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My Lords, I declare my interest as a retired dental surgeon with more than 40 years’ experience of clinical dentistry. I am a fellow of the British Dental Association, and I served on the council of the Medical Protection Society and chaired its dental section, Dental Protection, from 1995 to 2001.
I am pleased to see the Bill return in the current parliamentary Session. It has already had a lengthy gestation period, dating back to a 2015 report from the Public Administration and Constitutional Affairs Committee of another place. I hope that the Bill survives the current political situation, perhaps as carryover legislation.
My remarks will focus on the relationship between the new provisions in the Bill and existing legislation. Many medical practitioners working in the NHS today do so under immense pressure, but it remains one of the safest healthcare systems in the world. Colleagues in the dental profession welcome scrutiny of their practice and are always keen to learn and improve. Yet it must be said that there remains some suspicion about how the regulator, the General Dental Council, operates and that, for a variety of reasons, newly qualified dentists are increasingly deterred from the prospect of a career offering NHS dentistry.
Whether it is the onerous and detested dental contract, which fails to incentivise the prevention of tooth decay, or the fact that government funding for NHS dentistry per capita in England has fallen by 29% in real terms since 2010, we face a genuine recruitment crisis for NHS dentists. Three-quarters of practice owners report struggling to fill vacancies—up from half just two years ago. Practices are closing in large numbers as they struggle to recruit and to make ends meet under the current dental contract. It is important to remember that high street dental practices are run like small businesses. Owners must invest their own funds to set up and operate the practice, all at considerable personal risk. Unless there is a change of direction, we will soon face an even greater exodus of dentists from the NHS. With these points in mind, we must not only ensure that the current NHS contract is replaced and proper investment secured but create an attractive working environment for NHS dentists, where they feel confident that they are valued and supported and they are not treated as scapegoats on the rare occasions when clinical errors occur.
It is sad to hear anecdotal evidence from the British Dental Association that younger dentists increasingly report being more risk averse in their practices by, for example, referring patients to hospital more frequently, thus putting further pressure on other parts of the NHS. Such is the culture of fear in which they now operate. It is crucially important that any learning from clinical incidents takes place without recourse to a blame game. I welcome the spirit of the Bill in this respect, while the references to “no blame” and “improvement of systems” in the text are welcome. Nevertheless, these phrases are thin on the ground, especially as the word “punished” is used in Clause 37. More information is needed on how it is proposed to avoid completely any focus on blame.
When placing dental treatment under investigation, we must act in a proportional manner, particularly in cases of so-called “never events”. For example, removing the wrong tooth is of course both unfortunate and alarming for a patient, but it is vastly different from removing the wrong kidney or limb. I therefore hope that any new investigatory framework for clinical incidents would be able to differentiate between the varying severities of incident both fairly and transparently. Additionally, I would welcome some clarification by the Minister on the following three points.
First, how will the proposed Health Services Safety Investigations Body interact with the existing patient safety functions of NHS Improvement, with its national reporting and learning system and the patient safety incident management system? Will it replace those functions or work alongside them? Secondly, how will we ensure that dentists and other NHS staff are not being investigated by different bodies at the same time? I am not sure that the current wording in the Bill is strong enough when it comes to the HSSIB working together with other bodies. We must be sure to avoid completely any risk of “multiple jeopardy” in this regard. Thirdly, how will the HSSIB work with others to ensure that issues are handled by the most appropriate organisation in the first instance? Furthermore, we must consider the threshold at which the HSSIB would investigate. When would an incident be considered serious enough to investigate, and what would be the trigger?
In the Queen’s Speech, reference was made to the body being “professionally led”. I cannot ascertain whether the clause on medical examiners is intended to address this. It is not clear and seems to be more about local NHS offices. Being “professionally led” would suggest that the chief investigation officer and part of his team are members of the health professions, but I cannot see that this is defined.
Lastly, the Bill relates to the NHS, but issues also arise in the private sector. Given the current discussions and concern about botched cosmetic procedures, is this not a problem that also needs to be addressed? I reiterate that the focus of the Bill really does need to be on learning and improving systems, not on blaming individuals. With that in mind, I welcome the spirit of the Bill and look forward to more detailed scrutiny at Committee stage.