Health: Brittle Bone Society

Lord Colwyn Excerpts

Monday 6th June 2011 Lords Chamber

[Earl Howe]

My noble friend is absolutely right. As he knows, the UK is one of the pioneers of genetic research; it takes a lead role in the international human genome project and its application to medicine. The human genome project has sequenced the 25,000 or so genes that make us human and research is now looking at how groups of genes interact not only with each other but with environmental factors to cause disease. We remain absolutely committed to genetics research and aim to make the UK the best place in the world for that research to continue. If there are proposals relating to this specific condition, my department will be very pleased to receive them.

[Lord Colwyn]

My Lords, would my noble friend also pass his invitation to researchers in dentinogenesis imperfecta?

[Earl Howe]

My Lords, I shall need a small tutorial from my noble friend on that condition, which is not mentioned in my brief, I fear.

Health: Sickle-Cell Disease

Lord Colwyn Excerpts

Monday 14th March 2011 Lords Chamber

[Earl Howe]

I am in danger of giving the noble Lord the wrong answer and, if I do, I shall regret it. I had better write to him.

[Lord Colwyn]

My Lords, I declare an interest as chairman of the All-Party Parliamentary Group on Emergency Ambulance and Paramedic Services. The College of Paramedics is very aware of the skills levels of ambulance staff. Will the Minister consider the use of badges to identify staff according to their registration status, so that all concerned parties are enabled to make reasonable assumptions about their abilities as regards treatment and overall incident management?

[Earl Howe]

My Lords, I am aware of the suggestion to which my noble friend refers. The wearing of badges is very much a matter for local determination. Clearly, it is desirable that there should be consistency across the country. I understand that there is a regular meeting of the chief executives of ambulance trusts under the chairmanship of Peter Bradley, the London Ambulance Service chief executive. I suggest to my noble friend that the proposal is put to Mr Bradley as one that the joint chief executives could look at.

NHS: Front-line and Specialised Services

Lord Colwyn Excerpts

Thursday 13th January 2011 Lords Chamber

[Lord Colwyn]

My Lords, I congratulate the noble Lord, Lord Turnberg, on securing the debate and on his knowledgeable contribution. It was a privilege for me to work with him for a number of years at the Medical Protection Society.

I am delighted to be so far up the list this afternoon, although I am not sure if it is an advantage. I was given the number 2 slot in the last debate on health on 16 December and failed to excite the Minister with my questions. He has now kindly been in touch to tell me that there is a letter in my box. I am aware of the tremendous pressure that he must be under. I also failed to make an impression at Question Time earlier today and will make a comment on the regulation of herbal practitioners at the end of my few remarks, which will inevitably concern the dental aspects of front-line and specialised services.

NHS dentistry’s place in the health reforms is unusual. As well as being subject to a change in commissioning arrangements, with responsibility for primary care dentistry being transferred from primary care trusts to the new national commissioning board, dentistry will undergo a parallel overhaul of the way it works, with completely new contractual arrangements being developed. This is a pivotal time for NHS dentistry, in which the mistakes of the previous Government's 2006 reforms can be rectified. It will be vital that our reforms engage the dental professionals who will deliver care under the new system, and I am pleased to say that the British Dental Association has offered its broad support to two important parts of the reforms. The decision to transfer responsibility for commissioning from PCTs to the new national commissioning board has been viewed positively by the profession. Given the problems and inconsistencies witnessed under PCT commissioning, that is unsurprising. Dentists have also been positive about the reforms to the dental contract that the coalition Government are undertaking. These reforms build on the work of Professor Jimmy Steele, whose critical report on the current system has produced a vision of a better system. Pilots will begin in April to develop this.

On the face of it, dentistry looks to have a bright future. The risks inherent in changing systems and commissioning arrangements simultaneously were highlighted by Labour's reforms in 2006, when the ability of PCTs to manage the introduction of the new dental contract was undermined by a reorganisation of primary care trusts that saw their number halved. The success of the coalition Government's reform of dentistry will depend on having the right people in place to manage change at an early stage of the reform process. It will also require a balance to be struck between central commissioning and engaging the local expertise of bodies such as local dental committees and figures such as consultants in dental public health.

Dental public health is an important issue in its own right, and ensuring that dental public health expertise inputs into new arrangements and is integral to the wider reform of public health will also influence the success of the reform of dental care. This House needs assurance that the Government plan to utilise those local dental experts in the new commissioning arrangements.

Another lesson we must learn from the 2006 reforms is the importance of properly testing elements of reform. Two major parts of those reforms, the revised patient charges and the system of units of dental activity by which dentists' work is measured, were not piloted in the lead-up to April 2006. As I said, pilots for the new reforms will commence in April. They will test different models that will include patient registration, quality and capitation. The models are intended to lead to a new dental contract that will facilitate a more preventive approach to dental care. The pilots must be given time, they must be properly evaluated and their lessons must be learnt in dialogue with the dental profession.

The Government will need to tread carefully as they pursue each of these reforms, ensuring that a co-ordinated approach to dentistry is taken across all departments within the Department of Health. They must manage the various strands of reform that will contribute to the creation of new arrangements for primary care dentistry in England. What guarantees will the Minister provide that the work on the three strands that will impact on the delivery of primary dental care—the new contract, public health and commissioning arrangements—will be joined up and co-ordinated?

I conclude with a question that I was unable to ask earlier today. Will my noble friend offer any encouragement to patients and to the practitioners who use herbal medicine and who regard regulation—as recommended in November 2000 by the Walton committee, of which I was a member, and the Pittilo independent report set up by the Department of Health—as vital to the practice and continuation of their profession?

NHS: Reorganisation

Lord Colwyn Excerpts

Thursday 16th December 2010 Lords Chamber

[Lord Colwyn]

My Lords, I thank the noble Lord, Lord Touhig, for introducing the debate today, and I welcome him to the list of the usual suspects who discuss health matters in the Chamber. I have been discussing these matters here for more than 40 years. I cannot say that he made any constructive criticism at all. I remind the noble Lord that the Government are committed to protecting NHS funding and to increasing that funding every year.

I am aware, of course, that the BMA feels that the Government have not listened to constructive criticism of the plans, and it believes that the changes will be difficult to implement effectively. However, I welcome the reorganisation and look forward to hearing the views of other speakers, as it is my intention to concentrate on the issues that affect dentistry. I declare an interest, as I have been a practising dentist for more than 40 years. I am still on the register and am an officer of the All-Party Parliamentary Group for Dentistry.

NHS dentistry in England is undergoing a major overhaul. Three separate changes—shifting responsibility for commissioning dental care from primary care trusts to a new national commissioning board, the creation of new contractual arrangements for primary care dentistry, and the changes to public health—will all impact on the delivery of primary dental care.

I welcome today’s announcement and publication of the plans for pilots for a new, more preventive contract for NHS dentistry based on registration, capitation and quality, and I hope that the Government will ensure that the pilots are fully evaluated in consultation with the profession. These will begin in 2011. They will test new models that focus on providing continuing care for registered patients and they will improve access. The new dental contract will replace the 2006 Labour contract, which unfortunately continued the “drill and fill” treadmill. Plans to increase access to NHS dentistry and improve oral health include a capitation and registration system. This should bring back the real sense of having your own dentist.

We know that the commissioning of dentistry will change as part of the reorganisation of the National Health Service. The White Paper, Equity and Excellence: Liberating the NHS, outlines that dentistry will be commissioned by the NHS commissioning board. This decision has been broadly welcomed by the British Dental Association. We know that in the past local commissioning has been fraught with difficulties. There are significant advantages in the central commissioning of dental services by the NHS commissioning board, but it is important to emphasise that there will be a delicate balance to be struck between central determination and local flexibility.

Local expertise will continue to be vital in understanding and satisfying local needs. There needs to be a strong channel of communication between those tasked with understanding local needs and those responsible for national commissioning. For example, consultants in dental public health play a pivotal role in identifying need and balancing the provision of services to provide the maximum health benefits to diverse populations. It is central to the long-term efficacy of NHS dental services that the expertise of consultants in dental public health is fully utilised in any new system. Therefore, what plans do the Government have to utilise those local dental experts, including consultants in dental public health, dental practice advisers and local dental committees, in the new commissioning arrangements? In addition, we need to be careful that the Government’s positive work towards a new contract is not inhibited by the simultaneous reorganisation of the NHS.

We know that under the Labour Administration, in 2006, a new dental contract was introduced at the same time as PCTs were reorganised, merging them from 303 to 152. During the restructuring, many dental leads and commissioners were not in post to oversee the implementation of the new contract. This caused a number of problems, with many general dental practitioners being offered a contract in the days and weeks before they were expected to deliver it. As a result, a number of practitioners moved away from NHS dentistry.

At a time when growing bureaucracy, red-tape burden and increasing administration are eroding the morale of high-street dentists—and I do believe that this is a serious problem—what assurances can the Government give that we have learnt from the problems of the past, thereby ensuring that another cohort of practitioners is not lost?

Medical Profession (Responsible Officers) Regulations 2010

Lord Colwyn Excerpts

Tuesday 23rd November 2010 Lords Chamber

[Lord Kakkar]

My Lords, we have heard that the key priority of the General Medical Council for patient safety and ensuring continuing standards and confidence of the public in regulation is the process of revalidation. We have heard in the Chamber today very strong support for the regulations.

The early appointment of responsible officers is critical. It will ensure that the system can be tested. The noble Baroness, Lady Thornton, was absolutely right to raise the structure in which responsible officers in the area of primary care will eventually be able to operate, but this matter can be dealt with when the health Bill is laid before Parliament and the primary care structures in it can be appropriately scrutinised.

As we have heard, if the regulations are in any way derailed at this stage, there is a danger that the whole momentum of revalidation will be disrupted. It could cause anxiety in the profession and lead to unhelpful pockets of resistance. There is now an ideal opportunity for a mechanism and the early appointment of responsible officers to test potential systems and determine where the weaknesses are. This will occur before revalidation comes into force in its fullest form, and will therefore allow the General Medical Council to respond appropriately. I add my voice to those of many noble Lords in supporting the regulations.

[Lord Colwyn]

My Lords, although the principles behind revalidation, which aims to raise confidence in clinical standards, are welcomed, there are concerns over the ways in which the Department of Health plans to implement the process through the responsible officer regulations. There is also concern about the new regulations coming into force in January 2011, given the proposals in the recent health White Paper to abolish structures that were intended to support the role.

I agree with the noble Baroness, Lady Finlay, that the demands of the role outlined in the proposals will require a person of quite exceptional skills and competences. It is assumed that many medical directors will become responsible officers, which will significantly extend their role by extending their responsibility, powers and workload.

There is already a marked variation in the abilities of medical directors to investigate performance concerns and implement local disciplinary procedures. The additional duties are likely to be onerous. It is not certain that senior doctors with the necessary professional standing will be willing to take them on, or that it will be possible to find senior doctors with the necessary standing and experience to succeed in this role.

It is essential that adequate resource is allocated to support responsible officers and that they are appropriately equipped to carry out their responsibilities. The guidance to the draft regulations emphasises that there must be a “robust” medical management infrastructure to support the responsible officer and sufficient delegation of duties to enable the role to be delivered to a high standard. How will this work in practice and how will it be resourced?

The draft regulations do not reflect the changes proposed in the White Paper. Reference is made throughout to “designated bodies”. These include PCTs and SHAs, which are to be abolished by 2013. There is no detail on what structures will support responsible officers, revalidation and other aspects of performance management in primary care after 2013. This makes the decision to press ahead and appoint 975 responsible officers to strengthen systems in structures that are to be abolished difficult to understand. Surely, given the decision to delay revalidation and the uncertainty around the structures that will support performance management, more time is needed to pilot and evaluate the responsible officer system effectively before bringing these measures into force in January.

NHS: Prebiotics

Lord Colwyn Excerpts

Wednesday 17th November 2010 Lords Chamber

[Earl Howe]

My Lords, the noble Lord is absolutely right. It is appropriate for me to emphasise that, as he will well know, inappropriate prescribing of antibiotics is above all what has caused the high levels of infection that we have seen in recent years. The use of broad-spectrum antibiotics predisposes people to C. difficile infection, so it is important that those in the health service understand the cause and effect relationship involved.

It is also worth mentioning that tomorrow is European Antibiotic Awareness Day, so it is appropriate that this Question has been asked today.

[Lord Colwyn]

My Lords, I know what an antibiotic is, but can the Minister help me with what a prebiotic is and what a probiotic is?

[Earl Howe]

My noble friend has asked the question, and I hope that he will be pleased with the answer. Prebiotics are non-digestible carbohydrates that act by promoting the growth and/or activity of probiotic bacteria in the gut. The most common prebiotics are fructo-oligosaccharides, inulin and galacto-oligosaccharides. They are found in various vegetables and fruit, such as tomatoes, asparagus and bananas. The best example of a probiotic is yoghurt.

Health: Primary and Community Care

Lord Colwyn Excerpts

Thursday 24th June 2010 Lords Chamber

[Lord Colwyn]

My Lords, I congratulate the noble Lord, Lord Mawson, on securing this debate. I listened to his speech with great interest. He has a splendid vision for future healthcare and should be congratulated on all that he has done. I hope he will forgive me for not following directly his line of thought. I am not used to speaking so early in a debate; normally every subject has been covered by the time I get to my feet. I must concentrate on matters that have affected and will affect my dental colleagues. I have no need to declare an interest. I was in dental practice for more than 40 years but I have now been retired for two or three years.

As I said in the debate on the Queen’s Speech, the past 10 years have seen fundamental changes to the provision of dental services. We have been left with unfinished reform of NHS dentistry and must now work to deliver a better system both for patients and dentists, even at this time when the Government are making complex financial decisions which will affect us all. Alongside the challenges of oral health promotion and NHS dentistry, general dental practitioners face mounting challenges in the management of their practices. The creation of the Care Quality Commission, with which both NHS and private practices must be registered by the end of March next year, imposes a further layer of regulation on dental practices.

Why this current explosion in the evaluation, accreditation and remediation of health professionals? The CQC emphasis is on the registration and inspection of practices, rather than the assessment of individual performance. This will probably be followed by the General Dental Council’s proposed revalidation processes, focusing on individual registrants rather than the environment in which they happen to be working. There will be areas of overlap, which will need to be looked at to avoid duplication and possible misinterpretation.

The British Dental Association’s Good Practice Scheme recognises the practice, not the individuals within it, and Denplan Excel has, for nearly a decade, been independently auditing dentists against a full range of quality and oral health measures, regularly visiting the practices and de-accrediting those found wanting. The BDA has identified a significant surge in the demand for advice on regulatory issues. It says:

“It is clear from our analysis that the challenges facing dentists are increasing and changing”.

Paramount to its concerns is the growing burden that changes to professional regulation are placing on its practices and the impact it is having on the delivery of patient care. The BDA continues:

“Recent years have seen a significant and disproportionate elaboration of the regulation of dentistry, with the publication of new decontamination guidance and the advent of the Care Quality Commission. We hope that the (recent) announcement of the halting of the proposed vetting and barring regulations signal a fresh approach to regulation that puts patient care before bureaucracy”.

Dental Protection, the dental branch of the Medical Protection Society, which I used to have the honour of chairing, reports an unprecedented demand for its advisory services. It says:

“The controls are out of control”.

There is a widespread feeling in the profession, and a growing sense of anger and frustration, that there are too many hoops for practitioners to jump through, often resulting in a duplication of effort and with no real justification in most cases. The evidence base for many of these new requirements being imposed on dental practices is sketchy or non-existent. We desperately need a more balanced, logical and measured approach whereby any additional layers of governance are scientifically based and targeted where they are justified and most needed, rather than being applied across the board. The current environment is wasting the time, energy and money of many practitioners who are already doing an excellent job for their patients.

At a time when the new Government are proposing that high-performing schools should be inspected less often and freed from unjustified bureaucracy, the current excesses in the regulation of dental health professionals are impacting upon morale, deflecting effort and resources and ultimately not serving the best interests of patients. Now that many NHS practices are effectively operating on fixed incomes, any unnecessary expenditure in one area needs to be funded by cutting back on more constructive expenditure elsewhere.

I have received many letters from dental colleagues. I wish to quote from one that I received from Caroline Thornton, who practises in Gloucester. She comes from a family of dentists. Her grandfather was a dentist, as were her father, her brother and her husband, and she wants her 16 year-old daughter to become a dentist. She writes:

“We are trying very hard to conform to the avalanche of regulations piling up every day. However, in a recession, this is proving to be very expensive! We have spent thousands on a new sterilization room, paid for the nurses to be trained, registered, and their CPD up to date, CRB Checked, even though 2 are pregnant. We are having one of the surgeries revamped in August to make sure it is up to date with the HTN 1-5 regulations at a cost of £20,000, and even completed a clinical waste audit, amongst many other trivia, all at our own expense. At this rate we will have a lovely practice but be bankrupt!”

I could quote many other letters.

One detail that seems to be overlooked in this eagerness to be seen to be monitoring, documenting, auditing and acting is that when assessing the risk presented by an underperforming dentist, it pales into insignificance when compared to an underperforming medical practitioner or surgeon. Before all this monitoring, documenting, auditing and acting became an art form, how much actual damage was being done to how many dental patients? How often and how serious were the consequences? Medics can kill people. Even at the very worst, dentists are unlikely to do so. I am tempted to wonder whether we are creating an entirely new industry and spending an awful lot of money “fixing” an illusory problem, or heading off the hypothetical threat of a “virtual” problem that may not even exist in reality.

Genomic Medicine: S&T Committee Report

Lord Colwyn Excerpts

Wednesday 9th June 2010 Lords Chamber

[Lord Colwyn]

My Lords, I, too, thank the noble Lord, Lord Patel, for his effective chairing of this committee. I thank Professor Tim Aitman for his professional guidance and acknowledge the hard work of Christine Salmon Percival, Rachel Newton, Elisa Rubio, Cathleen Schulte and Cerise Burnett-Stuart. I also congratulate the noble Lord, Lord Winston, a member of our committee, on his guest appearance on the Front Bench.

This report has been described as a,

“remarkable summary of the state of science and the steps that the government should take if the NHS is to make the most of genomic medicine”.

I have been almost overwhelmed by the hundreds of documents and complexity of the information, but I am proud to have been associated with this inquiry into genomic medicine.

Ethical questions now need public discussion. I realise that any reference to “Government response” refers to the previous Administration and very much look forward to hearing my noble friend the Minister’s views on behalf of the new Government.

It seems likely that, in a few years, many babies will have their genetic code mapped at birth. One reading taken from a tiny drop of blood, as with the test for cystic fibrosis, will produce the single unit of heredity responsible for how we develop, grow, live and die. This will herald a new approach to medicine, where conditions such as diabetes and heart disease can be predicted and prevented. By examining inherited genetic variants, it is possible to identify raised risks of many conditions. Those at high risk can be screened more regularly and given advice and drugs to lower their chances of becoming ill.

This personalised medicine signals an enormous advance, revealing who is at risk, who will respond best to particular drugs and who will suffer the side effects of various treatments. These findings could lead to, for example, a genetic test of breast cancers to help doctors choose the right treatment for an individual patient, avoiding the current trial-and-error approach that in some cases exposes patients to the toxic side effects of a cancer drug that is destined to be ineffective.

The risks and social challenges posed by genetic tests and other health services sold direct to consumers have prompted various inquiries into personalised medicine. While DNA screens, personal MRI scans and internet advice services that bypass GPs have the potential to empower patients and encourage people to take greater responsibility for their health, they also have drawbacks. Genetic profiling services which screen DNA variations for links to disease traits are marketed as a way of identifying health risks that might be reduced by lifestyle changes or medical treatment. Companies sell products over the internet for a wide range of fees and many require no genetic counselling or medical supervision. Some tests have been criticised for delivering potentially misleading, unreliable or inconsistent results. There is not yet any evidence of real health benefits. The Select Committee made recommendations on the evaluation and regulation of genomic tests within and outside the NHS. The Government response to this, and to Peter Furness’s advice that the evaluation of diagnostic tests is inherently more complex and difficult than for therapeutic interventions, is vague.

The health service needs increasingly to involve the expertise of its laboratory scientists to turn a growing understanding of the human genome into better patient care. Training for NHS scientists should provide a broader grounding in genetics and equip scientists to be able to advise hospital doctors on which DNA tests might be appropriate and how to interpret the results. As part of this process, scientists may attend consultations between doctors and patients. They may play a key role, explaining to patients what the results are showing and working together as a team.

There were plans to trial a pilot scheme in the West Midlands last October before consideration of a national scheme. It was designed to help the NHS adapt to the rapid advances in genetics which could change the way that medicine is practised. As noble Lords will have heard, it is predicted that it may be possible to sequence a patient’s genome for £1,000 or less in the next two or three years, which may help doctors to provide care tailored to individual genetic profiles. The Select Committee believes that these developments require urgent reforms to NHS training and infrastructure.

Last year, there were many examples of the benefits of genetic screening tests. The first baby was born who had been screened to ensure that it was free of the breast cancer gene carried by a parent. At least 8 per cent of breast cancer cases are caused by specific genetic mutations. Identifying the rogue genes, BRCA1 and BRCA2, before the onset of disease will give people the chance to lead a lifestyle that minimises the chances of disease taking hold. Women with these defective genes are seven times more likely to develop breast cancer than those without the mutations. Faulty genes are responsible for between 5 per cent and 10 per cent of the 44,000 cases of breast cancer that occur in Britain each year.

As the noble Baroness, Lady Finlay, said, more personalised care has been promised following the discovery of a genetic signature that can determine whether breast cancer is likely to respond to common treatment. This allows doctors to predict which types of chemotherapy are most likely to benefit patients, sparing them some of the more toxic and unpleasant regimes that are unlikely to work.

The complete genetic codes of various cancers are being mapped. This information will transform treatment of the disease and has been described as the most significant milestone in cancer research in more than a decade. It is predicted that by 2020 all cancer patients will have their tumours analysed to find the genetic defects that cause them, with the information being used to select the appropriate treatments.

The Government agreed with the committee’s recommendation that the Department of Health, via NICE, instigate a programme for the evaluation of validity, utility and cost benefits of all new genomic tests for common diseases, including pharmacogenetic tests.

A genetic screening test could more than double the chances of pregnancy for women who undergo fertility treatment. A trial last year found that two out of three women having IVF became pregnant if their embryos were checked for abnormalities before being implanted, compared with less than one-third when the test was not used. The technique known as comparative genomic hybridisation checks chromosomes in the developing embryo and ensures that only those embryos with the best chance of becoming a healthy baby are used in fertility treatment.

The role of genetics in insurance has emerged as a controversial issue, with the development of increasingly reliable tests for DNA mutations and variations that are linked to disease. The possibility of an ability to sequence entire genomes at a reasonable cost within a few years and the widespread use of this test could open a new personalised approach to medicine in which diseases can be predicted and prevented, but the same data could be used by insurers to raise premiums for those whose genomes suggest an increased risk of illness, which could be a disincentive for taking tests.

The Association of British Insurers has placed a moratorium on genetic testing until 2014, with a revision due in 2011, the only exception being the Huntington’s predictive test whereby companies can demand test results for life policies worth more than £500,000 and health cover above £300,000. Privacy campaigners and some scientists have called for this to be hardened into legislation along the lines of the Genetic Information Nondiscrimination Act passed by the US in 2008. One issue that the Government response did not address was the committee’s recommendation that Government should negotiate with the ABI a new clause in the code of practice, moratorium and concordat on genetic testing and insurance that prevents insurers asking for the results of genetic tests which were carried out while the moratorium was in place. The committee said,

“we accept that action needs be taken to address a concern that the “sunset clause” of the insurance moratorium may deter individuals from taking genetic tests for fear of not being able to purchase adequate insurance cover after 2014”.

Some insurers have suggested that customers who take personal DNA tests may pay lower premiums because the results encourage a healthier lifestyle and that people who take genetic screening are likely to act on the results and therefore present a much better risk profile. Insurers may reflect this in premiums regardless of whether results are disclosed.

Currently, genetic susceptibility has reached a stage where only careful experimentation will provide the information needed to show whether testing should become part of the accepted standard of care. There is a danger of widespread testing without sufficient background information and the development of a market where products are not related to public health priorities and without benefit to the individuals and populations in greatest need.

In conclusion, having successfully managed to cut my speech from 28 minutes to l4—and now to 10—I thank the many experts and organisations who gave evidence to this fascinating inquiry. I think that it has made a significant contribution to improved health in the future. I hope that my noble friend will be able to indicate how this can be taken forward.

Queen's Speech

Lord Colwyn Excerpts

Thursday 3rd June 2010 Lords Chamber

[Lord Colwyn]

My Lords, I am delighted to be able to congratulate the right reverend Prelate the Bishop of Guildford on his warm-up from my noble friend Lord Hill of Oareford and for his interesting and informative maiden speech. I welcome him to the Bishops’ Benches, despite the lack of space. Many of us here will welcome his publicly declared belief that this House should be preserved as a revision Chamber for legislation and that serious thought should be given to our constitution, electoral system and your Lordships’ House. He has recently celebrated 40 years as a priest and was secretary for ecumenical affairs at Lambeth Palace for the late Lord Runcie from 1981 to 1989 before being appointed a canon of St Paul's. He became Bishop of Guildford in 2004. He is a supporter of the ordination of women and is in favour of women bishops. He has been highly critical of the EU and its remoteness from ordinary people. I have a feeling that the right reverend Prelate will enjoy himself in this House. His intervention in today's debate on the Queen's speech is particularly appropriate, as he is known to Her Majesty as Clerk to the Closet. It is his task to present newly appointed bishops to Her Majesty the Queen. We shall look forward to hearing from the right reverend Prelate in the future.

I intend to speak briefly to support both my dental and my musical colleagues. Dentistry is at another crossroads. The decisions made in this Parliament to transform the delivery of NHS dentistry will be extremely important. We have been left with an unfinished reform following the 2009 Steele review. We must grasp this opportunity if we are to improve the oral health of the nation. However, the challenge of reforming dentistry—to deliver a better system both for patients and dentists—comes at a time when tough financial decisions are to be made across all Whitehall departments.

The previous Government started to clear up the mess of dentistry, much of it self-inflicted, but there remains much for the new Government to do. I take this opportunity publicly to welcome the coalition Government's commitment in their programme for government. The agreement states that,

“we will introduce a new dentistry contract that will focus on achieving good dental health and increasing access to NHS dentistry, with additional focus on the oral health of schoolchildren”.

The acknowledgement of dentistry in this document is very positive and much needed. Despite an overall improvement in the oral health of the nation over the past 30 years, problems persist. As I have mentioned before in this Chamber, by the age of five, more than 30 per cent of British children suffer missing, filled or decayed teeth. In some parts of the country, as many as three-quarters of children are affected. Oral cancers, one of the conditions that dentists play a crucial role in detecting, are becoming increasingly common. There has been a 41 per cent rise in the number of cases of mouth cancer in the past decade and, in the last year for which the figures are available, 1,851 people died as a result of the disease.

Alongside the challenges of oral health promotion and NHS dentistry, general dental practitioners face mounting challenges in the management of their practices. The creation of the Care Quality Commission, with which both NHS and private dental practices must be registered by the end of March next year, foists a further layer of regulation on dental practices. Although registration is due to open in October, the registration fee is still not announced.

Requirements for decontamination are also changing, in the form of the Health Technical Memorandum 01-05: Decontamination in primary care dental practices. The profession is seeking clarification of the evidence base for these changes and has called for a review by NICE. The question is whether the changes offer the genuine reassurance to patients that make investing in them worth while.

Pressing challenges remain, but I believe that we have the opportunity to complete the unfinished reform and change the way in which NHS dentistry is delivered in England so it is more preventive, increases access and delivers good oral health. The challenges are threefold. First, the Government must complete the unfinished reforms, learning from the mistakes of the much criticised 2006 contract—in particular, avoiding the failure properly to pilot change. The contract was so disastrous that it initially saw access fall dramatically. Only in the past six months has access climbed back to the level it was at in 2006. I am delighted that the Government have committed to pilot any changes. Secondly, we must pursue consistently high-quality commissioning of primary dental care. Some PCTs perform well, but many have room for improvement. They must be properly supported in their work, particularly by ensuring that they employ or have access to dental practice advisers and dental public health expertise. Thirdly, there must be a commitment to tackling oral health inequalities to close the unacceptable chasm which exists between those with good and poor oral health as highlighted in the British Dental Association's general election manifesto, Smiles all round. I therefore welcome the announcement in the Queen's Speech that the voice of patients will be strengthened to improve public health alongside actions being taken to reduce health inequalities. The coalition has made it clear that dentistry is a priority. The task now is to work out the detail with the profession, to deliver real change for patients and dentists.

I have a few words to say about music. I hope that the coalition will be able to make a clear statement on the situation over the Live Music Bill, which was widely supported but failed to survive the last few days of the previous Administration. A widely criticised recent DCMS live music report claimed that overall live music is “thriving”, but acknowledged that this was not the case for smaller venues. However, the “thriving” conclusion was not based on any direct measure of performances, but relied instead on indirect evidence—an 11 per cent increase in live music licence applications, an apparent 20 per cent increase in the number of professional musicians, and a modest increase in self-reported gig attendance and Arts Council participation data. The last time that the DCMS surveyed actual performances in venues like bars and restaurants was in 2007. This showed a 5 per cent fall in performances after the Licensing Act came into effect in April 2005, measured against the benchmark of the 2004 pre-Act MORI survey which found that the majority of premises had had no music at all in the previous 12 months. This did not stop DCMS from calling it a flourishing live music scene.

The Live Music Bill, which would give licensing exemption to gigs for fewer than 200 people, reintroduce the “two in a bar” rule that allows one or two musicians to play with either minimal or no amplification and exempt hospitals, schools and colleges from requiring licences for events where alcohol is not being sold, should be reintroduced to Parliament as soon as possible. I believe that the Home Secretary, Theresa May, will be reviewing the 2003 Licensing Act and I urge her to consider separating entertainment licensing with an exemption for small gigs from alcohol licensing.

Grouping those two licensable activities together may have seemed a neat administrative solution, but it has seriously harmed live music in different ways, first by significantly reducing the number of places where musicians can work and radically increasing bureaucracy and, secondly, by creating the wholly misleading impression that live music is first and foremost a danger to society—as dangerous as alcohol. That is not only offensive to those who care for live music; it suggests that, as a nation, we have surrendered to petty officialdom.