

Nationality, Immigration and Asylum Act 2002 (c.41)

In section 133(4)—{**em**}in paragraph (a), subparagraph (v) and the preceding ''or''; in paragraph (b), subparagraph (iii) and the preceding ''or''.'.

Win Griffiths (Labour, Bridgend)

With this we may discuss the following:

Government new clause 18—Abolition of Public Health Laboratory Service Board.

Government new schedule 1—Amendments consequential on the abolition of the Public Health Laboratory Service Board.

John Hutton (Labour, Barrow and Furness)

The amendments provide for the abolition of the Public Health Laboratory Service board. The PHLS has played a long and distinguished role in protecting the health of the population since before the start of the second world war. I am glad to have an opportunity today to pay tribute to its many achievements over that period.

The Government are responsible for keeping the arrangements for health protection always under review. Last year, we consulted on proposals to create the new Health Protection Agency. The proposals were aimed at strengthening existing arrangements by integrating in one body responsibility for action not only on infectious diseases but on chemicals and radiological protection. I am glad to say that support for the proposals was widespread. We have taken them forward, and the Health Protection Agency was established as a special health authority on 1 April this year. Many of the functions previously carried out by the PHLS, along with the staff concerned, have already transferred to the new agency.

Chris Grayling (Conservative, Epsom and Ewell)

Is it not the case that the statutory instrument establishing the special health authority has not yet been passed by the House?

John Hutton (Labour, Barrow and Furness)

I am not aware of that, but the agency has certainly been established and is operational. I will examine the issues concerning the parliamentary timetable and clarify them for the hon. Gentleman.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

My hon. Friends and I prayed against a statutory instrument that was due in Standing Committee some weeks ago. That Committee had to be postponed because it would have clashed with this Committee's sittings on Tuesdays and Thursdays, and I have been waiting for it to be rearranged for some time. The hon. Member for Epsom and Ewell (Chris Grayling) has a point because it would have been good to discuss the secondary legislation before discussing this primary legislation.

John Hutton (Labour, Barrow and Furness)

I am sure that the hon. Gentleman is right that it would have been better to do that. The order is subject to the negative resolution procedure and the agency has already been established. If the House were to annul the regulations, we would have to introduce others. The negative resolution procedure is

not an obstacle to the new special health authority beginning its operations.

Andrew Lansley (Conservative, South Cambridgeshire)

Will the Minister confirm that the Government will not, in the long-term, leave the agency as an executive agency, but intend to create a non-departmental public body, presumably through further primary legislation, to incorporate the National Radiological Protection Board? When will that happen, and why is the Bill not an appropriate legislative vehicle for that?

John Hutton (Labour, Barrow and Furness)

We shall deal with the Health Protection Agency in primary legislation at the first available opportunity. We could not do that in the Bill for a variety of reasons, most of which concerned the preparation of the Bill. We want to do that as soon as possible, and it will certainly be necessary. I can confirm what the hon. Gentleman said about the functions of the NRPB. However, the HPA has been established and is up and running, and we want to build on that in subsequent primary legislation.

Chris Grayling (Conservative, Epsom and Ewell)

Will the Minister confirm whether Parliament has yet to endorse the formation of the special health authority and its legal status as an organisation of the HPA?

John Hutton (Labour, Barrow and Furness)

It is a special health authority and has been set up as such. I am grateful to the hon. Member for Oxford, West and Abingdon (Dr. Harris) for reminding me that the regulation has been prayed against. [Interruption.]

Win Griffiths (Labour, Bridgend)

Order. Conversations in the Room are getting rather loud.

John Hutton (Labour, Barrow and Furness)

It is possible that the House may decide to annul the regulations, but then we would have to introduce other regulations to give effect to our intention. However, the establishment of the special health authority would not be affected by that procedure. As I understand it, prior authority was not required to set up the special health authority.

To return to the amendment, the functions of the PHLS have been transferred, largely to the special health authority. One residual function for which it will remain responsible is the supply of some of the microbiology culture used by the NHS. Obviously, it will be necessary to review with the PHLS how such supplies can best be secured in the future. We would not want to abolish it unless and until those issues had been properly resolved, as I am sure they will be.

In a nutshell, there is no further need for the PHLS or its board to remain in existence on the statute book. We announced our intention last November to abolish them when legislative time permitted. The new clause simply puts that policy into effect.

Chris Grayling (Conservative, Epsom and Ewell)

It was interesting that the Minister did not pass me a copy of the explanatory notes. Given the Committee's experience some 10 days ago of the Government's failure to provide notes to a very late set of amendments and the scramble that took place immediately afterwards to provide them, I would have thought that the Department had learned its lesson and would ensure that such information was provided

when introducing a totally new dimension to the Bill, as it has in the amendment.

The proposal was not set out in the original draft of the Bill. That would have been perfectly possible, because plans to form the HPA and to take responsibilities from the PHLS were set out many months ago. There is no earthly reason for such matters not to have been included in the Bill. It is unfortunate that the Department has failed to come forward with any explanatory notes in advance of the Minister's remarks.

John Hutton (Labour, Barrow and Furness)

I did not respond to the hon. Gentleman's point because I understood that the ruling of the Chair was that it was not a point of order; otherwise, I would have. It may be helpful if I remind the hon. Gentleman that the provision of such notes is not customary practice. In fact, I cannot remember previous Governments, particularly Conservative Governments, producing additional notes. It is the practice on the introduction of a Bill to provide a set of explanatory notes and an explanatory memorandum, but it is not a rule or procedure of the House to provide notes for subsequent Government amendments tabled in Committee. We do so as a courtesy to advise members of the Committee what is happening.

As the hon. Gentleman helpfully reminded the Committee, the policy was announced several months ago, so every member of the Committee would have been fully aware of it.

Chris Grayling (Conservative, Epsom and Ewell)

The provision of notes may indeed be a convention, but common courtesy dictates that, if a new dimension is added to a Bill at a very late stage, it would do no harm, to say the least, to provide such information, particularly given the Committee's experience last week when the sitting had to be suspended because of the Department's failure to brief Members about the steps that it was taking. I am surprised that it saw fit to table additional clauses without providing information.

John Hutton (Labour, Barrow and Furness)

In a sense, the Committee is demob-happy this afternoon, which is not surprising, given that we all lead other lives.

The hon. Gentleman is expounding a very interesting constitutional principle. One thing that I have learned, not only in government but in opposition, is that when Opposition parties table very long, complicated amendments, we never have any explanatory notes or memorandums from them. That is a constitutional theory that he might like to develop.

Chris Grayling (Conservative, Epsom and Ewell)

I can safely say to the Minister that, if we come face to face again across the Committee Room and if he is puzzled by any of the amendments that I have been involved in tabling, I would be delighted to take a phone call from him and explain them to him.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

The constructive point, which I hope is still just within order, is that if GPs vote tomorrow to support, or make an announcement that they support, the new contract, and the Government then table a huge number of new clauses on Report as we expect, a

set of explanatory notes will be welcome and very important.

Chris Grayling (Conservative, Epsom and Ewell)

The hon. Gentleman makes a very good point. Clearly, that is on a different level from this issue.

John Hutton (Labour, Barrow and Furness)

We shall certainly do that.

Chris Grayling (Conservative, Epsom and Ewell)

I am grateful for that. So, setting that point aside—

Win Griffiths (Labour, Bridgend)

Order. That is exactly what I was going to say. Can the hon. Gentleman carry on with his comments on the amendment?

Chris Grayling (Conservative, Epsom and Ewell)

It is quite extraordinary that the Government are introducing in Committee a measure to abolish the residual PHLS before the House has debated the formation of the new organisation. Up to now, there has been only a Government announcement to the press. The Minister will correct me if I am wrong, but I think that there has been no statement to the Chamber about the plans, although there have been several written answers. The Government have made no formal statement to the House and have offered it no opportunity to debate the change.

This is quite a substantial change. The Government are bringing together a significant number of previously autonomous and separate bodies, and they are transferring laboratory services from a central organisation that provides a national monitoring network of outbreaks of disease and potential incidents of biological and chemical attack. That structure has been totally changed. The laboratories that would have provided that on-the-ground service have been transferred into local NHS trusts.

Andrew Lansley (Conservative, South Cambridgeshire)

On that point, which is relevant to something that I hope to say if I catch your eye, Mr. Griffiths, that does not include all laboratories. Nine regional laboratories have been retained as part of the Health Protection Agency, including the one on Addenbrooke's site in my constituency.

Chris Grayling (Conservative, Epsom and Ewell)

My hon. Friend makes an important point of clarification, but none the less, of the 44 public health laboratories, the vast majority—80 per cent.—have transferred to local trusts.

The reality is that a major change has taken place, which we are being asked finally to rubber-stamp today in the amendments. We are being asked to approve the abolition of the PHLS before the House has had the opportunity to debate the formation of the Health Protection Agency. I commend the hon. Member for Oxford, West and Abingdon on his prayer against the measure, which I very much support. I confess to having been beaten to something by his team—not a frequent occurrence. I can update him—that Committee sitting is due to be held on 26 June.

That will be the first opportunity that the House will have to discuss the changes and to decide whether it wants to establish a special health authority. Six days earlier, a Standing Committee is being asked to finalise the abolition of the predecessor body. That seems constitutionally bizarre and, at the very least, an improper approach to the processes of the House. In

my view, such significant changes should be debated properly before final decisions are taken. That is what next week's debate will enable MPs to do, but many months too late. The Government seem to believe that they can produce their policies, enact them and then ask the House for approval as an afterthought; that cannot be right.

I turn to the residual point. We know that most laboratories were transferred to NHS trusts or to the Health Protection Agency on 1 April. There is now only a residue of the previous organisation. The Minister made reference to the culture development operations at the PHLS, saying that no decisions have yet been taken about them and that the measure will not be enacted before the rest of the package. He will be aware that there has been considerable speculation, not least among staff, that the end process of the exercise will be privatisation or some form of trade sale of the culture operations.

Can I ask the Minister if that is one of the possibilities being considered? If he does not intend to privatise what is effectively a business—he made reference to whether the NHS had to secure the future supply of such cultures—is he considering a closure? Is he looking to buy cultures for the laboratories from third-party sources in future, or does he intend to retain the operation as a state-owned business? I would be grateful if he could clarify that for the Committee.

Will the Minister also clarify another point of confusion following the establishment of the HPA? One of the responsibilities that the former public health laboratories had was the monitoring of food. There may have been poisons in food, such as toxins put in deliberately. Let us consider the example of a food scare in relation to baby food. The message would have gone out from the centre of the PHLS to the different laboratories to say that they needed to investigate the matter. Laboratory staff would have gone to supermarkets and bought supplies of the brand of baby food concerned, and run tests on it. That would happen all around the country, and as a result, they would have been able to identify whether they were dealing with a one-off incident or a significant incident spread over a broad geographic area.

I understand that, with the dismantling of the public health laboratories, a number of the trusts taking over laboratories have declined to take responsibility for food, water and environmental microbiology. If a number of NHS trusts have declined to take over responsibility for key areas such as food monitoring, do those responsibilities still remain with the residual body of the PHLS? In today's discussion, are we seeking to abolish those bodies? If it is not the case that the residual body has retained responsibility, when did the transfer of responsibility for the monitoring of food take place, and where has it gone? Who is now responsible for the monitoring of foods as previously carried out by the PHLS?

I also want to ask about the residual financial liabilities for the PHLS. It was not clear from written

answers that I received before 1 April what would happen to those liabilities. Have they been transferred to the Health Protection Agency, and if so, in what amount? If not, do they remain with the Public Health Laboratories Board, and if so, in what amount? If they remain with the Public Health Laboratories Board, what will happen to those liabilities when the measure is enacted? Is that simply a liability that will be absorbed by Government? Will the Minister explain that?

Lastly, I would like to ask the Minister about a further dimension of the statutory and legal issue. He made mention of the fact that the establishment of the HPA as a non-departmental public body was not in the Bill and would have to return as future legislation. Clearly the legislative timetable in the House is extremely full, and it is certain to be some time before that can take place. Will the Minister explain more clearly, given the time frame that we have discussed in relation to the policy change, why it was not possible to start work on the relevant drafting much earlier?

Given that it has proved possible to bring forward an amendment that would allow the abolition of a core residual body, why was it not possible to establish the Health Protection Agency as a non-departmental public body? Is that because of disputes that remain between the Scottish Executive and the Government in Westminster over the relationships between the different parts of the National Radiological Protection Board in England and Scotland, and the reluctance in Scotland to have a national body covering that area? I would be grateful if the Minister would clarify those points for the Committee.

Andrew Lansley (Conservative, South Cambridgeshire)

I want to comment on the Health Protection Agency. I hope that you will bear with me, Mr. Griffiths. My remarks will not necessarily relate precisely to the residual functions, but I hope that you will give me a little latitude.

Win Griffiths (Labour, Bridgend)

I am listening carefully.

Andrew Lansley (Conservative, South Cambridgeshire)

Indeed. I shall try to stick as closely as I can to the subject. I suspect that I shall not be present if there is a discussion about the establishment of the special health authority next week.

My hon. Friend the Member for Epsom and Ewell raised a number of questions, to which it would be interesting to have the answers. I had understood that, as far as the east of England was concerned, responsibility for food, water and the environment had gone to Chelmsford to a separate laboratory under the HPA. It will be interesting to see if that is how things work.

Chris Grayling (Conservative, Epsom and Ewell)

My hon. Friend will be aware that the original intention was that responsibility for food would remain within the individual local laboratories. In some cases, the trusts have refused to take responsibility.

Andrew Lansley (Conservative, South Cambridgeshire)

My hon. Friend makes an interesting point. I would be interested to hear the Minister's response.

The Minister expressed his appreciation of what is being done by the Public Health Laboratory Service. I just wanted to add my appreciation to that. About 100 staff work in the laboratory at Addenbrooke's in my constituency and we appreciate the value of the work that they do. During the past few weeks—my hon. Friend the Member for West Chelmsford (Mr. Burns) will be aware of this—the only identified SARS case in the east of England, which originated in Chelmsford, was identified in an ambulance and transferred to Addenbrooke's. The laboratory at Addenbrooke's and the communicable disease surveillance centre at Colindale would do the work associated with dealing with that virus. To give another example, I know that many Members will be concerned, as Ministers are, about the level of hospital-acquired infections. The laboratory at Addenbrooke's is taking a leading role in the expanded reporting on hospital-acquired infections that Ministers are rightly expecting of NHS hospitals—going beyond methicillin-resistant Staphylococcus aureus.

The laboratories are involved in vital tasks. Although the structure has changed, I want to ensure that there will be co-ordination between a range of different functions extending to the support of emergencies, including chemical, biological and radiological releases into the environment. All that activity should certainly be brought together in relation to emergency responses. The draft Civil Contingencies Bill was published elsewhere today. That is a further instance of the way in which things need to be connected properly to create a more effective route for dealing not only with naturally occurring diseases, but with emergencies that might arise through terrorism.

It would be useful to explore a number of issues with the Minister. I will not necessarily raise questions; I will talk about my feelings about how things will develop. As I discussed with my hon. Friend the Member for Epsom and Ewell, not all the laboratories have transferred to the host trusts. In particular, the laboratory at Addenbrooke's, which is one of the nine regional laboratories, continues to be directly provided as a laboratory of the Health Protection Agency and the staff are the agency's staff. On the face of it, that is not a problem, but in the context of the Bill a different question arises. The Committee will have heard more often than it would have thought likely about the likelihood of the Addenbrooke's NHS trust becoming a first wave foundation hospital. One of the consequences of that is that Addenbrooke's may be an early implementer of ''Agenda for Change''. As the Minister knows, that may well lead to the exercise of additional pay flexibilities in that context at Addenbrooke's from an early date.

That is fine; I have no problem with it, and it is highly desirable that it should happen, but if the Health Protection Agency is not implementing ''Agenda for Change'' at the same time as Addenbrooke's, staff of the same character from the same professional groups on the same site might be earning different amounts as a result. There would be difficult consequences for recruitment for the Health

Protection Agency laboratory on the Addenbrooke's site, even if that were only transitional. I hope that the Minister will bear that in mind, not in order to delay the implementation of ''Agenda for Change'', but perhaps to ensure that if those two things are to happen, they can at least happen alongside each other on the same site, which would be much better for management reasons.

It is also true that the way in which the pathology and microbiology of hospitals in the Cambridge area are being managed is increasingly a matter of networks. I opened the new laboratories at Papworth hospital, which is also seeking to be a first-wave foundation trust. One consultant and several functions there are in practice managed by Papworth and Addenbrooke's together. In effect, a clinical network is already established between different hospitals, including the West Suffolk hospital, which has no intention of becoming a foundation trust in the first instance. We have a network, and a range of laboratory managements will actively run such matters together. However, the Addenbrooke's laboratory sits outside in the Health Protection Agency and is on a contract to the trust.

It is not for me to prejudice management discussions and I am not expert enough to be able to say whether it would be right for the laboratory to transfer to Addenbrooke's and be part of Addenbrooke's management, but I certainly hope that the Department can confirm that it is thinking carefully about that and is in active discussions with Addenbrooke's. If it is to have the management independence implied by foundation status, Addenbrooke's should be able to manage its pathology and microbiology activity as well. To do that, it would be better for it to own the laboratory, and contract to, and provide a service for, the Health Protection Agency, rather than the other way round.

One of the principle issues that stands between the present situation and that event is the structure of funding, which my hon. Friend the Member for Epsom and Ewell mentioned. If I understand it correctly, apart from Addenbrooke's contract with the trust, there is the question of core funding. The purpose of core funding is, in theory, the provision of funding to allow research and development, to provide for the public health and emergency activities of the laboratory and to allow an excess of capacity in the laboratory, beyond what the trust itself would purchase, to meet surges in demand. Particularly in the case of an outbreak in infection, that would enable it to respond with all the necessary laboratory capacity. However, in practice, core funding has tended to subsidise trusts' normal day-to-day activities.

If PCTs are to commission such activity from trusts in future, they will look carefully at what precisely the laboratories offer. If a PCT is to be responsible for core funding, instead of just having ring-fenced funds that are automatically transferred from the trust for laboratory activity, it will want to know more specifically what it is buying from the trust. It might not necessarily pursue the same route that has been pursued in the past: paying for surge capacity, paying

for research, and supporting and subsidising the trust's activities. My point is that one must be more sure about the level of funding that will be provided through the primary care trusts to laboratories that pass into the ownership of the hospital trusts or, in Addenbrooke's case, the foundation trust. If the Minister cannot help on that matter today, I hope that he can clarify how the core funding will work soon.

I have one other point, which is allied to the point about ''Agenda for Change''. In the past—I am trying to remember precisely when—I have tackled the Department of Health on the status of a number of health service professions and their ability to recruit. Addenbrooke's high reputation means that it is not difficult to recruit medical staff and, in particular, senior medical staff.

It is difficult to recruit biomedical scientists, who are an essential part of the laboratory process at Addenbrooke's. Not only do I want the question of ''Agenda for Change'' to be resolved, but there is a wider question about the recruitment of staff for the Public Health Laboratory Service or the Health Protection Agency. It is certainly possible for a biomedical scientist to become a clinical scientist and even to reach consultant status. In the past, I have argued to Ministers that we should be more open to the possibility of people moving between professions, or, more to the point, biomedical scientists, while remaining within the profession, should be able to acquire the status associated with clinical scientists up to and including consultants. For a graduate profession, biomedical scientists lack status within the NHS and their pay levels are very low compared with their qualifications and other professions.

Having said that, I must declare a family interest: some 32 years ago my father was chairman of the Institute of Biomedical Science. When Labour Members were decrying Conservative Members' recognition of and support for the values of the NHS—my hon. Friend the Member for West Chelmsford may be entertained by this—I was sitting here and looking across the river because on the day that the NHS was created, my father was working in a laboratory in County hall for London county council. He became an NHS employee on that day and worked for it for the rest of his working life—happily, he is still alive—including working at East Ham memorial hospital for about 30 years before retiring in 1983. He was always an NHS employee, and he and I have always subscribed to the values of the NHS.

Win Griffiths (Labour, Bridgend)

Order. I feel that I have helped the hon. Gentleman, but I must ask him to refer to the amendment or to take his seat.

Andrew Lansley (Conservative, South Cambridgeshire)

You have been a gent, Mr. Griffiths. Happily, I am about to conclude, but I wanted to find an opportunity to tell that story, and I thought that the issue of biomedical scientists in my constituency in the laboratory at Addenbrooke's was a suitable moment.

I hope that the Minister will consider my thoughts on the practical issues concerning the Health

Protection Agency, and in particular HPA laboratories as distinct from those that have been transferred to the trusts that house them.

John Hutton (Labour, Barrow and Furness)

I shall briefly deal with some of the points raised by Opposition Members. On the points made by the hon. Member for South Cambridgeshire (Mr. Lansley) on core funding, for the convenience of the Committee it will be better if I write to him, and I am happy to copy the letter to other members of the Committee. He raised several questions about ''Agenda for Change'' and the overall level of pay in the NHS for biomedical scientists. It is true that Papworth, because it is applying for NHS foundation trust status, that will be one of the early implementers of ''Agenda for Change'', and that should be welcome news for the staff at that trust. Obviously, the staff on the site who now work for the HPA work for a different employer. I understand that the close proximity with Papworth—

Andrew Lansley (Conservative, South Cambridgeshire)

Addenbrooke's.

John Hutton (Labour, Barrow and Furness)

Addenbrooke's, I am sorry. The HPA staff at Addenbrooke's are not covered by our early implementation agreements with the trade unions on ''Agenda for Change'', and it is probably best to stick to the agreements if we can.

The hon. Gentleman is right to point out that the problem is one of transition. The time period is actually relatively short. Subject, of course, to the experience of the early implementers, we will move to national implementation of ''Agenda for Change'' by next October. Therefore, I am fairly confident that the time involved will not operate in the negative manner that he fears.

I agree about the overall importance of attracting science graduates into biomedical science careers in the NHS. It has not always been easy to do that. Biomedical science is one of those vital NHS jobs that never get the publicity or focus that they merit. It is an essential service, and it is true that it has never offered the right pay.

I am glad that those issues are now being addressed, not only in the action that we have already taken to increase the starting salaries of, for example, biomedical scientists, but also in the proposals in ''Agenda for Change''. I am confident that we are heading in the right direction. We certainly need to, because so much work of the NHS depends on the skills and commitment of biomedical scientists.

The hon. Member for Epsom and Ewell asked about the media production facilities that the PHLS continues to operate. He knows, because he pays attention to such matters, that the PHLS board is consulting on options for the future of those facilities, including transferring them to other parts of the NHS or to the independent sector. No decision has yet been made on the final disposal options, and it is unlikely that there will be one until later this summer.

I apologise to the Committee for not making it very clear in my opening remarks—perhaps other comments would have been shorter, particularly

those from the hon. Member for Epsom and Ewell—how important it is that we all understand what we are doing in these arrangements, not just with the new clause but in the transfer of functions to the Health Protection Agency. We are not diluting the importance of this NHS service but finding a way to improve its effectiveness.

It is always worth bearing in mind that the PHLS laboratories have done an outstanding job of work for the country. We should never forget that. However, 32 former PHLS laboratories were transferred to local NHS management as of 31 March, and a much larger number—10 times that many—of laboratories that provide a similar service already operate under local NHS management in England.

Chris Grayling (Conservative, Epsom and Ewell)

Does the Minister realise that in most cases where the transfer has taken place there is not yet an individual charged with responsibility for delivering HPA requirements? I understand that service level agreements are not yet in place to ensure that the information that would have flowed from the laboratory to the centre continues to do so.

John Hutton (Labour, Barrow and Furness)

Obviously, the focus is on maintaining the quality levels of service in the laboratories. It is the job of the HPA to ensure that they are not lost.

The hon. Gentleman asked several questions about the transfer of residual liabilities. Liabilities in respect of the laboratories were transferred with the functions to the HPA at 31 March. That is covered by the statutory instrument, which will be subject to parliamentary debate later this month. Liabilities for media production will remain with the PHLS board, but the clause makes provision for any residual liabilities to transfer to my right hon. Friend the Secretary of State, should the need arise.

The hon. Member for Epsom and Ewell asked about food, water and environmental microbiological testing. He will be aware that in England, HPA-run laboratories are concentrating on reference microbiology. The HPA is responsible for providing food, water and environmental microbiology for local authorities as the Public Health Laboratory Service previously did, which local authorities said that they wanted. Food, water and environmental microbiological testing will be commissioned by the Health Protection Agency on a business-as-usual basis. I have not been advised of any trusts that have refused to take responsibility for food, water or environmental sample testing. If the hon. Member for Epsom and Ewell has examples where he thinks that is the case, I would be grateful if he would write to me and let me know so that I can take action to ensure that proper levels of service are maintained.

Amendment agreed to.

Schedule 12, as amended, agreed to.

Clause 176 ordered to stand part of the Bill.

Clause 177 - Commencement

John Hutton (Labour, Barrow and Furness)

I beg to move amendment No. 334, in

clause 177, page 90, line 27, leave out 'to 48 and'.

Win Griffiths (Labour, Bridgend)

With this it will be convenient to discuss the following: Government amendments Nos. 335 to 338, 451 and 561.

Government new clause 17—Amendment of provision relating to reform of Welsh health authorities.

John Hutton (Labour, Barrow and Furness)

The amendments make changes to the commencement clause. Amendment No. 334 is consequential to amendments Nos. 279, 280 and 281, which as hon. Members will remember, removed clauses 46, 47 and 48 of the original Bill. The clauses relate to annual reviews, other reviews and investigations, and failures in compliance by NHS foundation trusts.

Amendment No. 335 inserts in the appropriate place a reference to clause 82 of the Bill to correct another error in the Bill. Amendment No. 336 also corrects an error in the original print of the Bill. Amendment No. 337 reflects the fact that the current clause relating to the Commission for Social Care Inspection's duty to have regard to Government policy is being replaced by a new clause. The provision provides for a commencement of that new clause.

Amendments Nos. 338 and 451 provide for the commencement of the new clauses in the Bill relating to CSCI's ability to provide advice and assistance to the Governments of the Isle of Man and the Channel Islands at their request, and to publish reports of its inspections of boarding schools. New clause 17 and amendment No. 561 cover technical matters, which I hope will not take too long to go through.

New clause 17 corrects an error in the Government of Wales Act 1998, arising from an amendment to that Act made by the National Health Service Reform and Health Care Professions Act 2002. As it stands, section 27A of the 1998 Act refers to section 8(5)(b) of the National Health Act 1977, when it should refer to section 8(7)(b). The new clause corrects that error, which arose because of a renumbering of the provisions in the later Act.

Amendment No. 561 makes an amendment to clause 177 to provide for the new clause to come into force on Royal Assent, which will enable the statute book to be corrected as soon as possible.

Chris Grayling (Conservative, Epsom and Ewell)

I have two questions for the Minister. One relates to subsection (1), which states that the provisions

''shall come into force on such day as the appropriate authority may by order appoint.''

I am concerned that if the measures are introduced at separate times in Wales and England, we could end up with the curious anomaly of having a new Welsh inspectorate set up before the Commission for Healthcare Audit and Inspection was set up. Therefore, the Welsh inspectorate would have to deal with the Commission for Health Improvement before CHAI was set up. It would seem illogical that there are separate commencement dates for measures that apply jointly to England and Wales, or where there is logical and obvious operational need for the changes to continue in parallel. I would also like to ask the Minister if he could explain the purpose of subsection (3).

John Hutton (Labour, Barrow and Furness)

Clause 177(3) is a traditional clause. He will find similar provisions in most commencement clauses. It is fairly evident what it means: different days may be appointed for different purposes in the context of commencement. In relation to the point about commencement in Wales, I hope that that situation will not arise, but I do not believe it would be a huge difficulty if it did. In this House we have all had to come to terms—the Government have done so willingly, the Opposition less so—with the fact that devolution means that in Wales, those decisions are taken by the National Assembly. We in this House make decisions for England, but that is the devolution settlement.

Amendment agreed to.

Amendments made: No. 335, in

clause 177, page 90, line 28, after '120', insert '82'.

No. 336, in

clause 177, page 90, line 28, after '120', insert '122, 124'.

No. 337, in

clause 177, page 90, line 28, after '120', insert

'(duty to have regard to government policy: CSCI),'.

No. 338, in

clause 177, page 90, line 28, after '120', insert

'(arrangements with the Isle of Man and Channel Islands: CSCI),'.

No. 502, in

clause 177, page 90, line 33, leave out 'section 42' and insert

'sections 42 and (CHAI fees: Wales)'.

No. 451, in

clause 177, page 90, line 36, after '105', insert

'and (boarding schools and colleges: reports)'.—

No. 561, in

clause 177, page 91, line 13, at end add

'or to section (amendment of provision relating to reform of Welsh health authorities)'.—[Mr. Hutton.]

Question proposed, That the clause, as amended, stand part of the Bill.

George Young (Conservative, North West Hampshire)

The clause deals with the commencement orders. On what day does the Minister, as the appropriate authority, intend to introduce the various parts of the Bill?

John Hutton (Labour, Barrow and Furness)

Yes, right. How much time does the right hon. Gentleman think we have to do that? I cannot give him a specific timetable for the introduction of every clause of the Bill, and he knows perfectly well why. Some of those decisions will be made on the basis of contingent events as yet unclear. We will introduce the Bill and commence the clauses, and we will keep him informed; obviously, he will want to know when we do all those things. We talked about our commencement intentions in many of our discussions on earlier clauses, and he will want to reflect on that. For example, in relation to the provisions that we discussed during this morning's proceedings—I do not know whether he was here—we have in mind to introduce and commence the dental provisions no later than April 2005.

There will be different dates for different parts of the Bill, depending on other developments. The clauses on foundation trusts will be commenced at the earliest possible opportunity.

Question put and agreed to.

Clause 177, as amended, ordered to stand part of the Bill

Clause 178 - Transitional or transitory

John Hutton (Labour, Barrow and Furness)

I beg to move amendment No. 632, in

clause 178, page 91, line 21, leave out

'in relation to Part 3'.

Win Griffiths (Labour, Bridgend)

With this it will be convenient to discuss Government amendment No. 633.

John Hutton (Labour, Barrow and Furness)

Again, these are minor, technical amendments that will allow any order-making transitional, supplementary or consequential provision under clauses 178 or 179 to modify an Act of the Scottish Parliament if necessary. That will allow, for example, cross-references to this Bill, should it be enacted, to be made in Scottish legislation.

Originally, it was thought that that would be necessary only in relation to part 3, but on further consideration we have decided that we cannot rule out the possibility that it may be necessary to make such provisions in relation to other parts of the Bill, such as part 4 and the welfare food provisions in part 5. The amendments are simply designed to enable us to do that if necessary.

Chris Grayling (Conservative, Epsom and Ewell)

I have a quick question for the Minister. Is the amendment purely technical, or will it permit statutory changes to Scottish legislation? If so, that slightly goes against the devolution principle. Where is the line drawn with these powers?

John Hutton (Labour, Barrow and Furness)

The amendment does not go against the devolution settlement. It is designed to reflect the proper division of responsibilities between the Scottish Parliament and Executive and the Westminster Parliament. This is about defining parameters and ensuring that the legislation is amended as provided for here in relation to matters that are not devolved.

Amendment agreed to.

Clause 178, as amended, ordered to stand part of the Bill.

Clause 179 - Supplementary and consequential provision

Clause 180 - Extent

John Hutton (Labour, Barrow and Furness)

I beg to move amendment No. 634, in

clause 180, page 92, line 1, at end insert—

'( ) sections 119 and 120;'.

I reassure the Committee that this is a minor technical amendment that will not take too long to deal with. Clauses 119 and 120 allow CHAI and CSCI to enter into arrangements with the Ministers responsible to inspect health and social services provided in settings such as the armed forces. Clearly, as responsibility for the armed forces is not a devolved matter, such arrangements theoretically could extend to Scotland and Northern Ireland. The amendment extends the clauses to Scotland. As members of the Committee will know, the Bill already provides that the clauses extend to Northern Ireland.

Amendment agreed to.

Clause 180, as amended, ordered to stand part of the Bill.

Clause 181 ordered to stand part of the Bill.

New clause 17 - Amendment of provision relating to reform of Welsh health authorities

New clause 18 - Abolition of Public Health

New Schedule 1 - Amendments consequential on the

John Hutton (Labour, Barrow and Furness)

At this happy moment—[Hon. Members: ''Hear, hear!''] I know that everyone wants me to make this brief, and I will. May I record, on behalf of my hon. Friends and, I hope, other hon. Members—they will speak for themselves—our appreciation of the way in which you and Mr. Atkinson have chaired our proceedings, Mr. Griffiths? In a delightful way, you have been strict, fair and funny and we have all enjoyed serving under your leadership. I also extend, through you, our appreciation to the Officers of the House who have, again, shown distinction in supporting the work of right hon. and hon. Members. It may not be customary, but I should like briefly to express my appreciation to the many officials in the Department of Health who have provided support to my hon. Friends on the Front Bench. I have greatly appreciated their help.

This has been a generally well-tempered Committee. We have had some good debates, which have been of a high quality. I finish by expressing my appreciation to all members of the Committee, on both sides, for their forbearance and good humour, which have made the past four or five weeks of my life an unforgettable experience.

Simon Burns (Conservative, West Chelmsford)

On behalf of my right hon. and hon. Friends, I thank you and Mr. Atkinson for the exemplary way in which you have chaired our proceedings, Mr. Griffiths. You made them flow with ease and humour, and in a way that achieved the purposes of the Committee. I also thank the staff of the House, particularly the Clerks. As you know, Mr. Griffiths, we do not have access to parliamentary draftsmen, so we are particularly grateful to the Clerks for their help, which has been beyond the call of duty, in assisting us to make our opposition more relevant and effective.

I thank my right hon. and hon. Friends for all that they have done during this Committee to make it both informative and interesting.

I congratulate the Minister on the fluent way in which he led for the Government. I also congratulate him on being the great survivor of the Department of Health, despite our having started a mere five weeks ago. Then, we had three Ministers from the Department in the Committee; now, like ''Home Alone'', the Minister is here alone as the only representative of the Department of Health.

I also congratulate the Government Whip on his promotion during the course of our proceedings.

Perhaps surprisingly, there is one member of the Committee to whom every Member on both sides of the Committee—except perhaps two—owes thanks. I should like to pay particular tribute to the honesty and straightforwardness of the hon. Member for Cheadle (Mrs. Calton), who, unfortunately, is not present in the Committee. For many years, Government and Conservative Members have made the case that the Liberal Democrats will tell anyone anything in the hope of winning a vote. Thanks to this Committee and the honesty of the hon. Lady, we now have that on the record.

The Conservative party is reminding people throughout the country—as, no doubt, is the Labour party—of our second sitting, so many weeks and debates ago. It stands out like a beacon as a rare occasion of honesty and straightforwardness. When asked how an hon. Member can vote against the principle of foundation hospitals on the Floor of the House and then, within a week, tell the Committee that she supports her constituents' bid for foundation status in her constituency, the hon. Lady told us:

''We can all modify our opinions according to local circumstances.''—[Official Report, Standing Committee E, 13 May 2003; c. 57.]

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I was about to associate myself with all the comments that have just been made by the Minister and the hon. Member for West Chelmsford, but the hon. Member for West Chelmsford spoiled that. With the exception of his final comments, on which I shall not be drawn at length but to which I will return, I should like to associate myself with what he said.

The Minister said that the conduct of the Committee had made the last five weeks of his life unforgettable. I hope that he did not mean that literally and that he was not claiming that his life was to be terminated. I hope that he was referring to the ''past'' five weeks of his life.

It is no reflection on the Minister or on your chairmanship, Mr. Griffiths—and that of your colleague, Mr. Atkinson—that we did not discuss a significant number of clauses, particularly those dealing with CHAI and CSCI. The House should reflect on whether it is satisfactory that under a programme motion, we have spare time at the end of this sitting that could have been used for consideration

of those clauses. It is worth noting that—through no fault of yours, Mr. Griffiths, your colleague or, indeed, Opposition Members—large chunks of the Bill will go on to the statute book without being discussed in Committee.

Finally, the hon. Member for West Chelmsford must be dealt with. I am pleased that he has corrected himself. When he first raised what he considers to be those famous words, he said that my hon. Friend had said that principles could be altered according to local circumstances. He has demonstrated that he was wrong to say that—[Interruption.] The hon. Gentleman claimed on a number of occasions, as he can see from the record, that my hon. Friend had said that people's principles could be altered to fit local circumstances. That is not what she said.

The hon. Gentleman gave me notice five weeks ago that he would raise this and I am prepared to put on the record that if foundation trusts become the only game in town—as with PFI, another policy whose introduction we might regret—in terms of improving services for local people, we will be prepared to support our local hospitals while regretting the fact that that is the only option available. I know that that applies to some Labour Members, although they will not admit it. Unlike the hon. Member for West Chelmsford, we have proposed alternatives to Government proposals, as the record will show. The Conservatives have provided none. It has been enjoyable sparring with the hon. Gentleman, particularly when he thinks that he has won but has not. Events will show that to be the case.

Question put and agreed to.

Bill, as amended, to be reported.

Committee rose at twenty-nine minutes to Four o'clock.