NORTHERN IRELAND ASSEMBLY
COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY
OFFICIAL REPORT
(Hansard)
Health (Miscellaneous Provisions) Bill
Thursday 6 September 2007
Members present for all or part of the proceedings:
Mrs Iris Robinson (Chairperson)
Mrs Michelle O’Neill (Deputy Chairperson)
Rev Dr Robert Coulter
Dr Kieran Deeny
Mr Alex Easton
Mr Tommy Gallagher
Mrs Carmel Hanna
Ms Carál Ní Chuilín
Witnesses:
Mr John Farrell - Department of Health, Social Services and Public Safety
Ms Christine Jendoubi - Department of Health, Social Services and Public Safety
Mr Robert Kirkwood - Department of Health, Social Services and Public Safety
Mr Donncha O’Carolan - Acting Chief Dental Officer
The Chairperson (Mrs I Robinson):
I welcome Ms Christine Jendoubi, Mr John Farrell, Mr Robert Kirkwood and Mr Donncha O’Carolan, who are here to provide clarification and answer questions as the Committee commences its clause-by-clause scrutiny of the Health (Miscellaneous Provisions) Bill. Members have been provided with much written material, including a copy of the Bill, a detailed commentary and a copy of extracts from the legislation that the Bill seeks to amend. Members will recall that oral evidence was taken from groups before recess and that further written submissions were received over the summer.
Members should use the notes on the clauses that were prepared by the Department and which were circulated last week and the document provided by Committee staff at tab 4. The Committee will have several options on each clause. Before inviting the Committee to choose an option, I will ask the officials to outline briefly the purpose and meaning of each clause. Members may then seek clarification.
Following discussion with officials on each clause and the potential for amendment, the options available to the Committee will be: first, to declare itself content with the clause as drafted; secondly, to agree the potential for amendment and request that the Department consider the matter and report its position to the Committee — and by doing so defer consideration of the clause. If an amendment is considered appropriate, the Committee can invite the Department to say whether it would be willing to undertake the drafting of such an amendment.
Clause-by-clause scrutiny of the Bill will now commence. At tab 4 of the papers there is a list of suggested questions on each clause that have arisen from the written submissions. Members may wish to use those during discussions.
Clause 1 (Persons performing primary medical services: listing subject to conditions)
Ms Christine Jendoubi (Department of Health, Social Services and Public Safety):
The Bill amends The Health and Personal Social Services (Northern Ireland) Order 1972, which is Northern Ireland’s main primary health legislation. The amendments relate to primary care arrangements and specifically to family practitioner services. The Bill also amends The Smoking (Northern Ireland) Order 2006, as Kevin Shiels described earlier.
Clause 1 relates to primary medical services. It provides for a person’s inclusion — or continued inclusion — on the list of persons performing primary medical services to be subject to conditions. That is a new provision. It also provides for there to be one list for Northern Ireland, instead of the current four. That means that if a person is removed from the list, he or she will be unable to practise anywhere in Northern Ireland. At the moment, if someone is removed from one of the lists, he or she can still practise in the other three board areas.
That concludes my remarks on clause 1. I am happy to take questions.
The Chairperson:
If you do not mind, I will kick off. Clause 1 provides for a change from separate board lists to a regional list of primary medical services performers. By and large, that is generally welcomed. However, clause 1 also deals with the conditions for inclusion or continued inclusion on the list. The British Medical Association (BMA) has called for a suspension framework and a right of appeal against suspension. Is a right of appeal provided for in the Bill?
Ms Jendoubi:
We will discuss how the tribunal deals with these matters later, but, in general, the Bill does not provide for a right of appeal against suspension. It provides for a right of appeal against removal from the performers’ list, but that already exists, as far as general practitioners (GPs) are concerned. Other provisions in the Bill extend the performers’ list regulations to pharmacists, dentists and opticians, and a right of appeal will extend to them, too. However, at the moment, it does not provide a right of appeal against suspension.
That raises an interesting issue: the assertion that suspension is a neutral act has been challenged. The matter was put to bed by the Appeal Court ruling in the Mezey case, which found that it was not a neutral act. It is neutral in so far as it does not prejudice the outcome of a disciplinary investigation, but it has an effect on the individual concerned and their capacity to work.
The Chairperson:
The BMA is very keen on the right to appeal, and Kieran, as a GP, may want to comment on that.
Dr Deeny:
As a primary care professional, I believe that the Bill should make some allowance for a right of appeal. If I were suspended tomorrow, it would leave me in a dreadful situation professionally. It is very wrong that medical professionals do not have the basic right of appeal that every member of the public is entitled to in law. It leaves the profession very hard done by. I back the BMA completely on this: provision for a right of appeal should be built into the Bill.
Mr John Farrell (Department of Health, Social Services and Public Safety):
The health board would have to have reasonable grounds for suspending a GP. There would have to be clear criteria: suspension would not occur willy-nilly. The legislation does not contain the detail of the conditions that could apply when a suspension takes place; that detail will emerge in the regulations. However, the Department proposes to provide clear guidance on cases in which a suspension could be made. We will refer to the Appeal Court ruling on the Mezey case, which sets out the types of conditions that could apply.
Mr Robert Kirkwood (Department of Health, Social Services and Public Safety):
May I clarify the point? Clause 1 is specific to general practitioners — it applies to no other profession. Clause 1 amends article 57G of the Order, and nowhere in the clause is provision made for suspension. As Christine said, clause 1 simply amends a paragraph of article 57G to allow for subordinate legislation that would provide for one list, rather than requiring GPs to be on the list of the board in whose area they perform services. It also proposes new paragraphs (3A) and (3B), which allow for regulations to set out conditions for inclusion or continued inclusion on the list — the board can include somebody on a list, subject to conditions.
For example, a health and social services board that considers a GP who is returning from maternity leave to be falling short in some areas of her practice must ask that GP to undertake training to compensate for those deficiencies. When the practitioner had done so, she may apply to be included on a list so that she can provide services in the board’s area. It is a relaxation of the present provisions because it allows a board to put a practitioner on its list, subject to conditions.
The Bill also introduces an alternative to suspension. For example, if a board feels that a practitioner who is already on its list is falling short in one of his her competencies, it does not automatically have to suspend the practitioner. It will allow the board to discuss any problems that the GP may have so that a solution can be worked out amicably between them. The GP will remain on the list, but subject to conditions. That is what the clause does — no more and no less. Suspension —
Dr Deeny:
Is the word "suspension" used?
Mr Kirkwood:
No. The provision for suspension is already included in The Primary Medical Services (Northern Ireland) Order 2004, which inserted article 57G into the 1972 Order. The primary provision for suspension of GPs already exists — but only for GPs. The Bill has clauses that make provision for other practitioners such as dentists, pharmacists and opticians. The enabling power that clause 1 introduces is to draft regulations to amend The Health and Personal Social Services (Primary Medical Services Performers Lists) Regulations (Northern Ireland) 2004 list regulations, to move away from four lists to one list, and to introduce the conditions of conditional inclusion and contingent removal.
Dr Deeny:
Suspension without the right of appeal sounds like guilty until proven innocent.
Mr Kirkwood:
Clause 1 does not mention suspension of a GP. The primary power to suspend a GP already exists. The performers’ list regulations will be amended to include suspension of a GP. The regulations will set out in detail how that is to be done, the involvement of the National Clinical Assessment Service (NCAS) in such a suspension, and the period of suspension. That will be set out in regulations that will come before the Committee before consultation. You may say that there must be a right of appeal against suspension; however, there is no such right in England, Wales and Scotland.
The BMA has debated the matter at length. Northern Ireland is not going any further than England, Scotland and Wales; why should Northern Ireland be different from the established arrangements in England, Scotland and Wales?
Ms Jendoubi:
As Robert says, the Committee can discuss that matter when the regulations have been introduced.
Mr Kirkwood:
The regulations will cover the issue, but clause 1 relates only to GPs. It amends article 57G of The Health and Personal Social Services (Northern Ireland) Order 1972 concerning primary medical services and relates solely to GPs. Similar provisions are made in subsequent clauses of the Bill for ophthalmic, pharmaceutical and dental services. However, clause 1 will enable boards to move from a four-list system to one regional list, and it introduces powers of conditional inclusion and contingent removal, which, I feel, is beneficial, as it will give boards the power to put someone on their list. It will also allow them to introduce conditions rather than simply take the ultimate decision to suspend. The situations in which that option would apply will be set out in amendments to the performers’ list regulations. The legislation will appear as an SL1 letter to the Committee, setting out the policy decisions that will be implemented in the amending regulations.
The Chairperson:
There will be opportunity to discuss that matter later; however, I want to move on.
Dr Deeny:
These matters are of extreme interest to me. I agree entirely that four boards give the impression that there are four different health systems here. I believe that my practice is the only one that takes patients from three different health boards, and for many years I have seen the problems that that creates, so changing the system is a good idea. However, I am suspicious about using the word "suspension" to someone who might lose his livelihood without the right to appeal; it is irrelevant that there is no such right in England, Wales or Scotland.
Mr Kirkwood:
That is a debate for another day. Clause 1 is not concerned with those matters, and to debate them would be outwith its provisions. I know that because it is a miscellaneous provisions Bill; it jumps from here to there and is very hard to follow; but that is what it does.
Ms Ní Chuilín:
Perhaps this is a question for Kevin Shiels, but in order to include the point that Kieran Deeny made, will there be an opportunity to amend the clause rather than add to it? Can we amend what is already there?
Ms Jendoubi:
That would require an amendment to The Primary Medical Services (Northern Ireland) Order 2004.
Mr Kirkwood:
What sort of amendment do you want to make?
Ms Ní Chuilín:
One that would address the point that Kieran raised. What happens here matters to him.
Mr Kirkwood:
Yes, but Dr Deeny was talking about suspension; clause 1 does not cover suspension. An amendment could not be tabled to something that is not in the clause.
Ms Ní Chuilín:
That is fair enough.
Mr Kirkwood:
I hope that I have clarified the effect of the provisions of the clause.
Ms Ní Chuilín:
The point that I want to make, and which the BMA raised with us, is about how the costs of suspension would be covered.
Mr Kirkwood:
There are provisions —
Ms Ní Chuilín:
Are there detailed provisions for costs and how they will be contained?
Mr Kirkwood:
There is already provision for the payment of suspended practitioners in The Primary Medical Services (Northern Ireland) Order 2004, so there is no need for new primary legislation to cover that. There is already subordinate legislation that makes provision to pay a GP suspended by the tribunal or by the Interim Orders Committee. Once we introduce provision for health boards to use powers of suspension, we will amend the subordinate legislation to include that provision. We do not need new primary legislation to introduce that, so we do not need to include references to such payments in the Bill.
The Chairperson:
The health and social services councils of Northern Ireland have called for the amendment:
"preventing unsuitable inclusion by virtue of professional or personal conduct"
to be added to the conditions provided for in regulations. Is that already covered, and should it be added if it is not covered?
Mr Kirkwood:
It is not covered. The BMA picked that up with regard to the new condition that will be introduced for the jurisdiction of the tribunal on grounds of unsuitability by professional or personal conduct. The conditions that are being imposed relate to people who are to be included on a list or who are already included on a list. The reason that the unsuitability provision is not included is that there are no degrees of unsuitability: if a practitioner is unsuitable, he or she cannot be on a list and must be removed or suspended. If a board says that someone is unsuitable to be on a list for a professional or personal reason, it cannot impose conditions on the practitioner, because that person will already have been taken off the list. That is similar to the situation in England, Scotland and Wales.
Question, That the Committee is content with the clause, put and agreed to.
Clause 1 agreed to.
Clause 2 (Provision of dental services)
Ms Jendoubi:
Clause 2 introduces new arrangements for the provision of general dental services. It places a duty on each health and social services board to provide or to secure the provision of primary dental services in its area, to the extent that the board considers necessary to meet the needs of its area. Clause 2 also enables boards to enter into contracts with general dental practitioners to provide dental services for their areas.
The provisions in question introduce a range of regulation-making powers. Some respondents to the consultation complained about the lack of specificity of many of the provisions of the Bill. The reason for the lack of specificity is that they are regulation-making powers: the detail and underpinning measures that will allow for the implementation of the provisions of the 1972 Order will come before the Committee as regulations in due course.
Ms Ní Chuilín:
That makes no sense to me. There is nothing specific in the Bill, yet we are being asked to regulate something that is not specific.
Mr Kirkwood:
What Christine is saying is that the Bill introduces enabling powers to make regulations to enter into dental contracts. Many of the comments from the consultation referred to the lack of specific detail and wanted to know what would go into the contracts. Christine is saying that that issue will be dealt with further down the line.
The detail will be set out in the contract regulations that will come before the Committee; many of the new provisions are technical. Proposed new articles 60A to 61F will replace article 61 of the 1972 Order. That is it in a nutshell. Clause 2 introduces enabling powers to make regulations for entry into a general dental services contract. The terms of that contract are still being negotiated by the British Dental Association (BDA).
Ms Ní Chuilín:
Will the regulations come before the Committee?
Mr Kirkwood:
Yes. The enabling powers that have been drafted are more or less identical to the primary powers for the general medical services contract:
"Each Health and Social Services Board shall, to the extent that it considers necessary to meet all reasonable requirements, exercise its powers so as to provide primary dental services within its area, or secure their provision within its area."
Regulations will be written around that idea. Performers’ lists regulations will be written for dentists. There will be contract regulations. The regulations for the general medical services contract are like a book. The contract, its contents and how it will operate still need to be negotiated. Clause 2 introduces an enabling power to facilitate the writing of regulations that will surround the contract and the boards’ entry into contracts with dentists.
Mrs Hanna:
The matter is daunting for the Committee because it has concerns; it is, however, unsure of the stage at which it should talk about those concerns. Everyone wants the new services to have a positive effect. I hear a great deal from my constituents about the lack of National Health Service (NHS) doctors. There are concerns about the fact that what happens in England and Wales is being more or less copied here. The situation seems similar. I want to be sure that I know when I must intervene and express my concern about how targets will be set and measured and, indeed, about the availability of pilot schemes. I presume that now is not the stage to raise those concerns. However, I want to know when the Committee will have the opportunity to do so.
The Chairperson:
I have concerns that so many NHS dentists are removing themselves from the system and into private dental care and about the lack of dental practices.
Ms Jendoubi:
We hope that when a contract has been agreed by the BDA it will be piloted across Northern Ireland before it is rolled out. The contract must be underpinned by regulations that will prescribe with whom health boards can enter into a contract, what the contract needs to cover, and dental practitioners’ and boards’ responsibilities under the contract.
Services that can be contracted separately outwith the general dental services contract, such as those of individual, high-street dentists — orthodontists, for example — might be covered by a separate personal dental services contract under primary dental services. The underpinning legislation needs the primary powers of the Bill to enable the Department to make regulations that will bring the contract into being.
The Chairperson:
If I am reading you correctly, you are suggesting is that if the ‘i’s are dotted and the ‘t’s crossed, we may see more dentists wanting to operate in the National Health Service.
Ms Jendoubi:
Donncha would be happy to explain, at some length, the benefits that the new contract will bring.
The Chairperson:
Can we touch briefly on that? I am concerned; because many of my constituents tell me — as I am sure other members’ constituents tell them — that there are queues to get into a dental practice. The number of NHS dental practices that have gone over to private dental work means that services are reducing, especially in disadvantaged areas. We are all concerned about the dental health of young children, but if parents cannot afford to pay the private sector, we need more NHS dentists.
Mr Donncha O’Carolan (Acting Chief Dental Officer):
May I respond to the point that Carál made? Although it is very hard to comment on something so vague, the key is proposed new article 60A, which will place a duty on the boards to provide services in their areas. The 1972 Order allows dentists to choose where they set up and whom they treat. Significantly, proposed new article 60A will transfer the balance of power. The boards will have the power to decide where practices locate and to ensure that there is access in their areas. That is the fundamental provision of clause 2; the regulations will cover the detail on how that is done. The boards will hold the budget and they will decide how it is allocated. At the moment, services are completely demand-driven. The boards cannot compel a dentist to set up in a particular area or to see particular patients, so in many ways their hands are tied. The Bill will reverse that.
Ms Ní Chuilín:
On 2 July the Assembly debated the lack of availability of NHS dental treatment, although that might have been a premature debate. My understanding was that boards would be compelled to provide dental services in areas of high deprivation. Apart from being compelled to provide services, I thought that they might consider doing preventative work, improving education and health awareness and promoting healthy eating. It alarms me that aspects of dentistry could be streamlined or that professions could be categorised or sectioned off. I cannot relate that to the Bill. Market forces have determined whether there are dental services in our communities.
Mr O’Carolan:
That is correct. Dentists make all the decisions at the moment, but the Bill will give the boards power, and as they hold the budget they will be able to decide where they will target their money.
Ms Ní Chuilín:
If the long-term use of antibiotics rots a child’s teeth, the parents have to take out a bank loan to pay for treatment, because such treatment is deemed cosmetic. Rather than having to wait months for an appointment, parents should be able to avail of the service in their health centre or healthy-living centre. Access is the key, and at present many people do not have access.
Rev Dr Robert Coulter:
Will the new legislation interfere with the ability to sell a dental practice?
Ms Jendoubi:
No. A dentist will still be an independent practitioner working under a contract with the health board.
Mr Kirkwood:
It will depend on the negotiations on the contract. However, proposed new article 61B allows a health and social services board to enter into a contract with those specified in the sub-paragraphs. The contents of the contract have not been decided, so we cannot answer that today.
Ms Jendoubi:
This legislation will not affect that one way or the other.
Mr O’Carolan:
At present, dentists cannot sell their Health Service contract to anyone, so there will be no change.
Rev Dr Robert Coulter:
Therefore, it would not be in the contract at all?
Mr O’Carolan:
That matter would not be dealt with in this legislation. Dentists are independent practitioners and businesspeople. Their premises and equipment belong to them, so they are free to sell them.
Rev Dr Robert Coulter:
In proposed new article 60A(1) in the 1972 Order, each of the four health and social services boards would provide dental services. Is that really in the public interest, especially in the interest of those people who live on the periphery of a board area?
Ms Jendoubi:
Proposed new article 60A(1) places a duty on each health and social services board to provide for its area’s needs. That may mean a difference in emphasis but not in the service that is available. The Department of Health, Social Services and Public Safety is negotiating a Northern Ireland-wide contract with the BDA, under which everyone will work to the same terms and conditions. Therefore, as Ms Ní Chuilín pointed out, boards will have the flexibility to decide, for example, whether to set up a practice in a disadvantaged area. Moreover, it is not compulsory for dentists to enter into a contract. They will still be free to make that decision.
If a board cannot get an independent practitioner to set up in a particular area, it becomes the board’s duty to secure dental services in some other way; for example, by employing a salaried dentist or by temporarily appointing the Community Dental Service (CDS) to provide dental services where they are needed. Proposed new article 60A(1) merely places a duty on a board to ensure that dental services are available where necessary.
Mrs O’Neill:
The BDA suggests that proposed new article 60A(2)(b), which states that a board
"may, subject to such conditions as may be prescribed, enter into a general dental services contract".
Mr Kirkwood:
It is not contradictory. Proposed new article 60A(2)(b) refers to primary dental services. Proposed new article 61B(1) deals with a general dental services contract.
Ms Jendoubi:
That is the difference. Proposed new article 61B relates to the contract.
Mr Kirkwood:
Proposed new article 60A relates to primary dental services, which is the generic term for general dental services and personal dental services; therefore, proposed new article 60A(2)(b) does not contradict proposed new article 61B(1).
Mrs O’Neill:
May I have clarification on the categories of dental personnel who will be subject to the Health Service tribunals? For example, will hygienists, dental nurses, and so on, fall into the same category? Will that be covered by regulations?
Mr Kirkwood:
Yes, that will be set out in regulations. The tribunal services will cover healthcare professionals, so, when it has been negotiated and is in place, the contract will clarify what personnel, other than dentists, will be covered by the tribunal regulations. However, the overall provision for healthcare professionals will allow regulations to stipulate who will be covered.
Mrs O’Neill:
The BDA has also called for provision for piloting the new dental contract. The Northern Health and Social Services Board has interpreted clause 6 as meaning that pilot schemes will not be possible until the Bill has been passed. Is that correct?
Ms Jendoubi:
We can deal with clause 6 now if the Committee wishes.
Mrs O’Neill:
Shall we come back to clause 6?
Ms Jendoubi:
We are happy to deal with it now.
Clause 6 will remove the power to make pilot schemes for provision of personal dental services. However, it will not obviate boards’ power of the boards to pilot general dental services. We can do that without the need for primary legislation. We have agreed with the BDA that the new contract — when we get one that we all agree looks as if it is a runner — will be piloted before it is rolled out formally.
Mr Gallagher:
I have concerns about a couple of points. We have heard about the current problems with dental services. As has been said, the Committee wants an outcome that delivers a service for the public and that results in a profession that is worthwhile and rewarding for its practitioners. It is to be hoped that our dentists will enter into contracts because those contracts will be rewarding.
I am concerned about what is happening, for example, in England. I am not sure what you mean when you talk about British dental services. I presume that you mean dentists in Northern Ireland who are members of the BDA, and that you are in discussions with those dentists. I see that you are nodding by way of confirmation. That is encouraging. However, the contracts are not working well in England; they have not produced the desired outcome. There are still huge problems with dental services in England. After going to all this bother, we do not want to end up with bigger problems here.
Although I have heard that there is no contradiction between, under proposed new article 60A(2)(b) of the 1972 Order, entering into contractual arrangements with any person and, under proposed new article 61B(1), entering into general dental services contracts, it appears that there is one. Is it necessary to include proposed new paragraph (2)(b) of the 1972 Order? We are trying to solve a problem by removing any doubt or suspicion about the way forward.
Another point concerns the piloting of general dental services, which Christine mentioned. Will the boards pilot those new services before or after the new contracts are agreed? Will the Bill become law before the contracts are piloted, or will it be done the other way around? Will everyone be confused?
Ms Jendoubi:
Technically, the Department does not need either primary or subordinate legislation in order to run pilot schemes. However, for practical reasons, the Department will need to know the contents of the subordinate legislation in order to ensure that it is consistent with the content of the pilot schemes. The Department hopes to develop subordinate legislation at roughly the same time as the contract is implemented, so that we can ensure that the contract and the subordinate legislation are consistent.
The Committee will play its role by scrutinising the subordinate legislation that underpins the contract. The detail of the contract will be a matter for negotiation. Tommy Gallagher is absolutely right to say that the new contract that was established in England found no favour with the profession, largely because of the way in which remuneration was handled. Dentists’ activity is still measured in units of dental activity (UDAs), and that keeps dentists on what they refer to as the treadmill of "drill and fill". Dentists are paid for the amount of treatment that they carry out rather than for their professional time spent on preventive measures and the promotion of oral health.
We will try to take full account of the English contract and learn what we can from it, such as what to do and what to avoid. Together with the BDA, we will produce a dental contract that suits Northern Ireland and its dentists, that acknowledges their professionalism and that rewards them for the use of their time rather than for the number of root canals that they fill.
Mr O’Carolan:
We have never indicated that the English contract will be introduced in Northern Ireland. The Minister told the Assembly that on 2 July 2007. We hope that a joint communiqué with the BDA will be issued this month to all dentists. It will indicate how our contract will be different from the English one.
Mr Gallagher feels that there is a contradiction in the Bill. Proposed new article 60A(2)(b) deals with all dental services, which means primary care as performed by our independent practitioners as general dental services, and personal dental services, which we do not have in Northern Ireland at present. Regulations must be written for that provision to be introduced. Proposed new article 61B(1) deals specifically with the general dental services contract. It is necessary that that distinction be included in the legislation.
Mrs Hanna:
We want a better service; we do not want "drill and fill". We want to ensure that people are attracted to the dental profession, that they receive sufficient remuneration for their work and that they are not on that treadmill to which Christine referred.
The Committee has been given the impression that the content of the Health (Miscellaneous Provisions) Bill will change little. However, as Tommy said, if all contracts were to be signed before the pilot schemes were in place, it would be hard to undo the legislation if it were found not to be right. Surely it would better to find out first whether the pilot schemes work, before the contract is set in stone. It is important that that be done.
Ms Jendoubi:
The contract will not be set out in regulations, but its underpinning framework will be. The contract will be piloted. It will not be set in stone until after the pilots have been rolled out and it becomes clear what has worked and what needs to be tweaked. Only when we reach the point at which everyone is content will the boards enter into a contract with individual dentists. I agree that the full contract cannot be set out in legislation.
Dr Deeny:
I hope that the answer to both of my questions will be yes.
I have been approached in the past fortnight by a constituent and patient, who told me that she could not get an NHS dentist in either Omagh or Dungannon. She had tried to register with every one of them. Is what you are saying that, in future, clause 2 will ensure that the boards will bring that situation to an end?
Ms Jendoubi:
Yes.
Dr Deeny:
That answer is important, because if patients cannot get an NHS dentist, a serious deficiency in dental care exists.
Last week, I was appointed to the West Local Commissioning Group (LCG), having had to take the Department to the High Court, so I have an interest to declare. The health and social services boards will, at some point; come to the end of their lives — we know that. It is now too late to legislate for their replacement by LCGs, as was to have happened by 1 April 2008. Will the term "local commissioning groups" replace "boards" in the legislation?
Mr Farrell:
As Christine has already indicated, the answer to your first question is yes. As for your second question, when it comes to the use of the term "boards", the Bill must use terminology that applies to the structures currently in place. We currently have health and social services boards; however, if, after the review of public administration (RPA) is implemented, they are to be replaced by a new health and social care authority, any reference to "boards" in the existing legislation will have to be amended in the legislation that establishes the health and social care authority.
Ms Ní Chuilín:
The BDA has called for an independent adjudication of any disputes that may arise as a result of clause 2. Its concern extends to clause 3. To achieve that outcome, the BDA recommends that proposed new article 61E(2)(b) be changed from
"for the Department, or a person appointed by it"
to
"for the Department to appoint an independent person or panel".
Ms Jendoubi:
Again, that issue will be set out in regulations, so the Committee will have another chance to examine the details.
Mr Kirkwood:
The same dispute-resolution procedure that the general medical services (GMS) contract uses will probably be followed, whereby the Department appoints someone and a tribunal is established.
The Chairperson:
The BMA has queried the proposed change to the cross-heading after article 60 of the 1972 Order from "General Dental Services, General Ophthalmic Services and Pharmaceutical Services" to "Primary dental services". Moreover, in clause 5, Roe Valley Dental Practice has queried the change to the cross-heading and heading that precede article 15B of the 1972 Order from "personal dental services" to "primary dental services". What is behind the decision to use those different titles?
Mr O’Carolan:
"Primary dental services" is a generic term for general dental services and personal dental services, which is an alternative way in which to deliver general dental services. No personal dental services operate in Northern Ireland at present, but that proposed change to the 1972 Order gives the option of having those services in the future. Rather than include "general dental services" and "personal dental services" in every sentence, "primary dental services" is used as a catch-all term.
The Chairperson:
Therefore, "primary dental services" is used as an umbrella term.
Mr Kirkwood:
I want to raise a further point so that the Committee is aware of the full provision of clause 2. Although we have covered the contract issues, clause 2 will introduce proposed new article 61F to the 1972 Order. That provision sets out the enabling power for how dentists will be listed in future. We discussed that issue when we considered clause 1. The proposed new article sets out similar powers to those that are currently in place for GPs for conditional inclusion on a list and for contingent removal and suspension.
Question, That the Committee is content with the clause, put and agreed to.
Clause 2 agreed to.
The Chairperson:
If members agree, we will call a halt to our scrutiny of the Bill, because we are now due to hear evidence from the Northern Ireland Fire and Rescue Service. We will scrutinise the Bill further next Thursday. Clause 3, from where we will begin, is fairly short. I hope that it will be full steam ahead. Thank you very much.
Ms Jendoubi:
We look forward to it.