§ 1.43 p.m.
§ Mr. Baird (Wolverhampton, East)
I want to raise the problem of the imminent breakdown of the school dental service and of the dental priority classes as laid down in the National Health Act. As most people realise, there has been a substantial drift away from the public dental service into private practice. The reason for this is the disparity in income between the public dental officer and the general practitioner.
Some time ago the Government set up the Spens Committee to inquire into remuneration for dental surgeons, and they reported in favour of an income of roughly £1,750 per year net for a 33-hour chairside-week. That report has been implemented as far as the general practitioner is concerned. However, today the school dental officer is employed at a commencing salary of £650 to £750, and 1593 very few of them rise to the £1,000 a year level. Even with the tremendous loyalty which these men have to their own type of work, it is only natural that the result is that they have been forced by economic circumstances to go into the much more remunerative private practice.
I know that it is said in some circles —indeed, I have had mothers coming to me in my capacity as a general practitioner and saying this sort of thing—that the school dental officer is not a proper dentist. I have heard people saying, "I do not want to send my child to the school dentist; I want to send him to a proper dentist." The fact is that the school dental service and the dental service for priority classes is a specialised service. The practitioner in dentistry has not the time, patience, experience or ability to treat young children, whereas the school dental officer who has gone into the job because he likes working with children and has specialised in it and has the knack of treating these children, is much more able to do it than is the general practitioner.
At the same time, I think I should take this opportunity to warn school dentists who are discontented that all is not what it seems in private practice dentistry. Dentists just now are making very large incomes, but they are only making those incomes through working not 33 hours a week as recommended by the Spens Report, but an average of 60 and 65 hours a week, and if this goes on for long their health is bound to break down. Therefore, the remuneration is not as great as sometimes seems to be the case.
I would like also to emphasise—indeed, the Minister has recognised this fact with his priority classes—that this branch of dentistry is most vital to the health of the people. The general dental practitioner carrying on work in his own practice is doing what I would call a breakdown or a patching-up service, whereas the school dental officer and the dental officer treating young children and expectant mother cases, is, to a great extent, carrying out preventive dentistry, which is much more important.
Furthermore, if we have an efficient service for the priority classes and for school children, it will ultimately and most definitely take away some of the burden which at present is placed on the shoulders of the great mass of general 1594 practitioners in dentistry, and that is what the Government want. Therefore, we must see to it that we get that efficient service as soon as possible. If the drift away from the dental service goes on at its present rate, there will be no service left at all in the very near future. The drift, which has now been accelerated, has been obvious for a very long time.
I raised this matter on the Second Reading of the National Health Act over two years ago; the Government were warned time and time again by the Public Dental Officers Organisations and yet nothing was done about it until July this year, when for the first time the Minister recognised the need for some national machinery whereby these public dental officers should air their grievances. Doctors in the service of the local authorities have the Asquith Committee and national negotiating machinery, but the public dental officers have no such national machinery at all.
However, in July last the Minister of Health offered them a separate functional council within the Whitley machinery, which is envisaged for dental and medical practitioners within the National Health Act. Unfortunately, that offer was not accepted by the public dental officers. In all honesty, I must admit that from July until today the fault has been not with the Minister but with the public dental officers themselves. Without boring the House with details of the matter, I would point out that we have a caucus of an organisation which speaks for the dental profession called the British Dental Association, and the public dental officers, being tied up with this Association, were forced to take that Association's advice.
This organisation—I believe through lack of political insight and because they have been taking a purely party political attitude—has done more disservice to the dental profession during the last six months than anyone would think possible. For instance, they advised dentists to stay outside the National Health Act, and even today while 80 to 90 per cent. of their members are working under the Health Act, they are still advising them to stay out. It is pure lack of political sense. It was with the same lack of political sense that they advised the public dental officers to turn down the Government's offer in July. However, that chapter is finished and I can state this afternoon, after consultation with the 1595 leaders of the public dental officers, that if the Minister's offer of July is still open they will be only too pleased to accept it.
This afternoon I want to ask the Parliamentary Secretary one or two questions. First, can he tell me whether the offer of a separate functional council for all public dental officers at health centres, schools or hospitals, within the Whitley machinery, is still open. Secondly, if it is found that the local authorities who are responsible for the service are reluctant to sit on the functional council, will the Minister bring his good offices and any influence he may have to bear on the local authorities to persuade them to come in and set up this national machinery? Thirdly, may I ask the Parliamentary Secretary whether it will be possible, when this functional council is set up, for the Spens Committee Report to be the basis of any discussion on salaries which takes place within the functional council?
The reason I ask this last question is because in Statutory Instrument 1507 of 1948, which sets out remuneration for dentists employed in health centres, I find there is a range of remuneration as follows: Grade III, commencing at £650 and rising by annual increments of £25 to £900; Grade 11, rising from £900 to £1,500 by increments of £35; and Grade 1, with a commencing salary of £1,400 rising by £50 to £2,000—that is for administrative officers. So far as I can see, it will take a young dental officer, who enters at £650, nine years to reach £900, and then he is not guaranteed that he will enter Grade II. Why was this second grade necessary at all? Why not step a man up from £900 to, say, £1,500 in the one group and as soon as possible, according to his ability, leaving the higher group for administrative workers? If it is to take a man nine years to go from £650 to £900, that is not implementing the Spens Report and that will not get the dentists into the public service.
I hope the Parliamentary Secretary can answer these three questions for me. Of course, the Minister of Health has a very definite responsibility in this matter. It is no good putting a Clause in the Health Act saying that while there is a shortage of dentists we will concentrate on providing dental treatment for the priority classes unless we are going to 1596 do something to implement what is in that Act. If the Minister wants his Act carried into effect, he must do something, and do it very quickly. The position is becoming worse, not better. My hon. Friend the Member for Barking (Mr. Hastings) is here and I do not want to tread on his toes, because he knows more about what is happening in London, for instance, than I do, but I know that some months ago the L.C.C. closed down 10 children's dental clinics and they had a drift away from the service of something like 35 officers.
Perhaps I might quote to the House an experience of my own. The night before last a mother brought her child to me for orthodontic treatment. The general public do not know what that means. It simply means carrying out treatment to bring the teeth into proper alignment so that they occlude together in a natural manner. That is an explanation of a technical subject in very simple English. Now this is a most important branch of dentistry. It is a type of treatment whereby if we can obtain efficient occlusion in the mouth decay in after life is prevented. It affects the posture of the child and in many instances affects the mental health of the child.
This type of treatment can only be carried out between certain limited ages. I do not wish to quote any definite ages, but there are certain limited ages—certainly not much over 14 years of age. This child is 13½. Her mother brought her to me and said she had been on the school waiting list for over a year and had not even been inspected by a dentist. Therefore, she brought the child to a private practitioner who is no expert on the subject at all. The whole school service is breaking down, especially in respect of this orthodontic treatment.
I would also like to raise the question of the long-term policy. I know that childrens' dentistry must be based on the schools. That is the only way we can really get the great mass of the children for dental treatment. At the same time, is there any need for the control of the public dental officer to be under so many authorities? We have the local authorities responsible for the general administration, the Ministry of Education interested through the Education Act and the Ministry of Health interested because of the priority classes. 1597 As a matter of fact, when I suggested raising this matter on the Adjournment it was, at first, difficult to find out whether the Ministry of Education or the Ministry of Health would be responsible in this House for the public dental officer.
There is no necessity for these three different authorities each to have a finger in the pie. I know that local authorities have done good work so far as organising school dentists is concerned, but if we are to pay dentists an income in relation to the incomes being earned in private practice, I feel that the local authorities will no longer be able to afford to pay for it. At the moment, they receive a a 50 per cent. grant, but I cannot see them providing an efficient service if they have to meet the costs of higher salaries. We all know that in the past the school dental service has suffered because, to a great extent, it has been a charge on the rates rather than on the national Exchequer. While I realise that the Parliamentary Secretary can do nothing very definite today, I should like him to look at this matter.
I think the school dental service should be taken out of the hands of education committees and placed under the health committees. That would, at least, give the Ministry of Health a little more control than they have at the present time. I should like the Minister to say why this is not possible: that while the school dental service should still be based on the schools, the Ministry of Health itself should take over the organisation of the service. At the present time, every local authority has senior dental officers doing a lot of administrative work, whereas with proper organisation on, say, a regional basis, a tremendous amount of administrative work could be cut out and more time given for children to be treated as they should be treated.
I hope the Parliamentary Secretary will be able to do something this afternoon to help us over this problem. I can assure him that these school dental officers want to stay where they are, treating the children. They realise the importance of the work they are doing and it is greatly to their credit that more have not left the service during recent months. I hope the Parliamentary Secretary will be able to do something this afternoon to set the position right and to encourage these men to go on with the very valuable work which they are doing.
§ 1.58 p.m.
§ Mr. Somerville Hastings (Barking)
I want, in a few words, to stress the very serious plight in which London finds itself owing to the resignation of so many public dental officers. Thirty-three per cent. of the dental officers doing this wonderful preventive work in London have resigned. In London there are 20 centres either wholly or in part without dental officers. Twenty more centres which London was hoping to open—new centres, or centres that have been reconditioned, and which are ready or almost ready for opening—cannot be opened because we cannot get public dental officers to do the work. The reason for this is very simple. It is a question of money.
As has been stressed by the hon. Member for East Wolverhampton (Mr. Baird), most of the officers who do this work realise its importance and are very keen on it. But they can get so much more money outside. In London, the pay for dental officers starts at £640 a year. It goes up by £25 a year to £1,005. Only a fortnight ago one of the dental officers of London said he must leave because he had been offered a job as an assistant to a dentist for three days a week at £1,500 a year. That is a net figure, because there is no question of overheads; he is an assistant, and his principal bears the overheads. For the sake of the children of London and other places it is very important that something drastic should be done.
Let me stress, in a way that the hon. Member for East Wolverhampton (Mr. Baird) perhaps felt a little diffident about doing, the real importance of this public dental service. I have spent my life in dealing with troubles in the mouth and throat. Therefore, I have been in close contact with dental surgeons. I should like to stress the real importance of the preventive service in which they are engaged. Most of us go to the dentist when we have toothache, or if we think we may have decay in a tooth.
These dental officers, however, examine the children regularly, and deal at once with anything amiss they find. Not only are the children treated for any such troubles as soon as they start, but the children learn the importance of having their teeth examined regularly, and acquire the habit of going regularly for dental examination, and follow it through- 1599 out their lives. That is not the only thing. The dental officers instruct the children in the care of the teeth, not only in the need for cleaning them, but how to clean them and when. As my hon. Friend will agree, many people do not know how to clean their teeth, although they do their best.
Let me stress the importance of orthodontic treatment. Children may have deformities of the upper jaw which, if left uncured, give rise, not always at once, but in later life, to many different troubles in the nose and throat and in the chest. Many people with chronic bronchitis might not have had it if they had been able to have this treatment. It is a complicated treatment; it is a difficult treatment; it is a specialised treatment; and the ordinary dental surgeon does not get much experience in it, because it is carried out only in the case of children, and it is mainly the public dental officers who get the necessary experience in this specialised treatment. Their work is therefore so valuable in preventing a vast number of troubles affecting other parts of the body which occur, or may occur, in later life.
Therefore, I would stress the point that has already been made, that the Government should improve the terms of these public dental officers, so that they do not leave the service, but continue the beneficent work in which they are engaged.
§ 2.4 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. John Edwards)
My hon. Friend the Member for East Wolverhampton (Mr. Baird) has called attention to a very serious matter. He has shown his continuous interest in this field of public dental work. My hon. Friend the Member for Barking (Mr. Hastings) has drawn attention to the fact that this matter is, perhaps, more acute in London than anywhere else. Undoubtedly there are problems here which require the careful attention of everyone concerned.
The local authority dental services consist of two parts, first the school dental service which is provided by the local education authority under the Education Act, and then the special arrangements for the dental care of mothers and young children under school age made by the 1600 local health authorities under the National Health Service Act, 1946. Altogether, I think, there are between 800 and 900 dentists in local authority employment, and most of them are engaged in school dental work. Unfortunately, the service for mothers and young children has not yet developed to the same extent as the school dental service, and there are still relatively few dentists employed by local health authorities solely for the dental care of mothers and young children.
When the National Health Service Act, 1946, was passed, it provided in Section 22 for local health authorities to make arrangements for the dental care of mothers and young children, and it was hoped to give some guarantee to those classes, those for whose care the local health authorities have a particular interest, and it had been hoped that the classes concerned would have obtained treatment not necessarily available to ordinary patients of ordinary dental services. It was certainly the intention that all children should in time be given systematic examination and treatment from infancy to school leaving age, and that expectant and nursing mothers should be given the necessary treatment at the time when dental care is most important.
Because of the aims intended, at any rate, at that time, the local authorities wanted to expand existing services, and I think that most local authorities have been advertising for additional dental officers. Generally speaking, they have met with very little or no response. On the contrary, a number of the existing officers have given up their posts in order to go over to private practice. I am advised that over 30 per cent. have resigned in London, and in the other counties something like six per cent.—36 or so out of 600. I also know that there are some county boroughs that have suffered loss.
This, of course, is a serious problem. Most local authorities hold the view that the priority dental services ought to remain an integral part of the school health and local health services, and I do not think that there are many authorities who really want to divest themselves of this important function, merely because they are faced with a difficult salary problem. My hon. Friend had something to say about transferring functions, if I understood him aright, from the Ministry of 1601 Education to the Ministry of Health, and, I assume, corresponding transfers from the local education authorities to the local health authorities. That is an attractive proposition, but I must reject it. Clearly, I should soon be out of Order were 1 to embark on this, because to affect either of the changes it would be necessary to have legislation introduced.
§ Mr. Edwards
Certainly, but I do not want my hon. Friend to think that I am likely to consider it. However, if it were considered, the point of view of those working in the service undoubtedly will be taken into account. I think that it is agreed—in fact my hon. Friend indicated as much—that it is through the intimate association of these services with the schools and clinics that comprehensive and systematic examinations and treatment have been secured, and continue to be secured, on a scale not practicable in any other way.
We all know how large a part persuasion plays into tempting the unwilling patient into the dentist's chair. It is at the clinic that the expectant mother can be persuaded to have her teeth looked at, and encouraged to have the treatment which she needs. I think that it is by retaining full control of their dental services that local authorities can ensure that mothers and children for whose care they are responsible are given the supervision and treatment which they require. I would say, too, that the school dental service has its proper place in the school health organisation, and for both those services the Exchequer bears a substantial part of the cost.
Now I come to the most important point raised today; that is the question of pay. I understand that at the present time negotiations on pay are continuing, and the matter has, I believe, been referred to the Local Government Whitley Committee which deals with the pay of the higher officers.
§ Mr. Edwards
That may be so. I think that it is also true that this matter is to be considered by the joint council. I hope that while these negotiations are going on, the public dental officers will carry on with their local authority work. I should like to pay tribute to the loyalty which they have shown—those who have stayed—and I hope that while these negotiations are pending they will do their best to remain in the service to which they have contributed so much.
On all these questions of remuneration of dentists, I hope I shall have complete agreement in saying that we ought to start from the report of the Spens Committee. They made an impartial and careful inquiry into the whole matter, and, in any event, there is nowhere else where we can start. We must start from the Spens Report in all our discussions on dentists' remuneration. I would point out that when the Spens Report had to be translated into financial terms, there were two quite different jobs to be done. The first was to translate what the Spens Committee said into a scale of items of services. That assessment in terms of service on a fee basis was open to considerable possibility of error because, in such an assessment, the question of time—how long it takes a dentist to do a particular job—is important, and we could not be quite sure that we had given proper weight to the question of timing. That is a matter which we can only learn by experience.
As my right hon. Friend has always made clear, he intends to check the timing of the various operations on which the fees of the outside dentists are based. That is one side of the matter. The factor of timing does not arise when we are trying to put the recommendations of the Spens Committee into terms of a salary scale. It was, therefore, in the light of the Spens Report that the Minister formulated the scale for dentists working in health centres. Reference has been made to these scales. They are: Grade I, £1,400 rising by £50 to £2,000; Grade II, £900 rising by £35 to £1,500; Grade III. £650 rising by £25 to £900.
I do not suggest that the right thing to do is to take these scales and apply them as they stand to the public dentists, that is to say, to those employed by local 1603 authorities. The solution to the salary question which my hon. Friend has posed is to be found, I believe, by starting from these scales, based, as they are, on the report of an independent body. I do not want to suggest that the scales are necessarily suitable for application as they stand to local authority dental services. Some modification of details may be required. I would point out, in passing, that it was never our intention that the Grade I scale should be used for what I might call administrative officers. We had the Grade I scale in mind for dentists of quite outstanding clinical experience, of which, I think, the number is likely to be few.
§ Mr. Hastings
Can my hon. Friend say what percentages were envisaged as regards scales I, II and III, because that is very important in implementing the Spens report?
§ Mr. Edwards
What we had in mind was to have grades of pay appropriate to the various circumstances. I shall be happy to send my hon. Friend complete details of what was intended.
§ Mr. Hastings
May I press the point with regard to numbers? Were there to be ten per cent. on the No. I scale, 50 per cent. on the No. II scale, and so on? What are the percentages of these various scales because, as my hon. Friend knows, the Spens Committee envisaged that the dentist in the middle of his career would be receiving at pre-war rates about £1,600 a year net?
§ Mr. Edwards
I think that I have been misunderstood. The last thing I want to suggest is that local authority dentists should take these scales over as they stand. I say that these rates of remuneration are based on the Spens Committee Report and that is where, I think, the negotiations should start. Having said that, I do not want to embark on a purely hypothetical argument about what would happen to certain local authority dentists if they were put on these 1604 scales of pay. Therefore, I cannot even begin to give the percentage figures for which the hon. Member for Barking asked.
On the question of the negotiating machinery, I have taken a personal and fairly detailed interest in the setting up of the new Whitley machine for the health service. It is a matter of great satisfaction to me that we have now established Whitley machinery covering the whole of the health service for every occupational and trade group, with the exception of doctors and dentists. I understand that the doctors have expressed their willingness to come into such an arrangement. I am sorry that the dentists as a whole have so far not felt able to take part in a separate Whitley Council for all dentists. I take advantage of this opportunity to ask them to reconsider that matter, and whether they would not be prepared to make the Whitley system complete and come into a functional council which could be set up for all dentists. If, however, we cannot have a functional council for all dentists, my own view is that, nevertheless, it would still be desirable to have a functional council for salaried officers; by which I mean not only the local authority dentists, but of course the dentists employed in health centres.
This is not a matter on which my right hon. Friend has the last word; his direct interest in it is confined to relatively few of the number; and, as I have already pointed out, the great majority of these people are employed by local authorities. Local authorities are the employers, and how the negotiating machinery should be built up between them and those they employ is something which, in the end, they will have to settle for themselves. But whether it is done in one way or the other, it ought to he done—and it ought to be done without undue delay. I am satisfied that the discussions should start from the Spens Report as put into a scale for our own dental officers. That, I hope. answers the questions put to me. I am grateful to my hon. Friends for raising this matter, and I have gone as far as I can in indicating the line which I think should now be followed.
§ Question put, and agreed to.
§ Adjourned accordingly at Twenty-one Minutes past Two o'Clock.