§ 11.5 a.m.
§ Mr. Harold Steward (Stockport, South)
I beg to move,That this House notes with concern the shortage of dentists, and calls upon Her Majesty's Government to hasten their consideration of the recommendations of the McNair Committee on recruitment; to encourage the proper training and employment of ancillary dental workers; and to further the development of measures to prevent dental decay.It is now approximately six months since the McNair Committee presented its Report on Recruitment to the Dental Profession and, while perhaps it is still too early to expect from the Government a detailed statement of their plans, I felt that it would be useful to use my good fortune in the Ballot to provide the House with an opportunity to discuss this important service.
Dentistry has been the subject of three inquiries during the last thirty-five years. Although there has been a Dental Register since 1888, I think that public attention was first called to the condition of dentistry in this country during the First World War, when the state of the teeth of our recruits was so appalling that it was determined that at the earliest opportunity a committee should be set up to inquire into the state of the service and, in particular:the evils of unqualified practice.This, of course, was the Acland Committee, and in 1921, as a result of its findings, the dentists received what can be considered as their charter. By that, many people who hitherto had practised without any qualification were brought on to the Register and I think that 7,315, by the year 1924, had been included in the Register in that way, making a total at that time of 13,473.
The next committee was the Teviot Committee, set up in 1943, which 676 reported in 1946. That Committee was set up as a result of the Beveridge Report to discover whethera comprehensive dental service should be instituted as an integral part of the National Health Service.That Committee reported in 1946 and possibly one of the most striking features is that, although it is eleven years since that Committee reported, the McNair Committee, reporting in 1956, used almost identical words in many of its findings and recommendations. The McNair Committee, however, whose Report is the chief subject of this discussion, was set up:to ascertain the reasons for the lack of a suitable number of candidatesand to indicate possible directions in which remedies might be sought.
First, we should have a look at the numbers as they exist against the background of the past. The number of dentists in the United Kingdom, excluding the Colonial and Foreign Service, in 1924 was 13,380; in 1947, it was 15,025; and in 1956, 15,349. Of this latter figure, approximately 14,900 reside in Great Britain. The figure includes about 11,500 who are in general practice, both privately and in the National Health Service.
The significant point about these three figures is that the number of population per dentist has remained almost the same from 1924 to 1956. It was 3,363 in 1924; 3,300 in 1947; and 3,336 in 1956. During all those years there has been practically no increase in the number of dentists in this country.
The Teviot Committee, speaking of the shortage of dental manpower, said that it was neither sudden nor of recent development. In 1921, most dentists were in the over 45 age-group. The Register was overweighted with dentists in the higher age-groups. Recruitment, in the immediate post-war years, was progressing at the rate of 340 per year. During the war, as might be expected, it dropped to a new low, below 300.
The Committee went on to say that if, in the years 1948 to 1952, it should rise to 400 and thereafter to a figure of 425 per annum, it would take thirty years before the present effective strength would show any material increase. It meant that an intake of 800 into the 677 profession or 900 into the dental schools would be necessary to achieve 20,000 dentists in the whole service. The final words of the Teviot Committee were most important. They said that the problem of recruitment was not one containing its own solution. There was no promise that, if left to take its natural course, the number of recruits would rise to an extent sufficient to provide a profession large enough to meet the calls upon it.
We can find exactly the same words in page 10 of the McNair Report. After discussing the shortage, the McNair Committee said:The shortage is not of a kind which can cure itself and its consequences now are more serious than they were when the Teviot Committee reported, so that its cure is more urgent.I do not think there will be any difference of opinion in the House about the actual shortage, although there may be a slight difference about the degree, or the effect of the age of retirement. Although the intake into the dental schools increased last year, rising to the maximum that the schools were capable of absorbing in their present state, namely, about 645, nevertheless the prewar and the post-war recruitment, combined with the age of the dentists who came in under the 1921 Act, will leave a grave shortage during the next ten years.
We may differ whether a dentist does or does not retire at the age of 65. If we are to believe all that is said of the dentistry profession at this time, one can well understand that many dentists at that age may not be in a position to retire. Whichever view we may take, it is clear, either from the average age of retiring or the expectation of life, that a critical time lies ahead of us because of the shortage of entrants into the dental service.
What is the contribution made to health by dentistry? Without going into detail, or into paragraphs 31 to 33 of the McNair Report, I would quote what the Committee stated as its conclusion on this subject. It said, in paragraph 33:… we have no doubt that in a civilised community an effective dental service is an essential.I hope that the Minister can state categorically whether the Ministry accepts that conclusion.
678 What are the causes of the shortage? All committees have agreed that there are two prime reasons for it, as well as certain secondary reasons. The two prime reasons are the attitude of the public towards the profession of dentistry, and the disquiet within the service itself about the profession and the shortcomings which they see within it.
I suppose it would be true to say that between 1878 and when the Register was instituted in 1921 and the profession got its first charter, the average attitude of people towards dentistry was, "If I have a toothache I had better have the tooth out". Care of the teeth was practised only in a very minor way. The attitude of the public must in all circumstances be one of the factors determining the status of the profession.
We sympathise with the profession in its desire to enjoy a status commensurate with that of its medical colleagues, but it is not something which can be achieved overnight. It must be born in the reaction and the attitude of mind of people towards the dental service. Within that first of the two main reasons for the shortage we should concentrate very much on the health and care of teeth, publicity and tuition in schools and in later life.
Whatever view we take on this matter, we are all proud of the welfare services that have been instituted, but can take no pride at all in the relationship between the number of dentists and the population, in comparison with the figures of other countries many of whom are obviously very much poorer than we are. The ratio of dentists to our population has remained around the figure of one to 3,300 for a long period. In Canada, the figure is down to one in 2,790; in Sweden one to 2,271; in Norway, one to 2,000; and in the United States one to 1,667. We might expect a figure like that for the United States of America which is a wealthy country, but we cannot call Norway wealthy. Its figures compare to our disadvantage.
The attitude of dentists themselves is a fundamental factor. They say that they are unwilling to advise any young person to undertake dentistry as a career. Those are the words used in the McNair Report. The McNair Committee found evidence of that from dentists all over the country. There is no doubt that part of the attitude of dentists was connected with the 679 unhappy history of dentistry prior to 1921, but at least in 1921 the dentists achieved what was virtually a complete monopoly of the mouth. Further, in 1956 they achieved self-government in relation to their own profession.
On the other hand, it must be admitted that the three cuts made in their remuneration in recent years, whether justified or not, were bound to engender a feeling of insecurity and the feeling that the dentists had been treated unfairly. Similarly, there has been repeated criticism that their clinical freedom has been impaired under the National Health Service because of the necessity of seeking prior approval from the Dental Estimates Board.
I understand that in this respect the list of treatments which are now subjected to prior approval is gradually being whittled down. Certainly, it would restore a considerable amount of confidence within the profession, and in the liaison between the average dentist, his Dental Council and the Ministry, if the schedule could be not only further reduced, but subjected to continual review. That was a recommendation of the McNair Committee and perhaps my hon. Friend the Parliamentary Secretary will say what steps have been taken in the intervening period further to reduce the schedule and, also, what action will be taken for subsequent regular reviews.
Having said that, we come to what must be the greatest single cause of dissatisfaction of dentists in relation to their service, which undoubtedly is the financial problems that face the older dentists on retirement and which, of course, are bound up with the piecework system of payment to the profession. As an industrialist. I am not without some experience of piece-work payments. It has always seemed to me that piecework payments have their greatest reward in relation to semi-skilled labour throughout any service and certainly in relation to labour in which the experience which has to be gained can be acquired in a relatively short time, so that there is no further great difference from the output of experience.
In the case of the dentists, we find that their maximum salary can be achieved at the age of 35 and that thereafter there 680 is a gradual scaling down of the salary that is earned. As a layman, I would have thought that one of the fundamental points of dentistry was the experience which is gained by the dentists over a long period of years and that unless a system of remuneration can be found which takes account of this, there will always be dissatisfaction within the service.
It was, of course, a recommendation of the McNair Committee that there should be a thorough review of the whole system of remuneration and that some way should be found to lessen the financial uncertainty of the older dentists on retirement. I understand that the British Dental Association is examining this problem at present and, no doubt, the Ministry will be awaiting the Association's findings and recommendations before joint discussions on this matter begin.
§ Mr. John Baird (Wolverhampton, North-East)
Would the hon. Member therefore agree with some of us on this side who have always advocated that the fairest method of paying a professional man is by a salary?
§ Mr. Steward
I am very glad that the hon. Member has raised that point, because there is clear indication in the public service of some degree of satisfaction which can be given to the more experienced dentists whereby, being paid by salary which takes account of progressive experience, they rise in their profession and are more highly remunerated with time, whereas the reverse is true of private practice. On the other hand, I understand, although I am, of course, only a layman, that that was not a condition acceptable to the dentists at the time that the existing system of remuneration was fixed.
I would rather look to an entirely different system—that is, the group dental scheme system—whereby there should be a greater number of partnerships introduced into the profession. Thus the older, experienced man could concentrate on those operations which call for the highest degree of experience and skill, leaving the new entrant as his junior partner in the profession to perform the other tasks. This system has many other advantages also, but that is clearly one 681 of the advantages which it would have if dentists would consider group partnership schemes as distinct from the present system.
Another obvious advantage, which has been pointed out on many occasions, is that the overheads of single-practice dentistry account for some 48 per cent. of the total cost, whereas it is clear that in a group scheme these overheads, relative to the work performed, would be greatly scaled down. That would have its obvious repercussion in the salary to be enjoyed by the partners.
Another matter which is alluded to in the McNair Report is the introduction of women into the profession. Both of the previous Committees have been quite clear about this. They have said that the profession is one in which women have many natural advantages. There is, first, the natural advantage which they enjoy of caring for the sick and for those who are in pain. There is also the fact that the profession is one to which part-time service could be particularly applicable. It is a profession which could continue to be practised by the married women. All these are very natural advantages and I understand that they have received the approval of all concerned, both the Ministry and the dental profession.
Nevertheless, when we consider the figures they are unsatisfactory. Of the country's 15,000 registered dentists, 1,231 are women, or a proportion of 7.7 per cent. Mary of these women, no doubt, practise in the public service sector. In the University of London, the number of women students in their first dental year from 1950 to 1955 varied between 7 and 12 per cent. On the other hand, the percentage of women dentists and dental students in the Scandinavian countries was as follows: Norway, 30 per cent.; Sweden, 30 per cent.; Denmark, 40 per cent.; Finland, 75 per cent.
Despite all these advantages, despite the acceptance by all concerned of the principle of equal payment for equal work in the employment of women in the profession, certain hospitals in the country are still restricting the proportion of women entrants. I should like to know from my hon. Friend what steps are being taken not only to encourage recruitment to the educational services, but to overcome this difficulty with the hospitals.
682 So far, in taking stock of the actual shortage and some of the reasons for it, we can come to certain very positive conclusions. First, if we accept the Teviot Committee's figures, which were later accepted by the McNair Committee, we can quite clearly see that there is a shortage of dentists at present and that there will be a grave shortage within the next ten years. We can see certain of the steps upon which the McNair Committee reported and by means of which some change in the situation might be brought about towards the encouragement of those who are prepared to make dentistry their profession, but what we have not yet looked at is how we are to accommodate the extra number, if we are successful in recruiting them.
Of course, it would be quite easy for me or for anybody to spend somebody's else's money. Obviously, this will cost a lot of money, and there are obvious priorities in the demand for that money. The Teviot Committee stated that £1¼ million of capital would be required and between £200,000 and £300,000 per year to cover the extra entrants as foreshadowed at that time. No doubt those figures would be vastly increased today.
The Birmingham Dental School is now in its 1958 programme for rehabilitation and certain other measures are being taken to increase the numbers. I believe that the attitude of the profession has to be declared in respect of certain other matters before the Ministry could be expected very clearly to see the exact level at which it should train dentists during the next ten years. Nevertheless, when all that is said, it is quite clear that there is a financial burden to be taken into account, and steps to be taken in the universities before we can make this point any more satisfactory than it is at the moment.
The McNair Committee, in page 34, of its Report, in paragraph 103, makes certain very specific recommendations. It says:(a) Universities should at once consider how best they can provide additional places for students requiring to be taught chemistry, physics and biology.Also,(b) Universities should consider how best they can provide additional places in the pre-clinical year.683 and, further, in connection with the decline in the entrants to the medical service, what the effect of that decline will be in the possibility of recruitment into the dental service.
I understand that at present a committee is sitting on that particular aspect of the matter, and it is felt that by 1960 there will be some falling off in the number of places required for medical students. We should have a clear indication from the Government that, as and when that is brought about, these places will be used for this important service.
The McNair Committee goes on to say:(d) The Minister of Health, the Secretary of State for Scotland, the Boards of Governors of Teaching hospitals, the University Grants Committee and the universities should immediately consider what expansion of existing dental schools can be undertaken and how the necessary financial provision can be made.There are many claims on any money that might be available, and I hope that at the earliest opportunity the Government will say what they are proposing to do in this matter.
I know that I have not touched on all the recommendations of the McNair Committee about the shortage and recruitment of dentists, but I now want to turn for a few moments to what are the second and third parts of the Motion. The first concerns the ancillaries to the dental profession. I may be forgiven, perhaps, as a layman, for not seeing many of the difficulties which are inherent in the employment of ancillaries within the profession. At the same time, I think I am justified in turning to the parallel of the medical profession and in pointing out the great difference that there is there.
The dentists have always been rather jealous of their status. Is it not true to say that the status of the doctor has to a very large extent been built up by the glamour brought about by the ancillaries which surround his profession and their relation with the patient? We have the nurses and the sisters in hospitals saying, "Doctor says this" and "Doctor says that," with the idea that whatever the doctor says is absolutely right. We have the relationship between the ophthalmic surgeon and the orthoptist, and the orthopaedic surgeon and the physiotherapist, and all this, in my view, 684 forms the base which elevates the doctor to the apex of the pyramid, where he is surrounded with this glamour in the general reaction in the public mind.
I cannot see why the dentists insist on doing all the spade work of their profession when they never reach the pinnacle of glamour attained by their professional brethren. In the recommendations that are made by the McNair Committee for the employment ancillaries, I am disturbed, if I read it aright, to see the signs of the profession itself dragging its feet on every occasion rather than entering into the spirit of the employment of people on the fringe of their profession to relieve them of all the minor work, wherever that may be possible.
The question of dental hygienists has been referred to in both of these Reports, and I am quite certain that there has been a good deal of misconception about it. Nevertheless, if we look at the position after ten or twelve years, we find that there are only about 200 in the hospitals and the public services who are dental hygienists. Although the profession has accepted, in principle, the employment of these people, I understand that they add the corollary, at least in their minds, when there are enough in the public service, and they are committed in principle to introducing the experiment of what we might term dental nurses. So far very little has been done in that connection.
We know that a delegation went out to New Zealand in 1950 and found there that this was not only the accepted practice, but that it was an extremely valuable one. They found that the reaction in the minds of both the people and the dental profession to these dental nurses was of the highest possible character. Why will not the dental profession not merely give lip-service to the employment of hygienists and pursue with enthusiasm the experiments in relation to dental nurses, but also itself exercise pressure on all concerned to expedite the number who are introduced in this way?
There is one further ancillary which, understandingly, is perhaps the subject of a lot of difference of opinion. I refer, of course, to the dental prosthetist. There have been many references 685 to this question, and a good deal of publicity has been courted by the profession. The general attitude should be that, if the shortage continues, the dental profession should be ready to look again at the employment of these people with the object of lessening their own work and allowing them to concentrate on the more important parts of their profession.
I want to say a few words about dental health. I think it is in relation to dental health, starting at the earliest age, that we have the greatest shortcomings in this country. There has been progress, but undoubtedly there is a great deal of work yet to be done. I was told that in an experiment in which 12,000 children under the age of six were examined, six out of 20 milk teeth were decayed.
We have also been told that dental caries is prevalent in 95 per cent. of London school children. We are told how this can be overcome by diet. The teaching of this subject in the schools is a very important and urgent task. We are told also that this can be overcome by the fluoridation of water. This, again, is one of those matters which have been the subject of a lot of prejudice. This matter arose in the United States, in the first place, following the observation of pitted teeth which resulted from an excess of fluoride in the water. Research was carried out and the conclusion was reached that one part in 1 million—that is, one drop in a bucket of water—was the optimum value of fluoride in water which would itself reduce the prevalence of this disease by about 60 per cent.
I understand that some of the prejudice which has been engendered has even gone so far as to claim that the fluoridation of water is an interference with the liberty of the subject. In certain parts of the world, of course, fluoride exists in water in this exact proportion of one part in one million. I wonder whether there is any question of interference with the liberty of the subject because people in those parts of the world take that water.
There is the significant factor that at Slough, Maldon and South Shields this proportion of one part in 1 million exists and the condition of the teeth of the children in those places is so much better than in the rest of the country. Indeed, there is a direct comparison between South Shields and North Shields, which 686 is just across the river, where this condition does not exist and where the state of the teeth of the children is very much worse. Experiments are being conducted at Watford, Andover, Anglesey and Kilmarnock, and it is about nine months since the first experiment was started. It may yet be three years before results of any great significance can be published. I hope that every effort will be made to condition the minds of the public to the value of the use of an optimum fluoride content in the water.
The only other subject I wish to refer to is research. In the early days this profession was practised virtually by laymen without any background of research and relying entirely on their experience. We have seen the profession built up since 1921 with a fair degree of teaching and research behind it. But we have seen, also, by comparison with other countries, a profession in which too little value is still given to this important question of research. When the Government consider their conclusions in relation to the financial problems involved in expediting this service an I overcoming the shortage of dentists, I hope that the question of research will be given a prominent and significant part in these considerations.
§ 11.45 a.m.
§ Mrs. Eveline Hill (Manchester, Wythenshawe)
I beg to second the Motion.
I myself raised this subject a little while ago, and I do not think there need be any apology for raising the subject again, because it is so fundamental to the health of our nation. We frequently hear of the cost of the National Health Service, but surely our efforts must be concentrated on preserving health and not merely on curing the sick.
It is true that at present there is a greatly increased number of students in our dental schools, but when one inquires where they come from one finds that many of them come from the Commonwealth and other countries. The point which disturbs me is that we have no knowledge of how many of those people who are occupying places in our dental schools will be available to replace the losses which we all know are inevitable in our service.
I am not suggesting that we should not train these people from overseas.
687 We have the facilities to train them, and we want to help not only ourselves but people in the Commonwealth and our colleagues abroad. But this is a subject of which the Ministry must take note and in which more discussions must be promoted to enable this problem to be solved.
§ Mrs. Hill
I agree, but in view of the amount of wastage, and the number who are likely to retire in the future, those whom we can foresee being available are insufficient.
We have agreed that women dental hygienists should be trained. There should be an experimental scheme. New Zealand has dental hygienists, and I believe I am right in saying that Hungary, too, has these dental nurses. Some time ago I met one of the Hungarian refugees who had been employed in that capacity in her own country.
There is, however, a great wastage among girl hygienists. That is understandable. There is a tremendous call for the services of those young women in so many other branches of the medical profession. The point is: are there enough of these women who prefer to go into that side of the dental profession? In my opinion, the number is insufficient.
This brings me back to consider what available help we have that might be given more quickly in this service. My hon. Friend the Member for Stockport, South (Mr. H. Steward) mentioned the dental prosthetist. There is a possibility that people in this sphere would be willing to undertake further training, which could be much shorter than the training of girl ancillaries and hygienists, and thus render assistance to this profession more quickly.
We must not have closed minds or closed shops. We must be broad-minded if we are to do the best for our people. After all, it is no satisfaction to a patient to go to a dentist and have a temporary filling and then wait months before the treatment can be completed. That is not 688 a good thing. It is also not a good thing that our youngsters are not getting the adequate examination that they ought to have and, for all these reasons, I think that my hon. Friend the Member for Stockport, South has done a valuable service.
While we have at present a shortage of dentists, it is also true that they are mal-distributed. Some towns are fortunate and other areas, rural and semi-rural, are less fortunate. The Ministry and everybody concerned must get together to try to devise ways and means whereby this service can be better served, see how we can improve the help that is available and how help in the future can be extended.
§ 11.51 a.m.
§ Mr. Donald Chapman (Birmingham, Northfield)
I intervene in the debate to tell the saga, I think the tragic history, of a young man who wanted to become a dentist. I want to tell the story because of something which has been a thread throughout all our debates on the shortage of dentists, and that is the statement made by the hon. Lady the Member for Wythenshawe (Mrs. Hill) on 21st December when she raised this subject herself.
The hon. Lady then said:Another factor which I think needs to be looked at is that of grants to enable students to take up the profession. I think that careful consideration should be given to these grants and their scope widened."—[OFFICIAL REPORT, 21st December, 1956; Vol. 562, c. 1687.]I want to tell briefly the story of what must be one of the most parsimonious and reactionary local education authorities in the country in its attitude towards a young man who set out to be a dentist. I know that there is a shortage of places in dental schools and universities. I know that we want more places and that we want to extend scholarships pari passu with the increase in the number of places.
This young man lives, not in my constituency, but in a small mining town in South Yorkshire where I was born. I have the full approval of my right hon. Friend the Member for Dearne Valley (Mr. W. Paling) in raising this matter. The town is in his constituency. This young man's people happen to have been friends of mine since childhood, and they turned to me when they got into this trouble.
689 The young man comes of an ordinary, working-class family. His father is a brewery labourer, whose income is £518 per annum, or £8 per week. The young man set out to be a dentist and to take a course, which he has just started, which will cost about £1,000. He has virtually no hope, therefore, of help from his family. They sacrificed, first of all, to keep him at school. They kept him at school not only to take advanced subjects in the G.C.E. one year, but to take them again a second year because he had set his heart on this professional qualification.
In 1955, he passed at the advanced level in biology, physics and chemistry, reasonable results, though not brilliant. In 1956, he took chemistry again and two further subjects to fit him for dentistry—botany and zoology. Why botany comes into this I do not know, but apparently it has some connection with dentistry. The important point about this second year is that when he took the course his school was unable to provide him with any tuition at all in botany and zoology. He studied alone, either in school hours or at home, the school providing the books. He took the two years' course in one year. All credit to him, therefore, that he passed in botany. Although he failed in zoology, he got a good mark in scholarship zoology.
The Ministry of Education's recommendation is that students with two advanced passes in the G.C.E. should be considered for university and similar awards. This young man had four advanced passes by now, in chemistry, physics, biology and botany, and a good result in scholarship zoology. Although he had four advanced passes, against the Ministry of Education recommendation of two, the Yorkshire West Riding turned him down for any scholarship assistance whatsoever.
When I began to be interested in his case, I wrote to the Education Officer of the West Riding and asked whether certain facts had been taken into consideration. He replied that they had not been taken into consideration at all. Because the young man had not had a high total of marks, the authority had not bothered to take into consideration that he had studied on his own without a teacher or that he had taken the ex- 690 amination in one year instead of two and still had done pretty well in it. This was the encouragement given by the Yorkshire West Riding to a young man who had made all these sacrifices to try to become a dentist. It is an absolute disgrace to the country that the Yorkshire West Riding should behave in this way.
I raised the young man's case in the House, and I was satisfied that the then Minister of Education agreed with me in labelling the West Riding as parsimonious, niggardly and miserly. I was thankful to find that the Times Educational Supplement supported me in that view. I was unable to force any reconsideration of his case, and my only course was to go to private charity. I wrote to organisations over the length and breadth of the country to get them to take an interest in the young man, and I have received total grants this year of £150 towards the cost of the course.
But why should I have to go round to charity after charity like this in these days and say, "Here is a young man who is trying to be a dentist and is the admitted victim of misguided, miserly public policy. Will you, out of your private interest in this sort of case, help him to overcome the obstacles put in his way by a public authority?" These charities have responded nobly, but I do not expect them to be as generous again if I cannot obtain anything more for the rest of his course, which takes about four or five years.
We found on investigation that the West Riding was in a particularly shocking state in this respect. The comparison with its next-door neighbour, Lancashire, was quite startling. The Minister gave me figures in answer to a Question which I asked on 15th November. They showed that another 260 students would have to be paid grants by the West Riding every year to bring the West Riding up to the standard of generosity of Lancashire, and that is about 50 per cent. more than the West Riding gives now. Last year, the West Riding refused grants to 350 students with two advanced passes in the G.C.E., whereas Lancashire would have given grants to 260 of those 350 students.
It is all very well for the Ministry of Health and the Ministry of Education to come to that Dispatch Box, as has been done time and again, and talk about the 691 shortage of scientists and dentists whilst allowing this situation to continue. They know these figures as well as I do as a private Member of this House. They know that some local authorities are lagging behind, and yet nothing is done about it and the authorities are allowed to go their own way.
As a result of raising this case, complaints flooded in to me from the West Riding. For the benefit of people who take an interest in the training of scientists, I will read a letter from one West Riding parent which appeared in a newspaper. This parent wrote to say that her child had five advanced subjects in G.C.E., some of them also at scholarship level, and the child was refused a grant by the West Riding authority. The parent continued:She evidently didn't read the Manchester Guardian, and not enough classical English. They were not interested when she said she wanted to be a scientist and most of her time was spent with text books. In fact I don't think they liked the look of her. The board told this candidate that she ought to go for a teacher's training college. However, on the excellent advice of the Grammar School master she stayed on and took the State Scholarship exam. On obtaining this County authorities lost no time in sending their congratulations, and an honorary County major award.The lesson to be learned on facing boards of this description is: don't try to tell of your natural aptitudes, just find out beforehand what kind of small talk suits these selection boards.I hope that is not true of the way in which our county authorities are handling the applications of such young people for scholarships to become scientists or dentists or to follow similar vocations. The West Riding position is not unique, I am sure, since figures from many authorities show what a bad way they are in.
I wanted to discover how the colleagues of this young man were faring at Guy's Hospital, where he is now studying for the L.D.S. So I wrote to the dean of his faculty about his fellow dental students. The dean replied to me that twelve other students entered under the same conditions as this young man. He wrote:Of this number, one is receiving a grant from the General Dental Council, and five others are receiving grants from the following authorities: Sussex Education Committee, East Suffolk … Middlesex … Glamorgan … the East Riding of Yorkshire.So what emerges is, first, that the Ministry of Education is not checking on the lack 692 of generosity of certain authorities; while other authorities have taken a lead, and the colleagues of this unfortunate young man are in receipt of substantial grants to enable them to complete their courses.
I will take the story a little further before I conclude. As a result of my pressure in the House, I forced reconsideration of the entire awards policy of the West Riding and I understand that the outcome will be a slight improvement. From what the Education Officer has written to me to say, sixty or seventy more scholarships are to be given to all students but, to bring the West Riding up to Lancashire, 260 should be given, as I have said already.
The second thing I forced them to do was to bring in, as a new line of policy, that at the end of the first year consideration will be given to the examination results of students who have been refused a grant in the first place, in order to see whether, having reached the university under their own steam, they do well enough subsequently to be considered for university awards.
Having forced this in the West Riding, what do I find? Thinking at last that everything will be all right and that this young man will receive help towards studying for the L.D.S. diploma, a letter is received from the Education Officer putting us right back to the beginning again. The young man has a good report from the dean of his faculty, and yet a letter from the Yorkshire West Riding dated 18th February of this year states:You are aware, of course, that university awards are available for degree courses only. In the circumstances, since you are studying for the L.D.S. diploma, I regret that it will not be possible to consider your application for assistance.So we are right back where we started. We have forced improvement, we have forced reconsideration at the end of the first year, but the West Riding is still sticking to the fact that it will not offer any grant at all for the course which this young man is taking.
Let us look at what it means. This young man could not take the B.D.S. degree because he did not have the qualification in zoology. The West Riding had not a teacher to teach him that subject, so they left him to study on his own and, when he did not get the qualification in that subject, they 693 said they were sorry but he could not take the degree course, and therefore they could not make him a grant to study for the alternative, which is the diploma course.
What a scandalous situation. This is in one of our major local authorities: a young man penalised for trying for two years under his own steam to make his way as a dentist. How far have we to go in exposing such local authorities before we get them to act? Just look, Mr. Speaker, at the thickness of the file on this case which I have in my hand. Yet, at the end of it, I confess I am nearly beaten by a local authority that is reactionary and miserly, is even publicly acknowledged to be so, and yet will do nothing.
The first question, then, is how far we have to go in our condemnation and exposure before we get action. The second is, what is the Ministry of Education doing about this matter? The Parliamentary Secretary was courteous enough to tell me that he could not be here this morning. I know that he will want to read what I have said and will try to do something about it. What it reveals is that an enormous shake-up is required in the Awards Branch of the Ministry of Education. It is extremely complacent. as this case shows. Since I have raised the matter months ago I do not know of any significant action that has been taken.
Even when I put down a Question yesterday to find out how far this applied throughout the country, I found that they had not even bothered to collect the statistics. I asked how many authorities do not give grants to students studying for the L.D.S., and what action the Minister proposed to take in view of the shortage of dentists in this country. The reply from the Parliamentary Secretary to the Ministry of Education was:I regret that information necessary to answer the first part of the Question is not available, but if any such case were brought to the notice of my noble Friend he would be prepared to take it up with the authority concerned."—[OFFICIAL REPORT, 7th March, 1957; Vol. 566, c. 91.]Are we short of dentists or are we not? Is it a good thing that we should encourage youngsters to try for the L.D.S. and similar courses? If so, is it not the job of the Ministry of Education to know which authorities are unjustly penalising 694 students in this way, and is it not the job of the Awards Branch of the Ministry of Education to rap them on the knuckles as bard as it can until something is done about it? I should have thought it was patently obvious that this is what should be done.
After all, we have moved in the last five, seven and ten years into an era in which it is almost universally accepted that young people who have shown themselves able to benefit by a university course should have public funds made available to them in order to be able to do so. When we have got to that stage it is surely the job of the Ministry of Education to look at the laggards among our local authorities and to tell them bluntly that they ought to bring up their standards to those of the more generous of our local authorities.
I say to the Parliamentary Secretary that this will not be the last of this case, or of similar cases, that he will hear about. I say this because I am sure that my hon. Friends and hon. Members in all parts of the House will join me in pressing such cases until the standards of the generous authorities are applied to this young man and to similar students throughout the country, as is their due in this modern-day Britain.
§ 12.10 p.m.
§ Mr. Barnett Janner (Leicester, North-West)
I wish to raise one or two points which I think the Parliamentary Secretary will feel are of importance and in respect of which I hope he will give a satisfactory answer. We are all very much indebted to the hon. Member for Stockport, South (Mr. H. Steward) for having raised this subject today.
It is obvious that the pressure at present on the dental profession is terrific. One cannot in some cases make appointments under the Health Service for weeks or months. It is clear that what has been said by my hon. Friend the Member for Northfield (Mr. Chapman) is of tremendous importance. If the service is to be properly staffed, assistance must be given so that students will be encouraged to enter the profession and so fill up the gaps.
It is ten years since the Teviot Committee reported. The Committee stated at that time that 20,000 dentists would be required to meet the needs of the public. 695 It also stated that it considered that the question of ancillaries should be examined. That was ten years ago, and the McNair Committee repeats the warning given by the Teviot Committee. This means that during the ten years no real progress has been made in meeting the difficulties which existed at that time and were adumbrated for the future.
The McNair Report says:There is already a shortage of dentists, but its true extent has not yet made itself apparent. The advanced age of many dentists at present on the Register must mean that in the next few years the rate of retirement will accelerate, but there is little prospect of any countervailing increase in entry to the profession in the same period.The Report refers to the length of training and speaks of it being eight years before increased numbers of places in new dental schools have effect.
I believe that the Teviot Committee's estimate that 20,000 dentists are required is accurate. Nothing like that number is available. I know many dentists, and they are doing an excellent job. One used to be able to visit a fair and have a tooth taken out to the beating of a drum. Today we have a profession which is doing an excellent job and is assisting in the Health Service in a very important manner.
What is the problem that is upsetting the dental profession? I think dentists are a little overworried about the question of ancillary workers. After all, skilled engineers and other craftsmen recognise that they can make their energies go very much further if they use other people to undertake the purely routine work, and they do not feel that that kind of thing is in any way detrimental to the position of skilled men.
The modern dental student is taught all kinds of advanced dental technology, such as crown and bridge work and orthodontics, and all about manufacturing and fitting dentures, things which the dentist will not use in, for example, the school dental service. All the dentist requires for the school dental service is a knowledge of children's dentistry covering the filling of deciduous and permanent teeth. In a sense, the school dentist is, in relation to the extent of the knowledge which he has in other regards, frustrated.
§ Mr. Ede (South Shields)
Might I point out to my hon. Friend that persons of 18 and 19 years of age now come within the school dental service?
§ Mr. Janner
All right; there is no need for very much excitement about it. I am talking about the treatment of children's teeth. Let us leave out the expectant mothers and the rest who might be dealt with by dental surgeons who have the qualifications to which I have referred.
There are vast numbers of children whose teeth ought to be attended to and who might very well—I hope my hon. Friend the Member for Wolverhampton, North-East (Mr. Baird) who is in the dental profession will not take it amiss—be attended to by ancillary workers. To expect a highly trained dentist to carry out all the routine work is like training a man to paint portraits to be exhibited in the National Gallery and then expecting him to spend his time distempering a room. I am sure that my hon. Friend will agree that there are many circumstances in which ancillary workers can be used.
§ Mr. Janner
I expected that. Nevertheless, I think one would be prepared to see the managing clerk or even a junior clerk on some formal matters which hardly call for the attention of a senior or junior partner. For instance, one sends out documents to be copied; one does not need a solicitor to do the actual copying. All sorts of things are done in other professions by people who might be described as ancillary workers.
Far be it from me to attempt to tread on the delicate feelings of professional men, but I think one must use common sense in this matter. There is a vast need. Recommendations have been made for the purpose of meeting that need, but they have not yet been put into effect. 697 All I ask is that they shall be put into effect.
According to the McNair Report 2,800 dentists are required to provide a full school dental service. At present there are only 1,008. Consequently we need nearly three times as many dentists in the school service as we have at present. It means that in spite of all the ancillaries trained during the next ten years or so there will still be more work needed by children alone than the dentists can carry out. This is a problem which ought to be attended to as soon as possible.
I support the appeal made by the hon. Lady the Member for Wythenshawe (Mrs. Hill) for more women to be employed in the denial profession. In many cases women dentists have as much patience as male dentists, if not more. Unlike married women doctors, who find it difficult to do night work, women dental surgeons can more easily work part-time and still look after their homes because their hours are fixed. We also need to build more dental hospitals so that we may have sufficient facilities for teaching the numbers of students necessary to fill the vacancies. That is a very urgent requirement.
I cannot for the life of me understand why in this tremendous shortage we do not use men whose experience and background are such that they are quite capable of doing the work, who have professional diplomas and qualifications gained abroad, and who, in many cases, were used during the war for this type of service. We are a generous people. This afternoon we shall talk about refugees and about the human need to bring within our fold as many people as we can who have escaped from persecution.
People with dental qualifications of a high standard came here as victims of Nazi persecution and the horrors of the Nazi concentration camp. They were oppressed because of their race and religion. In most instances they were Jewish. Most of them have been naturalised British citizens for about ten years, which means that their background has been investigated, so they must be people of first-class reputation. They were not admitted to the foreign register under the former Dentists Act, 1878, although they had taken the same curri- 698 cula and possessed the same qualifications as dental surgeons registered up to about 1937.
§ Mr. Chapman
I am glad that my hon. Friend is raising this matter, but I wonder whether he has some examples. I had a number of cases brought to my notice and I investigated them with the Ministry. I was unable to discover any case in which the Ministry had been unjust, or in which the Dental Council had been unjust, because some of these people had qualifications which could not be checked, or had made claims which could not be justified. If my hon. Friend has some really outstanding cases, he should state them.
§ Mr. Janner
I am indebted to my hon. Friend. About 50 are still available for this purpose. They are perfectly honourable people, because when they were naturalised they had had their background investigated.
It was repeatedly pointed out that the position would be remedied by new legislation. That was reaffirmed by Government spokesmen during the proceedings on the Dental Bill, which became law in 1956. Under that Measure, the registration of foreign dentists was governed by provisions in Section 16, which stipulated that dentists would be entitled to registration if they held a foreign diploma and satisfied the General Dental Council that they had the requisite knowledge and skill. For proof of that, the Council might, if it so wished, require dentists to sit for an examination. According to the statements made by the then Minister of Health and the then Parliamentary Secretary during the Second Reading of that Measure, examinations would not be required for the holders of well known diplomas and degrees from universities and colleges outside the United Kingdom.
As German diplomas are well known, and, in the case of most applications up to 1937 were recognised under the former Act as requisite and adequate for registration, they should be considered as recognised diplomas within the meaning of Section 16 (3) of the Dentists Act, 1956. In my view, such holders should be entitled to admission without examination. I say "in my view" on the strength of the statements made at that time.
699 So far, regulations concerning registration under the new Dentists Act have not been approved by the Privy Council. That is the answer to my hon. Friend the Member for Northfield. It is, therefore, not yet possible to ascertain whether dental surgeons with German qualifications will be admitted without undergoing examinations. If not, their peculiar position should be taken into account. In a Written Answer on 18th February, the Minister of Health said:The General Dental Council has submitted regulations to the Privy Council for approval. An Amendment of the regulations to accord with the views of Parliament that the examination might be mainly practical has been suggested to the Council for consideration at its next meeting. …"—[OFFICIAL REPORT, 18th February, 1957; Vol. 565. c. 12.]It is a long time since the Act was passed. During that period we have lost the services of men who could be utilised in this way. It is decisive for the admission of these unregistered dentists, that that Amendment should be incorporated.
It is of equal importance that the necessary measures for the legislation are taken with the least possible delay. That would be in the interests not only of the dentists concerned, who, after many years of waiting, have set their hopes on the new Act—a year has elapsed since the Act received the Royal Assent and it has not yet been implemented—but would also help to overcome the shortage. I hope that the Parliamentary Secretary will be able to assist by assuring us on this and the many other points which have been put from both sides of the House during the debate.
§ 12.27 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. J. K. Vaughan-Morgan)
It may be for the convenience of the House if I intervene in the debate at this stage and comment on the matters which have been raised.
First, I should like to congratulate my non. Friend the Member for Stockport, South (Mr. H. Steward), with rather mixed feelings, on having chosen this subject. The House will understand my rather mixed feelings when I come to the end of what I have to say and I must confess that I do not have very much to add—a little, but not very much—to what was said by my hon. Friend the Member for Chislehurst (Miss 700 Hornsby-Smith), then Parliamentary Secretary, when she spoke on this subject just before Christmas.
Since I took up my appointment, I have been very much concerned with the affairs of dentists. I have very much enjoyed the contacts which I have had with the profession—in a social capacity, I hasten to add. I remember that when I was appointed, one newspaper commented on the likeness between my right hon. Friend the Minister and myself—a likeness which I, personally, cannot see—and stated that we were both tall and "full-jawed." That is probably my main qualification for speaking today. If it is true, it is a tribute to the profession, whereas if the rumours which have reached me are true, my hon. Friend the Member for Stockport, South does not know what he is talking about, because I am told that he has never been in a dentist's chair. Although that may be a very happy position for him, it causes me to wonder why he raised this subject—not that we do not very much welcome it.
I think that we shall have to set up a working party or some such body to examine my hon. Friend, to find out where he was educated; where he was born and brought up; what percentage of fluoride was in the water that he drank; whether he lived on porridge, and so forth. It will be a most interesting report, if and when we ever get it. My hon. Friend raised many very interesting points and covered very well indeed the matters referred to in the McNair Report.
There is one point that he mentioned upon which I should like to comment straight away. He referred to the possibility of a reduction in the number of applications which have to go to the Dental Estimates Board. I am glad to be able to tell him that some progress has been made in this direction. The British Dental Association is at present considering the list of items which now require prior approval, and we are awaiting its proposals.
To the hon. Member for Northfield (Mr. Chapman), to whose speech I listened with great interest and sympathy because of the way in which he dealt with the case with which he was concerned, I will say that I am sure he will not expect me to comment upon it in great detail, as it is a matter which primarily concerns another Ministry. I 701 believe that he has seen my hon. Friend, and I think I can go so far as to say that my hon. Friend is not satisfied.
§ Mr. Vaughan-Morgan
I think that his dissatisfaction may extend over a wide range of matters.
I want to try to avoid covering some of the ground which has already been covered. I certainly do not propose to go into every matter raised in the McNair Report. The salient fact which stands out, as all those concerned in this matter know only too well, is that this country needs more dentists. This knowledge comes at a rather strange and anomalous time in that we now have more dentists on the Register than ever before. At present there are 16,007 on the United Kingdom Dentists' Register, which is 1,103 more than in 1948, when the National Health Service was launched. But I will straight away admit that that is not a fair picture, because we are mainly concerned with the number in practice, under the general dental services.
Even there, some progress has been made, because the figure has risen in the last two years from 10,762 to 11,066. That has not been at the expense of the school dental services. I feel sure that the House will be interested to know that figures in the school dental services have risen from the equivalent of 713 whole-time officers at the end of 1951, when the situation was at its worst, to 1,008 at the end of 1955 and 1,023 at the end of 1956. I should add that the last figure is provisional and must be checked in due course.
In addition, the volume of treatment is still increasing. The number of courses last year showed an increase of 8 per cent. over 1955, although the number of dentists practising has increased by only 1½ per cent., from which the obvious deduction has been made that the dentists are working longer hours and with more efficiency to achieve this very welcome increase.
The greatest advance in treatment affects those under the age of 21, who are receiving an increasing share of it. There the courses for patients show an increase 702 of about 11 per cent. over 1955 and 90 per cent. over 1952. We must remember that the major part of the increase in the treatment of children takes the form of conservative dentistry. These figures suggest a continued expansion of the profession and of the volume of treatment. The position appears not unhealthy on the surface, but I do not want the House to think that we are in any way complacent about the underlying situation.
Why is there so much concern about the future? The number of dentists will soon drop very rapidly, due, first, to the present high average age of the profession, which will result in a high incidence of retirements and, secondly, to the fact that the high intake of students to dental schools which took place after the war has since fallen. I do not need to detain the House by reciting the whole story, showing why the average age is so high, and why the profession has not expanded at the same pace as others. My hon. Friend the Member for Stockport, South went into the past history of the profession. The crisis which is approaching is due very largely to the coming retirement of about 2,500 dentists who came in under the 1921 Act. Since then the academic standards have risen and an increasing percentage of academically trained dentists has taken the place of that class. We also have to remember that this is not the only profession facing a manpower problem. The teaching, scientific and engineering professions are facing similar problems.
Perhaps I may turn to the McNair Report, and what is happening now. I should like to quote the words used by my hon. Friend the Member for Chislehurst just before Christmas, because they are still true. She said:… most of its recommendations require joint or concerted action by a considerable number of bodies, and there are very substantial financial implications which also have to be considered."—[OFFICIAL REPORT, 21st December. 1956; Vol. 562, c. 1690.]The Committee itself was limited by its terms of reference to considering recruitment to the profession, but when surveying this problem we must think of the various other ways in which the shortage could at least be alleviated.
I will not go over them all, because they were largely covered before Christmas, but they include better distribution, 703 both geographically and as between services—because, despite a very welcome improvement, the shortage in local authority services is still more acute than anywhere else. We can also hope for increased recruitment, particularly from women dentists, and we feel that we ought to draw the attention of the profession to the advantages that group practice might present in overcoming some of the problems that will face the profession in the near future. There is also the question of the increased employment of dental hygienists.
I want to say a brief word about the points raised by the hon. Member for Leicester, North-West (Mr. Janner). As he knows, we are awaiting draft regulations from the General Dental Council, and the House will not expect me to say much more at this junction. I see no reason to expect that we shall be disappointed in what is forthcoming.
This is the stage at which I ought to say that we recognise and welcome the entirely changed status of the profession which the Dentists Act has brought with it. The General Dental Council, which now gives the profession a rank equal to that of the medical profession will, I am sure, prove thoroughly worthy of the task which Parliament has given it.
One of the important matters raised by the McNair Report was the fact that the public did not appreciate the true importance of dental health, as a result of which the profession did not enjoy the status which it merited. I think that the Dentists Act changed that.
The Committee further suggested that one of the measures which needed to be taken was the launching of a comprehensive national programme for dental health education, and made recommendations about the setting up for England and Wales on the one hand, and for Scotland on the other hand, of independent representative standing committees… to examine in all their aspects, the measures necessary to secure public awareness in detal matters, to advise on the form that publicity should take and to ensure that the several agencies carrying it out worked together.I can say that the B.D.A., as representative of the profession, and the General Dental Council, as the governing body, have told us that they support this 704 recommendation wholeheartedly. We have, since then, agreed with the Secretary of State for Scotland that one committee could more appropriately be set up for Great Britain, rather than to have two separate bodies. We cannot yet announce the setting up of this committee, because there are still some issues which have to be agreed, but we hope very soon to be able to go ahead. We hope, also—and I trust that I am not being too indiscreet in saying this—that some of the commercial interests which are linked with dentistry may have a substantial contribution to make to its work.
The McNair Report also held that the annual output should be increased to 800 dentists until such time as there are 20,000 on the register. Allowing for wastage, and for the training of overseas students, that would mean increasing the intake to between 900 and 1,000 a year as compared with the present 650. This is a very far-reaching proposal, and I am afraid that I have to say that it is still under consideration.
The House will realise that it involves a great deal of consultation, not just between the Ministries concerned but also with the universities and the University Grants Committee. One very constructive result which has come out of the McNair Report is that the very existence of the Report, and the publicity which it has received, has given a very much needed fillip to recruitment. In the current year, for the first time for some while, there are virtually no unfilled places in any of the dental schools.
Another point to which the Report and the Department pay great attention is the very important factor of preventive dentistry. The House will forgive me if I do not go into the details of the various measures that were suggested in connection with dental health education, but undoubtedly the most promising of all the measures affecting preventive dentistry is fluoridation. In the United States—although I see that, according to one of the newspapers, they are having a little heavy weather on the subject—they have already, after ten years, achieved a 60 per cent. reduction in caries among young people.
As my hon. Friend has said, demonstrations are in progress here in four 705 places, and we feel that once it is established to the satisfaction of all concerned that the materials, the machinery and the technique are available and understood, this experiment will be extended on a much wider scale. There will be some ignorance, perhaps, and some prejudice on the subject to be removed, but the profession itself is playing a tremendous part in helping the authorities to eliminate the prejudice that undoubtedly exists. I cannot help feeling that that is the most hopeful step we can look to in the future.
The shortage of dentists is a very real problem and will not easily be overcome. As the House knows, it takes four to six years to train a dentist, and the maximum number who can be added to the Register in the next few years is, therefore, limited to the number of students now in the schools. These are quite unlikely to match retirements in the period, so it seems inescapable that the position will become worse before it becomes better.
In a sense, I feel that this debate has come a little too soon. Although I am unable to announce firm decisions today, I can assure the House that my right hon. Friend fully appreciates the importance and urgency of the problem. The solution probably lies not in any one recommendation of the McNair Report, but in a combination of all the measures to which I have referred, coupled with expansion and development of the profession on the right lines. Therefore, although I regret that I have no startling announcements to make, I believe that this debate will bring to attention the difficulties which we are facing and will, therefore, serve a most useful purpose.
§ 12.46 p.m.
§ Mr. John Baird (Wolverhampton, North-East)
I must start by declaring my interest as a practising dental surgeon. I am rather sorry that the Minister spoke so soon, as there may be some points that will need an answer. I listened to him with interest when he spoke of the need for more dental education and for fluoridation, as some of us have been advocating for the last twelve years. We are, however, discussing the shortage of dentists, and when the hon. Gentleman sat down I understood why, perhaps, he had intervened so soon; because he gave not a single indication of what the 706 Government intend to do to try to solve this very serious problem and to increase the number of our dental surgeons.
The shortage is very acute indeed, and I thought that he was rather complacent about the school dental service. Immediately after the war, we were facing a very serious problem. We then had under 700 dentists in that service. It is now up to 1,000, but the then Minister of Health, now the Minister of Labour, suggested some time ago in this House that we needed nearer 3,000 than 2,000. I remember him arguing that the only way in which we could get an adequate number was to impose charges on the Health Service. We did that, but we did not get the dentists for the schools, nor will we until we get more dentists in the country as a whole.
The hon. Lady the Member for Wythenshawe (Mrs. Hill) spoke of the long waiting list for appointments. That, of course, is true; it ranges from two to seven or eight months. I must say that dentists, on the whole, are bad managers. I run one of the biggest practices in the country, and we never keep a patient waiting more than six weeks. Even that is too long. The trouble is that dentists do both private and National Health work, and the private patient gets priority. Where the dentists are working wholly within the Service I do not think that, even with the shortage, the waiting list should be all that long. The fact remains that because of the lack of an adequate number of dentists, it still is too long.
Apart from the present shortage, I warn the House that the situation will become very much more serious. We are an ageing profession, and a large number of dentists want to retire. The National Health Service started in 1948 and, under the superannuation provisions, dentists, after paying ten years' contributions, can retire on pension, and a very large number of them indeed are hanging on until 1958, when they will retire on pension. The estimate I have is that between 1,500 and 2,500 will leave the National Health Service within the next twelve months. That, of course, will give rise to a very serious problem, and there is certainly no room for complacency at the present time.
I wish to thank the hon. Member for Stockport, South (Mr. H. Steward) for 707 raising this matter once again. It has been discussed in this House on more than one occasion, but the Government do not seem to want to do anything about it, and, therefore, the more we ventilate the question the better. The hon. Gentleman said that one reason for the shortage of dentists was, perhaps, because of the remuneration and that people were not attracted to the profession. It is true that, under the present system of payment, after the age of 35—personally I should say after the age of 40, although all the figures point to 35—the earnings of a dental surgeon drop considerably.
On the basis of the Spens Report, it was suggested that dental surgeons working 32 hours at the chairside each week were making an income, on 1947 values, of £1,600 a year. I think that was the figure. That is an adequate remuneration, because every dentist in the country works much longer than 32 hours a week and they still live a fairly healthy life. Even though the income may fall after the age of 35, it should not go out from this House that dentists are badly paid. In fact, dental surgeons are among the best paid of the professional groups in this country.
There may be some need for a readjustment in the scale of fees but, compared even with doctors, I think that the incomes of dental surgeons are quite adequate. I believe that if we have a change of Government in the near future we shall have to look again at the question of evolving some system of salaried service for dental surgeons. That is the fairest way of paying in this rather strenuous profession. Even though there may be some opposition from the profession, I hope that a Socialist Government will face this question, as the Socialist Government of the time should have done in 1945–46, and I said so then.
The hon. Gentleman referred to the possibility of women entering the profession, and I wish to emphasise that. In every other country I have visited I have found a bigger percentage of women practising dentistry than in this country. What do the Government propose to do about that? It is not enough that we should talk about it in this House. Cannot steps be taken, in conjunction with local education authorities, to encourage women to come into the 708 profession, and to provide information about the opportunities which exist for them in the profession? This is something about which we cannot be complacent, and a wide field for recruitment is open to us.
My hon. Friend the Member for Northfield (Mr. Chapman) talked about the local authorities. Some local authorities have been parsimonious over grants to dental students. The attitude of local authorities in different parts of the country changes. Some are more generous than others. I should like to see a uniform system throughout the country to deal with this matter. Local authorities grumble at the shortage of dentists in the school dental service, but how can they expect to get an adequate number of dentists without paying adequate grants for the education of dental students? I consider that pressure should be brought to bear on local authorities in this regard.
The hon. Member for Stockport, South referred to dental ancillaries. He suggested that dentists were dragging their feet. I resent that, and I think every dentist would resent it. It is true that when the Dentists Act was before the House the profession suggested some reasoned amendments, but since it has become law I am certain that the profession has done nothing to prevent the progress of this experiment. The dentists are wholeheartedly endeavouring to make it work, and it is wrong to suggest that they are dragging their feet.
It is important to distinguish between the introduction of dental hygienists into the public dental service, our hospitals and school dental service, and into private practice. There is a big difference. I may get into trouble with some of my professional colleagues for saying this, but I believe that, if dental surgeons are allowed to employ young semi-trained girls in their surgeries under their supervision, there is a danger that some dental surgeons will exploit the position and use these girls to do more work than they ought to do. In my opinion, there must be strict supervision over the employment of these dental hygienists until we see how this thing works out. The public have to be protected. It is not merely a matter of getting more people to practise dentistry. We must see that people are not let loose on the general 709 public before they have had adequate training and education. Therefore I believe it essential that this experiment should be conducted in hospitals and in dental school clinics, but not in private surgeries.
The problem facing the profession is not a shortage of students. For various reasons we have an adequate number of students at the present time, although it may be that the position will alter. The present shortage is not of students but of places in the various teaching hospitals. That is why I was disappointed about what the Minister said, because he did not deal with that matter. We are all agreed about this. I know that the Parliamentary Secretary is interested in the matter. As a back bencher he spoke in all the debates on the subject. He knows the problem. We are agreed that we must expand our teaching hospitals, and the British Dental Association advanced various proposals. There is not a dental teaching school in Wales, and it is essential that we should get a school, say, in Cardiff; although, of course, the capital cost would be considerable. We must also expand our teaching hospitals at Glasgow, Birmingham and other provincial centres.
London presents a difficult problem. The British Dental Association put forward concrete proposals to the Minister some time ago, and it has been pressing them. But nothing has been done, and I wish to ask why. We are all agreed that this is an urgent problem. Every family in the country will be affected within the next year or two. It may be that people will have to queue even for emergency treatment. Why has nothing been done? I think it is because the Treasury will not find the necessary money.
When we examine this problem, we find that it comes down to a matter of party politics. I believe that the party opposite has a wrong sense of priorities. Hon. Members opposite, who have been advocating the need for more places in dental hospitals, and the expansion of dental education, have to face the question of how we are to find capital to build the necessary new hospitals and extend the present ones. There is no way to do that except through some system of priorities and the imposition of physical controls over capital. We are build- 710 ing new "pubs" not only on new housing estates but all over the country, and new petrol stations and vast new office buildings are going up everywhere. That is because we have what is called economic freedom, yet we cannot find enough money to expand the dental hospitals.
The present Minister of Health has not the courage to stand up to the Treasury. I am proud to say that when the Labour Government were in office we had a Minister of Health who had the courage to stand up to the Treasury. The Labour Party believed the Health Ministry was one of the major Ministries, and our Minister of Health was in the Cabinet. He was able to put his case firmly and strongly to his colleagues. The Tory Party has relegated the Minister of Health to a junior position and no one pays any attention to what he says.
From reading the newspapers during the last week, and noting the results of the by-elections, I am glad to say that I do not think it will be long before this squalid Government is defeated, and a Government put in power who will put right the system of priorities; who will put hospitals before public houses, and who will see to it that there is an adequate number of dentists in the country.
§ 1.0 p.m.
§ Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)
Before we leave this subject I wish to call the attention of the Parliamentary Secretary to cerain questions. Like other hon. Members who have spoken, I am glad that we have had an opportunity to discuss this matter. Everyone is grateful to the hon. Member for Stockport, South (Mr. H. Steward) for introducing the subject for debate in the House once again.
I share many of the views expressed by my hon. Friend the Member for Wolverhampton, North-East (Mr. Baird) about some of the background factors. I, too, am rather sorry, although I can well understand the reasons, that we have got nothing further of a more constructive character from the Minister though, at the same time, I appreciate his personal interest.
To revert to the subject of accommodation for training purposes, which is perhaps the kernel of the issue, I must say that we have had no comment even of a general character from the Government. 711 As this accommodation requires considerable capital allocation, I can well understand that the matter must take some time to settle. Nevertheless, there has been a long delay already. This is no new question. To be frank, it is one which was raised about ten years ago in the Report of the earlier Committee. It cannot be suggested that lack of accommodation is any new problem.
Therefore, one had some justification for hoping that there might have been at least an indication from the Minister about his views. For example, we were entitled to expect him to say whether priority in the provision of new accommodation would be given to Wales, about which of the provincial centres were thought to be the most important for development and when it was hoped that a start could be made. Even if a start is made now, even if we were able to start extensions or new buildings now, it would be some years before additional students would be under training and another five or six years before we should get any benefit from the larger number of qualified dentists in the profession.
We are thinking a long way ahead, but that must not be made the excuse for not taking decisions quickly. The further ahead we have to look the more important it is that the work should be started now. I wonder whether the Parliamentary Secretary can say a little more today about the actual projects which have been put forward, and especially about Wales, the further extensions at Birmingham, and about one or two other possibilities, for example, Glasgow and Sheffield. I should have thought that we could have had at least an indication from him about the way in which the views of the Government are developing.
It is rather sad that we seem to do our best to make ourselves almost the most caries-ridden—if that is the right word—nation in the world. Perhaps America is even more addicted to various methods of destroying teeth, but the Americans do at least provide a very large number of dentists and the general public there seem to be much more aware of dental needs than, on the whole, we are.
Therefore, I am glad to see that there are signs that a campaign is to be de- 712 veloped on health education lines to show people how they can take much greater care of their teeth, with the hope that in years to come—even though this may not be altogether to the delight of the dental profession—we might not need quite so many dentists; but that is a long way ahead, alas.
Still on the question of prevention, which, I am sure we all agree, is one of the most important features, again I would say that I am not very happy about the question of the addition of fluorides to water. We have been playing about with this for a long time now, and I should think that we have adequate evidence to tell us that this is a scheme which can bring very real benefits. I should have said that American experience was quite adequate to enable us to know what was likely to happen. It seems to me that the experimental schemes have been on the books for a long time. We had certain pilot schemes before those experiments, and it seems rather serious that the Minister can say no more today than that, after another period of some years, perhaps we will have further evidence that will enable us to decide how to go forward.
Can the Minister give any definite information about the termination of the experimental schemes? Can he say when advice may be offered to the local authorities and, possibly, when general schemes may be introduced? We already know enough about the subject to make a start without waiting very much longer. Although I am well aware that in some quarters there is anxiety, I think that if we dealt with this matter in the dental health education drive those fears would quickly be overcome.
There are many other matters with which we are concerned. It is right that when we discuss the whole question of recruitment to the profession we should think about ancillaries. I agree with those who have said that they hope that in future ancillaries will take their place in dentistry just as they have taken their place in most other professions, certainly in the general medical profession. I hope that the discussions which are now in progress will soon lead to a result. I understand that there was a slight holdup in the proposals for the experimental scheme that was to be introduced, and that the comments made by my hon. 713 Friend the Member for Wolverhampton, North-East are broadly the comments of the profession itself.
As far as I understand, it is the view of the profession that the scheme ought to be introduced first in the public health sector. Whether that is so or not, I hope that there will not be undue delay in starting experiments. There can be no doubt about the need for ancillaries in both public dentistry and, eventually, in the other sector as well.
There are many other questions, some of which have been touched on, which affect the whole issue. For example, we are not only considering the two Reports on dental recruitment but also the Guillebaud Report, which had some wise words to say on the subject. I should like to know when the Government intend to do something about the recommendations of the Guillebaud Committee about charges in the dental service.
The Committee made one proposal about how charges for dental treatment could gradually be dispensed with. I feel that that is a difficulty which must be overcome. The Committee suggested that once people had achieved a certain state of dental good health they should be guaranteed completely free treatment. That is one method of approach.
There must be general agreement that the present basis of charges is bad. In spite of the encouraging figures given by the Parliamentary Secretary with regard to people under 21, there seems to be an almost automatic £1 charge. The danger is that many people are discouraged from seeking regular treatment until there is a considerable amount of work to be done. They will not have to pay any more then than if they went regularly time after time. The number of hon. Members as well as of members of the public who can go without treatment for as long as the hon. Member for Stockport, South (Mr. H. Steward), who moved the Motion, must be rare.
In the interests of the general state of health, people should be encouraged to have their teeth looked after fairly early and not to leave them too long. There is a real need, therefore, to get rid of the present basis of charge, as it is a deterrent to good treatment.
We are chiefly concerned with when a start is to be made with some extension 714 of training, whether we can get the ancillary workers we want, whatever their field of work, and whether we can get the dentists to work together in groups with other dentists. I am sure that my hon. Friend the Member for Wolverhampton, North-East would be delighted if we could introduce a more satisfactory basis of payment than we have today. The idea of a salaried profession is attractive in many ways. In whatever way we get extra help into dentistry, we shall still need more training facilities. We ought to stress that issue in this debate, as well as the question which my hon. Friend the Member for Northfield (Mr. Chapman), effectively raised, of providing training grants.
I hope that the Parliamentary Secretary will take up this matter again with his right hon. Friend, because it obviously has the closest link with what we are discussing. Even at this late hour I hope that the Minister may find it possible to say a word or two more about the provision of facilities for training and when we may hope for a first scheme and for the first new construction to start. Even if he cannot say that—I see that the hon. Gentleman is shaking his head from side to side and not nodding it—can he not at least tell us what sort of priorities his Ministry envisage? Most of us are getting tired of the deferment of this issue.
We fully recognise that the hon. Gentleman has been in office only a very short time, but the matter must have been considered in the Ministry for a very long time. We are entitled to definite information now.
§ Quetion put and agreed to.
That this House notes with concern the shortage of dentists, and calls upon Her Majesty's Government to hasten their consideration of the recommendations of the McNair Committee on recruitment; to encourage the proper training and employment of ancillary dental workers; and to further the development of measures to prevent dental decay.
§ 1.14 p.m.
§ Notice taken that 40 Members were not present——
§ Mr. Deputy-Speaker (Sir Gordon Touche)
The time is now fourteen minutes past one. The Count will not operate for two minutes, which takes us within the prohibited hours.