NATIONAL HEALTH (DENTAL SERVICES)

HC Deb 03 May 1948 vol 450 cc1003-53

8.33 p.m.

Sir Hugh Lucas-Tooth (Hendon, South)

I beg to move: That an humble Address be presented to His Majesty, praying that the Regulations, dated 12th March, 1948, entitled the National Health Service (General Dental Services) Regulations, 1948 (S.I., 1948, No. 505) a copy of which was presented on 15th March, be annulled. May I ask your guidance, Mr. Deputy-Speaker, in moving this Prayer? So far as I know, we are entitled to have present a Member of the Government to answer the arguments which we put forward. At the present time, I see no representative of any Department in the remotest way concerned with the health or dental services present in this Chamber.

Mr. Deputy-Speaker (Mr. Hubert Beaumont)

If the hon. Gentleman is putting that as a point of Order, he may anticipate that such a Member of the Government will be present in due course.

Sir H. Lucas-Tooth

Could I ask that the Sitting be suspended, because, with the greatest respect, I see no reason for talking in the air, and I intend—

Mr. Deputy-Speaker

I certainly could not grant that. If the hon. Gentleman desires to make his speech, he had better make it.

Sir Wavell Wakefield (St. Marylebone)

Could we have an assurance that a responsible Member of the Government, able to answer the questions that will be addressed to the Government on this very important matter, is likely to be present in the Chamber in the immediate future?

8.36 p.m.

Mr. J. S. C. Reid (Glasgow, Hillhead)

I see that the Deputy-Leader of the House is present. I trust that he will take his place at the Box to say that something is holding up the Minister who is to attend this Debate, and that we shall have some responsible person here to reply to the Debate. This is a most important matter, and I hope the Deputy-Leader of the House is in a position to give that assurance to the House. The right hon. Gentleman knows that, for a whole hour, proceedings have been held up on the previous Order, and we expected that this matter would be reached before 8 o'clock. It is quite monstrous that no one concerned with the Department is here, and I trust, Mr. Deputy-Speaker, that you will allow the Deputy-Leader of the House to intervene.

The Secretary of State for the Home Department (Mr. Ede)

I must apologise to the House—

Mr. J. S. C. Reid

It is monstrous.

Mr. Ede

Really, I was trying to answer the right hon. and learned Gentleman courteously and I do not think that that interruption was called for. I must apologise for the absence of a representative of the Department concerned. An effort is being made to secure the immediate attendance of a representative, and in the meantime I will take notes of the proceedings so that whoever comes shall be in a position to answer the points that may be made by any hon. Member who speaks.

Mr. J. S. C. Reid

Further to that point, could I ask whether there is no telephone between here and the Ministry of Health? It was obvious that this matter was going to be reached at half-past seven. What has happened?

Mr. Deputy-Speaker

Sir Hugh Lucas-Tooth.

8.40 p.m.

Sir H. Lucas-Tooth

Members of the dental profession have suggested to me that, in the course of discussions between themselves and the Minister of Health, they have at times been treated with discourtesy which could only be interpreted as a deliberate action on the part of the Minister to bemuddle the discussions going on between them. I can only assume that this is a continuance of that course of conduct, and no doubt in due course it will be noted by those members of the dental profession who see a report of this Debate. In order to develop my argument, it is necessary that I should give some of the past history of this matter, but I will try to be as brief and as objective as I can. It was my intention if I erred from strict accuracy, to ask whether I could be corrected by the Member of the Government who was to reply. That is because the facts of the case are within the peculiar knowledge of the Government and can only be acquired by back benchers by means of difficult inquiries of a necessarily piecemeal character.

The statute which governs these regulations is the National Health Service Act, 1946, and Section 40 is the relevant one. Under Subsection (1), executive councils, which, in effect, will be the councils for each of the counties and county boroughs, are to make arrangements with dentists for the provision of services at a health centre or otherwise, and, under Subsection (2), regulations are to be made by the Minister carrying out that general intention. The regulations are to deal with the preparation and publication of lists of would-be practitioners in the dental service. They are to confer a right on any dentist who wishes to be included, so that it leaves it freely open to every dentist to say whether or not he wishes to come into the scheme. The regulations are to confer a right on any person to choose his own dentist, and they are to establish a Dental Estimates Board for carrying out the duties respecting the approval of estimates for treatment. The constitution of that Board and the method by which they are to carry out their duties was to be left to be prescribed by regulations.

Finally, the Section requires regulations to carry out supplementary matters and matters concerned with the remuneration of dentists. The Section in itself is in no sense of the word objectionable. It was not, in fact, opposed. I think I am right in saying, at any stage in its course through Parliament, and I rather think that it was not even amended.

At the time the Act was published, a White Paper was also published, and in that White Paper it was stated that dentists will normally be able to start treatment without further reference and subsequently to submit a claim for payment from public funds. That statement was quite explicit to the effect that in the ordinary way dentists entering the scheme would be able to carry out such treatment as might be agreed between them and their patients, without prior reference to anyone except themselves, and that it would only be in the exceptional case that it would be necessary to go to the Dental Estimates Board before a payment could be made from public funds. The matter was discussed in the Standing Committee on the Bill on the 16th day. The Minister of Health then announced that he was setting up a Committee on the lines of the Spens Committee on doctors' remuneration to consider the question of dentists' remuneration. He said: I doubt whether there is any real contradiction between the White Paper and the Bill. No doubt, that statement did a great deal to allay fears, which might otherwise have arisen in the minds of the dentists, that the Bill had in some way modified the provisions of the White Paper, and, as he stated there, it was his intention in the majority of cases that dentists and patients would be free to agree their own treatment under the scheme. The right hon. Gentleman was pressed for a more precise definition of what treatment could be carried out by dentists without prior reference to the Dental Estimates Board. His reply to that was: Necessarily I must discuss that with representatives of the profession."—[OFFICIAL REPORT, Standing Committee C, 25th June, 1946; C. 1727–8.] About a year has passed since the National Health Service Act became law, and there has no doubt been a great deal of dis- cussion going on between the dentists and the Ministry on the questions to which I have referred. So far as has been made public, the position appears to be that there has been a complete breakdown in the discussions between the dentists and the Minister of Health all along the line. That appears to be the position, at any rate, from the published reports. There are no further discussions going on, nor have there been any such discussions from about November of last year.

Again, it would appear to be the fact that the Minister of Health has adopted the attitude that, "This is my view; so far I am prepared to go, and no further." The complaint which reaches us from the dentists is that they have met with an attitude of complete intransigeance on the part of the right hon. Gentleman. That is the picture which we have obtained of the situation—a picture not altogether dissimilar from another one which was referred to in an earlier Debate some weeks ago in this House.

As I understand the position, two main issues have arisen between the dentists and the Minister of Health. There is the question of clinical freedom, and there is the question of the method of remuneration. I believe the argument has gone on those lines, namely, whether remuneration of dentists should be by fixed fees, as the Minister has insisted, or whether it should be by way of grants-in-aid or some similar system, as the dentists have asked. After the discussions with the dentists, S.I. No. 505, against which this Prayer has been put down tonight, was made on 12th March, 1948, and I think it is fair "to say that the provisions contained in this statutory instrument must be regarded as wholly the responsibility of the Minister. I ask whether he would accept that situation, or whether he would say that the document, in fact, incorporates any sort of compromise or agreement which he has reached as the result of the discussions. The order raises a very large number of questions and some of them will, no doubt, be raised in various parts of the House this evening. I would like to avoid the more detailed queries in opening this discussion and to deal with the major issues which are involved.

The provisions of the regulations can be stated fairly briefly. First, they make pro- vision for dentists entering the scheme and for the making of lists. They contain two sets of arrangements: one is the set of arrangements governing dentists practising in private surgeries, and the other is the set of arrangements governing dentists who are to practise in a health centre. I am very glad to see that the right hon. Gentleman the Minister of Health has arrived. The order sets up the Dental Estimates Board, as required by Section 40 of the Act, and that Board is to consist of a chairman and eight other members, six of whom are to be dentists. There will be nine members of the Board for the whole of the country. That is the scheme of the regulations.

The scheme falls to be divided between Part I and Part II of the first schedule. Part I of the first schedule deals with dentists practising in private surgeries, and I think it will be common ground on all sides of the House that that must necessarily include the vast majority of dentists for a very long time to come. There are extremely few health centres existing at the present time and there are very few plans actually framed for the building of new health centres. In fact, I think I am right in saying that, in the meantime, all building of health centres is completely suspended. I shall be very glad to hear that contradicted by the right hon. Gentleman later in the Debate. However true that may be, one thing is quite certain: it will be a considerable number of years before there are sufficient health centres in existence to take more than quite a small minority of the dentists required to look after the teeth of the people of this country.

In this schedule to which I have referred, dentists practising in private surgeries have to send their estimates to the Dental Estimates Board, and I think it is worth while referring to paragraph 7, sub-paragraphs (2) and (3), at greater length. They provide: (2) Where the extent of the treatment which the person is willing to undergo is not beyond that specified in column A of the second schedule to the regulations, the practitioner may proceed with and complete the treatment before sending the dental estimate form to the Board for approval. (3) Where the treatment which the person is willing to undergo includes treatment in column B of the second schedule, the practitioner shall as soon as may be, and in any case within 10 days after making his examination, send the dental estimate form to the Board for approval, and shall not proceed with any treatment other than the treatment specified in column A of the said schedule or such emergency treatment as is referred to in the footnote to the schedule, until such approval is received. The position, therefore, is that all estimates for dental treatment for the whole country have to be sent to this single Board of a chairman and eight members—all of them, whether requiring prior approval or not. I would refer to paragraph 14 of the preliminary part of the regulations, which states that: The Board shall appoint a person approved by the Minister to act as clerk and shall also appoint such other officers as may be necessary. When I read that statement for the first time, I wondered just how many other officers would be necessary in the circumstances. I should like to have some estimate from the right hon. Gentleman as to the size of staff which he thinks may be required to carry out the duties of this Dental Estimates Board. When I look at the second schedule divided into these two columns A and B, as a layman I confess I cannot take the matter very much further. The first column refers to treatment which may be completed without obtaining the prior approval of the Dental Estimates Board, and there is a number of forms of treatment which do not give any very definite idea to the lay mind of their extent. In column B, the treatments for which the prior approval of the Dental Estimates Board is required include such items as apicectomy and alveolectomy—the very words are difficult enough to be pronounced, let alone to be understood—[HON. MEMBERS: "No."]—by a layman. I sought the opinion of a dentist of my acquaintance on this matter, and he said that in his opinion 75 per cent. of his work fell within column B.

Mr. Baird (Wolverhampton, East)

Rubbish.

Sir H. Lucas-Tooth

Is the hon. Member suggesting that I am not speaking the truth?

Mr. Baird

No. I am suggesting that what the dentist told the hon. Member was rubbish.

Sir H. Lucas-Tooth

I am incapable of arguing the various merits of dental practices—

Mr. Baird

Yes.

Sir H. Lucas-Tooth

The hon. Gentleman is no doubt speaking from his own personal experience. I dare say that this was a very expensive practice.

Mr. Baird

It must have been.

Sir H. Lucas-Tooth

At any rate, in this case I was assured that 75 per cent. of the treatment given by this dentist would fall within the second column and not within the first column of the second schedule, and, therefore, would require prior approval before it could be carried out. If the right hon. Gentleman thinks that 75 per cent. is excessive, I should like to get the official estimate of what he thinks is going to fall on one side or the other. Perhaps the hon. Member for East Wolverhampton would agree that, at any rate in the case of the normal dentist, probably two cases a day coming his way would fall under column B and not under column A. I am making a rough estimate that, in the course of an ordinary practice, two cases daily, at least, would require prior approval.

Mr. Baird

The ordinary dentist sees on the average 30 patients a day. Is the hon. Member suggesting that two of them would come within column B?

Sir H. Lucas-Tooth

Yes.

Mr. Baird

Yes, possibly.

Sir H. Lucas-Tooth

I am suggesting that that is not an unreasonable figure to take as the barest possible minimum. I see that the hon. Member agrees with me. There are 12,000 practising dentists, so that if two cases a day fall within this category, something like 150,000 prior approvals will be required to be given per week. They will go to the Board consisting of a chairman and eight members.

Dr. Morgan (Rochdale)

And the staff.

Sir H. Lucas-Tooth

That is the point. One thing is quite plain, and that is that the Board itself cannot possibly consider these cases. I want to know what size of staff is to be required on the Minister's estimate to consider the number of cases which are to go forward for prior approval. Are they to consider every case on its merits? I imagine that that type of consideration would be for an expert dentist; it is the kind of job which could not possibly be done by a clerk. Or is it intended that this approval is simply to be done by a clerk? Which is it to be? Is there to be an enormous staff of trained dentists doing nothing but giving prior approval; or is there to be a collection of clerks putting on rubber stamps for no purpose whatsoever, except to waste time? What is to be the position? That is the question I put to the Government. I suggest that either way no really useful purpose will be served by requiring this immense number of cases to be sent up for prior approval.

In venturing that opinion I have very powerful support. "The Times" has not always been friendly to the Conservative Party in the view it has taken on matters in this connection; and it has at times given very strong support to the right hon. Gentleman in his view. But in its leading article of 12th April last, I find this statement: It cannot be denied—the British Dental Association has itself admitted it—that some control of the tooth removing and tooth replacing proclivities of some dentists is essential in the public interest. It is open to question, however, whether the list of controlled work should include so many items other than the substitution of artificial for natural teeth.

The Minister of Health (Mr. Aneurin Bevan)

Does the hon. Member accept the position that control should he established?

Sir H. Lucas-Tooth

Yes, certainly.

Mr. Bevan

Then how is it to be done? Who will do it?

Sir H. Lucas-Tooth

I entirely accept the position that there must be some control.

Mr. Bevan

Exactly.

Sir H. Lucas-Tooth

Of course there must be some control; but my argument is that column B of the second schedule is far too extensive, and that a great deal that now comes under column B should be removed into column A. That is my case.

Mr. Baird

What does the hon. Member suggest should be removed from column B to column A? What items should be removed? Could he specify even one or two of them?

Sir H. Lucas-Tooth

I have already disclaimed any particular knowledge of dental matters.

Mr. Baird

Surely, it the hon. Member is moving a Prayer tonight he can at least give us some guidance on what type of items he suggests should be removed from column B to column A. Until we know that, we cannot follow his argument.

Sir H. Lucas-Tooth

If the hon. Member cannot follow my argument, I am afraid it must be because he is unwilling to do so.

Mr. Baird

Oh, no.

Dr. Morgan

Some of us are quite willing to follow the hon. Member's argument, because we know the difficulties of the situation. But he really must come prepared with his facts, and be able to tell us what items he is concerned with, and what items should be transferred from column B to column A. It is a difficult problem, and if the hon. Member wants the Order amended, he must tell us how he is prepared to do so.

Sir H. Lucas-Tooth

I shall not withdraw my argument. My statement is far too extensive—

Mr. Bevan

The hon. Member has admitted that there should be control; in other words, that there should not be merely an arrangement between dentists and patients and that the public should foot the bill. Having admitted that there should be some control, surely he is now under an obligation to state what are the frontiers of control; what should be controlled and what should not be controlled? Otherwise, his argument is in the abstract and, therefore, purely platitudinous.

Sir H. Lucas-Tooth

If the right hon. Gentleman had been here a little earlier he would have heard me read his own reply when that very question was put to him in Committee. He said: Necessarily I must discuss that with representatives of the profession."—[OFFICIAL REPORT, Standing Committee C, 25th June, 1946; c. 1728.]

Mr. Bevan

Well, I am discussing it.

Sir H. Lucas-Tooth

The right hon. Gentleman is in a fortunate position. I am not in that fortunate position—

Mr. Bevan

Then why pray?

Sir H. Lucas-Tooth

Because my information is that in fact a very high proportion of the treatment done by dentists will fall under column B. If the right hon. Gentleman disputes that, then it is for him—

Mr. Bevan

No.

Sir H. Lucas-Tooth

He is the responsible Minister. I can only go by what the experts tell me. That is all that any Member of this House can do. I must not, however, take up more time over this. It is for the right hon. Gentleman himself, when he makes an order of this sort, to justify the division between the prior approval and the non-prior approval cases. If the Minister is adamant that all dentists and their patients must be harassed, because of a certain number of dishonest dentists, on a very wide range of cases, I would make this suggestion to him: why require such a very large proportion of cases to be submitted for prior approval to one single central body, such as the Dental Estimates Board? Would it not be more satisfactory to have three columns?—one consisting of column A as it now stands, and column B subdivided into the cases which are really expensive, to put it plainly, and which should be sent for prior approval to the Dental Estimates Board, and the intermediate cases in which a dentist, before carrying out the work, would require a second opinion of another dentist on an approved list. That would avoid this enormous centralisation and the very great delay which must necessarily ensue if we centralise to this extent.

This would be very much the sort of machinery which the Minister has provided in part II of this schedule—the case of dentists carrying on their practice in a health centre. In the case of dentists practising in a health centre, it will not be necessary to submit these cases to the Dental Estimates Board, and the dentists can get on with the job, subject to the approval of a local dental officer. Why cannot the same kind of system be adopted in the case of the dentist in the surgery? Instead of the local dental officer, it would be necessary to call in a second opinion of some specially qualified dentist. That would avoid a great deal of centralisation and be a better plan than that incorporated in the order.

As regards dentists in health centres, I ask the right hon. Gentleman exactly what is his intention. It is not quite plain from the order how it is to operate. I think that the position is that all dentists practising in health centres are to be salaried practitioners. Those who work whole-time will be whole-time salaried practitioners; those who work part-time will be paid a salary in respect of the time during which they are working in the health centre. I would like some information on that score, and I would tell the right hon. Gentleman quite candidly that I view the suggestion of salaried practitioners in health centres with a good deal of apprehension. [HON. MEMBERS: "Why?"] I know that hon. Members opposite, unlike the right hon. Gentleman, are desperately in favour of full-time salaried service for all medical and dental practitioners.

Mr. Baird

We made it clear on Second Reading of the National Health Service Bill and in Committee that what we want to see is healthy competition between the health centre and the general practitioner, which is entirely different from a whole-time salary basis.

Sir H. Lucas-Tooth

Am I to understand that the hon. Member is not in favour of fully salaried practitioners in health centres?

Mr. Baird

I am suggesting that we should let the better type of service win.

Sir H. Lucas-Tooth

I do not want to pursue this matter at great length, because time is getting on and there are other points I want to raise. We are generally opposed to the principle of salaried practitioners, and subject to what the right hon. Gentleman may say—

Mr. Bevan

Who is opposed to it?

Sir H. Lucas-Tooth

We on this side.

Mr. Bevan

Are the Conservative Party opposed to whole-time dentists? Will the hon. Member quote the authority for saying so?

Sir H. Lucas-Tooth

The question is so far academic.

Mr. Bevan

Who is opposed to it?

Sir H. Lucas-Tooth

I am opposed to it.

Mr. Bevan

Ah.

Sir H. Lucas-Tooth

I believe it is a fact that my view is shared by my hon. Friends. The position is still academic, because it is not plain, on the face of the order, what is the right hon. Gentleman's intention, and it is exceedingly difficult, if not impossible, to criticise until we know that.

The last general issue involved is the method of remuneration of dental practitioners. The Spens Committee, which considered this question, has not yet reported. I believe that we are to have the report in the near future, and perhaps the right hon. Gentleman will be able to tell us something about it. In spite of the fact that the Committee has not reported, the order deals with the matter to this extent. It states:

"TERMS OF SERVICE FOR DENTAL PRACTITIONERS PRACTISING ELSEWHERE THAN AT A HEALTH CENTRE

(2) Except as otherwise provided in the regulations, a practitioner shall not suggest, demand or accept from any person for whom he is providing general dental services or from any other person the payment of any fee or remuneration in respect of any treatment which he is required to give under these terms of service:"

As I understand it, that means that every practitioner is given a single flat-rate for each item of treatment whatever his skill, whatever his experience and whatever amenities he may offer.

Mr. Baird

Rubbish.

Sir H. Lucas-Tooth

I think I heard the word "rubbish," but I should like to know the answer from the right hon. Gentleman. If that is not the position, it will go some way to ease our minds, and, I have no doubt, the minds of those in the dental profession. If I am right and there is to be a uniform flat-rate, then I say that that is entirely wrong. It is wrong to ignore skill and experience, and it is silly to ignore such things as amenities.

Dr. Morgan

How else would the hon. Member do it?

Mr. Baird

Can the hon. Member tell us how he would measure the skill of one dentist as against the skill of another? That is the problem we are all facing.

Sir H. Lucas-Tooth

The hon. Member has got to the root of the political theory of his party. Under a free system, where there is bargaining, the more skilled the person, the higher rate of pay he gets.

Mr. Baird

Is the hon. Member suggesting that the dentist who charges the highest fee is the best dentist?

Sir H. Lucas-Tooth

I think it would be better if the hon. Member developed his own speech later. Broadly speaking, the more skilled and more experienced dentist is able to command higher fees than the less skilled dentist. Also, he may have a more central office, and a more comfortable waiting room. [HON. MEMBERS: "Oh !"] Yes, and quite properly, too. Somebody has to pay for these things, and if it is not to be the patient it must be the State. This question must be dealt with in one way or the other. I understand that the profession has asked that it should be dealt with by way of grant-in-aid, that is to say, there should be a basic flat-rate payment as between the State and the dental practitioner, but that the practitioner should be able to bargain for an additional sum over and above that payment.

I fully recognise that that proposal, by itself, could not stand. There are objections. If the proposal is that there should be a free service, then a suggestion such as I have adumbrated would mean that there could be no free service. It would be worse than that because a pure system of grant-in-aid must lead towards a tendency to subsidise the dentist, which would defeat the whole object of the scheme.

The proposal of the Government would be even more fatal. What will happen? If a low basic rate is paid, without taking into account any of the skill or other qualities I have mentioned, the better dentist, who is able to command higher fees, will invariably stay out, and the only ones who come into the scheme will be those who have been somewhat rudely described as the "blood and vulcanite" type. They will do so because they will come in on the lowest rate; the higher skilled and more experienced dentists will tend to stay out. The result will be that the scheme will tend always to keep the less efficient, less competent dentists, and lose the more competent and more efficient men. Only by staying out of the scheme can they command anything better than the very low basic rate.

I regard this as a difficult problem, and I recognise, in all sincerity, the difficulties facing the Minister. So far as I am concerned I recognise that he cannot accede altogether to the idea of a pure grant-in-aid. But there are other schemes, and I am certain that it is not beyond his ingenuity to devise one—

Dr. Morgan

Tell us one.

Sir H. Lucas-Tooth

There could be a classification into groups—A, B, C, D and E.

Dr. Morgan

According to skill?

Sir H. Lucas-Tooth

I suggest that there could be a classification on the higher rate of charge, and that dentists could go into which classification they chose. Of course, if they went into a classification having the higher rate of charge, that would necessarily tend to limit the number of their patients. I throw that out as a suggestion which might be an administrative way of dealing with this matter. I am quite certain that if this scheme as it stands is allowed to go forward, it can only finish up by wrecking the whole of the hopes that were based on this scheme by all sides of the House. I am quite satisfied that this order can lead to nothing but a futile service from which the best elements of dentistry are kept out, which must ultimately lead to the disappointment of the patient and which will certainly lead to an extra obduracy on the part of the dentists—I used the word quite inoffensively—which must make it impossible for them to come to reasonable terms with the right hon. Gentleman.

9.21 p.m.

Sir Wavell Wakefield (St. Marylebone)

I beg to second the Motion.

Now that the Minister is here I want to make a protest against his absence in the earlier part of this Debate. I am sure it was not discourtesy but sheer incompetence and inefficiency on the part of the Government and in particular of his Department. I feel it is only right at the outset of my remarks in view of the opportunities he has of being here on time, to make this protest. I should like to reinforce what my hon. Friend the Member for South Hendon (Sir H. Lucas-Tooth) said before the Minister arrived. He said that the dental profession were feeling very strongly about the way in which the discussions they have had with the Minister have been carried out. They feel there has been discourtesy and there is a strong feeling—

Mr. Bevan rose—

Sir W. Wakefield

It the Minister would permit me to finish my sentence I will give way. I want to support what has been said by my hon. Friend that there has been a feeling of dissatisfaction, a feeling that there has been discourtesy—

Mr. Bevan

This is the second or third time that the representatives of some part of the medical profession have made that statement. If it is repeated I will publish the verbatim report of the exchanges between me and representatives of the medical profession. This is quite discourteous. All these conversations are confidential, and I am quite helpless when a stupid statement like that is made. If they are continued I will at the opportune moment publish confidential reports.

Sir W. Wakefield

I am making a statement of what the dental profession feels.

Mr. Bevan

It is untrue.

Mr. Baird

Is the hon. Gentleman for St. Marylebone (Sir W. Wakefield) speaking on behalf of the Consultative Committee of the dental profession or not?

Sir W. Wakefield

I am speaking on nobody's behalf but my own.

Lieut.-Colonel Lipton (Brixton)

Then do not make grave charges.

Sir W. Wakefield

I am voicing the complaints of those who elected me here. One of the main reasons for hon. Members being in this House is to ventilate grievances, and I am ventilating a grievance at the moment. The right hon. Gentleman referred to the medical profession, but I am speaking of the dental profession.

Mr. Bevan

Will the hon. Gentleman, who is generating more heat than light, inform the House of any evidence of discourtesy.

Sir W. Wakefield

I said there was a feeling amongst the dental profession that there was discourtesy. There is dissatisfaction at the way in which the discussions were carried out.

Lieut.-Colonel Lipton

Amongst whom?

Sir W. Wakefield

Amongst members of the dental profession.

Mr. Bevan

That is not right.

Sir W. Wakefield

I have made my statement and I am prepared to stand by it.

Mr. Tolley (Kidderminster)

Give us the evidence.

Sir W. Wakefield

The next point I want to make was made by my hon. Friend who moved this Prayer.

Mr. Alpass (Thornbury)

On a point of Order. If an hon. Member makes a statement of that character, should he not when challenged by the Minister to produce evidence, either withdraw the statement or produce his evidence?

Mr. Deputy-Speaker (Major Milner)

Hon. Members must, of course, be responsible for the statements they make. The Minister will have an opportunity to reply.

Sir W. Wakefield

The argument that was put by my hon. Friend before the Minister arrived referred to special treatment. The questions that he asked I will ask again now in order that there may be no misunderstanding upon the subject. What discussions have taken place with the dentists? What is the outcome of them, in connection with this special treatment, about which reference was made during the passage of the National Health Service Bill? I repeat the questions, so that the Minister may have a full opportunity to answer them.

It might be for the convenience of the House if I took Statutory Instrument No. 505 of the National Health Service and went through it for the points which I want to make and the questions I wish to ask the Minister, in the order in which they come. I hope that way will be the easiest for the Minister when he makes his reply and will be for the convenience of the House. The first point is at the bottom of page 1, on the subject of "dental treatment."

It is a well known fact that there is a shortage of dentists at the present time. I want to ask the Minister what his intentions are about denture work which is done by independent, qualified dental technicians. Reference has not been made, in the statutory instrument so far as I can see, to the position of such people, but I understand that a large part of the repair work to dentures is undertaken by denture repair services independently of dentists, and that they supply the public direct. I understand that there are some 500 of these services, established in different parts of the country, and that they handle more than one million dentures annually. What is to be the position of these people. Are they to continue to supply the public direct? If so, how do they come into this scheme under the Regulations? Are they to be required to supply the dental practitioners? It is desirable that some explanation should be given of this position, in the public interest, in view of the shortage of dentists and in order that the public and the denture people themselves may know what the position will be under the Regulations.

On page 4, paragraph 10, is this statement: It shall be a condition of obtaining general dental services that a person shall, it required by the Board, submit himself for examination by a dental officer. Those words suggest a reflection upon the professional skill and ability of the dentists. I should like, the public would like, and this House would like to know what exactly is intended by such proposals. Perhaps the Minister will be good enough to amplify the paragraph.

The next question concerns the Dental Estimates Board. In paragraph 12 of this statutory instrument, it is stated: The chairman and members of the Board shall hold office during the Minister's pleasure. Will the right hon. Gentleman tell the House whether these will be full-time members or part-time? There is to be a chairman of this board, six medical practitioners and two other members. What are their terms of remuneration and, in making these appointments, is it proposed to make them for a long period or for a short period? Obviously practitioners on this Dental Board must be fairly fully informed by recent practice as to the position. Will they be part-time, and therefore practising their profession part-time? If they are to be full-time, is it for a year or two years? Quite clearly, if they are away from their profession for some considerable time, they will not have that up-to-date knowledge of existing conditions which is desirable. Could the House be told more about these appointments and the conditions pertaining to them? Who are the two other members it is proposed to appoint? Are they lay members or have they some professional or legal training, or what? It is desirable that the House should know more about that, and I hope the Minister will be able to give us an answer.

My next point concerns paragraph 21. I would like to support the proposal made by my hon. Friend for some form of decentralisation, otherwise there will be great delay in patients being treated. My hon. Friend stated, and it seems reasonable, that there will be some 150,000 treatments a week to be examined, and treatments must not be proceeded with until these estimates have been approved. I can well imagine considerable correspondence taking place between the dental practitioner who sends in his estimates and the Board, which makes inquiries on the special treatment required. Presumably the Board will not put a rubber stamp on every estimate, and considerable time may elapse before the treatment required by the patient can be carried out if correspondence is involved. Therefore, I would like to know what the Minister is proposing to do to limit this delay which is likely to occur as a result of the method laid down in this order.

We ought to have some idea what policy the Board will adopt in coming to a decision on what is suitable treatment and what is not. Is it the amount of money available? I see the right hon. Gentleman is leaving the Chamber, but I would like to have his attention for a moment because I am asking about something of considerable importance. [An HON. MEMBER: "Touchy."] I am not touchy at all. I am making a point, and I want an answer. What will determine the decision of this Board as to whether special treatment should be given or not? Will it be determined by the needs of the patient, or by the amount of money available?

Mr. Baird

For the first time it will be according to the needs of the patient.

Sir W. Wakefield

Will it be the case that half-way through the financial year we shall suddenly find that we are running out of money, and that, therefore, there must be a clamping down on the kind of treatment to be given to the patient, whether he needs it or not? These are matters of importance about which we ought to have some information.

Paragraph 22 deals with replacement of dental appliances necessitated by lack of care, and says it may be necessary that the inquiry shall take the form of an oral hearing by a committee of the Council constituted for this purpose. Who has to bear the cost of this oral hearing? The patient may have to attend before this committee of the Council and give evidence. Must he pay for all these expenses, together with the time which he has lost in giving such evidence, even if the evidence which he gives is considered by the Council to be satisfactory? Is there to be any differentiation? If he is not successful, and the Council thinks that there was carelessness on his part, must he then pay his own expenses? It is important that information should be given on this point. Paragraph 22 (3) says that when the council have determined whether the patient should bear the whole or a proportion of the cost of a replacement, they will communicate their decision to the patient, the practitioner and to the Board. Has the patient any appeal against this decision to any person or body and, if so, to whom? There should be some right of appeal, and I hope that the Minister will consider inserting here the right of appeal to some person or some body.

Mr. Baird

To whom does my hon. Friend suggest that the appeal be made?

Sir W. Wakefield

I am not suggesting that the appeal should be made to any specific or particular body. I am asking the Minister if he will consider a right of appeal to some individual or some body. There is no statement that the patient has any right of appeal whatever.

Mr. Baird

What body is fit to judge between a dentist and a patient? Can the hon. Member suggest a body with professional knowledge?

Sir W. Wakefield

Apparently the Council is supposed to be a fit body to make a decision. If that is so, there should be a higher body to whom appeal may be made; that is only British justice. Invariably in this country there are higher courts of appeal in all our legislation. It is the interests of the public which we on this side of the House consider, and I suggest that in the public interest there should be a right of appeal for people who feel they have a grievance.

In all these regulations there is an enormous amount of form-filling to be done. An examination should be made to see if this is necessary. After this Debate, on the Motion for the Adjournment, we are to debate the shortage of newsprint, which is a very serious matter for this country. I suggest that the amount of paper which will be required for this scheme, which is so typical of this Government—always filling in forms, with more and more forms—indicates that a revision should take place of this matter. Dentists are in short supply, and they are going to be required not to look after the people but to fill up forms, and, so far as I can see, the time of dentists will be increasingly occupied in filling forms instead of filling teeth and providing patients with dental appliances.

There is another question which I want to ask the Minister. In page 8 of the first schedule, paragraph (3) states: A practitioner's surgery shall be furnished with suitable equipment and the practitioner shall provide treatment with suitable instruments. That is a very proper provision, but I would like to ask how a practitioner is to know what is considered suitable equipment and who is going to decide what is suitable equipment. If the practitioner has not got suitable equipment, and we all know that it is very expensive, what facilities are to be made available to help him to purchase such equipment? It may well be that there are dental practitioners without the financial means to enable them to purchase the necessary and expensive equipment required of them. All I ask is what facilities are envisaged under this order to enable practitioners to acquire the necessary equipment, if it is suggested that what they already have is not suitable.

Finally, I suggest that it is altogether wrong that members of the dental profession should be asked to sign up when they have not the remotest idea what form of remuneration, either by method or amount, they are to obtain. They are asked to sign a blank cheque, and I ask that the Government should defer the bringing into operation of these regulations until it is possible for the dental profession to know the method and amount of their remuneration, because if it is brought in prematurely the people will suffer, as they suffer so much already from the administration of this Government.

9.43 p.m.

Mr. Baird (Wolverhampton, East)

I am surprised at the method of approach of the Opposition to this question tonight, and I can only assume, being a dentist myself, that the two hon. Gentlemen opposite who moved and seconded this Prayer were sitting in the dentist's chair and that the dentist said "I want you to move and second this Prayer, otherwise—" and then they forgot all about it till tonight. The thing that surprised me most was their lack of knowledge. They did not know the first thing about it. Time and time again we made interjections and asked questions, but could get no answer. Let me now try to answer one or two.

The first suggestion was that the dental profession were feeling very strongly about these regulations, and that they were going to oppose the Act because of the regulations. What is the true position? Actually, taking the Metropolitan area, the dentists of the British Dental Association are organised in the Metropolitan branch of the B.D.A. The Members of the branch are mostly practising dentists in London. Meetings of the branch have taken place, after one of which the "Evening Standard" published on its front page a picture with the heading "Dentists Oppose National Service Plan." This picture showed a mass of hands against this scheme. Underneath it said that this mass meeting of the Metropolitan branch had voted by 370 odd to 11 against the scheme.

What is the true position? The Metropolitan branch of the British Dental Association has over 2,000 members, and in the Metropolitan area which the branch covers there are 7,000 dentists. Yet at this meeting in London it was decided by 300 votes to 11 not to enter the scheme. The fact of the matter is that the great mass of the dentists will not attend these meetings. They do not want to commit themselves one way or the other until they know what remuneration they will get. For anyone in this House to say that the dentists oppose the scheme is utter nonsense. There has been no plebiscite and no democratic method of judging the views of the dentists up to the present.

If we are to have a National Health Service we must have a Dental Estimates Board to adjudicate between the patients and the dentists and the Government and the dentists. Anyone who is in favour of the National Health Service must admit that the Dental Estimates Board is necessary. Furthermore, I am sure that both sides of the House will agree that the National Health Service should be a free service. That cancels out almost immediately the argument of the weakness of the Dental Estimates Board and the argument in favour of grants-in-aid. The criticisms which have been levelled against the Dental Estimates Board are entirely irrelevant. Obviously there are many hon. Members who do not understand all the intricacies of this problem. There are two schedules under the Act. There is what is called schedule A, under which dentists will be able to carry out work without any prior approval or anything in writing at all in relation to the Ministry of Health and themselves, and that is a broad list.

Sir H. Lucas-Tooth

The hon. Gentleman said "without anything in writing at all." I do not think that is quite correct.

Mr. Baird

Yes—without anything in writing at all before the work is commenced. That is what the dentists are worrying about. Then there is schedule B under which the dentists, before commencing work, will have to have prior approval of the Dental Estimates Board. It is essential that the House should realise that in 1946, when the Minister was framing this scheme, he was very keen that the dental profession should be consulted and that their views should be worked into the scheme. At that time the British Dental Association published a memorandum of suggestions for a dental health service. Right throughout the scheme and in the Bill it will be found that the Minister has followed almost word for word the suggestions of the British Dental Association as to what should be with prior approval and what should be without prior approval. The British Dental Association has changed its views since then, but at that time the Minister could seek no higher authority than the British Dental Association, which spoke for the dentists.

The hon. Member for South Hendon (Sir H. Lucas-Tooth) put forward the argument that if we needed all these prior approvals, it would mean that decisions would be taken by a lay clerk instead of by a dentist who was a member of the Dental Estimates Board. The truth of the matter is that in the great majority of these cases there will be an almost automatic decision. Where there is any question of doubt, the dentists on the Dental Estimates Board will be consulted, but the great mass of cases will go through without any need for any professional opinion at all.

In the Debate on 9th February, I suggested that schedule A should be broadened to include crowns and inlays. I may be wrong, but I believe that when the suggestion was put to the contact committee of the dental profession some members of the contact committee turned down this suggestion because they believed that there were some members of the dental profession who were not capable—I must choose my words carefully—of carrying out all types of crowns and inlays without prior approval. Other members of the committee turned down the suggestion because they were afraid that if crowns and inlays were included in schedule A, the scheme would become too rigid. I believe that one of the main arguments on behalf of the dental surgeons is that if we abolish prior approval altogether, that would result in rigidity. By including prior approval we get an elasticity in what would otherwise be a rigid scale of fees. If we have purely one list, with a scale of fees for every item on that list, it is a very rigid system; but where we have more skilled work requiring prior approval of the Dental Estimates Board, there could be a varying fee for each item, thus abolishing the rigidity which would otherwise occur. That is one of the items about which the hon. Member who moved this Prayer does not know a thing.

I would like to ask the Parliamentary Secretary two questions. With regard to the appeals to the Dental Estimates Board, what does he consider will be the delay between the dentist's applying for an estimate and the acceptance of that estimate? What time does he think the Dental Estimates Board will take in replying to the dentists? I believe it will be very short. Can the Parliamentary Secretary give that figure? Secondly, what is happening to my suggestion in the Debate of 9th Febru- ary for including crowns and inlays under schedule A?

I want to say a word or two about remuneration. It is entirely wrong for hon. Members opposite to suggest that the Minister is responsible for the delay in the publication of the Spens Committee Report. If at the beginning the dentists had agreed to serve on the Spens Committee, the work of the committee could have commenced much earlier than it did.

Sir H. Lucas-Tooth

I certainly never made any such suggestion.

Mr. Baird

I am not suggesting that the hon. Member said the Minister was responsible for the delay on the part of the Spens Committee, but the hon. Member who seconded said that the delay in the Bill—

Sir W. Wakefield

I never mentioned the Spens Report at all.

Mr. Baird

The hon. Gentleman spoke of the delay in coming to a decision about remuneration. Perhaps the hon. Gentleman does not realise that the delay in coming to a decision on remuneration is because the Spens Committee has not yet reported, although we can expect a report in the next few days. One of the great advantages in the Spens Committee is this. In the past the remuneration of dentists has been completely unbalanced. An hon. Member on the other side mentioned "blood and vulcanite," but in the past dentists have earned their main remuneration from extracting teeth and making dentures. The fee paid for preserving teeth was much smaller in comparison. One of the practical advantages of this National Health scheme is that we shall be able to have a balanced scale, and the dentists who carry out conservative work will be paid a much more adequate fee, and the fee for dentures will be much more balanced in return. That is one of the big advantages of this National Health Service.

Mr. Linstead (Putney)

How does the hon. Gentleman get that information? The Spens Report has not yet been published.

Mr. Baird

Perhaps I am speaking out of turn, but every prominent member of the dental profession, both in favour of or against the Act, feels I believe, that there should be a fundamental charge in the scale and basis of fees, by which remuneration is paid. A balanced scale: that is something for which the dental profession have been fighting for a generation, and because of prejudice they have never been able to obtain it. I do not want to go into the argument the hon. Member made about grants-in-aid, but he did argue that a dentist should be paid according to his skill, according to the comfort of his waiting room, and so on. I challenged him, and he was not able to answer me. How can we judge a dentist's skill? That is the basis of our argument. Once we can evolve some method of judging the skill of a dentist we shall be willing to accept that as a basis, but no one can argue that a dentist who receives the biggest fee is necessarily the best dentist.

Sir H. Lucas-Tooth

Does the hon. Member suggest that we can ignore the dentist's skill altogether?

Mr. Baird

Not at all. I will elaborate the point later. The point is that the dentists getting the biggest fees are not necessarily the best dentists. Many dentists working, for instance, in the East End of London in working-class districts are just as good as the dentists in Harley Street who are paid bigger fees. Dentists with comfortable waiting rooms and with the social graces are not necessarily the most skilled operators. [Interruption.] It is all very well for hon. Members opposite to laugh, but this is the truth. If hon. Members opposite will go down to some of these areas, they will find dentists just as good as those they meet in Harley Street.

The hon. Gentleman asks, how are we to judge a dentist's skill? What happens at the present time? The ordinary dentist practising amongst working-class people may want to treat a patient, for instance, by apicectomy, but the patient cannot afford it. Perhaps, the dentist wants to fit a bridge, but the patient cannot afford that. So the tooth is extracted instead or a denture is fitted. That happens time and time again. Under the National Health Service Act, however, there is a broad scale of fees, to include all that work, and the patient will not have to pay anything at all. The dentist in a working-class area will be able to treat his patients by gingivectomy or apicectomy, whether the patient can afford it or not, and the dentist will be paid an adequate fee for the work he does. That will encourage the dentists to do good work.

The Opposition today are suggesting that people should use repair shops and that mechanics should be able to enter the dental profession by selling dentures directly to patients. The dentists and the dental mechanics and their trade union are against this dilution of the dental profession. Yet that is what was suggested by the hon. Member for St. Marylebone (Sir W. Wakefield). I challenge hon. Members opposite to state here and now if what they suggest is the policy of the Conservative Party. The hon. Member for St. Marylebone suggested that some guidance should be given to the Dental Estimates Board with regard to the financing of the scheme. He asked whether money is to be the deciding factor? Hon. Gentlemen opposite do not understand what has been going on under National Health Insurance dentistry in the past. Money was then the deciding point. It came out of the surplus profits of the approved societies. Time and time again dentists who wanted to carry out better class work could not raise the money. Now, for the first time, under the new National Health Service Act, money will not be the deciding factor, but the needs of the patients will be. The hon. Member suggests that every dentist will have to provide suitable equipment. He does not understand that at the present time dentists have to provide suitable equipment, and if they do not, the Dental Benefit Council can score them off their list.

Hon. Members opposite are always telling us that the Labour Government believe in bureaucracy, and like forms for forms' sake; and the hon. Member for St. Marylebone said that under this Act there would be more and more forms to fill up. What is the position at the present time? Under National Health Insurance dentistry a patient comes to see me in my surgery and says, "I am an insured patient, I want treatment." I reply, "I am sorry, but I cannot see you until you apply to your approved society for a form." From some societies to which application is made the form is returned immediately, but other societies send back an application for a form. The patient fills up that application for a dental letter, which is returned about 10 days later. The patient takes that to the dentist, who fills it up in detail and sends it off to the approved society for approval. He then waits anything from a week to a fortnight —sometimes longer—and then he receives the approval back, or it is sent to the Dental Benefit Council for approval.

Mr. McGhee (Penistone)

By a clerk.

Mr. Baird

Yes, by a clerk. Then, by the grace of God, the dentist can commence treatment. What happens under the National Health Service Act? The patient goes to the dentist and says, "I want this work done," and the dentist commences the treatment and finishes it—apart from dentures, about which we all agree the patient must be safeguarded; then, at the end of the treatment, the dentist makes out his bill and signs it, and the patient countersigns it; the bill is then sent to the Ministry, who guarantee to pay the bill within one month. In face of that, it is suggested that we Socialists are in favour of bureaucracy. Under this National Health Service Act, for the first time we are getting rid of this form filling, as far as dentists are concerned—in all types of dentistry.

I appeal to hon. Members opposite: if in future they wish to move a Prayer in this House, please get to know the facts before wasting the time of the House, as they have done tonight.

10.2 p.m.

Mr. David Renton (Huntingdon)

I was wondering what the hon. Member for East Wolverhampton (Mr. Baird) would say tonight, because during the Committee stage of the National Health Service Act he expressed some anxiety about having to submit anything to, an estimates board; and, indeed, he moved an Amendment to Clause 40 as follows: Provided that regulations made for the purposes of this paragraph shall not prescribe for the approval of estimates before dental treatment is undertaken."—[OFFICIAL REPORT, Standing Committee C, 25th June, 1946; C. 1727.] I must say that this evening I have been impressed with the sincerity of his attitude towards the question of submitting estimates to the Board.

Mr. Baird

In Committee I suggested that there should be prior estimates where the fitting of an appliance was necessary, and I then spoke on the authority of the British Dental Association, as the hon. Member would see if he read the whole of my speech.

Mr. Renton

I have read the whole of the hon. Member's speech. Indeed, I would not have quoted him unless I had done so. He is perfectly right in what he says, and I did not say that he had said otherwise. All I said was that he expressed anxiety—which is what we all do—and that the hon. Member went so far as to move an Amendment, in the precise words which I have related.

I am impressed by the sincerity of his remarks tonight about how this will work out in practice. He asks us to get hold of the facts. I speak with some considerable experience as a patient in these matters, and, if I may be allowed to, I will draw upon my experience as a patient. Let me make it abundantly clear that I have not seen my dentist for nearly 18 months, and I have not discussed the dental service with any dentist, either directly or indirectly for over a year. Therefore, perhaps I shall not be accused of any kind of partiality in this matter. On what should be submitted to the Dental Estimates Board, my hon. Friend the Member for South Hendon (Sir H. Lucas-Tooth) very rightly resisted a temptation which I shall not resist. I make so bold as to say that it would be interesting to know the views of the hon. Member for East Wolverhampton, and certainly of the Government, with regard to some of the matters in the second schedule to these regulations.

If hon. Members will turn to page 15 they will find under the first item "Diagnosis" that where a radiological examination at a cost exceeding£2 2s. has to be made, there has to be a reference to the Dental Estimates Board. In urgent cases that may give rise to serious difficulties, as it would have done in an urgent case of my own about two years ago. I had a severe impacted wisdom tooth. I was here at the House one night with a swollen face. The next morning I saw my dentist, and he said that the first thing necessary was an X-ray examination. If that X-ray examination had cost more than two guineas and the matter had had to be referred to the Dental Estimates Board, I could not have been operated on the next day, as in fact I was.

Dr. Morgan

The hon. Member will find in the Schedule which he has quoted a dagger reference mark against the removal of impacted teeth, with the proviso that this service as an emergency treatment can be commenced without prior approval.

Mr. Renton

I am aware of that, and I was coming to that point. There is not that sort of dagger symbol opposite item No. 1—diagnosis, radiological examination—as there is against impacted teeth. If one of these beautiful little symbols enabled an X-ray examination to take place in an emergency I would have no quarrel, but I suggest that it should be there.

Mr. Baird

It is on the free list up to two guineas.

Mr. Renton

If the X-ray examination costs more than two guineas—[Interruption.] I think that the regulations should make clear what is the position instead of making it appear to be something completely different. This is a matter for the Parliamentary Secretary to clear up. We started this Debate without any representative from the Ministry of Health. We now have the Parliamentary Secretary present, but the Minister himself has disappeared. One would like to know whether he is playing at home or away tonight.

The second item is prophylaxis. Could the hon. Member for East Wolverhampton sincerely and with accuracy tell us the difference between normal scaling and extensive scaling, because if there is a very clearly defined treatment, I am sure that it would be of interest to lay Members of this House, who include everyone except himself, to know about it. I can foresee difficulties over the word "normal," which is the most difficult word in the English language to define. I should have thought that, bearing in mind that everybody under the National Health Service is to have the right of free treatment, all forms of treatment and scaling, even the removal of cigar stains from the teeth of hon. Members on both sides of the House, would come within the patient's right under the scheme. That is another suggestion for the Government to consider in answer to the challenge given by the Minister to the hon. Member for South Hendon (Sir H. Lucas-Tooth).

I now come to the last item in the Schedule—oral surgery—removal of impacted teeth, buried roots, cysts, etc. This service, if the treatment is urgent, does not require to be submitted to the Dental Estimates Board; but why should it ever have to be submitted? Surely, every patient within the National Health Service if he has impacted teeth, a cyst or a fractured jaw is entitled to treatment as a right. So why should that matter be submitted to the Dental Estimates Board?

Mr. Baird

Who is to decide what fees shall be charged? Is a dentist to be left to charge any fee and some outside authority not to lay down what is an adequate fee?

Mr. Renton

The hon. Member knows perfectly well that the real issue, in considering this second schedule, is whether or not a patient shall undergo treatment before the cost has been approved or after the cost has been approved. If that is not the only issue, then let us have some clarification from the Government.

The National Health Service Act is an enabling Measure. The real operational control is contained in the regulations the Minister may make under it. This discussion tonight is, therefore, of very great importance. Many people will say that it is of even greater importance than the discussions which took place on the Act. I am absolutely astonished at the frivolous and sometimes cheap way in which this discussion has been treated, because the whole of the dental health of the nation will in future depend on the wise planning of these regulations. Just as the regulations contain the essence of the Act, so we find that the schedules contain the essence of the regulations. The first schedule lays down the terms of service for dental practitioners practising elsewhere than at a health centre. In paragraph 2, we are referred to another set of regulations, which are not the subject for discussion tonight. If we want fully to understand this schedule, it is desirable to refer to Statutory Instrument No. 507, National Health Service (Service Committees and Tribunal) Regulation, 1948. If hon. Members will turn to paragraph 7 (5), they will see it stated that a practitioner shall complete treatment with reasonable expedition. So far so good. It continues: and shall— (a) in the case of treatment to which subparagraph (2) of this paragraph applies, not take longer than six months from the date upon which the person is accepted by him for treatment; I should jolly well hope not.

Dr. Morgan

Read Subsection 2.

Mr. Renton

I have already drawn attention to that.

Dr. Morgan

Read the latter part of it.

Mr. Renton

No doubt the hon. Member will have an opportunity to speak later on. It seems that where the matter is referred to the Board, because it does not come under column A of the second schedule, the treatment has to be given within six months. Surely that period should be shortened. The number of matters in these regulations about which I could comment is legion. I hope we shall have a reply from the Government about the most important points which have been raised in the Debate. Having studied and tried to follow the development of the Health Service since the National Health Service Act was first introduced, I must say that the regulations embody all our worst fears as to what would happen to a professional service when a Government got hold of it—our fears as to whether a dentist would have clinical freedom, whether there would be delay because of compliance with red tape, and because of form filling. It is because I feel that seriously and sincerely, and that there are serious defects in these regulations, I believe we should follow the advice of my hon. Friend the Member for South Hendon (Sir H. Lucas-Tooth) and ask His Majesty that they be annulled.

10.16 p.m.

Mr. Keeling (Twickenham)

I do not think the House has ever been treated with greater discourtesy, negligence or cynicism than tonight. Not only was there no representative of the Ministry of Health here for the first quarter of an hour or 20 minutes, but when the Minister himself came into the Chamber he did not listen, did not take a note, went off without an apology, and has not reappeared since. The matter we are debating tonight is one which affects the health of everybody in the country. I want to ask only one question, and I suppose I must think myself fortunate in having present the Parliamentary Secretary who, apparently, is willing to listen and, I hope, answer—

The Parliamentary Secretary to the Ministry of Health (Mr. John Edwards)

I hope this point will not be elaborated. I apologise to the House, and particularly to the hon. Member for South Hendon (Sir H. Lucas-Tooth) for not being here all the time. I have, however, a very detailed note of what he said, and I was present during the proceedings after he spoke. If it should happen that I overlook any point, I shall be happy to give way. I am sorry I was not here at the start, but I did not anticipate that the Prayer would be moved quite so early.

Mr. J. S. C. Reid

If I am fortunate enough to catch your eye, Sir, after the Parliamentary Secretary has spoken, I can assure him that the point will be elaborated.

Mr. Keeling

The Parliamentary Secretary does not appear to have noticed that my main complaint was against the Minister of Health himself. I want to ask this question: Is it contemplated, under these regulations, that not only the supply of new dentures, but also the repair and replacement of dentures, must always go through the hands of dental surgeons? As I am sure the hon. Gentleman knows, at present a large part of this repair work is undertaken by dental repair services, operating independently of the dentists in supplying the public direct. I understand that there are at least 500 of these independent dental mechanics or dental repair firms in the country, and that between them they handle over a million dentures annually. I should be glad of a reply on that point.

Dr. Morgan

I want to ask only one question in connection with these regulations which, I think, are good as a whole. With regard to the Second Schedule, I can understand that the removal of infected teeth, buried roots, cysts, etc., can await treatment and reference to the Dental Board, but from my experience I am sure there are very few fractured jaws which can await treatment. It is quite true that the paragraph says that this service under an emergency treatment can be commenced without prior approval, but it seems to me unnecessary to include fractured jaws in the Schedule at all, because one would expect from one's experience that there are very few cases of fractured jaw which would not receive emergency treatment.

10.21 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. John Edwards)

It is clear that the right hon. and learned Gentleman the Member for Hillhead (Mr. J. S. C. Reid) does not want information on the schedule or indeed on any part of the order, but if he should happen to catch your eye, Mr. Speaker, I shall listen to what he has to say. A number of details have been raised on the regulations, and it would be better if, first of all, I were to deal with the matters of considerable principle that were raised by the hon. Member for South Hendon (Sir H. Lucas-Tooth), who moved the Prayer to annul this order. The first thing I want to make absolutely clear is that the regulations define dental treatment, as, if I may quote, all proper and necessary treatment which a dental practitioner usually undertakes for a patient, including examination and advice, the obtaining of, radiographs, scaling, treatment of the gums, fillings, extractions, scouring, provision of artificial dentures and their repair and remaking, etc. That is a very comprehensive definition. The regulations also require the dentist to employ a proper degree of skill and attention and to provide all the treatment necessary to secure dental fitness that a person is willing to undergo. This means that the regulations provide for a higher standard of service, and it is my right hon. Friend's hope that dentists will, in fact, give all the services and that the treatment, both technically and aesthetically, will be of such a quality as will secure a first-class standard of dental fitness, so as to promote general health. I would also point out that every dentist who enters the scheme will, in fact, have made a solemn declaration along those lines, and I should not expect that any of them would do anything other than their best work. I should not expect dentists to do shoddy work or even to feel obliged to do what some of them call "utility" work.

The second thing is that we do not want to interfere any more than is absolutely necessary between a dentist and his patient, but the dental service is a free service and is mainly paid for out of taxation. The State, therefore, has some interest in the cost and in the standard of service. Having said that, I would emphasise our desire to allow the fullest possible latitude. We have sought to reduce to the minimum the intervention of the Dental Estimates Board. We are aware, as no doubt Members on both sides of the House are aware, of the mutual confidence between dentists and their patients, and no regulation takes away the personal responsibility of the dentist to his patient. For our part we do not want to impair that relationship in any way.

Since we cannot in the nature of things have all the work done in health centres, nor can we have a panel system of the kind that we have for the general practitioner service on the medical side, we are obliged to have some system of payment for getting the work done. We shall be glad to have any suggestions about the way in which the remuneration may be made, when we have received the advice of the Spens Committee. Even under these regulations it is clear that the dentists will be able to carry out very much more work without prior approval than was possible under the National Health Insurance dental arrangements. Under those arrangements approval was given by a lay body, the approved society, with varying periods of time being taken for the approval. Now, approval will be given by the Dental Estimates Board, which is predominantly professional, and it will be given with all speed.

Let me insist that prior approval will not be required for urgent treatment or for normal conservative work. There may be hon. Members who have read the proposals of the profession set out some time ago in a pamphlet. If they have seen the proposals advocated early in 1946, they will find a striking similarity between them and the proposals set out in the regulations now drafted. The arrangements will have to be reviewed, of course, in the light of experience, and we shall be prepared to consider any changes rendered necessary as time goes on.

I would not wish hon. Members to feel even now that we are sitting back and taking the whole situation for granted. It may be for the convenience of the House if I read a letter which my right hon. Friend the Minister of Health addressed to the chairman of the Dental Estimates Board. It is dated 28th April, 1948, and refers to two of the points upon which anxiety has been expressed. If I may read it, the letter is as follows:

"Dear Mr. Boness,

In writing to thank you for accepting the Chairmanship of the Dental Estimates Board, and to send you my best wishes for the success of the Board's work, I should like to mention two points to which I hope the Board will give particular attention. I am most anxious to ensure for general dental practitioners who take part in the National Health Services the widest possible measure of clinical freedom compatible with reasonable safeguards and the maintenance of a proper standard of treatment. The arrangements embodied in the General Dental Regulations will need to be reviewed in the light of experience as to their working in practice, and I would like the Board to advise me, after experience, whether they think that these arrangements can be relaxed so as to give greater freedom to the dentist, and, if so, to what extent.

It is most important that the submission to the Board of estimates of treatment for prior approval should not be allowed unnecessarily to delay treatment, and I would ask you to ensure that these estimates are dealt with as quickly as possible, and that you should aim at letting the dentist know the Board's decision on the estimate in the normal case within one week of receipt of the estimate."

That letter shows that we have not taken a dogmatic and final view about the treatment to be given without submission to the Estimates Board, and that we have already indicated to the chairman of the Board the view of the Minister that, in ordinary cases, the reply of the Board should come back within a week.

Mr. Renton

Will the hon. Gentleman allow me? Upon how many cases to be dealt with per week is that estimate of the time to be taken based?

Mr. Edwards

No; I am sorry I cannot give the number of cases. I ought to say that the Board itself has not yet met and therefore we have not had the opportunity of consulting the Board on the point. After the most careful examination of the problem, we are of the opinion that this maximum period of one week is one that we can expect to get in normal cases.

Mr. Renton

In other words, it is more of a target than an estimate.

Mr. Edwards

When I say we have given this matter careful examination and have come to this conclusion, it does not mean we have set a target, although in one sense this is true. It means that we think this is what is reasonably possible under the arrangements which we anticipate will be made.

Sir H. Lucas-Tooth

Does this mean that the Board itself will be able to make decisions? I gave figures which indicated that something of the order of hundreds of thousands of cases a week are coming in. Could the right hon. Gentleman give the House some idea of the sort of machinery which is contemplated?

Mr. Edwards

If I am asked whether I anticipate that the Board itself is going to see every estimate and pass it, the answer clearly is, "No." The Board's job will be to supervise the large staff of persons dealing with these estimates as they come in. Over a relatively short space of time—we have had considerable experience of this already in other things—most of these cases will be reduced to a matter of routine. I do not think anyone who knows anything about the dental profession will deny that the great majority of cases will be capable of being dealt with in due course by means of the rules. The responsibility will be that of the Dental Estimates Board, but the actual work, of course, will have to be done by the staff employed by the Board.

Sir H. Lucas-Tooth

Am I right in thinking that there is a difference between that and what was said by one hon. Gentleman, namely, that there will be some discretion to the Dental Estimates Board in regard to rates of fees to be paid? If it is to be routine, presumably there will be no discretion about fees.

Mr. Edwards

No, the hon. Baronet must understand that I am not now talking about remuneration. I am not in a position tonight to talk about remuneration, because we have not had the report of the Spens Committee. All I am saying is that the estimates will come to the Board and on their responsibility, either directly or indirectly through their staff, decisions will be taken which will go back to the dentists within a week in normal cases. [HON. MEMBER "Like the approved societies."] In some cases like the approved societies. If we are able to keep to this maximum period of one week in normal cases, we shall have improved upon the general arrangements of the approved societies. I am not complaining about the approved societies. If it cannot be done by a central machine like this with greater efficiency than by the approved societies with all their dispersed staffs, then there will be something wrong with this centralised system and no real reason for going on with it.

Mr. Keeling

Before the right hon. Gentleman leaves the question of the Dental Estimates Board, may I ask a question about what he said just now about urgent work? He said that urgent work would not require the prior approval of the Dental Estimates Board. If hon. Members will turn to page 15, they will see the footnote which exempts from prior approval only three cases, namely, extractions, removals of impacted teeth, and treatment of fractured jaws—only those marked with daggers. What about all the other treatments under column B which might be urgent? Might not apicectomy be urgent? And how about alveolectomy? It might very well be that that, too, was urgent.

Mr. Edwards

Let me take the case put by the hon. Member for Huntingdon (Mr. Renton). The hon. Gentleman put a concrete case before the House, and, if I may say so, it was a very fair case. In my view—and, of course, I am speaking as a layman—such a case would clearly be covered by "emergency treatment," and though I would not expect that two guineas would cover it, if not it could, nevertheless, be done.

Mr. Keeling

There is no danger against it.

Mr. Edwards

If treatment is "emergency treatment," then it is to be done by the dentist without prior estimate. May I pass now to a point of principle raised by the hon. Member for South Hendon, namely, the question of grant-in-aid. It is important to distinguish between the good work and the bad, and my friends in the trade union movement will know that this is essentially the same problem we have to face as to how one can get really high quality work on the piece-rate system without a quality system. I do not believe that the right way is the way of grant-in-aid. In the regulations we are contemplating a kind of a grant-in-aid in respect of a particular appliance in that people may elect to have a particular form of denture, and will pay the difference between the expensive denture and an ordinary one, in accordance with the scale which we lay down; but we are not anticipating a grant-in-aid in respect of treatment in general, and I do not see how we can possibly agree to a system of that kind which would, in certain circumstances, allow patients to pay more to certain dentists than to others. That would be running completely counter to the arrangements. We ought not really to make possible the abuses which would be possible if we had the grant-in-aid system.

I noted the suggestion which was made that we might grade the dentists. That is an idea which is attractive at first sight, but what I ask the House is who is to do the grading? Clearly, no lay body could do it; I do not know whether my hon. Friend the Member for East Wolverhampton (Mr. Baird) would say that the dentists would come together in a certain locality for the purpose of grading one another. While I do not deny that there is a genuine problem with the man who is doing particularly good work, I do not know any answer. What has been said so far has not, I suggest, helped us, and I should be glad to hear any further views.

There were certain detailed points which have been made, and which it is my duty to answer—especially some that were made by the hon. Member for St. Marylebone (Sir W. Wakefield). The subject of treatment, about which he asked, is clearly provided for. Regarding denture repair shops, it is our intention that they should not be included in the service. All repairs under the National Health Service will be under the supervision of dentists. Questions were asked about inspections of patients by the Ministry's officers. My view is that this would only happen where some question was raised by the Dental Estimates Board in regard to treatment, and that I would expect to be very rare.

I was also asked about the Dental Estimates Board itself. The Board, which has now been appointed, consists of a chairman and four dental members, who are full-time. There are also two part-time dentists and two part-time laymen, the laymen being there really to watch the interests of the consumer. We have appointed two laymen—Mr. Spackman, who is an old trade unionist and an ex-member of the General Council of the T.U.C., and Mr. Alsop, who is chairman of the Derbyshire County Council. We hope that this Board, with adequate staff, will be able to look after the consumers' interests.

Sir W. Wakefield

Can the hon. Gentleman say how long these appointments are for? My point was that it might be desir- able for these dental practitioners to be in close touch with what is happening, and that they ought not to be on the Board for too long.

Mr. Edwards

I have not that information at the moment, but I will let the hon. Member have it. I think the hon. Member also asked what the members of the Board are to be paid. The full-time chairman will be paid£1,900 a year, the four full-time dental members will be paid£1,65o a year; and the two part-time dentists and the two part-time time laymen will be paid at the rate of seven guineas a day.

I was also asked questions which seemed to suggest a limitation of treatment because of limitation of funds. I think I made it clear at the beginning of my remarks that we want whatever is clinically necessary to be done. It is not our intention to put any financial limit within the limitation which is laid down in the regulations. Questions were asked about oral hearings. The Executive Council will have complete power to pay the out-of-pocket expenses of patients if they have to be heard. There is no right of appeal, but I hope it will be agreed there will be singularly few cases in which there is much to merit appeal proceedings. The Executive Council will, after all, have a large number of members watching the patients' interests. The Executive Council is so composed that it is really capable of looking after the patients' interests.

Now, as to forms, which are a matter of the greatest importance. We want, if we can, to get reasonable efficiency with the use of as few forms as possible. We cannot avoid forms, but we have spent a good deal of time trying to work out a system which will keep their use to a minimum. There are, I think, only two forms of any importance: one is the dental estimate form and the other the form for special treatment. One hon. Member was also concerned about the equipment which the dentist may need. All I can say is that if a dentist is doubtful, he had better consult the Executive Council or a dental officer of the Ministry. In any event, no financial assistance is forthcoming for the equipment which a dentist may need.

Dentists have not, at the moment, been asked to join the scheme. We tabled the regulations because, clearly, they should be discussed, but we have not actually asked dentists individually to join the scheme, because that ought to be deferred until the financial terms and remuneration are available.

The hon. Member for East Wolverhampton asked questions about the extension of the work that could be done without prior submission to the Dental Estimates Board. There were full and confidential discussions with the contact committee to which he referred, and I think it can be said that some echo of those discussions is to be found in the letter to the chairman of the Board, which I read a few moments ago.

Turning to the speech of the hon. Member for Huntingdon, the wording of the second schedule was prepared and settled in consultation with the profession, and there are three reasons why we must have that schedule. First, there are a large number of cases where, quite genuinely, we must settle the fee, and we do not think it fair—nor would the dentists take on a large amount of work —if it were to be done without their knowing what they were going to be paid for it. I ask the hon. Member to believe that a large amount of dental work can be done and then paid for on a fixed standard charge. It is only fair to the dentist for him to know what he is to get for a particular job. Secondly, we must have in a few cases financial safe-guards against abuses. Thirdly, there will be cases, where we must have some way of settling treatment. It is for those reasons that we prepared this schedule, and I imagine it was for much the same reasons that the profession itself, in 1946, when it put forward its views also implied that there would be some treatment on their own responsibility and some which would have to be approved. It seems to me proper that we should have that arrangement.

I do not anticipate any difficulties of the kind which the hon. Member illustrated by his reference to the differences between normal and abnormal scaling. Dentists know what they are talking about. Normal scaling would indicate the removal of superficial tartar, whereas deep scaling would require a number of attendances. There may be technical points requiring elucidation, and if there are, they can be elucidated in relation to the profession. The Minister has been asked in the last few days whether he will receive a deputation. He has said that he will be happy to discuss any points with the profession, and we have asked the Association to let us know the points to be discussed.

Mr. Renton

May I be allowed to mention that when the Parliamentary Secretary mentioned earlier the case of getting X-ray examination down within the treatment in item I of this Schedule, he may have overlooked the fact that in page 9, paragraph 7, sub-paragraph 3, it is made abundantly clear that the dentists will not be allowed to proceed with the emergency treatment unless it is in column A, or is referred to in the footnote. Therefore, he may wish to correct his earlier remarks that the X-ray examination to which I referred, costing more than two guineas but being urgent, would not necessarily have to go to the Dental Estimates Board. It clearly would have to go for approval, and I think that he was perhaps wrong when he said that it would not.

Mr. Edwards

The hon. Gentleman adheres to his point of view, but I am advised that the actual case he put up would be covered by emergency treatment and if the radiological examination cost more than the two guineas, it could proceed.

Mr. I. J. Pitman (Bath)

Is not the hon. Gentleman making a muddle between treatment and diagnosis? I can conceive radiological treatment or a case of deep X-ray therapy over a long period costing more than two guineas being "treatment." I understand "treatment" in that sense of the word. Would the hon. Gentleman direct his attention to my hon. Friend's question with regard to diagnosis and not "treatment"?

Mr. Edwards

I thank my hon. Friend for putting it again, but I said that, taking the case given to me, and having considered it, my advice was that such a case would be covered and could be regarded as "emergency." After all, it is extremely unlikely that the result of such a diagnosis would mean that nothing at all would have been done.

Mr. Renton

It is expressed—

Mr. Speaker

This is not a Committee stage. After all, we are on a Motion.

Mr. Renton

On a point of Order, Sir; may I have your Ruling? When the Parliamentary Secretary has expressed a view which shows that he is really wishing to go against the precise wording of his own regulation, am I not entitled to put it to him as the only error he has made?

Mr. Speaker

The hon. Gentleman is not strictly entitled in a Debate of this kind to speak again. It is only by courtesy that he is allowed to do so, and that point, presumably, has been noted and may be met in the final speech.

Mr. Edwards

I am sorry that the hon. Gentleman does not feel that I am dealing honestly with him, but the point has been put perfectly plainly, I am giving as good an interpretation as I am capable of giving, and I have taken the precaution of confirming that view. That is the opinion I have to give at the moment. I am not the final authority to determine what interpretation shall be put upon this point, and if it should be that in due course I am found to be wrong, then I will withdraw; but as I understand the case actually quoted, which includes X-ray treatment, it must, I think, be regarded as "emergency." I will not go any further. I have given information to the best of my knowledge, and there I shall leave it.

Earlier I was asked a question by the hon. Member for St. Marylebone about the permanency or otherwise of the Dental Estimates Board posts. They are permanent. We do recognise that it is necessary that dentists who serve on the Board should keep in touch with developments in practice, and we propose to discuss that matter with them so that they shall not get completely out of touch.

In conclusion, I will say that we have done our best under the regulations to preserve clinical freedom and yet to protect the patient and see that the State is reasonably safeguarded in the matters of the maintenance of a standard service and the payment to be made for it. There will be a good deal to discuss when we come to the question of remuneration, but I, at any rate, am satisfied that these regulations, following very closely indeed the proposals of the profession made at one time or another, represent the best that we can do and, therefore, I ask the House to resist the Prayer.

Mr. Keeling

May we have a reply about the dental repair service?

Mr. Edwards

The hon. Gentleman could not have heard me. I made it perfectly plain that the dental repair service other than by a dentist is not included in the new service at all.

Mr. E. P. Smith (Ashford)

Is the hon. Gentleman aware that the average dental profit made by dentists is somewhere in the neighbourhood of 400 per cent., and can the hon. Gentleman assure us that these regulations in no way impinge on that?

Mr. Edwards

Remuneration is a matter yet to be settled.

10.55 p.m.

Mr. J. S. C. Reid (Glasgow, Hillhead)

It seems to me that the behaviour of the Government on this Prayer tonight has been very strange. It would have been strange had this been a matter of merely minor or local importance, but when we take into account that, next to the medical service, the setting up of a dental service is one of the most important and difficult steps in the whole sphere of social progress and security, I can only say that the attitude of the Minister of Health tonight is in my experience quite unprecedented.

It must have been obvious to the Government Whips at an early stage this evening that this Prayer might well be reached about 7.30 p.m.; but no one was present to represent the Ministry of Health for a considerable period after 8.30 p.m. Then the Minister came in and we thought that at least he was going to listen to the remainder of the Debate and that at least he would speak on the matter—but no, he made some of his characteristic interjections and then pointedly walked out again. What the engagement was which required his presence at about 9 p.m. I do not know, but he knew perfectly well that this very important Prayer was coming on; and to come in, flaunt his presence here, and then deliberately to walk out, was about as discourteous as even he could manage to be. It is not very surprising, if the right hon. Gentleman behaves to the dentists in the way he behaves to this House, that he has made so little progress, and I trust it will not be very long before another right hon. Gentleman has the opportunity of dealing with the dentists and thereby introducing this service in rather better circumstances than are likely to prevail if the present incumbent of the office has more chance to show his characteristic gifts in this matter.

A number of interjections were made in the course of the remarks of my hon. Friends behind me, asking what we would do in place of the provisions of this order to which we object. The answer is perfectly simple. We would consult with the dentists and try to get their co-operation instead of trying to antagonise them, and I am perfectly certain that if we did consult them in a reasonable frame of mind, we would get a response.

Mr. Edwards

Can the right hon. and learned Gentleman tell me of any point in time since the passing of the Act when my right hon. Friend has not been in consultation with the dentists?

Mr. Reid

I think a great deal depends on the spirit in which one approaches the dentists, and the right hon. Gentleman the Minister of Health has made perfectly obvious tonight the spirit in which he approaches his duties. It is not surprising that that spirit does not lead to success.

Mr. Edwards

Will the right hon. and learned Gentleman answer the question?

Mr. Reid

I quite agree that there has been contact, but not co-operation. The Parliamentary Secretary to the Ministry of Health has told us that it is not the intention of the Government to interfere unduly between the dentist and his patients. We do think that this scheme does represent undue interference and, indeed, it was made quite clear by the hon. Member for East Wolverhampton (Mr. Baird)—the only dentist who spoke to-night—that that was his view, too, because he made a valuable suggestion that this prior approval should only be required if the dentists' cases were such as to require more, or to deserve more, than the normal rate of remuneration.

The Parliamentary Secretary has not in the least explained how this matter is going to be covered. The dilemma was put to him at an early stage that either the examination of these hundreds of thousands of applications was going to be real or it was going to be a farce. If it is to be a real thing, it can only be conducted by competent qualified people. Of course, if it is to be a farce, it can be conducted by anybody. Is the proposal that there should be a large staff of qualified dentists acting under this provision?

Mr. Edwards indicated dissent.

Mr. Reid

I see the hon. Gentleman shakes his head, and, therefore, there can be no value whatever in these preliminary examinations, unless it appears on the face of the document that there is something unusual about the case. If, for example, the instructions—they must be instructions if these are not qualified people—allow from two to five guineas, or from three to five guineas, for the particular type of operation, depending on whether it has included so much of this or only so much of that, it is easy to scrutinise the thing. Any qualified person can say, if it qualifies for three or five guineas, "I will tick it off." If that is all there is about it, a published scale would do the same thing, and if all that is being submitted to the scrutineers is an application which, on the face of it, asks for more than the rules allow, why ask for the other applications to be sent in at all?

It seems to me that the Government are setting up an elaborate, expensive control to get a vested interest on the part of those who exercise the control, and what is expressed by the Minister in the letter which was read out—was that some time the controls will decide to abolish themselves. It is not likely they will do that. Surely, a more sensible line is that we should start in freedom and if freedom does not work, then we should put on some controls. In other words, we should let everyone go ahead and if we find that that does not work, we should get in more clerks and people to run it. To get in a whole staff organisation and then to say, "We are going to loosen up later," is the wrong way to go about it, because it is not likely that that will happen.

Let me pass to the schedule itself. Let me take first the point which was made by my hon. Friend the Member for Huntingdon (Mr. Renton). If this is the sample of advice which the Minister of Health in his Department gets, then heaven help this scheme, because the advice quite plainly is bad. No doubt that is the intention, but if it is the intention it has not been communicated to the draftsman of this regulation or else the draftsman is a precious bad one. I should think the former is the case. Let me look at this document. In column B we see a reference to treatment. It has nothing to do with diagnosis—it is treatment. It says, Treatment for which the prior approval of the Dental Estimates Board is required. Amongst the first items is Radiological examination at a cost exceeding£2 2S. od. That is for examination, not treatment. The case was mentioned of an emergency where the cost exceeds two guineas. The case of emergency is dealt with in paragraph 7 (3) on page 9, and, so far as I can find, nowhere else. If there is anything anywhere else I should be glad if the hon. Gentleman would inform me, because it might alter the case, but until I hear of something somewhere else, I shall assume everything is to be found here. The schedule is controlled by the operative terms of the document, and they say: Where the treatment which the person is willing to undergo includes treatment in column B of the second schedule, the practioner shall… send the dental estimate…for approval, and shall not proceed with any treatment other than treatment specified in column A…or such emergency treatment as is referred to in the footnote to the schedule, until such approval is received. The footnote to the schedule—the only one that is relevant—states: This service, if emergency treatment, may be commenced without prior approval. and that is not attached to radiological examination.

Mr. Edwards

I think the right hon. and learned Gentleman has overlooked the fact that there is a definition of dental treatment in the regulations, and that definition includes obtaining radiographs. Therefore, if we take column A of the schedule and look at emergency treatment — Treatment for the immediate relief of pain or other urgent symptoms. the word "treatment" there must be understood as defined in section 2 of part I of the regulations. The right hon. and learned Gentleman is more expert in these matters than I am, but I hope I have shown him that if he takes the proper definition of treatment and relates it to column A, then what I have said is fully carried out.

Mr. Reid

The hon. Gentleman has shown that these regulations are at best ambiguous, and at worst against him. But I do not intend to pursue that matter further. This is an important service, and if he has not the technical facilities in his Department to enable him to produce a more workmanlike document than this, it is high time he had.

Mr. Edwards

All I am saying is that if the right hon. and learned Gentleman has not read the document, it is high time he did.

Mr. Reid

In any event the matter is at the best ambiguous, and it would be much better if a more intelligible document had been put before the House. It is very odd, if one comes to look at this. The items marked with a dagger may he commenced without prior approval but how far can one carry them without prior approval?

Dr. Morgan

Nonsense.

Mr. Reid

I have been challenged about being rude about the drafting, and I intend to show that I was justified.

Dr. Morgan

This is childish.

Mr. Reid

I am not dealing with the contents, but with the manner in which it is presented. (I). Removal of impacted teeth. At what stage has one to stop that operation and ask for approval? That is not the only item on which the language is plainly absurd.

Dr. Morgan

The right hon. and learned Gentleman does not know anything about it. Let him stick to his law—and Scottish law at that.

Mr. Reid

Let me revert to the regulations. I do not think the hon. Gentleman has anywhere met my hon. Friend's points, but there is not any good in my making them again, because he did not meet them the first time and he will not meet them the second time. It is quite clear that the general public have got into their heads expectations with regard to the immediate benefits of this scheme which cannot be fulfilled. It is quite clear that many people think that if they wait until July they will get this, that or the other free. The Government have never specifically said that that is so, but they have never damped down those expectations very violently. That was so even in the leaflet which came round the other day: At present there are too few dentists to make the full service available. That means that they will be able to get their service after some delay. I wonder how much delay, if anybody applies in July? The relevancy of that is this. I cannot help feeling that the Minister of Health would have been rather more cooperative with the dentists if he had not felt that the general public are going to have a shock when they find the true position, and that he, the right hon. Gentleman, would come in for the blame

unless he could shift that blame to the shoulders of someone else; and that one of the main objects, throughout this period, has been to try to put the dentists in the wrong, so that the public may be induced to blame them; and that it is for that reason that the right hon. Gentleman has dealt with the dentists as he has done. It is for that reason that these regulations are so unsatisfactory as they are. In these circumstances it seems to me that we have no alternative but to vote against these regulations.

Question put, That an humble Address be presented to His Majesty, praying that the Regulations, dated 12th March, 1948, entitled the National Health Service (General Dental Services) Regulations, 1948 (S.I., 1948, No. 505), a copy of which was presented on 15th March, be annulled.

The House divided: Ayes. 45; Noes 147.

Division No. 136.]	AYES	[11.13 p.m.
Agnew, Cmdr. P. G.	Howard, Hon. A.	Raikes, H. V.
Bowen, R.	Hutchison, Lt.-Cm Clark (E'b'rgh W.)	Ramsay, Major S.
Boyd-Carpenter, J. A.	Keeling, E. H.	Reid, Rt. Hon. J. S. C (Hillhead)
Bromley-Davenport, Lt.-Col. W.	Law, Rt. Hon. R. K.	Renton, D.
Buchan-Hepburn, P. G. T.	Legge-Bourke, Maj. E. A. H	Shepherd, W. S. (Bucklow)
Carson, E.	Lennox-Boyd, A. T.	Smith, E. P. (Ashford)
Channon, H.	Linstead, H. N.	Smithers, Sir W
Clarke, Col. R. S.	Macdonald, Sir P. (I. of Wight)	Spearman, A. C. M.
Conant, Maj. R. J. E.	Mackeson, Brig. H. R.	Strauss, H. G. (English Universities)
Crosthwaite-Eyre, Col O. E.	McKie, J. H. (Galloway)	Studholme, H. G.
Darling, Sir W. Y	Macpherson, N. (Dumfries)	Wheatley, Colonel M. J. (Dorset, E.)
Drewe, C.	Manningham-Buller, R. E	Willoughby de Eresby, Lord
Hare, Hon. J. H. (Woodbridge)	Mellor, Sir J.	York, C
Harvey, Air-Comdre A V	Mott-Radclyffe, C. E
Hollis, M. C.	Neven-Spence, Sir B	TELLERS FOR THE AYES:
Hope. Lord J.	Pitman, I. J	Sir Hugh Lucas-Tooth and
		Sir Wavell Wakefield.
NOES.
Adams, Richard (Balham)	Crawley, A.	Hughes, H. D. (W'lverh'pton, W.)
Adams, W. T. (Hammersmith, South)	Davies, Edward (Burslem)	Hynd, H. (Hackney, C.)
Allen, A. C. (Bosworth)	Deer, G.	Hynd, J. B. (Attercliffe)
Austin, H. Lewis	Delargy, H. J.	Janner, B.
Baird, J.	Driberg, T. E. N.	Jeger, G. (Winchester)
Barton, C.	Dugdale, J. (W. Bromwich)	Jeger, Dr. S. W (St. Pancras, S. E.)
Bechervaise, A. E.	Dumpleton, C. W.	Jenkins, R. H.
Belcher, J. W.	Ede, Rt. Hon. J. C.	Johnston, D. H.
Berry, H.	Edwards, John (Blackburn)	Jones, D. T. (Hartlepools)
Bevan, Rt. Hon. A. (Ebbw Vale)	Evans, John (Ogmore)	Jones, J. H. (Bolton)
Binns, J.	Farthing, W. J.	Jones, P. Asterley (Hitchin)
Blenkinsop, A.	Fernyhough, E	Keenan, W.
Blyton, W. R.	Freeman, J. (Watford)	Kendall, W. D
Bowden, Flg.-Offr. H. W.	Gibbins, J.	Kinley, J.
Bowles, F. G. (Nuneaton)	Gibson, C. W.	Lee, Miss J. (Cannock)
Braddock, Mrs. E. M. (L'pl, Exch'ge)	Glanville, J. E. (Consett)	Lyne, A. W.
Brook, D. (Halifax)	Griffiths, D. (Rother Valley)	McAdam, W.
Brown, George (Belper)	Griffiths, W. D. (Moss Side)	MoEntee, V. La T.
Brown, T. J. (Ince)	Guy, W. H.	McGhee, H. G.
Bruce, Major D. W. T.	Hale, Leslie	McKinlay, A. S
Buchanan, Rt. Hon. G	Hamilton, Lt.-Col. R.	McLeavy, F.
Burden, T. W.	Hannan, W. (Maryhill)	Mallalieu, E. L. (Brigg)
Burke, W. A.	Hastings, Dr. Somerville	Manning, Mrs. L (Epping)
Callaghan, James	Henderson, Joseph (Ardwick)	Mellish, R. J.
Champion, A. J.	Herbison, Miss M.	Middleton, Mrs. L
Collindridge, F.	Holmes, H. E. (Hemsworth)	Mitchison, G. R
Collins, V. J.	House, G	Moody, A. S.
Corbet, Mrs. F. K (Camb'well, N. W.)	Hoy, J.	Morgan, Dr. H. B.
Corlett, Dr. J	Hudson, J. H. (Ealing, W.)	Morley, R.
Morris, Lt-Col. H. (Sheffield, C.)	Sharp, Granville	Wallace, G. D. (Chislehurst)
Moyle, A.	Silverman, J. (Erdington)	Wallace, H. W. (Walthamstow, E.)
Neal, H. (Claycross)	Simmons, C. J.	Warbey, W. N.
Nichol, Mrs. M. E. (Bradford, N.)	Skeffington, A. M.	Wells, P. L. (Faversham)
Nicholls, H. R. (Stratford)	Smith, C. (Colchester)	Wells, W. T. (Walsall)
Noel-Baker, Capt, F. E. (Brentford)	Smith, H. N. (Nottingham S.)	West, D. G.
Paling, Will T. (Dewsbury)	Snow, J. W.	Wheatley, Rt. Hn. J. T. (Edinb'gh, E.)
Pargiter, G. A	Sorensen, R W	White, H. (Derbyshire, N.E.)
Pearson, A.	Soskice, Sir Frank	Whiteley, Rt. Hon. W.
Porter, G. (Leeds)	Sparks, J. A	Willey, O. G. (Cleveland)
Price, M. Philips	Steele, T.	Williams, J. L. (Kelvingrove)
Pritt, D. N.	Swingler, S.	Williams, R. W. (Wigan)
Pursey, Cmdr. H	Sylvester, G. O.	Williams, W R. (Heston)
Randall, H. E	Taylor, H. B. (Mansfield)	Willis, E.
Ranger, J.	Taylor, R. J. (Morpeth)	Wills, Mrs. E. A.
Rhodes, H.	Thomas, D. E. (Aberdare)	Woodburn, Rt. Hon. A
Robens, A.	Thomas, Ivor (Keighley)	Yates, V. F.
Roberts, W. (Cumberland, N.)	Thomas, John R. (Dover)	Younger, Hon. Kenneth
Ross, William (Kilmarnock)	Thornoycroft, Harry (Clayton)
Royle, C.	Tomlinson, Rt. Hon. G.	TELLERS FOR THE NOES:
Sargeod, R.	Walker, G. H.	Mr. Popplewell and Mr. Wilkins.