HC Deb 08 July 1949 vol 466 cc2599-608

Motion made, and Question proposed, "That this House do now adjourn."—[Mr. Bowden.]

4.0 p.m.

Mr. Mellish (Rotherhithe)

I wish to raise the question of the closing of a dental clinic in my constituency because, although it may appear at first sight not to be a very important matter, I would bring to the notice of my hon. Friend the Parliamentary Secretary to the Ministry of Health the fact that it is not an isolated case. What is happening there, unfortunately, has had to happen in many other places throughout the country. In London alone, there have been 25 similar instances where dentists, owing to the fact that they can get higher rates of pay in private practice, have now left local government service. It is a problem which is causing not only great concern and alarm in local government circles, but is causing disaster to a service which has done magnificent work in the past.

Let me say a few words about my own clinic, and, in doing so, I know I shall be forgiven for saying that my own constituency of Bermondsey — which I represent together with my hon. Friend the Member for West Bermondsey (Mr. Sargood)—has a first-class record for public health, and has, for a great number of years, been the leading borough, not only in London, but throughout the country, in regard to public health services. Many years ago we opened what is referred to even today as the finest solarium in any borough, and also two first-class dental clinics. The one opened in my part of the borough, in Rotherhithe, was given first-class service by two full-time dental surgeons. I have here some interesting figures showing the work which that clinic has done. It catered, in the main, for what we call "priority cases," for example, maternity cases and in 1947 our own dental surgeons treated 1,363 maternity cases. They also treated 816 children, which is even more important. The total number served at that clinic in 1947 was 4,777.

For many years, this service has been appreciated by the people, and I suggest that it is one of the reasons why for the last 20 years, we have been a Labour- controlled council. But we have now to face a very serious problem arising from the introduction of the new National Health Service Act. The resignation of this full-time dental surgeon from my clinic on 31st March added one more to some 25 similar problems throughout the County of London, that of finding replacements. I wish to pay my tribute to the London County Council who did all they could to help my local authority in this matter, and also to the Ministry of Health, who have tried to do all they can to overcome this problem locally. The House will be interested to learn that the London County Council went as far as Westmorland to find a dentist to replace the one we lost. They offered him £1,250 a year to come down to Rotherhithe, but he refused it because it was not enough. Even if he did not say it was not enough, at least that was the implication. His age was 63.

Mr. Kenneth Lindsay (Combined English Universities)

What was the previous salary?

Mr. Mellish

I think it was about £980—I cannot be sure—when the scheme was then taken over, and I think that £1,250 would, if necessary, have been paid if the dental surgeon who resigned had remained.

Following the introduction of the general dental service on 5th July, 1948, with remuneration by scale fee methods and the removal of the economic barrier between patient and dentist, the recruitment of dental surgeons by local authorities throughout the country became virtually impossible. Unless recruitment is re-established the dental services of local health authorities will perish. These services were to have been the spearhead in the drive to improve the dental health of the nation as they are confined to treatment for mothers and children, and, in particular expectant mothers. We call that the priority dental service.

The Ministries of Health and Education are both involved here, through the National Health Service Act, 1946, and the Education Act, 1944. In my view a solution will be possible only when all dental practitioners in the National Health Service are remunerated by the same method, and in accordance with the value of their individual work to the community. The particular problem of the Rotherhithe Dental Clinic is further complicated in that 50 per cent. of the treatment given there is for patients who do not fall within "priority" category. They are, in fact, the general public and, as such, fall within the ambit of the local executive council or the general dental service organisation. Pending the outcome of negotiations at present in hand the L.C.C. have acted as agents for the local executive council in this and similar dental centres and have remunerated practitioners in accordance with the L.C.C. scale of salaries of £750 rising to £1,250 per annum.

In the general dental service organisation practitioners working in their own premises are paid by a scale of fees for work done, while those working in provided treatment centres such as that in my constituency are paid by salary. The approved salaries range in three grades from £650 to £2,000 per annum, but no clearly defined machinery for up-grading has yet been made known, and recruitment, to the lower grades at least, is very unlikely in the face of the present scale of fees. In others words, the best place financially in which to carry on dental practice today is in one's own private premises. Our own dental servants have left our service. Mothers, because of their physical condition and their household duties, and children, because of the time and particular skill required for their treatment, are unpopular with private practitioners. To these practitioners, time is money and they have no time to waste on children, whose teeth are rather awkward to deal with, and occupy time during which the dentist could be dealing with two or three adults, or on expectant mothers, who usually require a little additional time to be devoted to them. Those classes of people are not welcomed by the ordinary private dentist. I do not wish to generalise too much, or to give the impression that I am indicting all private practitioners. Many of them are doing a fine job but many of them are not, as we know full well.

The problem is very serious indeed. The service given under local authorities up to 5th July was, I know, recognised by my right hon. Friend as being of the greatest value to the nation. Today, we see that dentists who have operated the service have, in the main, left local government service to go out on their own in order to earn more money. The private practitioner is now paid not on the quality of his work, but on how much he can do. That is a very serious problem. In my constituency now, thanks to the L.C.C. and the Ministry of Health, we have been given the services of a part-time man, which means that for only three evenings a week is the surgery open again. This is quite inadequate to our needs, and I beg my hon. Friend to give us some assurance, if not of an immediate solution, at any rate of some long-term solution.

In raising this question for my constituency I recognise that I must be speaking for many others. I read the other day that in Willesden, for example, 22,000 school children had only one dentist available. I do not know the figure in my constituency, but it must be a comparable one. The people to whom I referred deserted us in the hour of our need, and I believe that something should be done to recruit them again. Whether money can do it or not I do not know, but something should be done.

4.10 p.m.

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

I am very glad that my hon. Friend the Member for Rotherhithe (Mr. Mellish) has raised this very important matter, which is not only important for his own constituency, but, as he rightly says is of importance throughout the country. It is a matter of the greatest concern to my right hon. Friend that the development of the priority services that we would wish to see has undoubtedly been interfered with by the way in which many practising dentists have been moving into private practice.

In dealing with details regarding his own constituency, and the provisions available there, my hon. Friend rightly said that the London County Council have been able to secure the help of a part-time dentist for three evening sessions at the Rotherhithe New-road Clinic. There is provision also available at the Grange-road clinic which is, and has been for some time, taking priority cases. I would pay a tribute to the dentists working there, and those who are still working at clinics in other parts of the country, who have realised the vital importance of their work.

Throughout London a general dental service is provided by the general dental practitioners, and I believe that in London there are altogether something like 1,000 dentists in actual practice. It may very well be that some of these dentists—I would not like to think there were many of them—wish to secure the greatest financial benefits possible by trying to take the cases which are most remunerative to them. That is a problem we must face. As I have said, this is a problem which concerns not only Rotherhithe, but many other parts of the country, and we are most anxious to see these services built up again.

I believe that one of the difficulties is that the Whitley machinery for settling dental remuneration has not yet been set up. My right hon. Friend has expressed his views very clearly on this subject. He is anxious that there should be no further unnecessary delay in securing the co-operation both of the dentists' organisations and the local authority associations in agreeing to set up a Whitley Council so that the whole matter may be properly investigated. I gather that after some initial difficulties the dental organisations have agreed to participate in such a discussion for the setting up of a Whitley Council but, unfortunately, up to now, the local authority associations have not done so. In view of the fact that some local authorities in different parts of the country found it necessary to revise their salary scales for dentists in their own employ it would appear that there is now no reason why they should not come into the discussions and get this matter cleared up, with, I believe, a great possibility of encouraging the proper development of the services we all want to see.

Several authorities have already revised their scales, including the London County Council itself, although that revision has not yet had the effect we should have wished. While it is true that the effect of the 20 per cent. reduction in the gross fees paid to dentists in general practice under the health scheme has not yet had the full effect, we would certainly hope that the action of the Minister, together, with co-operation in setting up a Whitley Council, would have the effect of narrowing the gap between the remuneration in health centres, as set out under the Health Service Act regulations, and the remuneration in general practice under the Health Service Act for dentists under the revised scales. We hope that this action will have narrowed that discrepancy. We hope that it will encourage more dentists to remain in clinic work and more to enter it in future.

Mr. Mellish

As I understand it now, the dentist in private practice gets paid not on the quality of his work but on how much he can do. There seems to be no limit to the amount of money he can get. Is that matter being looked into? Naturally, many dentists are working at full capacity in order to deal with as many people as possible, so that their wages can go up. That is one of the reasons why people are resigning.

Mr. Blenkinsop

I fully appreciate the point. The only way effectively to check the quality of the work done is by the professional checks already established. Hon. Members will have heard of some recent cases where fairly severe fines have been imposed upon such dentists as have not carried out proper professional work. I am sure that the majority of dentists wish to maintain a proper level of professional conduct. I hope that they will be the first to join with us in condemning those few of their number who give the profession as a whole such a bad name. The rates laid down for health centres appear to us fully to carry out the Spens recommendations, and to supply very reasonable and fair remuneration to dentists practising under them. There would not appear to be any good reason why dentists should not accept employment in health centres and clinics, doing work of the greatest importance in which they could have a sense of achievement.

The real solution to the problem lies in the training of more dentists. As long as there is an overall shortage of dentists we are bound to find these serious difficulties in manning up the services in dentistry which we regard as the most important. We are doing our utmost to encourage the effective training of as many dentists as possible. Training centres are full and extensions are being undertaken which, we hope, will increase still further the flow of new dentists into the service. Both my right hon. Friend and myself feel that the action of local authorities in future—joining with us in discussing this matter of setting up proper Whitley machinery —together with the steps already taken, will lead to a satisfactory solution. I assure my hon. Friend that we are deeply concerned about the present position. We are most anxious to see the fullest possible development of the priority service, and we welcome the opportunity he has taken to bring this matter to the attention of the House.

Mr. Mellish

May I have an assurance that the Ministry and the L.C.C. are doing all they can to re-open the Rotherhithe Clinic with a full-time dental service?

Mr. Blenkinsop

I am very willing to give that assurance. We will do all we can to help the London County Council to get a more satisfactory arrangement than that which now exists.

4.19 p.m.

Mr. Kenneth Lindsay

I understand that the Parliamentary Secretary can only speak to the brief which he is given; but it is not good enough.

Mr. Blenkinsop

Perhaps the hon. Gentleman will allow me to say that I do not quite know what he means by the words "speak to the brief."

Mr. Lindsay

A matter of this importance is naturally the responsibility of the Ministry of Health. I do not want to attack the hon. Gentleman himself. I understood that the Minister of Health—and I have supported him for three years—was a first-class administrator. As a member of the Estimates Committee I have been into this question very thoroughly. It is not good enough for the Parliamentary Secretary to talk about people moving into private practice. The Minister of Health has barged into the Ministry of Education and upset the education services of this country. He has no right to do it, he is guilty of bad administration. The Minister of Health has no right to upset the school dental service and the local dental service which have slowly accumulated enormous prestige over the last 45 years.

Mr. Blenkinsop

Surely the hon. Member will agree that if the local authorities' associations would agree to co-operate in the setting up of proper Whitley machinery, which is the right way to discuss general rates and conditions for this service, we should have a far better chance of settling this point.

Mr. Lindsay

Naturally. I have been into this very carefully and I listened carefully to the Parliamentary Secretary's speech. He talked about machinery not being set up and some authorities having revised their scales, and about the 20 per cent. reduction not yet having been put into practice——

Mr. Blenkinsop

The hon. Member must know that the 20 per cent. reduction has been put into practice, but it will obviously not become effective until dentists are taking on new patients. They have a long back-log of orders for which they will be paid at the old rates.

Mr. Lindsay

I understand that. Finally, the Parliamentary Secretary talked about training new dentists. But children and others are going without dentists. That is the point we are making.

Mr. Skeffington (Lewisham, West)

They have always gone without.

Mr. Lindsay

I know; it has always been weak. But the point is that it is not the function of the Minister of Health to make the public part of this service, under a Socialist Government, worse than it was before.

Mr. Mellish

I hope the point I made has not been misunderstood. I am not blaming the Minister. The point of view I take is that it is the private dentists themselves who have deserted the schools and the local health services in order to earn more money outside. I say, quite frankly, that I should have thought the rate of pay of £1,250 a year would have been enough to get any man, with any sense of pride in dentistry, to do the job.

Mr. Lindsay

The Minister of Health has created conditions in which a man can earn far more in private practice than in public practice. He has created those conditions. On the Estimates Committee—and we can speak about it now—we have been into this very carefully. There was a gross misunderstanding, in the original Estimates, of the way in which dentists were working and, naturally, human nature being what it is, they have taken advantage of it. What I want the Minister of Health to do is this—and this is why I dare to join with the hon. Member for Rotherhithe (Mr. Mellish), although he does not seem very pleased to have me as an ally. I want the Minister to see that this question is made much more urgent for the Ministry. There was a Question the other day to the Minister of Education, on which I intervened. I object to seeing the public service being upset by conditions which have been created, not willingly of course, but by bad administration, bad estimates, in the dental services. I want the Parliamentary Secretary, if he will, to ask the Minister of Health to see that a greater sense of urgency is brought to bear on that problem. It is not a question of training dentists. That takes six years. I know the conditions in the dental schools and universities. We cannot solve the immediate problem that way.

What will happen, by and large, over the country, where these public services are being neglected? What will happen to children? It has taken years to build this service up for children, and to get parents to co-operate. My hon. Friend the Member for Tavistock (Mr. Studholme) knows that; he was once on the London County Council. It has taken years to build up this respect for the public service. I do not mind whether the Minister takes very drastic steps to bring the dentists back into the public service. This is not quite as important as the dock strike, but we have taken emergency powers today to deal with a national situation, and I want the Ministry of Health to take, at any rate, urgent powers to bring back dentists into the public service to see that the people who cannot afford to let their teeth go untreated for three and four years are given the best possible service. I think that that is a duty of a Socialist Government.

Mr. Blenkinsop

With the leave of the House I should like to say that I am a little surprised at the intervention of the hon. Member. He has vigorously pressed a point which we fully appreciate—the urgent need for proper treatment. Although he talked in general terms about emergency action to be taken, he gave us no clue at all as to the sort of action he would wish us to take—unless he wishes us to force dentists to move from private practice into the dental clinics. I think we are entitled here to ask the hon. Member, when he makes such vigorous and challenging remarks as he has just done, to follow them up with some elucidation of the sort of proposals to which he would give his full support.

Mr. Lindsay

It is not my business to tell the Government what they should do, but just as they have taken emergency powers—latent emergency powers—for the direction of labour, so I have no objection to the taking of such powers with dentists.

Mr. Deputy-Speaker (Mr. Bowles)

It would not be in Order to discuss that, because it would require legislation.

Mr. Blenkinsop

I hope that nothing I have said suggests in any way that we are complacent about this matter, but I insist that we feel that the best way of ensuring the flow back into the public service that we all desire to see is to get effective discussions through the Whitley machinery. We urge the local authorities' associations to co-operate with us in that.

Adjourned accordingly at Twenty-eight Minutes past Four o'Clock.