New Clause.—(PROHIBITION OF PART TIME DENTAL PRACTITIONERS.) (Hansard, 19 October 1949)

§ Mr. Baird
I beg to move, "That the Clause be read a Second time."
I should declare my interest in this matter as a practising dentist, but I should like to point out that I am not speaking as a dentist, but as a Member of this House, not in the interests of the dental profession, but in the interests of a large number of my constituents who are suffering because of the unethical practices of a considerable number of dentists in my division. The new Clause is supported by between 50 and 60 other Members of this House.
I wish to make it quite clear, that, when the National Health Service Act was discussed two years ago, I myself and Members on both sides of the House fought for the liberty of the two professions, dental and medical, in being able to treat both private and public patients. I was in favour of that course, and, therefore, it is with some reluctance that I am now moving this new Clause, which will withdraw that right from the dental 604 profession. I make no apology for moving it, however, because, in my opinion, the racket now going on in the dental profession in regard to public patients must be stopped.
I want to quote one or two examples of what is going on in my own division at the present time. There is, first of all, Racket No. 1. A patient who is in pain—perhaps it is his own fault, because he ought to have had his teeth cared for earlier—goes along to a dentist and asks to have the tooth removed, and, of course, the pain removed at the same time. The dentist tells him that he is fully booked up for six weeks, a fortnight or perhaps only a week ahead, but that, if the patient comes back after some days, he will see what he can do for him. If the patient offers to pay, the dentist will take the case right away, or within an hour, which immediately cancels out the argument that he was too busy.
Racket No. 2, which is very prevalent, arises from the fact that the National Health Service Act is a compromise. Payments are offered to dentists by means of an itemised scale of fees for every operation. According to this scale, some operations pay much better than others. In our efforts to encourage people to save their teeth, we try to induce them to have fillings, and this operation is better paid than that for fitting dentures. A number of dentists are accepting patients who require fillings and refusing those who require dentures, or are telling the latter that they must either wait or have it done privately.
The third racket—I am only quoting three—is that of talking down the National Health Service Act. The dentist says to the patient, "If you come to me under the Act, I can only give you a second rate type of treatment, especially with regard to dentures. They are cheap; we cannot supply the best materials. If you want a good job, come to me privately." This sort of thing is going on in spite of the fact that the dentist is being paid to carry out the best possible type of treatment.

§ Sir H. Lucas-Tooth
Has the hon. Member brought any cases of this sort to the notice of his right hon. Friend?

§ Mr. Baird
Perhaps the hon. Gentleman does not know the position as well as I do. I have had particulars of such 605 cases sent to me from all over the country, being, as I am, one of the two dentist Members of this House, but there is great difficulty in proving such cases. The discussion usually takes place between the patient and the receptionist, and not between the patient and the dentist himself. Moreover, most of these things are quite legal in themselves, within the meaning of the Act.
As a result of pressure from hon. Members opposite, dentists have the right to treat both private and public patients. I do not know how general is the situation I have described, but, so far as my own division is concerned, I have made a survey from which I would estimate that at least 75 per cent. of dentists are turning away patients in pain unless they are prepared to pay, and I believe that sort of thing is fairly general throughout the country.
I once argued that there was only a small minority of the profession carrying out this unethical practice, but I am now convinced that there is a fairly large proportion. I do not know what the solution is, but if the Minister can suggest other ways of stopping or minimising this practice, I shall be only too pleased to hear them. To my mind the real solution is large-scale health centres with a fully salaried dental service. Only in that way shall we stop it. Another temporary way would be for the regulations which allow a patient to make representations to the local executive council to be simplified. They are very cumbersome at the present time and are difficult for the patient to understand. Apart from this new Clause, the only other solution is for the profession itself to discipline its members.
When I put down this new Clause some three months ago I received letters from two of the dental organisations. I shall read one of them to the House. It says: Our attention has been drawn to the Amendment sponsored by you to the National Health Service Act (Amendment) Bill which, if successful, would deprive dentists on the list of, executive councils from treating private patients. I am instructed to inform you that our association is completely out of sympathy with you in this matter and desires to place on record its strong disapproval of your action. In conclusion, should the proposed Amendment be pursued further, our association will resist it to the utmost. 606 I replied to that letter in a tone which I think hon. Members on both sides will agree was reasonable. I replied: My attitude is well known. I fought with the profession to have the principle of the freedom of the dentist to treat both private and fee-paying patients incorporated in the Act. This right is now, however, being abused and the abuse must be stopped. I would much rather that the dental profession itself disciplined those of its members who are betraying the high standards of the profession, and I am writing this letter to promise you that if the three dental organisations will come out in the open and condemn the unethical practices of some of their members I will withdraw my new Clause tomorrow. If, however, by their silence they condone this degrading of the profession, I have no alternative but to continue my agitation, which I am convinced is in the best interests of dentistry. Up to date, I have received evasive letters from two of the dental organisations, but not one of them has accepted my challenge, and nothing has been printed in any of the dental journals, condemning this attitude and asking dentists to act more ethically.
That is the brunt of what I want to say. This sort of position is not due to the fact, as some dentists argue, that they are too busy to treat all these people. I know that dentists are busy and are doing good work, but they are being well paid for doing it. It would not be difficult to organise a system of priorities whereby those suffering pain, and expectant mothers and young children could get immediate treatment under the service. Even if the Minister cannot accept this new Clause just now, I appeal to him to let it go out from this House that its Members condemn the attitude of those dentists who turn away patients in pain unless they are prepared to pay for the treatment they receive.

§ Mr. Sparks
I beg to second the Motion.
I support this Clause because I think it is important that the matter should be cleared up in the interests and for the benefit of the patient under the National Health Service scheme. Very wide publicity has been given to the provisions of the new Act providing the dental service, and, consequently, a number of people go to the dentist expecting to receive treatment under the scheme and they simply cannot understand why a particular dentist should refuse to treat them in an emergency unless they are 607 prepared to go as private patients and pay the ordinary fee.
In the public interest, therefore, it ought to be clearly established that where a dentist is practising under the Act, he only treats National Health Service patients and not private patients. This would mean that those dentists who wanted to pursue a private practice could take the private patients, and those who elected to practise under the Act would look after those people who wish to take advantage of the National Health Service Act. If that were done, it would avoid a great deal of confusion and a great deal of disappointment in the minds of a large number of members of the public who when they go for immediate treatment find they cannot receive it under the scheme.
Owing to the sort of practice described by my hon. Friend the Member for East Wolverhampton (Mr. Baird), many of them think that the whole National Health Service scheme is a bit of a fraud. They are quite wrong, we know, but when they go for treatment and find that by the payment of 15s. or £1 they can have extractions straightaway, whereas if they go as National Health Service patients they have to wait anything up to six weeks, they naturally cannot understand the justification of it—nor can anybody in this House.
The Minister has had a large number of these cases brought to his attention by hon. Members, including myself, and I receive continuous complaints of this sort of thing from my constituents. That being so, I think that the Minister should lay down quite clearly that those dentists who elect to practise under the Act should confine themselves to treating National Health Service patients. As my hon. Friend pointed out, the dentists are being paid extraordinarily well under the scales laid down by the Minister, and, in view of that fact, I think that they should be prepared to do their very best for the National Health Service patients.
Those dentists who do not like the idea of the National Health Service scheme should be left free to practise privately and the public would then know that if they wanted private attention they could receive it by going to such a dentist, and that, on the other hand, if they wished to be treated under the scheme 608 they could receive such treatment by going to a dentist operating the scheme. Such an arrangement would avoid a great deal of confusion and clear up some of the very bad practices which my hon. Friend has brought to the attention of the House and which have now continued for a considerable time, and are likely to continue unless something is done to end them. Some arrangement can surely be come to between my right hon. Friend and the dental profession to clear up this abuse which is taking place in a very large number of dental surgeries throughout the country at the moment.

§ Sir H. Lucas-Tooth
The Minister of Health has at times accused some of us on this side of the House of stirring up controversy in connection with the National Health Service. It would now appear that some 50 or 60 of his own supporters have stirred up by this new Clause a more acute controversy than anything we have succeeded in doing, because this Clause is like taking an electric drill to an exposed nerve. The hon. Member for East Wolverhampton (Mr. Baird) knew that fact perfectly well
6.0 p.m.
We on this side of the House are utterly and fundamentally opposed to this new Clause in principle. In the first place, if a Clause of this kind were to be added to the Bill it would be the grossest possible breach of faith with the dentists. They have come into the scheme on the footing that the scheme will allow them to engage both in public and in private practice.

§ Mr. Baird
Does not the hon. Member consider that the action of these dentists in turning away patients is a breach of faith with the patients?

§ Sir H. Lucas-Tooth
I shall say something about that in a minute. The fact remains that the dentists came into the scheme because they were assured that the scheme allowed them to carry on both their private and their public practices. If anything were now done to go back on that, it would certainly be regarded—as indeed it would be—the grossest possible breach of faith with the dentists.
The hon. Member for East Wolverhampton spoke of a "racket." Indeed he enlarged upon it, and indicated certain 609 things which would certainly amount to a racket if they occurred. When this scheme was first brought forward in this House I remember putting down a Prayer to annul the order constituting the scheme and arguing on that Prayer that the scheme as presented would necessarily lead to just the sort of complaints which the hon. Member for East Wolverhampton has made this afternoon. We saw then quite clearly that the scheme was bound to create a certain amount of difficulty, which would necessarily mean that certain wrong things would be done under the service.
I do not think any hon. Member on either side of the House would have disagreed with the hon. Member for East Wolverhampton if he had said that a number of bad things are being done under this service. It is clear that among the many thousands of dentists, there are some who will take advantage of the present circumstances, but the overriding difficulty of the dental service is that there is a great deal more work to be done than the dentists can possibly do. It is because that fact was apparently overlooked when this scheme was put into operation that we have the present difficulties of which the hon. Member has complained.

§ Mr. Baird
If there is an area which is under-doctored, do we say that it is ethical for a doctor there to treat patients who pay him and reject those who cannot afford to do so, even if they are dying?

§ Sir H. Lucas-Tooth
I am perfectly certain that there are doctors, dentists and professional men of all sorts who are prepared to work 10, 12 and even 15 hours a day for the public good, but I am also certain that there are quite a lot of very respectable professional men who are not prepared to work beyond a certain point for no advantage whatsoever. Under the scheme as it was first introduced, and to some extent still, certain dentists are working far longer hours than they should do. They say to themselves, "I am prepared to work eight or 10 hours a day," or whatever number of hours it may be, "in the public service, and I shall reserve two or three hours for my own private practice." There is nothing unethical about that.
It is because that has occurred in a number of cases that certain dentists today are not taking any more patients 610 under the scheme but still have a certain amount of room for private patients. It may be that that is not the highest possible standard of ethics, but it was the result which was bound to follow upon the scheme.

§ Mr. Bevan
Why?

§ Sir H. Lucas-Tooth
Because it too great a pressure is put—

§ Mr. Bevan
Who put it?

§ Sir H. Lucas-Tooth
The right hon. Gentleman. The right hon. Gentleman must have known the number of dentists in existence. He must have had some sort of an idea of the kind of pressure that would be brought to bear on them if a free service were introduced in the whole country in the place of a paying service. I do not wish to pursue that point at great length, but if the right hon. Gentleman really wishes to investigate this subject he might read the Report of the Select Committee on Estimates of this House which shows the position extremely clearly.

Dr. Guest
Is the hon. Gentleman aware that some dentists devote one day a week to National Health Service patients and keep the rest of the week for private patients? They have plenty of time but they will not take National Health patients on the days which they reserve for private patients. Is that ethical?

§ Sir H. Lucas-Tooth
The hon. Member has asked me whether that is, ethical—

Dr. Guest
No doctor would do that.

§ Sir H. Lucas-Tooth
The hon. Member is getting very hot under the collar.

Dr. Guest
I am, very.

§ Sir H. Lucas-Tooth
The right hon. Gentleman has admitted that it is perfectly ethical for a dentist to remain out of the service altogether. If instead of remaining out altogether, he gives one day a week to the service, surely he is, on the whole, doing a better service to the country—

Dr. Guest
There is a difference between the words "legal" and "ethical."

§ Sir H. Lucas-Tooth
The hon. Member would be right if he accepts this 611 standard of ethics, that it is right to compel any professional man, whether doctor, dentist, or whatever it may be, to work for the State.

§ Mr. Bevan
He is working for his patient, not the State.

§ Sir H. Lucas-Tooth
We are discussing whether he should be compelled to work under a public scheme or whether he should still have the right to work in either capacity, or only to some extent for a private person. It is quite fair for any doctor or dentist to say that he will divide his time between both.

§ Dr. Morgan
He is breaking his contract.

§ Sir H. Lucas-Tooth
I cannot really deal with all these interruptions; if I did I should take up the entire time of the House.
If this new Clause were added to the Bill every dentist would have to make up his mind whether he would be a dentist in the public service or whether he would carry on a purely private practice. We should, therefore, have two services. The profession would be split completely and there would be no overlapping. That would be entirely and fundamentally wrong. If this service is to be a success it must be linked up with private practice. We shall get only bad results if we have a free public service catering for a certain section of the population and a separate private service for a different section of the population paying fees. I think that can only have bad results and I should deplore its coming into effect.
It must be remembered that although this new Clause is applicable only in the case of dentists, if the right hon. Gentleman were to accept it then the principle would be equally applicable all along the line. If we can say that a dentist who enters the service must be compelled to give up his private patients, then we should be equally justified in saying that a doctor who enters the service should be compelled to give up his private patients.

§ Mr. Paget (Northampton)
That is not so. The whole point is that the doctors have played the game and the dentists have not.

§ Sir H. Lucas-Tooth
That is a very interesting interruption from the hon. and learned Member because it would appear that his reasons for supporting the Clause—as I understand he does—is that he intends it as a punitive action against the dentists for what they have done. Is that so?

§ Mr. Paget
If the hon. Member is asking me, I want the proper service for the ordinary patient who has toothache. If the position was that the dentists played the game and gave that proper service, when they were doing both private and public patients, as the doctors have done with their patients who are ill, we should say, "Go on with it." They have not played the game and, therefore, we have to adopt other methods.

§ Sir H. Lucas-Tooth
In other words, the hon. and learned Member simply wishes to visit retribution on the heads of the dentists. Let me remind him of this. The position of the dentist is, in fact, different from the position of the doctor in that the dentist receives a fee whether he takes a public patient or a private patient. I think it is beyond controversy that, even now, the fees paid in respect of public patients are fully as high as those which are paid by private patients.

§ Mr. Baird
The hon. Member does not seem to realise that every penny of the dentist's income received from the State is declared to the Income Tax authorities for tax purposes, but that there is no way of checking so far as his private patients are concerned.

§ Sir H. Lucas-Tooth
There were so many noises coming from the hon. Member's side of the House that I could not hear what he said.

§ Mr. Baird
The remuneration received by the dentists from the State is 100 per cent. taxed because it has to be declared, but—and I am making this charge after due consideration—there is a considerable amount of the dentist's private income, at least in a large number of cases, which is not declared because it is so difficult for the Income Tax authorities to prove what is his real income.

§ Sir H. Lucas-Tooth
The hon. Member is himself a dentist. I have seen a 613 good deal of fouling of one's own nest, but I do not think I have ever seen such an example as this.

§ Earl Winterton (Horsham)
Hear, hear.

§ Mr. Baird
I came into this House to represent my constituency, East Wolverhampton, not the dental profession.

§ Sir H. Lucas-Tooth
Before the hon. Member interrupts me again, I must warn him that I shall not be able to give way any further. He has made a charge against the dentists which, broadly speaking, I believe to be quite unjustified. There are certainly exceptions. Among so large a body of men it would be astonishing if there were not. But the fact remains that these difficulties have arisen because the scheme is top-heavy and did not take account of the tremendous load which would rest upon it. We have these difficulties because of that. If this Clause were accepted, it would be a breach of faith with the dentists and it would be a splitting up of the service into two, which would be a bad thing for the community as a whole. I hope very much that, on behalf of the Government, the right hon. Gentleman will indicate that he is not willing to accept it.

§ Mr. Bevan
If I had been in any danger of accepting the new Clause it would be in consequence of the speech to which we have just listened. I have never seen such a complete exposure of general ethics as that which we have had from the other side of the House this afternoon. What the hon. Member for South Hendon (Sir H. Lucas-Tooth) suggests is that if the patient goes to a dentist's surgery in pain, it would be ethical, on the part of the dentist to prefer to treat a private patient who would pay more.

§ Sir H. Lucas-Tooth
I never said anything of the sort.

§ Mr. Bevan
If the hon. Member will look at what he said, in HANSARD tomorrow, he will find that, if he did not say it in those precise terms, he said practically the same thing.

§ Sir H. Lucas-Tooth
I took great trouble to point out that the fees paid by private patients were, in fact, lower than those paid by public patients.

Hon. Members
Withdraw.

§ Mr. Bevan
It is no good hon. Members saying that. I am the very last person to be bullied. When we have general charges echoed by the noble Lord the Member for Horsham (Earl Winterton)—

§ Earl Winterton
rose—

§ Mr. Bevan
I have not yet finished my sentence about the noble Lord. When the noble Lord says "Hear, hear" to a charge that my hon. Friend was fouling his nest, the "Hear, hear" meant that hon. Members opposite would put professional solidarity against the public interest.

§ Earl Winterton
I am not concerned in the argument at all. In fact, I was not following it; I was reading my Notice Paper. My attention was called to the fact that for the first time in my long experience in this House an hon. Member opposite thought fit to bring a most discreditable accusation against his own profession. That is why I cheered when my hon. Friend said that the hon. Member for East Wolverhampton (Mr. Baird) was fouling his own nest. It is the first time I have known it to happen.

§ Mr. Bevan
I make no comment to the House about the statement that has been made, but it is the duty of hon. Members to consider the general and the public interest against the sectional interest. That is the proper standard of conduct for a Member of this House, but we have had all the time from the other side of the House, ever since I have been a Member of it, surrender to every professional pressure group, and always a general neglect of the public interest before a professional pressure group. We have had it again tonight. In fact, the dental profession has been guilty of worse conduct than any other profession in the Health Service. That is obvious from the cases which have been brought forward. It would have been much better if hon. and right hon. Members opposite had deprecated that conduct, and not tried to apologise for it, to explain it away and to blame it on to the scheme. I should have thought it was their duty, as hon. Members of this House, and the duty of everybody who has the well being of the patients at heart, to deprecate unprofessional conduct and not to 615 try to find justification for the ethics of the jungle—commercial discrimination against people in pain.
As a matter of fact, what we have to consider here this evening is which practice is on the increase; whether the good practice or the bad practice is on the increase. Is the Health Service operating to drive out the bad behaviour and is it encouraging the good behaviour, or is the reverse taking place? If I were satisfied that the misconduct of a part of the dental profession—and we must always bear in mind that we are talking about a part of the dental profession and not of the dental profession as a whole—was on the increase, then I should accept the new Clause, because I would then consider that it was necessary to defend the public patient against the misbehaviour of some of the dentists. But I am satisfied, on experience, that the misconduct is on the decrease and that the behaviour of the dentists, generally speaking, is improving. Therefore, I say it is far better for us to allow the disciplinary machinery which has been established under the scheme to operate against the person who is misbehaving, and I hope that before long the opposite of Gresham's law will prevail, and that the good will drive out the bad.
I have had instances brought to my notice of discrimination which I consider to be not only unjust but cruel. There is, for example, the case of a schoolteacher who applied for dentures. She was not able to do her work at all without dentures. I have it on the authority of one of my hon. Friends here that, because this was not an offence against the Service, against the legal contract, she was informed by the dentist, "If you want them under the National Health Service you must wait for four or five months, but if you want them privately you can have them in a week." That is monstrous misconduct. [HON. MEMBERS: "Is not that true?"] Yes, but it is wrong.

§ Sir Ian Fraser (Lonsdale)
Surely that is, in fact, true, and that is what is the matter with the Service.

§ Mr. Bevan
No. It is what is wrong with the dentists. If the dentist realises he has a schoolteacher who must have those facilities to do her work rightly, he is doing a disservice if he deliberately 616 says to her, "If you want them free you will have to wait for them." By saying she will have to wait he leads to the assumption that he has not time to do the work. How, then, would he have time to supply the dentures privately? This is exploitation of the principle of free choice. I am surprised at the hon. Member. I am astonished at him. This is the kind of moral morass into which the Opposition fall in these matters. If the dentist in this case were doing his duty, if he were behaving with a proper sense of public spirit—and mark you, Mr. Speaker, the hon. Member has said that, in many instances, the dentist is better paid for public service than for his private services—then that selection—

§ Sir H. Lucas-Tooth
I gave the right hon. Gentleman a perfectly good explanation. The dentists are overworked. A very large number of them quite deliberately devote a certain proportion of their time and efforts to the public service and a certain proportion to private service.

§ Mr. Bevan
Does not the hon. Member realise the dilemma he gets himself into every time he interrupts? If the dentist is overworked, how is it possible to do the work privately and not publicly? It is the same work, and the dentist is in the position that he will do a certain amount publicly and a certain amount privately. What has actually happened in this instance is that we have had no control whatsoever on the money which the patients have been paying for private work. None at all. We have no evidence about which costs less.
When the hon. Member speaks about the pressure that we unreasonably brought to bear against the dental profession, I point out that in the beginning it was pressure brought to bear upon this House by the dental profession. Really, what was the matter at the beginning of this scheme was that we had exploitation of scarcity value by the dental profession as a whole. When he speaks about a contract between the Minister of Health and the dental profession, I point out that the largest organisation did not advise its members to join the National Health Service. They came in as individuals. There is no contract in existence. I could accept this new Clause without breaking any contracts with the dental profession. The 617 hon. Member has got his facts as bad as his morals. Nevertheless, I am not going to be influenced by what he has said.

§ Colonel Stoddart-Scott (Pudsey and Otley)
Before the right hon. Gentleman leaves the question of dental ethics, is there not in the dental profession a body similar to that in the medical profession, which has the General Medical Council? That would deal with dentists who behave unethically. If there is not such a body, will he set up one?

§ Mr. Bevan
What is wrong here is social ethics. It is not a case of a dentist's misbehaving himself in respect of his patient when he has taken the patient as a patient. This is bad social morality, by which the dentist inflicts unnecessary hardship and pain upon people on account of the fact that they are poor, because if they are not poor they can buy his services. That is the whole point. That is the reason why we have the National Health Service. It is to enable ordinary citizens to have access to medical skill without having to be blackmailed in doing so. That is the whole point of it. It is the Opposition that have led me into this obiter dictum. I hope they will be silent, or that, if they speak, they will pay more regard to the general welfare and less to a number of pressure groups.
As I said when I rose to speak, I do not propose to accept this new Clause, because I believe it would not be in the best interests of the Service as a whole. I think a number of dentists might immediately say that they would not give any public service at all, in which case we should have a large number of patients who would not be treated. It is obvious that a very considerable volume of patients has been treated by the dentists already, and that a great deal of relief has been given. So I would deprecate any move just now which would have the effect of depriving people of the services of dentists.
As I said at the very beginning, I am satisfied that the good practices are driving out the bad practices. It is obvious, for example, from the number of emergency cases that what happened in the beginning is not happening now on the same scale. Extractions are taking place, giving immediate relief, on a far greater scale than before. Furthermore, we have tightened up the situation so that 618 a dentist cannot say now that he will extract the teeth under the National Health Service and provide the dentures privately. That is an offence against the Service. It is an offence against the regulations. Once a dentist has agreed to treat the patient, the full treatment must be under the National Health Service and the dentist cannot discriminate between different parts of the treatment. He can reject the patient if he wishes, but he cannot reject any particular part of the treatment once he has started it.
I hope, therefore, that, in all the circumstances, and for the welfare of the scheme as a whole, this new Clause will not be pressed. I am sure that the many first-class people in the dental profession will be deeply pained by the belief that the general public do not hold the dental profession in the esteem in which they would like it to be held, and I hope, therefore, that we can put this bad thing behind us and look forward to a general improvement in the Service.

§ Lieut.-Colonel Elliot
I am sure that with the concluding sentences of the Minister's remarks there will be general agreement, but I think his tongue led him into betraying himself when he said that he had been led away into this obiter dictum—with the emphasis on the "bitter," for bitter indeed the emphasis was. The fact that emerges from his discussion is that the Minister agrees with my hon. Friend the Member for South Hendon (Sir H. Lucas-Tooth) and rejects the views of the hon. Member for East Wolverhampton (Mr. Baird). [HON. MEMBERS: "No."] Yes. The Minister asks the House to accept the view of my hon. Friend the Member for South Hendon that the new Clause should be rejected, and to reject the view of the hon. Member for East Wolverhampton that the Clause should be accepted.
Furthermore, he accepts the view of my hon. Friend that the practices are the practices of a minority—a tiny minority—of the profession, and rejects the view which led my hon. Friend to remark that he had never heard of such a case of fouling his own nest as that of the hon. Member for East Wolverhampton, who said that 75 per cent. of the profession in his division were not merely carrying out unethical and unsocial practices but were, indeed, engaged in frauds on the Inland Revenue.

§ Mr. Baird
I said no such thing. I said that 75 per cent., on my estimate, were turning away patients in pain because they would not pay the dentist's fee.

§ Lieut.-Colonel Elliot
Yes, but he went on to say much more dangerous, damaging and libellous things than that. He said that the reason they took these fees was that the fees returned under the scheme were subject to tax and the fees which they were getting back under the counter, black market, were not subject to tax. That was the accusation of the hon. Member for East Wolverhampton.

§ Mr. Baird
If, as the hon. Member for South Hendon (Sir H. Lucas-Tooth) says, the dentist is often paid a smaller fee for the work which he does privately than the fee which he would get if he treated the patient publicly, why does he treat the patient privately? Why does he not treat him as a public patient?

§ Lieut.-Colonel Elliot
What the hon. Member has to justify before the House is the accusation of fraud upon the Inland Revenue which he brought against the vast majority of the dentists in his own division, and, by implication, upon the rest of the profession throughout the country. He was bringing forward his division as typical of divisions throughout the country.

§ Mr. Baird
indicated dissent.

§ Lieut.-Colonel Elliot
Yes. He did not bring forward Wolverhampton as a cesspool of iniquity singular and unique in the country. He said that he was bringing forward this Clause, which does not apply only to Wolverhampton but which applies throughout the country, and which could only be justified on the basis that the practices and proportions which he mentions would also apply throughout the country. That was a contention rejected by the Minister of Health and on that he asked the House, if there is a Division on this Clause, to go into the Lobby on the side of the hon. Member for South Hendon and against the hon. Member for East Wolverhampton. That seems to me to be the position in which the hon. Member for East Wolverhampton has got himself and from which I leave him to extricate himself.

§ Mr. Bevan
I am not in a position to express an opinion about that any more than the right hon. and gallant Gentleman. He may not be in a position to express an opinion, but he expressed it. The right hon. and gallant Gentleman will read HANSARD tomorrow and there he will see how that statement is not correct. What he says is that I have repudiated the statement made by my hon. Friend that there was a disposition to pocket cash receipts. I am not in a position to confirm or deny that statement, any more than is the right hon. and gallant Gentleman.

§ Lieut.-Colonel Elliot
The right hon. Gentleman is, I think, a little forgetful, which is not surprising in view of the wild and woolly words which he uses. He has appealed unto Caesar and to Caesar he must go. I also appeal to HANSARD. He will there find that he said that the proportion that was mentioned by the hon. Member for East Wolverhampton was not the proportion he had in mind and he mentioned a smaller proportion. No one can call 75 per cent. a small proportion.

§ Dr. Morgan
He said a minority.

§ Lieut.-Colonel Elliot
Does the hon. Member think that 75 per cent. is a minority? Let him get his arithmetic right before he intervenes in the House. The Minister has said that he does not believe that the charges which the hon. Member for East Wolverhampton made, and the extent to which they were made, were justified.

§ Mr. Scollan (Renfrew, Western)
He never said any such thing.

§ Lieut.-Colonel Elliot
The hon. Member for Western Renfrew (Mr. Scollan) has no right, I think, to come in and defend the Minister. The Minister, on the whole, is perfectly capable of defending himself. I have never heard of his sheltering even behind the hon. Member for Western Renfrew.

§ Mr. Baird
There are certain areas of the country where this practice has been carried on to a much greater extent than in others. I quoted my division because in my division it is being carried on to a great extent. I know of other areas where there is co-operation to a great extent with the Minister.

§ Lieut.-Colonel Elliot
The hon. Member now begins to modify his charge. He does not modify his Clause. His Clause remains an accusation over all the country. It is a proposed remedy for all the country—a proposal, which the Minister has turned down, applying 10 all the country. He cannot get out of it by saying that his own division is particularly bad in this respect, because he has brought forward a general Clause, and if he says that 50 or 60 other hon. Members have signed it, I take it that he wishes us to believe that the reasons which he gave for the Clause are also widespread throughout the country.
The hon. and learned Member for Northampton (Mr. Paget) said that he was very concerned in the relief of patients suffering from pain through toothache. That is what everyone is concerned with. The question is how will it best be brought about. The hon. Member for East Wolverhampton said that it would be best brought about by passing this Clause, and the Minister says that it will best be brought about by not passing this Clause.

§ Mr. Scollan
I am afraid the right hon. and gallant Gentleman is "passing the buck."

§ Lieut.-Colonel Elliot
We are not "passing the buck." We are engaged in the examination of as fouling a speech about an honourable profession as was ever delivered in this House, and I am refuting it out of words from the mouth of the Minister of Health. That is very important and necessary.
Now we come to the actual merits of the new Clause. The amendment is a danger because it may militate against what we want. I think that the Minister was perhaps a little cavalier in the dismissal of the arguments of the hon. Member for South Hendon, when he said that he thought this thing was due to heavy pressure placed on the dental profession. I think that is so. I think that is how these practices arose, that the pressure was so great as to produce a perfectly legitimate income, in some cases up to £20,000 or £30,000 a year, and that the pressure was out of all proportion to the pressure put on other professions.

§ Mr. Bevan
May I ask the right hon. and gallant Gentleman to qualify that 622 statement, otherwise his friends the dentists will be more angry with him than they probably will be already. He must always think of these figures as gross payments and not net payments and very often as involving a group of people.

§ Lieut.-Colonel Elliot
I am well aware of that. I think that the Minister will not deny that the pressure and the facts—both the way in which the remuneration worked out and the length of hours which the dentists were willing to work—were both out of all proportion to what he had envisaged when he brought in the scheme. As for the remuneration, the mere fact that twice, purely by a overhead cut, he reduced the remuneration is proof of that, and the report of the Committee on the subject, showing that dentists were working chair-side hours far beyond what had been expected, is proof of the other. Both are evidence of a great strain placed on the profession. The only way in which it can be fundamentally remedied, is by an expansion of the number of dentists. That will take time, and it cannot be done in time to remove this strain.
It is for those reasons that hon. Members on this side drew attention to the strain which the scheme would put on a number of dentists which was insufficient to carry it out. The strain is shown in one extreme case which has been mentioned in connection with the school dental service.

§ Mr. Sparks
Is the right hon. and gallant Gentleman trying to justify the practice of which we complain, of a dentist declining for a period of six weeks to extract a tooth which is causing pain, but agreeing to extract it at once provided the person pays 15s. to have it done? Is he or is he not justifying that practice? That is the kernel of our case.

§ Lieut.-Colonel Elliot
Certainly not. What I am discussing is the new Clause. This is the House of Commons, and we are not debating an abstract question about whether an extraction should or should not take place.

§ Mr. Baird
rose—

§ Lieut.-Colonel Elliot
I hesitate to give way again. If I do so, I hope I shall not later on be accused of holding up the proceedings.

§ Mr. Baird
If the right hon. and gallant Gentleman had been listening to me earlier on, he would know that I admitted that this new Clause was cumbersome. I said I did not know that it would really work, because I had always been in favour of the principle of the choice of a professional man. I said the best solution was for the dental organisations themselves to discipline their members. Does the right hon. and gallant Gentleman agree that both sides of the House should appeal to the professional organisations to discipline their own members? If so, I will at once withdraw my new Clause.

§ Lieut.-Colonel Elliot
Certainly, we would all agree, on both sides of the House, that the dental profession should be actuated by the highest professional motives, and should conduct itself on a high social and ethical level. But does the hon. Member for East Wolverhampton seriously think that the best way to produce that is by hurling the wild and reckless abuse at them that he has done—or, indeed, to a lesser degree, some of the more inaccurate remarks of the Minister of Health? I do not blame the Minister of Health so much, because he is a man of high temper, of very active and vigorous reactions, who has been under great strain recently, much of whose advice has been turned down—the advice given by his powerful newspaper was rejected.
I therefore sympathise with the right hon. Gentleman. I am sure that later on he will regret the somewhat vehement way in which he rejected the Clause, because sometimes, I will not say the cloak-and-dagger attitude, but the bladder-and-poniard attitude of which he is such an exponent, leaks into his conciliatory speeches. The weapon which he naturally seizes, the poniard, is not naturally the one which is most useful for dispelling suspicion.
Therefore, I would only say that tonight his conclusions are very sound, but I think the supporting contentions which he advanced are not so sound. What we are concerned with in this House is his final conclusions, and all we can say is that his conclusions are unexceptionable. We agree with his view, but we disagree with the view of his hon. Friend the Member for East Wolverhampton, and if 624 he divides the House against his hon. Friend we shall be only too pleased to give him every support in the Lobby.

§ Sir I. Fraser
I wish briefly to say a few words about the rights of the professional man himself, which seem to me to have been overlooked in this Debate, and overlooked in general. I say this quite advisedly. I do not believe that there is a medical man or a dentist who would deliberately cause pain to any person, rich or poor, paying or non-paying, by neglecting him when he came into the surgery. At the same time, I do say that a man has a right to determine, to some extent and to some degree, the kind of work he will undertake, and that right should not be wholly denied to him.
The Minister of Health himself would undoubtedly feel that he renders some service to the community by espousing the cause of those who believe in him up to the present, and by generally saying a word for Wales and for Labour supporters—and, he would probably say, for the people. But suppose he chose to retire and to become a professor of philosophy in a university of Wales. Who would say that he had been cruel to the people by denying them services he alone can render—services as poignant and important as that of pulling out a tooth at the right moment? If he chooses to say "I prefer to do politics only one day a week in Caernarvonshire County Council, and on the other days of the week I will study philosophy", has he not the right at least to choose to some extent what he will do with his talents?
6.45 p.m.
Why should the right hon. Gentleman say that men who are dentists, doctors, physiotherapists, or members of other ancillary services of the National Health Service, must do what they do in a particular way, and that if they do not do it in that particular way they are knaves? They may merely be people who choose to do their work in a particular way. I cannot myself see that any harm is done by, broadly speaking, giving the medical men and women, the dentists and the ancillary practitioners, the right to be partially in the Service and partially out of it. Indeed, we may get a much wider and broader viewpoint by taking that more tolerant view. For my part, I am very glad that the Minister has taken that view.
625 My reason for rising to speak is that I discern such a strong view being taken upon this matter by some of those behind the Minister. I think they are making a mistake, I am sure they are doing an injustice, and I want to try to persuade them by my arguments, and by putting before them and the House a particular example, that they ought not to go so far in this matter of trying to destroy and encouraging the destruction of private practices. It is quite clear that if this view is taken by back benchers of the Labour Party, if they remain in power or come back to power and go on pressing the Minister or his successor, some day or another a Clause like this will be passed, and it will be the thin end of a wedge. When they have got the dentists compelled to work full time they will then have the doctors, and finally the physiotherapists—the people I am interested in.
This is a very brief illustration of how people can be hurt and have harm done to them without it being meant. There are just a couple of hundred blind physiotherapists. There are not so many things blind people can do, but they can do this, and do it extremely well. It suits them best to be in private practice, but the system of this scheme discourages their private practice. The Minister, at my request—and I thank him for this—wrote to all the hospitals and said "Give these men jobs in the hospitals." Well, that is something. I want them to have part-time jobs in the hospitals so that during the other part of their time they can undertake private work for which there is a call, which they need and which they can do extremely well. Up to the present the Minister has not refused this part-time work, but if this kind of agitation goes on behind him against part-time work for dentists and doctors, the time will come when the private practices of these men will be destroyed; they will not be able to give so many days or hours a week of public service in the hospital and then do some private work in the evenings, or during the other part of the week.
While we realise the doctors' oath and the dentists' ethics, the kindly feeling of all of us must support the view—which I am sure is general—that any of us, whether we do it by pulling out teeth or by giving kindly advice, try to relieve pain 626 and to help people, perhaps by seeing them, even when we are overworked and tired, whether or not we get fees for it. Most people behave in that way, but we have at least a right to choose in general the way we do what we do. If we do not want to be engaged primarily in the public service, or partially so, then let us choose to do the work we can do in another way. My protest, therefore, is not against the Minister, for he has been right here, but against those back benchers who would destroy all the liberty and all the freedom of the professions one after the other.

§ Mr. Baird
Despite the arguments of the right hon. and gallant Gentleman, and after listening to my right hon. Friend, I beg to ask leave to withdraw the Motion.