§ (2) In the application of this Act to Ireland, the expression "the Minister of Health" means, unless the context otherwise requires, the Lord Lieutenant of Ireland, and any reference to a registered chemist and druggist shall include a reference to a registered druggist and to a licentiate apothecary.
§ (3) For the purposes of Section six of the Government of Ireland Act, 1920, this Act shall be deemed to he an Act passed before the appointed day.
§ Lieut.-Commander KENWORTHYI beg to move to leave out Sub-section (2) and Sub-section (3).
This raises the question of whether or not this Act shall apply to Ireland. I think it is ridiculous to apply an Act of this sort to Ireland and I see that the name of the Chief Secretary for Ireland is on the back of the Bill. What is the use of passing Acts for the self-government of Ireland—or the alleged self-government of Ireland—and then trying to thrust domestic legislation of this sort upon them.
§ Mr. SEDDONThe interested parties in Ireland want it.
§ Lieut.-Commander KENWORTHYThe hon. Gentleman cannot possibly know the state of affairs in Ireland to-day. Ordinary social life is completely disrupted over a great area of the country and I do not think this Act will run, any more than any other Act, in a great part of Ireland. 172 Apart from that, it is a purely domestic matter and might well have been left to the Irish Parliaments or constituent assemblies, or whatever they may end up by having in that country. It shows a lack of a sense of humour to suggest that it should be applied to Ireland, but I presume this part of the Clause was put in when the Bill was drafted a long time ago, and the Ministry of Health does not know what is going on at the other side of the water.
§ Colonel WEDGWOODI beg to second the Amendment.
§ Sir A. MONDI do not know why Ireland should not have the benefit of this Bill. If they do not want it at some future date, I have no doubt they can get rid of it then. We do not anticipate that Ireland will always remain in its present disturbed condition. Further, if you were a dentist practising in Ireland, and Ireland was excluded, and if you wanted to come and practise over here in England or Scotland, you would then be unable to do so. That, I think, is a sufficiently good reason why Ireland should not be excluded. I think my hon. Friend's solicitude for Ireland might allow those practising there the possibility of earning a living on this side of the Channel. If at any time in the future the Government of Ireland decides to adopt any other course, there is time enough to do that when they have a Parliament of their own functioning.
§ Lieut.-Commander KENWORTHYWhat happens under this Bill to the American dentist? Is he to be allowed to practise here?
§ Sir A. MONDThe American dentist who holds degrees equivalent to the degrees of an English dentist entitling him to qualify can, of course, practise in this country, but we do not provide for dentists who do not hold equivalent degrees to come and settle down here. All that this Amendment would do would be to exclude the unregistered dentist in Ireland from the benefit of getting on the register.
§ Lieut.-Commander KENWORTHYI beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ Motion made, and Question proposed, "That the Bill be now read the Third time."
173§ Colonel WEDGWOODI beg to move, to leave out the word "now," and at the end of the Question to add the words, "upon this day three months."
I move this as a protest against the general way in which this Bill has been approached in the House to-night. Nearly every hon. Member who has spoken seems to think that this is a Bill affecting merely dentists and dental practitioners, and that all we have to consider is whether they are placated, whether they are satisfied that their interests in life, their vested interests in the practice of a profession, have been properly safeguarded. That is not the point of view from which we should look at this Bill. It is a question entirely of whether we are going to get a better dental service, and whether we are going to pay too much for getting it. The argument in favour of the Bill ought to be, not that the unregistered practitioners have got inside the charmed circle, but that the existence of this monopoly—for it will be a monopoly—will ensure a higher standard of dental practice throughout the country. I have no doubt that when hon. Members who are members of the medical profession support this Measure it is because they think it will raise the practice of dentistry, but I am not at all certain that giving to any body of people a close monopoly is likely to improve the work they do. It may be that by making the examinations sufficiently stiff they may get a higher standard, but they also make the time of training longer and more expensive, and they exclude a. certain number of intelligents in the country who might otherwise come into the practice of the profession, but who, by the cost of training required, are ruled out from the practice of the profession. I do not believe any industry or profession is really benefited in the long run by being made into a close corporation. The very fact that the competition of the American dentist is ruled out, that once you are on the register you are on the top of the educational tree, so far as the practice of your profession is concerned, means that there is no longer an incentive to improve your knowledge of your practice, and in so many cases we see that where there is a monopoly, and where people are happy in the enjoyment of that monopoly, they lose some of the enthusiasm and fire which competition often gives.
174 That is one side of the question. Hon. Members will say that this is going to raise the practice of dentistry, and there may be something in that, but I am certain there is a very important consideration that we ought to take into account on the other side. This Bill is undoubtedly going to raise prices. Every dental practitioner who gets on the register has got to fall in with the scale of fees given to dentists on the register. It is certain that nine-tenths of the working classes of this country—probably more—get their dentistry done at present by unregistered practitioners. Nearly every colliery village I know has its dental practitioner, but no regular dentist. These people practise the art of dental surgery. They do not do it very well, but they are cheap. These same people are going to carry on their practice as they did before, just as well or just as badly, but they are going to be able to charge much more for doing it. The public as a whole may get a better dental service in time, but it is certain that they are going to pay more for the present sort of dental service for a long time to come. The members of the Departmental Committee saw quite clearly that the public would pay for this Bill. They knew that giving the unregistered practitioners and the full dental surgeons a monopoly would certainly cause the public to pay in increased fees, and they tried to balance that off. In order to avoid any very heavy rise in dental fees, they proposed in their Report at the same time a public dental service which would naturally be much cheaper than the private practice which would spring up under this Bill.
Then they had to take into consideration another factor. They knew that under present conditions the quite poor men became first of all dental mechanics and then unregistered practitioners. The doctoring profession draws almost entirely from the middle classes, but the dental profession drew largely from the working classes. They knew quite well that once you got the present unregistered practitioner and the fully-qualified practitioners together on this register, giving them power on their board to regulate admission to the profession, that would tend to restrict admission, and keep up the standard of examination, partly because they wanted better dentistry and partly because they wanted 175 to keep out competition. Every monopolist hates competition more than anything else. Under those circumstances, entry to the register would mean a very heavy expense, comparable, indeed, to the expense which is incurred by a medical student before he is entitled to practise medicine. I am told that it often costs £5,000 before a medical student can start practice, and that for the dental service it costs £1,000. The Departmental Committee which inquired into this matter, and reported in favour of this Bill, reported also in favour of a public dental service to keep down costs to the public. They recommended, also, that there should be a large number of scholarships to enable sons of the working classes to become fully-qualified dentists.
The Coalition Government have taken one part of this Report, which will raise the cost to the public, and they have dropped the other two parts, which would keep down the price to the public and enable the sons of working-class people to become dental surgeons. It is not fair to the House to say that this Bill is the result of a Departmental Inquiry, and that it is an agreed Bill. That is not how we look at it. We want to see that either the whole of that Report is carried or none. I quite agree that something ought to be done in the direction of that Report. I would not mind this Bill provided we could get a public dental service and the scholarships. I think, if that Committee had been more largely composed of members of the working classes, we should have got a more radical Report even than that Committee reported. But certainly, to take out a conservative proposal to form dentists, as doctors are, into a close circle of experts, to argue with whom is almost blasphemy, and to leave out the slightly liberal provisions in that Report, seems to me to be typical of the Coalition Government, and of this we on this side of the House cannot be expected to approve.
§ Notice taken that 40 Members were not present. House counted; and 40 Members being present—
§ Sir A. MONDMy hon. and gallant Friend stated—and I do not quarrel with 176 him—that the real way of looking at this ought to be whether or not the dental surgery of this country could be improved. I quite agree, and this Bill hopes in time to bring that about. I would like to point out that this was proposed to be done in the original Act of 1878. There is nothing new in principle in this Bill. It is by mere accident that a large uncontrolled, unregistered, unqualified dental service has been allowed to work in this country, and one of the most difficult and important operations on the human being has been allowed to be practised by anybody who sets himself up, without any knowledge of any kind, and that the public have been entirely unprotected against this kind of thing. We are now amending the defect in that Act, and endeavouring to bring dentistry, which is an important branch of medical science, up to a higher standard. In order to do that, we are including a large number of men who have not, perhaps, got the academic, but who have the practical experience, and very liberal provision, indeed, has been made for them. The hon. and gallant Member said the only result would be to put prices up to the public. I wonder why he said that. There is nothing in the Bill to enable them to do that. The hon. and gallant Member knows that supply and demand play an important part—
§ Colonel WEDGWOODNot when you have a monopoly.
§ Sir A. MONDHas the hon. and gallant Member seen any Bill referring to medicine which lays down any prices?
§ Mr. LAWSONThe solicitor to the Incorporated Dental Society suggested before the Departmental Committee that a scale of fees should be fixed.
§ Sir A. MONDI think it would be a difficult proposition to try to apply a fee for a practitioner in a colliery village and a practitioner in Harley Street. After all, fees cannot be charged higher than people are able to pay. It will be impossible to extract money where it cannot be paid, and that is what is commonly overlooked. If the Bill had been to exclude a large section of those who are practising now, and creating a scarcity of dentists, I could see the force of the hon. and gallant Gentleman's Amendment.
§ Colonel WEDGWOODThat is what it will do.
§ Sir A. MONDNo; it will not do that. It will practically include everybody. Practically the same number of dentists will be in existence, and they will find that they will not be able to charge more than they did before. But in time, undoubtedly, a better class of people will go into dental practice and will raise the whole status of dentistry. My hon. and gallant Friend remarked1 that we have only raised the price to the public, and appeared to think that if only we supplied a free public dental service the public would not have to pay. A free dental service would certainly cost the public a great deal. I am not altogether opposed to that view, but the times are not propitious for carrying it out, and, further, this Bill is not the place to do it, and the only result of the rejection of this Bill would be that there would be no really good dental service. In view of the fact that the Bill is so urgently required in the best interests of the public, I do hope my hon. and gallant Friend will not persist in this Amendment and will allow me to have the Third Reading.
§ Mr. RAFFANI hope my hon. and gallant Friend the Member for Newcastle-under-Lyme (Colonel Wedgwood), having delivered a most interesting speech drawing attention to matters which deserve attention, will now be satisfied to allow the Bill to go forward with the unanimous approval of the House. I agree with him that in this matter our primary concern must be the public welfare and not the position of those who practise either as registered or unregistered dentists; but as I understand the Minister in charge of the Bill, his observations on that point were used in answer to some suggestion that the unregistered practitioner would be placed in a position of disadvantage under the Bill. The Departmental Committee, which examined this question with great care, and heard a great number of witnesses, had constantly in view the public interest. It was not interested, except in so far as was necessary to reconcile opposing and divergent views, in maintaining any monopoly interests, but was interested mainly in the public welfare. The Departmental Committee had the evidence of representative Members of the Labour party, like Mr. Sidney 178 Webb, whose views, I believe, nearly always commend themselves to my hon. and gallant Friend.
§ Colonel WEDGWOODOh, do they?
§ Mr. RAFFANAnd an hon. Member who was highly respected in every part of this House, the late Mr. W. C. Anderson, also gave very valuable evidence. I believe the evidence of both Mr. Webb and Mr. Anderson stressed the point to which my hon. and gallant Friend has referred. My hon. and gallant Friend has rendered a public service in drawing attention to these two matters. In my view, this Bill is the first step towards carrying out the recommendations of the Committee. The proposals with regard to public dental service and with regard to the scholarships are not matters which could properly be put in a Bill of this kind; they are administrative matters, but in view of the statements made by the Minister of Health to-night, I hope attention will be given to them, especially in regard to scholarships, and that provision will be made in that direction. As the Departmental Committee found that legislation of this kind would render the very greatest service to the public at large, and would tend to improve the whole status of the dental profession in this country, I hope my hon. and gallant Friend will now allow the Bill to pass into law, but that he will continue to press both for a public dental service and for the system of scholarships recommended by the Committee.
§ Major MOLSONI would like to advocate passing this Bill in the interests of the public, and not in the interests of any branch of the profession. My hon. and gallant Friend (Colonel Wedgwood) in Committee upstairs advocated that a great many more should be admitted into the dental profession, and his view was supported, and I am sorry to find that he comes down on the Floor of the House now and wishes to wreck the Bill. The Bill has been supported by the British Dental Association in a most self-sacrificing and generous manner. They have advocated the admission of unqualified men into the profession for the good of the profession, and not for any purpose of a monopoly. As to the question of a monopoly, my hon. and gallant Friend seems to forget that by this Bill we are going to double the number of qualified 179 dentists in this country, and if we increase the supply surely that is the best way of reducing the price.
§ Colonel WEDGWOODThe quality.
§ Major MOLSONThe quality will improve. The object of this Bill is to protect you and the public from unqualified men and from the disastrous effects of unskilled work on the mouth. I am sure we all wish to have this Bill passed as an agreed Bill in the interests of the country. We have considered it upstairs, and we have tried to carry the Bill, irrespective of party politics, as it is entirely for the benefit of the public, and I am sorry that the hon. and gallant Member, from, I am sure, merely a spirit of opposition, is now opposing this Bill. Upstairs the Labour party advocated various Amendments. The British Dental Association most generously, as I consider, gave way and did not oppose the Amendments of the Labour party, and for this reason I hope the Labour party will not continue to oppose the Bill, and that we shall pass it as an agreed Measure, not for the benefit of one profession, but for the benefit of the public.
§ Mr. BRIANTI am sorry I was not here at the beginning of the discussion. Although I had no intention of voting against the Report stage I do wish to voice my protest against the Bill. It contains many provisions which seem to me of extreme danger to the public. I am not particularly interested in dentists, though I think they are dealt with very hardly in this Bill. It will have cost a good dentist, it is estimated, nearly £1,000 before he is fully qualified for his profession. There are thousands of men who have spent their time and their money to make themselves fully qualified, and under this Bill they are, without any differentiation whatever, put on exactly the same status as a man who may not have had any experience whatever and no training, who may have been, for all we know, and has in some cases, been a butcher or a blacksmith. That is not fair to the dentists. I am still more upset by feeling that the public has no protection. The only protection the public has is that some at least know the difference between the man who has qualifications and the man who has not. Between the man who can put up some designation outside his shop or house 180 which says what are his qualifications, and the man who can and does now stick up the word "professor"—whatever that may mean no one knows—but which passes among the ignorant men going down the street, somewhat stupidly if you like—which, I say, passes amongst these men who imagine that a man who makes the biggest display is the more skilled dentist. The general public ought to have, as I suggested in Committee, by Amendment, a separate list. The public ought to know to whom they are going. I do not want to debar the public going to any man they choose, but they ought to know who the man is. As it is, the average member of the public will not, know whether the dentist he is under is on the roll and qualified or not. The present position is not fair to the public. It is the perpetuation of what has amounted to a grave and gross scandal. I am speaking here from personal experience, not certainly of my own mouth, but many have come to me at different times who have been, one can only use the word "swindled" by the advertising dentists. Over and over again poor people have come to me and told me that they have paid three guineas for a denture and in order to get the money quickly the unskilled man has fitted the denture a long time before the mouth was in a condition to have it fitted; the consequence was that after say, four months, the teeth did not fit, and the patient has been asked for another two or three guineas to have the thing put right. As a matter of fact, if there was some separate designation as we suggest, and you named the wholly qualified dentist as a "qualified dentist" and the other man as a "dental practitioner," then the public generally would know which was which and to go to the one they chose. I do not want to overstate the point. There are men who have not the technical qualifications who from long experience are skilled, but it does seem a great mistake that men should be admitted who would not for a moment be admitted in any other profession, say the medical or the legal, and in thousands too. In fact in this case the majority in future will be men about whom there is no proof of any qualification except they have been in some sort of practice for a certain number of years. I am anxious that the Bill should go through. I think it is a gross injustice to 181 the qualified dentist. I do not, however, wish now to obstruct the Bill, which I hope will be more useful in actual working than appears to me to be likely to be the case from the actual wording of the Bill. The House, I say, is committing itself to a scheme to which it would not have committed itself for any other profession. I only want to say further that the only thing which reconciles me to the Bill is that it will prevent additional and further unqualified men. That is a great-recommendation, in fact the only recommendation for the Bill to me, and that in course of time the unqualified men will drop out, but we shall have to bear the class of dentists who will be on the present register. There are many grave objections to the Bill, but taking it all in all, and anxious as I am that there should be some improvement, and that if this Bill does not go through it will defer the date for any improvement, I do not care to vote against the Bill.
§ The remaining Orders were read, and postponed.