SCHOOL DENTAL SERVICE

HC Deb 08 May 1950 vol 475 cc106-26

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

7.12 p.m.

Squadron-Leader A. E. Cooper (Ilford, South)

When a Member is fortunate in securing an Adjournment Debate these days, he has either to miss his dinner or get ready for his breakfast the following morning. I make no excuse for raising this subject of the school dental service so soon after the Debate on the Education Estimates. I had hoped that the Minister would make some reference to the problem during his speech, and his reticence on this subject is most disquieting. Surely he is aware of the serious position in the country. I should have thought the matter was of sufficient importance and urgency to warrant some statement during the Debate on the Education Estimates.

Shortly, the position is that the service is breaking down. It is one of the real casualties of the National Health Service. School dental officers are leaving the service to take up more lucrative employment in private practice. I will not weary hon. Members with details of the incomes to be earned in private practice, as they are well known to the House; sufficient to say that three, four or five times the salary of a school dental officer can be earned in private practice. Is it any wonder, therefore, that the service is being slowly paralysed?

The school dental service is not new. It dates back to before the 1914 war, and without doubt has brought about an improvement in the health of the nation. Regular inspection and treatment have succeeded largely in preventing serious illness and, in addition, the importance of good teeth being properly looked after has been borne in on children in their most impressionable years. It was never adequate, but nevertheless it has continued to develop. By January, 1939, some 783 whole-time officers were employed by the local authorities. The war interfered with the progress, but even so, by 1st January, 1946, 634 officers were engaged, rising to a peak of 921 in 1948. Would that this progress could have been maintained. Since the passing of the National Health Act the numbers have fallen steadily, and on 1st January, 1950, the figure reached 738, and is now lower.

We should consider the effects of this upon inspections. Perhaps the House will forgive me if I quote the authority I know best. I have made considerable researches into this subject in recent weeks, and the figures I am about to quote for Ilford are virtually the same throughout the country. In 1938, with a school roll of some 19,000, 22,820 children were inspected. In 1948, the school roll had increased to 20,267, but the number of inspections had fallen to 11,467. In 1949, the school roll had increased to 21,123, and the inspections had fallen to 3,757. Using the figures for the first four months of these years and relating them to the whole of the year, we find that the number inspected will fall this year to something like 2,556.

It seems to me that the problem is twofold. First, there is the long-term problem of training sufficient dentists to cover both private requirements and the school dental service. Secondly, there is the immediate problem of maintaining the school dental service during the interim. We should like to hear from the Minister what progress is being made to secure the first of these objectives. When does he expect that we shall have sufficient dentists to ensure a reasonably good service?

As far as the second problem is concerned, is a salary adjustment necessary? The reason these school dental officers are leaving is simply that more money can be earned in private practice, but if the Whitley Council, which is now discussing this matter, reaches a conclusion, is it likely that they are going to award a scale of salaries which will give the school dental officers anything like the amount of money they can earn in private practice? Let us assume that they do that. What will be the effect on local government administration generally? We shall have the school dental officer earning a higher salary than the town clerk and the borough surveyor, which would throw the whole thing out of balance. It is unreasonable, therefore, to suppose that they will fix the salaries on that level. We are driven irresistibly to the conclusion that the salary they fix will be so far below the level a man can earn in private practice, that we shall not be able to retain them in the school dental service.

Therefore, it seems to me that there is only one way in which this problem can be solved in the interim, and that is to negotiate with the British Dental Association at ministerial level for some sort of part-time service. I would point out to the Parliamentary Secretary that in March of this year the British Dental Association issued an appeal to all dentists to make available at least one half session a week to treat school children, until such time as the Ministries of Health and Education and the local authorities have risen to their responsibilities by providing a proper service for the children. It is, of course, appropriate that in putting forward proposals such as this, one should look into their practicability. In our own town, we have already started negotiations with the local dentists' association to see whether it is possible to do anything along these lines of providing a full-time part-time service, so to speak, by providing by a rota system a sufficient number of dentists to give us the necessary service throughout the town.

Our consultations, as yet, have not been concluded. We still have some way to go, and it will be necessary, if some results such as these can be achieved, for the Ministry to agree to a sessional fee somewhat higher than is paid today. If they do agree to a sessional fee on a higher level, they will be forced into a somewhat difficult position. It will mean that in some authorities we shall have dental officers leaving the service to take on part-time service if the sessional rate is substantially higher than their present fixed income. Nevertheless, the situation must be faced. The service is breaking down, and unless we get the dentists, and get them quickly, it will break down completely. We cannot afford to have the health of our children, and through them the health of the nation, impaired by any lack of effort on our part.

7.20 p.m.

Mr. Baird (Wolverhampton, North-East)

I should like to congratulate the hon. and gallant Member for Ilford, South (Squadron-Leader A. E. Cooper) on the reasonable and sane speech he has made on this problem. Too often when this question has been raised in the House, hon. Members have spoken as if there were an easy solution to the problem. I am glad the hon. and gallant Member realises there is not.

In regard to salaries for school dental officers, there have been considerable improvements since 1945. I remember making one of my first speeches in the House on the Second Reading of the National Health Bill and from the "British Dental Journal," a fortnightly publication, quoting an advertisement for school officers. The average salary was £450 rising by annual increments of £35 to about £600. I have got the current issue of the "British Dental Journal," and five years later here are some of the salaries which are offered. Walsall Education Committee offers a salary of £935 a year subject to adjustment when the new national scales are settled. The Metropolitan Dental Clinics want a dentist at £900 a year rising by annual increments of £35 to £1,500. The City of Gloucester are advertising for an assistant officer at £950 rising by annual increments to a maximum of £1,000. The House should realise that under pressure from the Government, local authorities have gone a considerable way to meet the school dental officers on the matter of salary.

As the hon. and gallant Member said, salary is not the only drawback here. We should realise—and I do not know whether the hon. and gallant Member does so or not—that the main responsibility for the school dental officer does not lie with the Government but with the local authority. It is true that the Minister of Education and the Minister of Health are both interested, but the fixing of the salary chiefly lies with the local authorities. In the very nature of things local authorities are apt to be cheeseparing in their attitude to the service, which is to be met out of the rates. One of the main problems of the school dental officer is that he cannot negotiate direct with the Government about his salary while dentists in private practice can.

Furthermore—I think this is one of the main reasons why we are not getting young dentists in the school service—local authorities very often are reluctant to give the school dental officer the tools with which to do the job. Several of the school clinics in various parts of the country are a disgrace, and local authorities are often reluctant to provide out of public funds dental equipment which is in any way comparable with what a dentist would have in private practice.

Another point to be remembered is that under local authority service there is far too much book work to be done. Every tiny little local authority has a senior dental officer, who has to do a certain amount of form filling every week or every month. I believe the long-term solution—I put this to the Minister because I should like him to say something about it as I have raised it before and have never had an answer—is to take the school service over though letting it remain on a school basis. Why cannot the Ministry of Health take the service over and organise it on a regional basis in collaboration with the education authorities? In that way the cost of equipping the service from the rates would be taken away and put on the National Exchequer, which would be a good thing; and, secondly, a considerable amount of wastage of dental manpower would be cut out, because now it is doing too much work of a written nature, on a regional basis there would be a more efficient service with the number of senior dental officers cut down.

As the hon. and gallant Member for Ilford, South said, the number of school inspections has fallen within the school service. It is also true that the British Dental Association has sent a circular to its members asking those in private practice to do part of the work done by the school dental service. I am not advocating this. I think it would be a bad thing if the school service broke down, but as a temporary measure this is a good suggestion. It should not, however, be necessary for the Government, the British Dental Association or any other organisation to ask them to treat school children when they come in for dental treatment. During the last few years, because of the large demand for dental treatment, child dentistry, being finicky work taking a bit longer, has not in many cases been popular with dentists, and where the child should have been at the front of, the queue very often it was at the back because of financial considerations. There are, however, some dentists—they are a considerable number—who give priority to school children.

The hon. and gallant Member for Ilford, South, has complained because the Government have not negotiated with the British Dental Association on this question. This is not a political question; it is an ethical question. Large numbers of dentists have realised the need to treat children, and I am glad the Association has sent out the circular they did, but there is no need to negotiate on this. The Government, I am sure, will give them every blessing, but the local authorities should get in touch with the local dentists and see if they can negotiate a temporary service, but the Government cannot be asked to negotiate with the Association, because this is a matter for the local authority.

There is one other point about which I should like to tell the House. The Government are quite aware of this problem. We know, for instance, that the only ultimate solution is more dentists. Unfortunately, in the years before the war for almost a generation there was no expansion of the facilities in this country for the education of dentists, but since the war we have laid our plans and we are to have one or two new dental hospitals. There is one already opened in Newcastle, and I believe there is to be another in Aberdeen as well as one in the North Midlands. We are in need of a great many more dentists.

In this connection there is a further problem. With dentists making as much as £1,500 to £2,500 a year in private practice, it is very difficult to get them to take up a teaching job at say £1,500 a year. There is a great dearth of dental teachers of all kinds, and even if we have the physical buildings we still have the problem of finding the teachers to teach the students as they come along. We are aware of this problem, and we are facing up to it.

There is one other way in which the Government are trying to tackle this problem. In New Zealand a very interesting experiment has been going on for some years. There they have dental hygienists who are young girls. They do about two years' training under a dental surgeon and then they are allowed to treat children. I am told it is a very successful experiment. They both fill and extract children's teeth. I have met some of them when they were here on holiday, and they are intelligent and attractive young ladies. From what I have read, I believe it is something that we could adopt in this country.

The Government realised that this was going on and they sent a mission to New Zealand which was out there during the General Election. I believe it has come home. I do not know what the report will be, but if, as I believe, it will be a favourable one, then, within a very short period, we shall be able to start drawing upon the right type of young girl to go into the school dental service and help to relieve the shortage of dentists. I see the hon. Member for Luton (Dr. Hill) looks worried. As a professional man I agree that it is always doubtful to dilute a profession in any way, but if we limit this dilution to the treatment of school children, under the supervision all the time of qualified dental surgeons, it will not do very much harm. We therefore have to look at the question of dental hygienists in the school dental service very seriously as a help to solving our temporary problem.

There are other points to be remembered. There is the question of fluorides in dentistry, which may have a revolutionary effect upon the prevention of caries in children. This matter is in the experimental stage but the Minister of Health has had the vision to be interested in the matter. That is a new approach from the Government Front Bench in health matters.

Finally, with regard to the salary position, the school dental officer himself has to a great extent been to blame. The position could have been put right two years ago, when the Government almost went down on their knees to the school dental officers and asked them to come into Whitley machinery in direct negotiation with the local authorities so as to get down to the salary question. I know and appreciate the attitude of the British Dental Association. I see in the "British Dental Journal" that they have now recognised the fact that the school dental officer should set up his own Whitley machinery as soon as possible.

Squadron-leader A. E. Cooper

The hon. Member is saying that he is reading that in the "British Dental Journal" now. I would like to point out that the Minister wrote to the former hon. Member for Ilford, North, as far back as 4th August of last year and that these words are included in that letter: I am grateful to hear that both parties have now agreed to the formation of a National Dental Whitley Council. That was 10 months ago.

Mr. Baird

The hon. and gallant Gentleman has no doubt not been involved in these negotiations, so I can inform him that for two years now the British Dental Association has several times been on the brink of going into Whitley machinery, but has always drawn back. The occasion to which he refers was one of the times when it was on the brink. Negotiations have been called off by the British Dental Association, but I see there is a possibility of the school dentists going into Whitley machinery within the next month or two. The British Dental Association have said to the school dentists, "Go ahead and set up your machinery, because you are negotiating not with the Ministry but with the local authority." Therefore there is a possibility that we shall get it in the near future.

Many hon. Members on the other side of the House are now taking an interest in these health matters. That is a healthy sign and I welcome it. I believe that if we look at the school dental service in the same way on both sides of the House, we shall get a solution to that problem in the near future. The school dental officers have done a great work in the past, and it would be a great pity if the service were to break down. I have welcomed this opportunity to take part in the Debate.

7.34 p.m.

Dr. Hill (Luton)

If the hon. Member for Wolverhampton, North-East (Mr. Baird) will forgive me, I will not attempt to follow him in his generosity in distributing the blame for the present difficulty to the representative body of his own profession; nor will I quarrel with his expression of pleasure at finding that from both sides of this House there is an increased interest in the Health Service. I hope that will dissipate any view he may have held that an interest in the welfare of the people is a prescriptive right of one side of this House.

The hon. Member referred to a number of factors in the situation. On many points I agree with him. I believe it would be wise for us now openly to expose the present position and to urge that, whatever may have been the difficulties in the past, the time is long overdue for urgent steps to meet a situation which, because in part it is irreversible, is damaging to the health of the children of this country. I believe that there are two main factors, to one of which the hon. Member has referred, the shortage of dentists. It is an inescapable position. I resist the temptation to follow him upon the subject of dental hygienists and the issue of dilution that is involved. The plain fact is that there are two few dentists today to provide a dental service for the community as a whole.

Paradoxically, the result of applying a dental service to the community as a whole has been to deny it most of all to that section of the community that needs it most. These people need a dental service to which they have become accustomed over the years. I have no doubt that, among all the forms of dental care, there is none to compare, in terms of the health of the people, with the dental care of school children, not only because it is in large part a care in early life, but because there has grown up in the school dental service a tradition which, without political implication, I may call conservative dental care. The present position is that a proportion of the children of this country are receiving no dental care whatever. Those who are receiving it——

Mr. Baird

I would point out to the hon. Member that the number of school dental officers is almost as large as it was in 1939. The school dental service was built up for a few years after the war, but we have now almost as many as we had in 1939.

Dr. Hill

I will not enter into a statistical calculation. I will reassert as a fact that today a proportion of the children of this country are denied dental care. I believe that that denial of dental care is due to the decision to offer dental care to the whole community while there was an insufficiency of dentists to do the work. The fact remains that a proportion of the school community lacks dental care and even though the position may be rectified in the next few months, it still remains true that those children have suffered and may subsequently suffer dentally because of that lack of care.

The second factor, however much the hon. Member for Wolverhampton, North-East, may refer to questions of organisation, is, as everyone knows, that by the operation of the Spens Committee's Report and by its translation into terms of remuneration, the level of remuneration in dental practice outside the school clinic has proved much more attractive than remuneration inside it. Some may assert—I certainly do not—that the terms outside have been over-attractive. Others will say with much greater justice that the remuneration of the school dental service has remained far too unattractive in relation to current conditions.

The point which I desire to stress is that, given such disparity of remuneration, the result of a dwindling corps of school dentists is inevitable. I have no doubt that the same principle applies in other directions, not excluding the teaching profession. Faced with those two facts, an insufficiency of dentists and a disparity of remuneration, I do not think that we should be content to say—and I hope the Parliamentary Secretary will not say—that the Minister must await the discussions in the Whitley Council, that regionalisation is the solution. I hope that at this late date—for the date certainly is late—he will find it possible to grapple with the situation.

How can he grapple with the situation? You may rule this outside the scope of our discussion, Mr. Speaker, but, as I see it, it is publicly to recognise that there is insufficient dentist personnel for the whole population and publicly to decide to give priority to the school population in this field, whatever that may mean in the provision of dental care for the rest of the community; and secondly—for it is no good merely touching the main underlying issue—swiftly to produce new scales of remuneration for school dentists which will have the effect of retaining them in the service and of attracting them to the service. I notice that when he finds Whitley discussions for the reduction of remuneration in the dental field going too slowly, the Minister of Health issues a decision by the Minister to reduce remuneration, leaving it for subsequent arbitration to say what the reduction should have been.

Mr. Baird

There is no Whitley machinery for the negotiation of salary increases or decreases for the dental profession. They negotiate directly with the Minister. There are no rules in the game. They can prolong discussion as long as they like.

Dr. Hill

In my experience, the art of prolongation can be managed either in indirect discussions between the Minister and a profession or within the now hallowed confines of Whitleyism. The point I want to make—I do not make it as a point of criticism—is that when a Minister on public grounds desires to reduce the outgoings of a service, he finds ways and means of speedy action unimpaired by the prolongation of Whitley machinery.

What I suggest is that so urgent is the problem of school dental care, so urgent is the need for securing sufficient dental personnel for the purpose, that intervention by the Minister is what is needed in order to secure the speediest possible adjustment of this situation. It is not putting it too highly to say that at a time when, with the good will of all sides of this House, an effort is being made to improve the quality and to extend the range of the various parts of the Health Service, here, in what is, to me, one of the most important parts of any Health Service, a precious part of the Service, is being allowed to decline while arguments go on.

Maybe the hon. Member for Wolverhampton, North-East, is right in what he says about those arguments or lack of arguments between the Minister and the British Dental Association and arguments between the associations of local authorities and other bodies. The problem is too serious to permit of any prolongation of the present most unsatisfactory position, and I urge the Parliamentary Secretary not to rely on arguments which distribute blame or praise for the various delays which have occurred but to regard this as an urgent problem approaching a national scale, in the decay of the school medical service under our very eyes.

7.45 p.m.

Dr. Barnett Stross (Stoke-on-Trent, Central)

I do not intend to detain the House long, but there are one or two points which need investigation. I was very interested to hear the speech of the hon. Member for Luton (Dr. Hill) and his stressing of the fact that remuneration to the dental service in the schools is not sufficient to attract enough people to do the work satisfactorily and completely. Everyone will-agree with him, but it is not entirely a simple matter. After all, dentists working in the schools—in the past certainly, and even today—do not put in the number of hours which the professional man does in private practice. Therefore it would be a question not of total remuneration but of a sessional basis. I presume that the hon. Member for Luton had in mind that these people should be paid on a sessional basis but at a higher rate.

Dr. Hill

Appropriate remuneration. I do not intend to suggest that it should be equal remuneration with what is earned outside, but it should be appropriate remuneration sufficient to attract the needed dentists.

Dr. Stross

That puts it clearly. I must answer that by saying that I believe that young men of energy and vigour will still tend to be attracted outside rather than to the school medical service and that we are not likely to solve the whole of the problem easily that way.

Mr. Baird

We have not cleared up the question of remuneration. The salaries at present being paid, at least by the more enlightened local authorities, to school dental officers are, according to the statisticians of the Ministry, the appropriate salaries recommended by the Spens Committee. The Spens Committee recommended a salary of £1,650 a year for a dentist at 40 working a 33-hour week. A salary rising from £1,000 is very near the appropriate salary. The problem is that dentists in private practice are getting considerably more than the sum visualised by the Spens Committee, and in order to get dentists into the school service again we shall have to pay them more than the Spens Committee recommended.

Dr. Stross

I am grateful to my hon. Friend the Member for Wolverhampton, North-East, because he tends to make my point clearer—that because of the very high remuneration that some of the men get outside, the tendency will be for many young men to go outside rather than to stay in or to ask to come into the school dental service.

That brings one at once to the point mentioned by my hon. Friend of the training of unqualified or not fully qualified workers to assist in the service. He wondered whether it was a retrograde step. All of us must agree that we are very cautious and suspicious about any dilution of this kind. I believe that we accept that it is a proper principle that there is no operation in medicine or dentistry of so trivial a nature but that the more highly qualified and skilled the operator the better ultimately it will be for the patient. That is a suitable and proper attitude to take. A further point would be that it is not only the operation that one has in mind, whether it be to fill a tooth or to extract one, but it is desirable for the operator to be capable of making a diagnosis when the child opens its mouth and exposes its teeth. We cannot expect untrained personnel to be able to make a diagnosis as efficiently as men and women who are fully trained.

Most of us recognise that legislation, even at its best, does not erase an evil as one can, with an india-rubber, erase a sentence written in pencil, which one does not like. At its best, good legislation spreads the load of the burden as evenly and as fairly as possible so that the shoulders best able to carry the burden should do so. Here I must agree entirely with the hon. Member for Luton "when he states that we want none of this burden to be carried by these weak, young shoulders. Everybody in this House is agreed that we want our children to be assured of the best treatment being given to them as expeditiously as possible. If the Ministry have made up their minds that men or women with a short training may help for a time or permanently to do this work, well and good; we shall have to accept it and hope that it will ultimately get us out of this difficulty. But whatever is done requires to be done expeditiously.

I wonder if a way out could have been found by asking every dentist who entered into the Health Scheme to give a session or a half day per week to the children in his area? It should not have been too difficult to organise so that all the children in a given area, by rota, could receive treatment in that way. I should imagine that the dentists would have been only too glad, and then we could have been certain that the children would have the priority for which all of us are asking. It may be that this would be administratively too difficult, but it is a suggestion and at all costs we want no further delay in seeing that some remedy of this type is found.

7.52 p.m.

Mr. George Thomas (Cardiff, West)

I must apologise to the hon. and gallant Member for Ilford, South (Squadron-Leader A. E. Cooper) for not having been here at the beginning of the Debate, but I am grateful to him for having brought to the attention of the House one of the most pressing problems in the education and health services of this country. Indeed, it is only a few weeks since I raised this topic, along with that of the difficulty of children obtaining their school spectacles.

I listened with growing interest to the hon. Member for Luton (Dr. Hill) who, if he will forgive me for saying so, I thought was in danger of working himself into a ferment on the question of finance. The hon. Member seemed upset that the Minister had shown signs of economising in the Health Service at the expense of the dentists——

Dr. Hill indicated dissent.

Mr. Thomas

Well, the hon. Member thought the Minister had acted too expeditiously. I understand that a dentist in Wales received £24,000 last year for one year's work in the service, and I am convinced that that scandalous state of affairs is bound to be an impediment to an adequate school service—is the hon. Member for Wolverhampton, North-East (Mr. Baird) wanting to jump up again?

Mr. Baird

I will, if the hon. Member does not mind. Hon. Members should not make general statements without qualifying them and without knowing what they are talking about. I am not suggesting that the hon. Member does not know, but in the case of the dentist to whom he was referring, those would be gross earnings, of which at least 52 per cent. were expenses, and also it is quite possible that he may have been employing one or two assistants. Perhaps he is getting far too much, but do let us have the figures correct.

Mr. Thomas

My points have not been made in vain if I have been able to bring my hon. Friend to his feet to defend the dental profession. It is a remarkable feat for which I take due credit. The question of school dentists ought to be tackled in this House from the point of view of how best the deficiency can be remedied. I believe that in certain areas of the country, dentists are already giving sessions to the school. Perhaps the hon. Member is aware of this?

Mr. Baird indicated dissent.

Mr. Thomas

They are already getting together voluntarily and taking their turn in giving a session to one-tenth of the children. I believe my hon. Friend the Parliamentary Secretary to the Ministry of Education knows that this has taken place in the City of Cardiff. Would it not be possible for new entrants to the profession to be required to do two years' service in the schools before entering into the wider sphere of activity? I do not mean to practise on the children because they are already qualified to practise on the public, but to let them give some service in the schools where there is an urgent need. If hon. Members are sincere that this is indeed one of the most urgent problems in the education service, why should we run away from the fact that dentists, like anybody else in the community, must be prepared to go where there is the greatest need?

The terms of service which dentists give at present in certain parts of the country are greatly appreciated but it is upsetting that a part of the public health service should be so seriously upset when a National Health Service is introduced. I can hardly believe that it is finance alone which has caused professional men to leave a service so important to the children. If such were the fact it would speak ill for the professional standards of the people concerned. If the teachers behaved in that manner they would flock in thousands from the schools at present. They are there from a sense of vocation and they are giving their service even though they have a financial grievance. So I would not like to think the dentists had acted from that motive; it may be there are other chances of promotion outside. I say to my hon. Friend that this problem brooks no delay. In every part of the country we need a similar scheme to that in operation where the local dentists are loyally taking their turn in the schools or setting hours apart in their own surgeries when the children only can attend.

7.58 p.m.

The Parliamentary Secretary to the Ministry of Education (Mr. Hardman)

I am grateful to the hon. Member for Ilford, South (Squadron-Leader A. E. Cooper) for having raised this topic on the Adjournment tonight. I am sure he will appreciate, and I hope other hon. Members will also appreciate, my caution in replying to the many suggestions that have been made. Reports of one kind or another are awaited. Negotions are afoot for the setting up of Whitley machinery. The likelihood or not of local or national agreement with the dentists as to part-time service is still a matter not only of discussion but of growth and development. So I hope it will be appreciated by hon. Members on all sides of the House that I do not want to say anything in reply to this Debate which exacerbates what is an extremely tricky and serious situation.

I am not by training either a dentist or a member of the medical profession, so in some respects I may be a little out of my depth in replying to this Debate. Of one thing I am convinced: reading the papers and looking at the files on this topic in my own Ministry, I am personally convinced that the only solution—and it is a long-term solution, because it takes time to train men and women—is to have a great addition of trained dentists to the dental profession. We have been increasingly anxious at the Ministry at the deteriorating position of the school dental service, and we realise, as speeches tonight have shown that others realise, that that deterioration is due to the steady fall in the number of school dentists.

Immediately after the war, acting under the stimulus of the Education Act of 1944, we set about trying, first, to enable the school dental service to overcome the effects of the war years and then to build up a really efficient, comprehensive service of regular inspection and treatment in the schools. For a while we were successful. The number of school dentists, full-time and part-time, rose from an equivalent of 634 full-time at the beginning of 1946 to 921 at the beginning of 1948. With this number of dentists it was possible to maintain an efficient service with reasonably adequate arrangements for regular inspection and treatment.

Even then—and we must admit this frankly—only about half of the required staff was available to meet an ideal service in the schools. We have, therefore, to admit that there has been—and it has been accentuated—a general shortage of dentists. So long as this continues, we shall be very glad to see the numbers back even at the 1948 level which I have mentioned. Unhappily, from an equivalent of 921 full-time school dentists at the beginning of 1948, the total had fallen to 866 at the beginning of 1949 and to 738 by the beginning of 1950. This fall is undoubtedly due to the fact that an increasing number of school dentists have found higher remuneration outside their school work. Because of the National Health Service the school dental service is no longer as attractive as it used to be to new entrants to the profession.

There are some other figures which we must take into consideration in dealing with this question. Last June, the rate of remuneration for dentists in the general service was reduced by about 20 per cent. A few days ago the rate has been reduced—I think, from 1st May—by a further 10 per cent. I suggest, without laying too much emphasis on this, that these reductions will help to reduce the discrepancy between the earnings in general practice and those in the school dental service, although the effects of the latest reduction will not be immediately apparent. Taking into consideration the figures which have been mentioned by my hon. Friend the Member for Wolverhampton, North-East (Mr. Baird), who mentioned that the best authorities are paying a reasonable salary to their school dentists—an increase on salaries offered about two years ago—the discrepancy between the salaries of dentists outside the schools and those still in the school dental service has been narrowed.

But we would be blind to the situation if we were to say that, with the number of school dentists available for the treatment of school children, it is possible to maintain an efficient service. At present it is not Conditions vary somewhat between one area and another, but there are some areas where it is proving difficult, if not impossible, to provide even emergency treatment, and we have to face this fact. In other areas the difficulties are not so great, but if the decline of the last 18 months or two years continues, the conditions now to be found in the worst areas will become more or less widespread throughout the country.

It has been emphasised I think by every speaker tonight that the cause of the fall in the number of dentists practising in the schools has undoubtedly been the uncertainty as regards their salary position. Unlike the doctors, the dentists in local authority employment have never had any recognised salary scheme. As has been said, negotiations have been proceeding for some considerable time, perhaps for too long a time, to establish a Whitley Council to deal with dentists' salaries generally. One committee of this council would deal with the salaries of dentists employed by local authorities including school dental officers. Attempts to set up this negotiating machinery have met with a number of difficulties and at different times either the dentists or the local authorities have been unwilling to join in

Some progress has been made recently, but on 22nd April of this year a representative board of the British Dental Association passed a resolution indicating that they were not now prepared to enter generally into Whitley Council machinery but agreed to a Whitley Council covering public dental officers only. This resolution has been brought to the notice of the local authority associations by the Ministry of Health and I hope that Whitley machinery to deal with the dentists in local authority employment may still be set up.

I agree with the hon. Member for Luton (Dr. Hill) that the sooner such machinery is set up, the better and that those of us with any authority in these things should be impatient of any undue delay. If the machinery is set up the question of salaries can be at once considered, bearing in mind always the present situation and general Government policy as to personal incomes. I am afraid, however, that this latest development is bound to lead to some further delay, which we can ill afford in view of the present position of the school dental service.

What we have to do as a matter of urgency is to overcome the difficulties of the last two years. It is also important that we should investigate other ways of easing the pressure on the school dental service, and speakers on both sides of the House have referred to possibilities in this direction. We have, as has already been mentioned, been looking into ways of doing this. My hon. Friend the Member for Wolverhampton, North-East, referred to the official mission, upon which my Ministry was represented, which was sent to New Zealand to obtain a report on the New Zealand system of school dental nurses. These nurses are employed by the New Zealand school dental service after two years' training—I speak unprofessionally here, and may be pardoned, I hope, for so doing—in the dental care of children. I am not arguing about this, because I am incapable of being accurate as to what precisely that means and how far this means a dilution of professional ability. The mission has recently returned to this country and we are awaiting its report with very keen interest.

The other development which was mentioned by my hon. Friend, which is one of considerable interest to a layman like myself because it sounds so easy for one's children, has been the setting up of a working party by my right hon. Friend to direct and organise an investigation into the prophylactic effect of the local application of a solution of fluoride to school children's teeth. One has heard of flueologists for chimney sweeps, but the word fluorides in relation to school dentists is a new word to me. It sounds easy, but I presume it would be years before we could say that the use of this substance is to save dental treatment in adolescence.

As part of the investigation that is taking place, I understand that the teeth of about 3,000 children in different parts of the country are to be treated in this way with the full consent of the parents, which we at the Ministry of Education always try to obtain. Work on this has already begun. It is a long-term policy of research and it will, as I have said, be some years before we know the results. Obviously if the prophylactic value of the treatment turned out to be high, the saving in demands on the school dental service for treatment might be very considerable. I understand that research work on this subject is also going on in the United States of America.

But, whatever benefits may come from these long-term developments, it is no use concealing the fact that at the moment the school dental service in this country is in a very serious condition. The establishment of the National Health Service has created a heavy demand for dental treatment for adults who previously had not been able to afford the cost of that treatment. The number of dentists in the country has not been sufficient to meet this demand, although for the most part they have done valuable work in trying to cope with it. Consequently, competition between the general dental service and the school dental service is arising.

I am sure that hon. Members on all sides of the House will support my hon. Friend the Member for Cardiff, West (Mr. G. Thomas) in his remarks about the prestige of individual members of the school dental service who would be the last to think of leaving the service at a crisis in the dental treatment of school children such as this. As the hon. Member for Luton (Dr. Hill) so rightly said, here in the treatment of the teeth of young children we lay the foundation of good health in adult years. Members of the school dental service have been doing a great job in the schools and I am certain that most of them are not prepared lightly to give up their responsibilities in the service simply on the ground of increased remuneration outside. I do not pretend to know exactly what it is because I know nothing professionally of the service itself, but if we can get this better balance between remuneration outside and remuneration in the schools, the recent losses from the school dental service to the general dental service should be made good and I think the school service may be restored at least to the level of efficiency on which it was able to operate two years ago.

As I have pointed out, I have been a little outside my experience in replying to a Debate of this kind, as I do not pretend to know the professional niceties, or indeed the professional etiquette or technicalities of this subject, but I do know as an educationist that I can, with wholehearted warmth, support the anxiety of every speaker in this Debate about the immediate future of the dental treatment of our school children. It is our duty as a responsible Ministry, in cooperation with the local authorities and others concerned, to put this matter right, as soon as possible.

To the hon. Member who raised this topic tonight, I say that we are grateful that the subject should have been raised by him and should have provoked so interesting a Debate. The many suggestions that have been made by hon. Members on all sides of the House will be considered by my right hon. Friend and myself and our officers. We are not prepared to allow this service to decline any further. We shall do our best to meet the situation and to meet it urgently.

Mr. Somerville Hastings (Barking)

Before my hon. Friend sits down, may I ask what steps his Ministry are taking: to increase the number of students in training for the dental profession, which he and I agree is a fundamental question?

Mr. Hardman

I must confess I cannot answer that question. I have not looked at that part of the file, but I am naturally prepared to let my hon. Friend know. I must ask the indulgence of the House when I say that I do not know the answer now.