Oral Answers to Questions
Debate between Paul Beresford and Simon Burns(12 years, 9 months ago)
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Mr Burns
As the hon. Gentleman knows better than I do, the running of the NHS in Scotland and Wales is a matter for the devolved authorities. I speak for the English NHS, and I can tell him that that we have guaranteed that the budget of the NHS in England will be a protected one for this Parliament in which there will be real-terms increases, albeit more modest than in the past. But we have seen in Wales in particular a fall of just over 8% in funding. That is the decision of a Labour Welsh Government. The moneys that are saved in the health service in England through cutting out bureaucracy and through greater effectiveness in delivering care will be totally reinvested—100%—in the NHS in England.
Sir Paul Beresford (Mole Valley) (Con)
I may have an interest—a remote one—in this question. I expect my right hon. Friend would agree that every patient who chooses to have private health care rather than national health service care, for whatever reason, is one less case on the national health cost and care bases. Does my right hon. Friend agree that it may be appropriate for the Treasury to do a cost-benefit analysis so as to consider a tax encouragement for individuals, especially those over 65, to take out private health insurance?
Mr Burns
I do not want to disappoint my hon. Friend, but I am afraid I do not agree with that. What the Government have to concentrate on is giving the maximum amount of resources within the protected budget to the provision of health care in this country, to ensure, enhance and improve the quality of care for patients in England. That is the priority, not providing tax relief in any shape or form for people who use their choice for private health care.
Variant Creutzfeldt-Jakob Disease
Debate between Paul Beresford and Simon Burns(13 years, 7 months ago)
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The Minister of State, Department of Health (Mr Simon Burns)
I congratulate my hon. Friend the Member for Mole Valley (Sir Paul Beresford) on securing this important debate and on his thoughtful and well-informed comments on a matter of public concern and genuine importance. I also pay tribute to his ongoing commitment to keeping the issue of variant CJD in the public consciousness, not least through his various debates on the Floor of the House and his questioning of Ministers.
My hon. Friend asked about the Government’s response to vCJD, and I am happy to have this opportunity to update the House. Thankfully, the incidence of cases of clinical vCJD in the UK remains at a very low level, with a total of 175 cases recorded. Since a peak of 29 onsets in 1999 and 28 deaths—sadly—in 2000, the trend has fortunately been continuously downward. In 2010, there was only one new case. There have been no cases presumed to be associated with surgical or dental procedures and no known transmissions presumed to be associated with blood since 1999. The reality contrasts with some predictions that surrounded early discussion of vCJD in the late 1990s. Some people forecast large numbers of infections and deaths far in excess of what has come to pass. However, this is perhaps understandable given the uncertainties that still remain around the disease.
Although we can be pleased that the worst-case scenario has not materialised, we must remain vigilant and continue to do all we can to reduce risks to patients through potential transmissions via blood or surgical procedures. Many aspects of this condition remain unknown, and because of the unusual nature of the presumed infectious agent—the prion—are likely to remain so, as my hon. Friend alluded to. Existing measures have been put in place to reduce the risk of secondary vCJD infection passed from person to person, and it is vital that these are maintained unless evidence becomes available to indicate that they are no longer necessary or are otherwise ineffective.
Some measures put in place to protect against the transmission of vCJD also provide additional benefits to patients. One example is the continual improvement of decontamination practices across all of health care. This is vital to ensure that care is delivered safely with low levels of infection risk from all manner of infections, including vCJD, bacterial, protozoal and viral risks. The maintenance and improvement of existing, and the development of new, decontamination systems are essential for maintaining patient safety.
The Government take high-quality decontamination very seriously, and I can announce today that the Department of Health is commissioning a new programme of decontamination-related research. The Department will make available £2.4 million over the next four years to fund this research, which will include support for the development of cold plasma decontamination technologies, specifically for use in narrow channelled instruments such as endoscopes. Another study will aim to optimise the effectiveness of automated washer disinfectors used to wash and sterilise surgical instruments. Other projects will address new methods for detection of residual protein contamination on instruments following routine washing and disinfection.
In addition to decontamination, another vCJD risk-reduction measure that provides additional health benefits is the removal of white blood cells from all blood for transfusion. The removal of white blood cells not only reduces the risk of vCJD transmission, but reduces the risk of cytomegalovirus transmission, transfusion-associated lung injury and transfusion-related fever, and has other benefits. The provision of synthetic clotting factors for the treatment of all patients with bleeding disorders such as haemophilia is another measure associated with both reducing the risk of vCJD transmission and improved patient care.
Sir Paul Beresford
I thank my hon. Friend for his announcements and I note his repetition of some of the points that I have already made. Does he accept that there are already three commercially available materials that can be used for cold sterilisation—but which are not being used and to which the Government have given only semi-recognition—and could also be introduced extremely quickly? Secondly, I note his point about white cell depletion, but a filter has been available since 2006 that would take red blood cells out as well, greatly improving the restriction of the prion.
Mr Burns
I am grateful to my hon. Friend for that intervention. If he bears with me, I will come to both those points. I want to outline what the Government have been doing, but towards the end of my speech I have a number of comments to make in response to some of the valid points that he raised in his speech.
As I was saying, the provision of synthetic clotting factors for the treatment of all patients with bleeding disorders such as haemophilia is another measure associated with both reducing the risk of variant CJD transmission and improved patient care. Those products, although not suitable for all patients, eliminate all variant CJD and other blood-borne infection risks to those patients.
All the health care actions taken to reduce the risks of person-to-person transmission of variant CJD have costs. Estimates of the annual cost of blood-related protection measures alone amount to approximately £40 million. However, many costs that are badged as variant CJD risk-reduction measures would be incurred even without that specific risk. Without a variant CJD risk, many of the blood-related measures, including leucoreduction and the use of synthetic clotting factors, would continue because of the wider safety and other benefits that they confer. The Government also continue to support payments to those affected by clinical variant CJD through the Variant CJD Trust. The trust has paid out approximately £39 million to patients and their families over the last 10 years.
In the latter part of his speech my hon. Friend talked about the risk of contamination via dentistry, which I would like to address now. There have been no known, or indeed suspected, cases of variant CJD transmission arising from dental procedures. However, there are still considerable scientific uncertainties that prevent us from quantifying the specific potential risk. The Department of Health has focused on improving standards of dental decontamination over the last decade, as the risk from blood-borne viruses—especially hepatitis B and C, and HIV—is a recognised risk in dental practices. Approximately 500,000 people in this country are infected with those viruses, and there are more than 1.5 million patient contacts every week in NHS dental practices. It is essential that the quality of local decontamination in practices must be of the highest standard.
The available equipment for and knowledge about decontamination is constantly changing, as my hon. Friend is aware. We update our policies to keep pace with those technical and scientific developments. An essential feature of the British Dental Association guidance, published in 2004, was the importance of both the sterilization and pre-sterilization cleaning components of the decontamination process. Indeed, the essential quality requirements in the Department’s guidance, as set out in “Health Technical Memorandum 01-05”, were similar to those in the British Dental Association’s original A12 document.
Guidance from the Department of Health states that all dentists should use automated washer disinfectors as part of best practice. There are three reasons for this. First, they provide a consistent and reliable cleaning and disinfection process. Secondly, they contain the washing and disinfection process within a sealed unit, which helps to minimise the risk of spreading microbiological and chemical hazards. Thirdly, there is strong evidence that automated washer disinfectors are effective in removing the worst of the contamination from dental instruments and that they deliver a much greater degree of consistency in cleaning. This will reduce the worst-case risks to subsequent patients.
Also, following the recently commissioned research on optimising the efficacy of washer disinfectors, we expect their performance to improve significantly in the coming years. Initial research indicates that the use of automated washer disinfectors can reduce general protein contamination on instruments by a factor of up to 10,000. The reduction in hydrophobic proteins, similar to prion proteins, is roughly a factor of 100. Automated washer disinfectors are therefore very useful in improving the quality of instrument cleaning and reducing risk.
Sir Paul Beresford
I was not picking on dentistry specifically, because washer disinfectors are also used in hospitals. They are an excellent idea. They are very expensive, but we are going down the right road. The problem is, however, that the prion sticks to certain stainless steel instruments used in dentistry and elsewhere in hospital services, and the washer disinfector will not remove it. However, if the Rely+On, or one of the other two products, were utilised either in the soak beforehand or in the washer disinfector, that would make the process much more effective as far as the prion is concerned.
Mr Burns
Again, if my hon. Friend will bear with me, I will come to these points when I deal with a number of the issues that he raised in his speech.
The guidance encourages the purchase of automated washer disinfectors. However, no time frame has been stipulated and they were not part of the essential quality requirements that all practices had to meet by the end of 2010. A 2009-10 national survey on policy, equipment and procedures used by local dental practices in the decontamination of their instruments showed that more than 70% were at or above the standard required by Department of Health guidance. That figure is likely to improve further, as many other dental practices are close to the required performance level.
The British Dental Association was fully involved in the development of the guidance, and is supportive of the principles underpinning it. The guidance is also consistent with the BDA’s advice sheet A12, “Infection Control in Dentistry”, published in 2004, which states:
“CJD and related conditions raise new infection control questions because ‘prions’, the infectious agents that cause them, are much more difficult to destroy than conventional micro-organisms, so optimal decontamination standards need to be observed. As a universal precaution, all instruments should be thoroughly cleaned before autoclaving, in order to remove as much matter as possible.”
During 2006-07 and 2007-08, the Department of Health made £100 million of capital funding available through PCTs for use in primary dental care. One of the areas identified as suitable for that money was the improvement of standards of decontamination in primary dental care. Many PCTs have provided grants to practices to support the roll-out of automated washer disinfectors in primary dental care.
These and other variant CJD risk reduction measures will remain in place and we will continue to consider all other options where there is evidence of their overall efficacy, safety and cost benefit. For example, we closely follow the development by commercial and academic organisations of potential blood screening tests. While recent progress—as exemplified by the recent publication in The Lancet of the Government-funded prion unit’s development of a prototype diagnostic test—is promising, there remains no test suitable for screening blood donations.
Another possible technology is, as my hon. Friend mentioned, prion filtration, which aims to remove the presumed variant CJD infective agent from blood. In early 2012 on completion of a clinical trial, Ministers will consider the possible use of prion filtration in addition to leucoreduction to reduce further the potential risk of infection from red blood cells. I trust that that helps to answer one of my hon. Friend’s points.
Sir Paul Beresford
I thank my right hon. Friend again for giving way, and for his tolerance. His statement is interesting, although under the previous Government there was a demand by the Department to provide an impact assessment on the P-Capt filter, which should have been ready for Ministers in October 2009. Will he inquire whether that is available, and if so have a look at it? It would speed up the decision making.
Mr Burns
I can answer my hon. Friend instantly on that. I said just before his intervention that we expect the trial results in 2012, and the impact assessment will be completed only when the trial is completed. The impact assessment, then, will not be available until 2012 when the trials have been completed. I hope that that explains it, and satisfies my hon. Friend.
I would like to enter a note of caution that, as with all new technologies, it is important to consider all the potential costs and benefits to ensure that, as far as possible, the benefits they offer and the costs they incur—both financial and clinical— are fully understood. One example was when single-use tonsillectomy instruments were introduced in 2001 to reduce the risk of variant CJD infection. The instruments were withdrawn within a year, after the death of a number of patients. This clearly shows that no matter how good the intentions, there can, sadly, sometimes be unintended consequences with the introduction of thoroughly assessed new technologies.
My hon. Friend raised a number of issues, which I would like to go through methodically. He talked knowledgeably about prion filtration and effectively asked what was the Government’s position on its use to reduce the risk of variant CJD. I can advise him that the independent Advisory Committee on the Safety of Blood, Tissues and Organs considers that there is evidence that a particular filter is able to reduce potential infectivity in a unit of red blood cells and has recommended—subject to satisfactory completion of the clinical trial—the introduction of filtered blood to those born since 1 January 1996. The Government are undertaking an evaluation of the costs, benefits and impacts to inform a decision on whether to implement that recommendation. As I said to my hon. Friend a few moments ago, that is expected to be completed in 2012, when we will also have an impact assessment, which could be studied.
My hon. Friend raised the issue of funding. The current funding by the Department is for studies led by Professor Collinge. Between 1996 and 2012 the Department of Health will have provided more than £18.2 million for studies led by Professor Collinge, which is in addition to his funding by the Medical Research Council. Through the RDD policy research programme, the Department currently funds two studies that underpin and are integrated with the MRC Neuropathogenesis Unit funding. The National Prion Monitoring Cohort funding is worth £3.04 million between 1 April 2008 and 31 March 2012. Secondly, the development of an effective treatment for prion infection by humans is funded to the value of £7.2 million from 1 February 2006 to 30 June 2012, in partnership with GlaxoSmithKline.
Sir Paul Beresford
First, I am astonished that the PRISM trials have taken so long. They were supposed to finish in 2009, and they have dragged on for a further three years. We really should be worried about the potential development of infection in the intervening period.
Secondly, the Minister has delighted us with the research figures, but they pale into insignificance in comparison with the volume of expenditure by the national health service on imports of blood products and blood serum from the United States in particular. Collinge’s team have produced the test and one of the three soaks, so he has achieved positive results. It would be a mistake to stop now, rather than investing a little more funding to support the next stages of the test so that the tree that was planted initially can bear fruit.
Mr Burns
I always welcome any justified lobbying for extra funding, especially if it is for research. I do not think it appropriate for me to promise my hon. Friend the earth from the Dispatch Box this afternoon, but I will promise him that I will ensure that his request and his justification for the provision of further funds are drawn to the attention of the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton). No doubt she will consider what he has said and write to him in due course.
Sir Paul Beresford
I thank the Minister sincerely, because it is unusual for Ministers to give way with such regularity. Perhaps it is also unusual for them to receive requests.
I understand that the Under-Secretary of State has considered the matter, and is looking to the private sector to fund the advances and further testing. The private sector is unlikely to do that because it has no incentive, but, as a Minister in the Department of Health looking after the nation’s health, my right hon. Friend has every incentive, as has the Under-Secretary of State.
Mr Burns
I admire my hon. Friend’s persistence and congratulate him on it, but I fear that it will not push me any further at this moment. I hear what he says about the meeting between my hon. Friend the Under-Secretary of State and Professor Collinge. I cannot comment on that, but I reiterate yet again that I will draw my hon. Friend’s comments to the attention of my hon. Friend the Under-Secretary of State so that she can reflect on them. No doubt she will be in touch with him once she has had time to do so.
My hon. Friend mentioned the three decontamination products. They have not yet been proven suitable for use in the standard decontamination cycle in health care, and we must therefore await the conclusion of the research. Once we have seen the results of that research and, in one case, the impact assessment, we shall be able to seek to make positive progress.
Let me reassure my hon. Friend that the Government take the risks of variant CJD very seriously indeed. Because of the uncertainty surrounding it, we cannot be satisfied that we can stop looking for ways of improving and enhancing the protection of members of the public, and minimising the development and spread of this particularly horrendous medical condition. Successive Governments have introduced a wide range of precautionary measures focused on reducing risk to protect public health. I assure my hon. Friend that we will maintain them and keep them under review as new evidence emerges, and that we will ensure that any new measures under consideration are effective, safe and appropriate.
Question put and agreed to.
Dental Practitioners
Debate between Paul Beresford and Simon Burns(14 years ago)
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The Minister of State, Department of Health (Mr Simon Burns)
indicated assent.
Sir Paul Beresford
The Minister is nodding sagely so perhaps I will believe him. The fire prevention regulations are enforced by the local fire authority and any CQC interest in that area is duplication. To my amazement, there is even duplication in the CQC requirements, some of which are addressed many times. For example, evidence that practices have appropriate confidentiality protocols in place must be provided to satisfy outcomes 1, 2, 6 and 21.
Dental providers must comply with 28 standards, but there is no guidance on what the CQC requires as evidence of compliance. Furthermore, it is unclear who the auditors of the process will be. To give an example provided by people who have lobbied me, the NHS Partners Network and the NHS Confederation state that generally, their members have been subject to mixed messages and unclear instructions from the CQC about what to expect from it. They say that in the current financial climate, such uncertainty is particularly difficult for their members and runs the risk of adding significantly to costs without yielding safety and quality benefits. The ultimate guillotine is having one’s practice shut down for failure to comply with a potential deadline of April next year, which is causing deep concern in the dental profession.
Finally, I turn to costs. The current situation is that there is no fee for CQC registration. In contrast, my fee to be paid this month to the General Dental Council is £576, the same as for the majority of dentists. However, the CQC is consulting on proposed fees, which it wishes to divide up depending on the size of a provider. The fees proposed are disproportionate, as the lowest fee is to be £1,500, for a provider with one location, such as my own small, part-time surgery, whereas £48,000 is to be charged for a provider with 101 or more locations.
One of the most glaringly ludicrous points is the extreme jump in fees from one level to another. For example, if a dental firm has 100 practices it will pay £24,000, but if it merely adds one more practice, its fees will double to £48,000. The situation has to be dealt with, and it is in the hands of the Minister and his colleagues to do so. The CQC is charging ahead blindly, apparently with little knowledge and with no response to concerns that have been expressed. It has finally agreed to sit down with the General Dental Council in the next week or two and discuss the potential duplications in registration costs.
I understand that there are organisations similar to the CQC in Wales and Scotland, and both appear to be working closely with the GDC without duplication. The result is that the annual cost to Welsh dentists for their organisation is not between £1,500 and £48,000, but probably in the region of £80 and certainly less than £100.
There is an opportunity for Ministers to act before it is too late, and before too much money is wasted. If necessary, the forthcoming Public Bodies Bill will enable Ministers to remove the CQC from its role of regulating dentists. I remind the Minister that all the problems that it is having with dentists, and dentists with it, are likely to be repeated, and more, in the case of general medical practitioners. They are next on the list.
I await the Minister’s considered response, and I hope that he will take a step back and promise to consider the points made by me and, in particular, by the many organisations that have lobbied on the matter. It would be helpful if there were a serious meeting between Ministers, the GDC, the CQC and the BDA. It is overdue.
The Minister of State, Department of Health (Mr Simon Burns)
I begin by congratulating my hon. Friend the Member for Mole Valley (Sir Paul Beresford) on securing this debate on an issue that I know is of some concern to him and other dentists throughout England. He said at the beginning of his comments that he was a friend of mine and hoped that he still would be by the end of my speech. I echo that, because I, too, hope that we are still on friendly, and hopefully speaking, terms by the end of the debate.
My hon. Friend will know that the coalition Government do not believe in regulation for the sake of regulation. However, there are areas in which regulation is important for the interests of vulnerable people who are less able than others to defend their own interests. The provision of health care and adult social care services is one such area, and since 1 April 2009, the Care Quality Commission has been responsible for regulating those sectors under the Health and Social Care Act 2008.
The Government support the role of the CQC in ensuring that providers of health care and adult social care provide services that, at the very least, meet the essential levels of safety and quality that every patient and service user has a right to expect. I am sure that my hon. Friend would not argue with that, or with the enforcement powers that the CQC can use when providers fail to meet essential levels of safety and quality. He will be aware that the Government are committed to strengthening the CQC’s role as an effective regulator of health and adult social care services in England.
At the moment, NHS and private health care providers are registered by CQC under the 2008 Act, as are providers of adult social care. From April next year, providers of primary dental care and private ambulance services will also be registered. From April 2012, providers of primary medical care will be brought into the registration system.
There are a number of reasons why it is right to bring primary dental care providers into registration and to require them to meet essential levels of safety and quality. First, the current regulatory systems for dentists focus on the competence of the individual. However, how organisations and systems are managed is just as important in protecting the safety of patients. CQC registration will provide the framework to ensure that the provider, as well as the individuals within it, meet essential levels of safety and quality.
Secondly, increasingly complex treatments are being provided in primary care settings. For example, it is likely that more oral surgery will be carried out in primary care in future, and the General Dental Council has seen an increase in complaints about harm caused to patients by the placing of dental implants. Those developments make it even more important to ensure that providers have adequate systems in place to protect the safety of patients. Registration with the CQC will allow potential problems to be identified and addressed before they result in harm to patients.
Sir Paul Beresford
The Minister mentioned the GDC and complaints about dental implants. There has also been an increase in poor endodontic work, all of which can be dealt with adequately by the GDC. The situation does not need a huge, monolithic organisation such as the CQC.
Mr Burns
I am very grateful to my hon. Friend for making that point. If he will bear with me, I will, at a slightly later stage in the course of my remarks, address whether working together can minimise the level of overlap so that there is no unnecessary duplication.
Thirdly, registering primary dental care providers will ensure that the same levels of safety and quality are met irrespective of where care is provided. One patient could be treated in hospital where the quality and safety of their care is regulated by the CQC, while another receives the exact same treatment elsewhere without that same guarantee. Wholly private dental providers, treating some 7 million patients, are currently subject to no formal scrutiny of the service that they provide.
Finally—I know that my hon. Friend has raised this subject in the past—registration will provide greater controls on the decontamination of used dental instruments. Guidance on decontamination is set out in “Health Technical Memorandum 01-05”. Although that has no legal standing, the CQC can monitor whether providers, including those in the independent sector, meet its requirements by enforcing the cleanliness and infection control registration requirement.
It is the view not just of the Government that the registration of dentists will bring benefits; that view is shared by the dental profession. Responding to the consultation on registration of dental providers with the CQC in June 2008, the GDC said:
“We broadly welcome the establishment of the Care Quality Commission…Whilst we are responsible for the registration and regulation of the whole dental team, whether they work in the private or public sector, there has been no additional means of regulating wholly private dental services…up until now. We believe that this role can be covered by the CQC and would further enhance patient protection”.
The British Dental Association was equally supportive, saying:
“Wholly private providers are currently unregulated (beyond individual professional regulation) and we believe it is essential for this to be addressed.”
Sir Paul Beresford
I actually touched on that at the beginning of my short address. The Minister has to realise that the consultation came before the CQC moved into the area of dentistry, before the BDA realised what the CQC was going to do and before the monolithic and, what I called, almost cancerous growth of this organisation.
Mr Burns
I am grateful to my hon. Friend for that intervention. As far as I know, however, the BDA was aware at the time that dentists were going to be registered under the CQC, and as I see it, the comments on the consultation process were made in the knowledge of that information.
I know there has been concern among dentists about the potential impact of registration with the CQC, and my hon. Friend made an interesting and vigorous case highlighting what he perceived to be some of the problems. However, I have some sympathy with those dentists concerned that the process of registering with the CQC will be onerous and time consuming. I can assure him, however, that for the majority of dentists—those who already provide high-quality services—there will, to my mind, be no difficulty in meeting the essential levels of safety and quality.
The experience of HTM 01-05 demonstrates this point. Before the introduction of the guidance, dentists raised concerns about the burden that complying with it would place on them. Only today, we have published the results of the dental national decontamination survey, showing that when HTM 01-05 was published in November 2009, about 70% of practices were already meeting the essential quality requirements for decontamination, with approximately a further 20% of practices very near the essential quality requirements. The remaining small minority of practices were not.
This experience will, I believe, be repeated with CQC registration. Most dental providers already give their patients a high-quality service and will find that they already meet the registration requirements. In those relatively small numbers of cases where dentists do not meet essential levels of safety and quality, registration with CQC will force them to improve. This is the purpose of regulation, and such an outcome would result in safer and better dental care for patients.
My hon. Friend has spoken about the potential for overlap in the role of the CQC and the General Dental Council in the registration of dentists, and he raised it again in his first intervention on me. I would like to address that point now. I read with interest the recent letter from a number of dentists in The Daily Telegraph making the same point as him. The CQC and the GDC are working closely to ensure that the roles of the two regulatory bodies are closely co-ordinated. Indeed, the two regulators have agreed and set out a memorandum of understanding that explains how they will co-ordinate their activities and share information to ensure that they do not duplicate actions and therefore create any risk of double jeopardy. It is vital that CQC registration complements the professional regulation of dentists by the GDC. The important word there is “complements”.
Sir Paul Beresford
I spoke to the president of the GDC last week, and she said they are having a meeting to discuss this for the first time. So the Minister’s information might have gone a little awry.
Mr Burns
I take on board what my hon. Friend says. However, the information I have been given, as I said earlier, is that the two regulators have agreed and set out a memorandum of understanding explaining how they will co-ordinate their activities and share information to ensure that they do not duplicate actions. I trust that that action is correct, I trust that they work closely together to achieve that aim, and I will certainly get back to him if—despite what I have been led to believe—that is not the case.
My hon. Friend also referred to the proposed level of registration fees for dental providers. As he is aware, the Care Quality Commission is currently consulting on its proposals for annual registration fees, which will apply to all providers, including dentists, from April next year. I would like to emphasise that they are proposals for consultation. I would certainly urge all dentists in England to make their views known to the CQC through the consultation process as soon as possible, and certainly before it ends, on 17 January. I heard what my hon. Friend said, and I have seen the consultation document. I can only repeat—and repeat quite vehemently—that it is important that all dentists take part in the consultation process and ensure that the CQC is fully aware of their views before it ends. I should also add that the CQC’s final fees scheme is subject to the consent of the Secretary of State. It would obviously be wrong of me to prejudge the consultation process or what will happen at its conclusion. All I can do is advise my hon. Friend and the profession to ensure that they lobby the CQC as part of the consultation, so that it is left in no doubt about the views and concerns of dentists on the issue.
My hon. Friend also mentioned Criminal Records Bureau checks, which I know have been a particular issue for some dentists. CRB checks are important to ensure that those responsible for the delivery of services are fit to do so. In earlier registration rounds, CRB checks have revealed convictions that were not otherwise declared. Those dentists who already have a CRB disclosure countersigned by their primary care trust can use it for CQC registration. I know that there have been practical problems with getting the required CRB checks carried out, and I understand the frustration that this has caused for some dentists. As a result, the CQC has increased to 100 the number of post offices that can process CRB disclosures on its behalf. That will go some way towards helping to deal with some of the practical difficulties experienced in getting a CRB check. The CQC is also exploring with Post Office Ltd the possibility of extending the service to the entire post office network.
Although there is a degree of anxiety among dentists about CQC registration, I hope—although I am not convinced—that I have reassured my hon. Friend that the majority of dentists, who already provide good services, have no need to fear CQC regulation. For the small number who do not provide a safe service, registration will provide an effective mechanism to bring about improvements for patients. Indeed, that is the very purpose of regulation.
In spite of the concerns, I am pleased to have been told by the CQC that the registration of primary dental care providers is so far proceeding smoothly. More than 7,000 dentists, including nearly 1,600 who operate solely in the private sector, have enrolled in the CQC’s registration process. The CQC has now invited those primary dental care providers to submit applications. I understand that the first completed application was returned to the CQC within three hours and that more than 400 applications for registration had been returned by the end of last week. With what I believe has been a good start, I am hopeful that the task of registering dental providers with the CQC will be completed on schedule by 1 April 2011, and that patients will have the assurance that whichever dental practice they use, whether NHS or private, they will receive care that meets essential levels of safety and quality.
Question put and agreed to.