§ 7.0 p.m.
§ Mr. Crookshank
I beg to move, in page 2, line 8, after "of," to insert "appliances other than."
This Amendment is not really of very great importance, but I think I should explain the effect of it. The wording in the Bill is "the repair of prescribed appliances" and the Amendment will make it read:the repair of appliances other than prescribed appliances.The effect of this Amendment is to turn the thing round. As the Bill is drafted, what the Minister would prescribe would be appliances for the repair of which a charge would not be made. Under this Amendment he would prescribe those for the repair of which a charge would be made. I think that, on the whole, the new suggestion is better than the old one.
§ Amendment agreed to.
§ Mr. John Baird (Wolverhampton, North-East)
I beg to move, in page 2, line 14, to leave out from "be," to "where," in line 16, and to insert:one tenth of the current authorised fee in excess of one pound where such authorised fee exceeds one pound. Provided always that—1727 The object of this Amendment is to change the method of making dental charges. Instead of the present method of making an overall charge for the first £1 worth of dental treatment, the first £1 worth would be free and a percentage charge would be made for all treatment costing over £1. We are now nearing the end of the discussion on this Bill, and I wish to protest that, while we have had a fairly adequate discussion on Clause 1, in which hon. Members on this side of the House were able to make very valuable points and teach the Minister something about his Bill, and while we have not got anything like what we want, we have got something, with regard to the dental aspect we have got almost nothing at all. I wish to register that protest in moving this Amendment.
- (a) No charge shall be made in respect of services for which the current authorised fee does not exceed one pound, and
It is my opinion—and we have already discussed this for some short time—that this method of levying dental charges is one which was drafted in haste. The only other reason I can think of for the adoption of this method of levying the charge is that the proposal did not come from the Ministry of Health but from the Treasury. I am wondering if this is another example of the kind of thing referred to by my right hon. Friend the Member for Ebbw Vale (Mr. Bevan)—Treasury planning. Is this another example of the Treasury coming along, making a calculation on paper and saying to the Ministry of Health, "Let everyone pay £1 for the first £1 worth of treatment and we will get so much money" and the Ministry of Health, ignoring the advice of their dental advisers, accepting this without realising, from a professional point of view, the dire consequences of this method of making a charge.
If a charge is to be made—and I deny that a charge is necessary; we on this side of the House do not want any charges at all—the type of charge which the Minister is imposing will deter a patient from making regular visits to the dentist. It will penalise patients in pain and it will lend itself to all types of abuse. We had an Amendment on these lines on the Committee stage, but it was not called. There was a certain amount of discussion on this point, and the Minister of Health argued against this proposal. He said: 1728It is a fact that if the Amendment were adopted the greater part of the estimated savings—and they are considerable, for they are estimated at £6 million during a full year—would be lost, and it is one of the objects of this Bill to secure those savings.We want to be reasonable in this Amendment. The proposal is that after the first £1 worth, which would be free, there should be a 10 per cent. charge. The Minister's argument is that a 10 per cent. charge for treatment costing over £1 would not bring in the estimated revenue. I am willing to withdraw my Amendment if he will give an undertaking that he will draft another Amendment to make a percentage charge which will bring in the same amount.
I am not putting this forward from a narrow political aspect but from the point of view of encouraging people to come along for dental treatment. I think it is better to have a percentage charge to bring in the required amount of money than to adopt the method which is proposed in the Bill. What else does the Minister say? He goes on to argue against this charge in these words:Patients would tend, human nature being what it is—I am not blaming anyone—to have treatment costing up to £1 and then they would stop. They would go again another time and have treatment up to nearly £1 and then stop. … It has surely always been the object of dentistry to persuade patients to make themselves fit dentally."—[OFFICIAL REPORT, 24th April, 1952; Vol. 499, c. 818–9.]His suggestion is that if our method of imposing the charge were adopted the patient would go along and have £1 worth of treatment, then stop for a while and then go back again. It is true that there might be some abuses. There are abuses of all Acts. But I suggest that for everyone who would abuse a charge made under the method I propose—and there would be some—thousands and thousands of patients would not go along for conservative treatment if the Minister's method is adopted.
There is no doubt as to which is the better way of conserving the teeth of the people of this country; it is the way suggested by this Amendment, put forward from this side of the House, and having the support of the dental profession. I think this method is a sensible one. It is obvious that the method put forward by the Minister was drafted in haste, without any consultation with the dental authorities.
1729 The other argument against our method was put forward by the bright young things of the Tory Central Office who sit on the third bench opposite. Their argument is that the method prescribed in the Bill will be a deterrent, which is necessary because we have not enough dentists, and in this way we would encourage dentists to leave the public service and go into the school dental service. That argument does not bear looking at.
The hon. Member for Enfield, West (Mr. Iain MacLeod) put forward this point in his speech the other night, when he said that there was a tremendous influx of dentists into the school dental service. He also estimated that, in order to have an efficient school dental service, we must have between 2,000 and 3,000 dentists. The number of dentists we have today is a full-time equivalent of 712. The number of dentists who have gone into the school dental service since the last charge was imposed is a full-time equivalent of 22.8.
How long would we have to go on making other charges in order to get the figure up to the establishment which the hon. Member admits is necessary for an efficient school dental service? The fact is that a lot of rubbish has been talked about this in the debates on this Bill. It is simply a red herring drawn across the path to justify these charges. We have had a lot of talk about these charges being necessary to get an efficient school dental service. There has been talk about the poor children not getting treatment; but the Government have introduced a Bill, which has gone through all its stages in the other place and is due to be discussed here soon, which will provide for dental ancillaries to give inferior dental treatment to school children.
§ Mr. Baird
I am very sorry, Mr. Speaker; I shall not develop that point any further.
The hon. Member for Wolverhampton. South-West (Mr. Powell), said the other night that it was obvious that, as a result of these charges, dentists were going into the school dental service, and he based his argument on the fact that the estimates for the school dental service had been rising. I tried once of twice 1730 to intervene when he was speaking in these debates, but he would never give way. He has not the courage to face me on the public platform and discuss the suggestions he makes on the Floor of this House. The reason there has been an increase in the estimates for the school dental service is that the Labour Government increased salaries for dentists in order to attract them into the service.
§ Mr. Iain MacLeod
The major evidence before the House at the moment is the Scottish evidence. The Scottish scales of the Whitley Council came into operation in February, 1951. If the hon. Gentleman cares to consult the Scottish Report—I have not got it with me at the moment—he will find that there was no influx at all as the result of the improved Whitley Council scales, and that the entire increase took place after July, 1951, when the charges were imposed.
§ Mr. Powell
I happen to have the Report here. The paragraph in question says:The negotiations of the Dental Whitley Council resulted in February, 1951, in the publication of the Council's recommendations for the remuneration and general conditions of service of full-time dental officers employed by local authorities. Although there was little appreciable increase in the total number of dental officers by 31st July, 1951, a number of new appointments were made dating from the beginning of the present school year and by December. 1951, the total number of 1731 dentists (including the whole-time equivalent of part-time appointments) had increased from 94 at the beginning of the year to 104 at December, 1951.That is a 10 per cent. increase in six months directly following upon the first imposition of the charges.
§ Mr. Baird
I hope that in future the hon. Member for Wolverhampton, South-West, will be more courteous than he has been in the past and will give way to me as I have given way to him tonight. His quotation does not meet the point at all. My argument is simply that there has been no influx into the school dental service at all.
§ Mr. Baird
It is nothing like that. For England, Scotland and Wales the increase is equivalent to 22 out of 900. There is no justification for the argument that the charges will build up on efficient school dental service. I hope the Tories will drop that argument which is completely false. The right hon. and gallant Member for Kelvingrove (Lieut.-Colonel Elliot) said that since the Health Act came into operation the health of teeth had deteriorated. That is completely untrue. I am glad that the Minister has exempted children. They are now being treated in the surgeries of the ordinary dental practitioner to a much greater extent than before. Every day I have children brought to my surgery by their mothers, and I think it is much better that they should come to the family dentist in this way.
§ Mr. Baird
I am not going to give way to the hon. Member again.
At the present time we in the dental profession are facing revolutionary changes. Up to a short time ago we accepted the fact that there was no such thing as conservative dentistry for the great mass of the people, but, as a result of a free Health Service, we are building up a teeth consciousness among the people. As a practising dentist, I have seen a great improvement in people's teeth over the last 25 years and a marked improvement over the last three or four years, and even before that. There are 1732 other developments going on. For instance, the Dental Commission in America are considering the question of fluorides.
I submit that if the Minister imposes any charges at all he will undermine the health of the people's teeth because he is going the very worst way about it. I say to him as a professional man—and I think I am speaking for the great majority of my professional brethren—that if charges have to be imposed he should accept our point of view and introduce a proportionate charge which will not penalise the sensible patient who goes to his dentist for six-monthly appointments.
§ Mr. Arthur Holt (Bolton, West)
I beg to second the Amendment.
I wish to draw the attention of the House to some figures which have not so far been quoted and which, I think, cast some light on the argument whether the Act of last year actually had some effect in getting people into the dental clinics or in moving them on to more conservative dental treatment. On 13th March this year, I asked the Minister of Health the number of dentures supplied to patients under the National Health Service, and the cost to the State during the period 1st January, 1951, to 20th May, 1951, and 21st May, 1951, to 31st December, 1951.
The interesting thing about this increase is that in the first period up to 20th May there were under the National Health Scheme 1,800,000 dentures supplied at an estimated cost to the State of £7,500,000, and that for the remainder of the year, from 21st May to 31st December, 2,300,000 at an estimated cost of £9 million. If hon. Members with mathematical facilities will do a little sum they will see that nearly all the dentures supplied in the last half of the year were apparently supplied free of charge as, otherwise, I calculate that the cost would have been £9,500,000. The charges imposed last year are only now affecting the dental profession. Many dentists, particularly in working class areas are now finding things a little more difficult and are not quite so busy as they were.
Whatever else is said about this charge, it is ill-timed. As the Chancellor said in one of his earlier statements relating to this Bill, the purpose of the charge is not only financial but is to bring supply more into line with demand. This point 1733 has been overlooked. If no charge had been made this year we should have found in a few months that the situation was a great deal better than hon. Members might expect as regards the conservation of teeth generally and, in particular, children's teeth—although I do not suggest that when the full effect of last year's Act comes into force it will cause a large increase in dentists going to the dental clinics.
I think, however, that the imposition of this full charge on top of the charges effected last year may create a different situation from that which hon. Members opposite expect. For that reason I say that it would have been far better to have left it out, and if the right hon. Gentleman would at this last stage accept this Amendment it would be a great improvement.
This Amendment proposes a method of charging which would completely and absolutely destroy the savings which it is intended should be made under this Clause. Let me remind hon. Members opposite, particularly in view of what the hon. Member for Wolverhampton, North-East (Mr. Baird), said, that we on this side of the House do not like charges any more than they do, and that these charges are forced upon us by the financial situation which the late Government left behind them. That is the sole reason for their introduction.
Let me explain to the House what the effect of this Amendment would be. The estimated saving resulting from the proposals in the Bill is somewhere in the region of £6½ million. So far as we can ascertain, the probable saving which would result if this Amendment were accepted would be in the region of £500,000, so that, in fact, this is a completely and utterly wrecking Amendment.
There is no system of that kind which would exclude the first £1 and add a percentage afterwards which could possibly produce the amount of money which has to be saved in this connection. One could have a charge running up to 100 per cent. for everything over £1. At the moment everybody up to the age of 21 should have his teeth in good, if not perfect, condition. It seems wholly exaggerated to say that persons over 21 are not in a position to go to the dentist once every six months, as the hon. Member for Wolverhampton, North-East, suggested was a reasonable course to take—and, indeed, it is one which we hope people will follow. After all, the earnings of young men of 21 today should surely be sufficient to enable them to meet any charge of that kind.
§ Mr. Manuel
There is one factor which we have to remember. Today, many young men are undergoing National Service. When they come out they take up apprenticeships at the age of 21, and in many cases they are earning very little. It is not so easy as the hon. and gallant Gentleman suggests for these youngsters to pay for dental attention.
I have every sympathy with them if it is not so easy, but, honestly, I cannot appreciate the point. I do not understand how, even on apprentice wages, a young man is not able to visit his dentist once every six months. I simply do not believe it.
If one looks at the figures and statistics one cannot swallow that suggestion. There is another point in connection with this Amendment. It would favour those who only require a small treatment while it would adversely affect those requiring treatment on a large scale. It is an inducement to people to have only partial and not whole treatment.
The question of the school dental service has been raised. We are told that in Scotland the number of those employed 1735 in that service has increased from 94 to 104. That is an improvement, and I am sure the hon. Member for Wolverhampton, North-East, is glad of it. But I can tell him of a greater improvement. The figures, as I understand, up to 31st March this year show that there were 121–115 employed and six having been appointed who have not yet taken up their appointments. But surely there is agreement in the House that today we have not got a dental service which is capable of dealing efficiently with all dental treatment required by people of every age in the country. Surely that is accepted.
I am not going to give way again. The hon. Gentleman is very good at making speeches and then getting up and making a whole lot of supplementary speeches later.
The whole point is that until we have a national service of that kind there must be priority classes, and we must do everything we can to see that these priority classes receive the greatest measure of attention. We have provided for that. In fact, we provide for a priority service meeting exactly the same requirements which were put forward by the right hon. Member for Ebbw Vale (Mr. Bevan) when he was Minister of Health. We have provided a service for children, adolescents and nursing mothers. These are the priority classes which, I am sure every hon. Member would agree, should have the best and greatest possible treatment.
I think the House must agree that this Amendment defeats itself from the very start, particularly in view of the figures which I quoted relating to the diminution in saving. I do not think that there is one Member—even the most optimistic of Members—who would expect the Government to accept a wrecking Amendment of this nature.
I do not want to complain, but from the very beginning of this debate this afternoon I have tried to 1736 discover a way of making little improvements to the Bill here and there. I think I may fairly say that the Joint Under-Secretary of State for Scotland has made no contribution to that at all.
My hon. Friend the Member for Wolverhampton, North-East (Mr. Baird), made a reasonable proposal. Perhaps it is not a perfect proposal, but it is certainly reasonable. He said, "From my professional experience I tell the House that this is a bad method of tackling this matter from the point of view of dental health and hygiene." He is entitled to expect an answer. Hon. Members in all parts of the House repeatedly bring their specialist experience to bear on many problems.
My hon. Friend said, "I do not agree with charging, but I am willing to withdraw my Amendment if the Government will propose some other way of getting the amount which they say they require, but it should not be done in a fashion which will destroy those good dental habits which this Government, following recent examples, has taken such pains to build up." All the hon. and gallant Gentleman said is, "I do not understand why anyone should find it difficult to find the fees to go to a dentist every six months."
§ 7.30 p.m.
The right hon. Gentleman knows perfectly well that the Government have advisers as well as Members of this House. We take advice in many places. The right hon. Gentleman knows that perfectly well, and if he had been listening to me he would have heard that the suggestion made by his hon. Friend was utterly impracticable.
I am quite well aware that the hon. and gallant Gentleman has advisers, but I have never heard it suggested before in the House that because there are advisers outside the House those inside the House with specialist experience and skill should not be listened to. The hon. and gallant Gentleman's case was that he could not believe that anyone should have any difficulty in finding the money to go twice a year to the dentist. The hon. and gallant Gentleman's case was, once more, that it was the economics of the country that demanded this Bill.
1737 He has frequently put himself on record as being unable to appreciate these points. I have a cutting here that I did not mean to use, but I think I had better put it on record because it explains a good deal of the hon. and gallant Gentleman's approach to this health problem—and it is a health problem, although he seems not to appreciate it. This is a cutting from a Scottish newspaper of 28th February, reporting what the hon. and gallant Gentleman said at a meeting of the Pollok Unionist Association:There is far too much loafing going on in this country today, and we all know it.That is the frame of mind that the hon. and gallant Gentleman brings to these problems. That is the reason why he is unable to give any quiet examination of the constructive suggestions offered by my hon. Friend. This is not for him a problem relating to the health of the people. It is an opportunity for him to score backwoods Tory points.
I am sorry that the Minister of Health has not promised even to look again at this matter. After all, he has gone some way to accepting the very point of view offered by my hon. Friend. He has said that it is important that we should catch up this backlog of bad dental health and the consequences of bad dental health. "I am willing to exempt; up to 21 I am willing to give free examinations," says the right hon. Gentleman. Will he not accept his own logic and admit that this is an unfortunate method? Will he not look for some other method of finding the same sum, without breaking these health habits? This is not a wrecking Amendment. It is a genuine attempt to meet the difficulty, and I wish that the right hon. Gentleman would examine it in that way.
§ Mr. Manuel
Just a brief point in connection with Scotland, because I think we have to get this on the record about the school dental service in Scotland. The hon. Gentleman the Member for Enfield. West (Mr. Iain MacLeod) gives the impression that the school dental service in Scotland is meeting the needs of the position, and that the number of dentists is sufficient to give a reasonable service. In the Scottish Report it is amply demonstrated that there is just no practical service at all. It says that the Borough of Aberdeen has 27,942 schoolchildren on the register, and two dentists 1738 to look after them; the number of children actually inspected by those two dental officers is 3,081 out of the total of 27,000 and more. Glasgow, with 172,382 children on the register has only 19 dental officers, and only some 38,000 of the children are inspected.
Obviously, parents—and I want to stress this, as on the last occasion—are interested in dental hygiene. What is happening is that parents are directing their children to the family dentist. If they do not do so there can be no inspection, treatment, or dental work done for the schoolchildren. I do not think that that can be denied, and I want to challenge the hon. Gentleman the Member for Enfield, West. Does he not agree that the proper thing to do in circumstances like these is to use the National Health Service? What is to happen under the Bill? If people have to pay up to £1 for conservative treatment many families will not just be able to manage it. The Minister is laughing.
§ Mr. Crookshank
I will tell the hon. Gentleman what I was laughing at. The hon. Gentleman has quoted figures for a period during which his right hon. Friends were in office.
§ Mr. Manuel
I made this quite clear on the last occasion. I am not disagreeing with that observation of the right hon. Gentleman at all. That is perfectly true. What I was saying was that, whether we like it or not, children have to go to the family dentist if their teeth are to be preserved. Therefore, we ought not to apply this charge.
§ Mr. Iain MacLeod
I think there is one thing which should be said, because, apart from the point about the responsibility in time which my right hon. Friend has just made, I really cannot believe that the hon. Member for Central Ayrshire (Mr. Manuel) has not seen the fallacy which torpedoes his entire argument.
§ Mr. MacLeod
Certainly. I am delighted to explain it. The hon. Gentleman was quoting details of the examinations in a school year when there were, at the most, 94 dentists in the whole of Scotland. I put before the House today figures which show that there was an increase of 10 per cent. Agreed?
§ Mr. MacLeod
Did not the hon. Member hear my hon. and gallant Friend just now from the Box saying that the figure is now 121; that the figure has gone from 94 to 121 in that time? That is very nearly an increase of 30 per cent. Does the hon. Member not realise how very much better the teeth of the children in Scotland are to be looked after this year as a result of the 30 per cent. improvement announced today from that Box by my hon. and gallant Friend?
The figures given by the hon. Member, of examinations a year ago, are absolutely irrelevant. They were examinations carried out not only under Socialism but by 94 dentists. There are now at least 121, and if this trend continues there will be a great deal more in a few weeks and a few months, and the dental health of the children of Scotland will be a great deal better in the future than it has been in the past.
§ Sir E. Boyle
The hon. Member for Wolverhampton, North-East (Mr. Baird), complained that we had not spent enough time in discussing Clause 2. I must say I thought his complaint would have carried more conviction if he had shown on the previous occasion that he paid any attention at all to the facts adduced by my hon. Friend the Member for Enfield, West (Mr. Iain MacLeod), and by the Minister. I am bound to say that he will have to do very much better than he has done tonight before he will be invited to a public debate in my constituency or in that of any other hon. Member listening here.
I do not want to detain the House for more than a minute, but I think that the hon. Member for Wolverhampton, North-East, presented us with a very misleading picture when he said, "I am quite ready to withdraw this Amendment if the Minister wishes to substitute a higher percentage which will yield him the estimated Revenue." I would say this to the hon. Member. Many people have to have very expensive treatment now, and if a percentage could be found which would bring in anything like the same amount of money as the Bill itself proposes it would bear very heavily indeed on a small number of people who are really in need.
I can understand anyone saying that they dislike the charges and do not think them necessary. I said on the Second Reading of the Bill that I thought they 1740 were necessary, and I stand by that. But it is no good thinking that there is a feasible third alternative to the proposals that are put before the House. I think that the right hon. Member for Greenock (Mr. McNeil) vaguely suggested that there was a third alternative which my right hon. Friend could suggest which would avoid the disadvantages of our proposals and yet bring in a comparable amount of money. I believe that he was suggesting something for which there is no foundation in fact.
§ Mr. Ross
The right hon. Gentleman is doing the wrong thing, in the wrong way, at the wrong time. I think that the Front Bench opposite have an amazing facility for doing the wrong thing and then putting both feet in and choosing the worst possible of all the ways of doing it.
It is astonishing that the hon. and gallant Gentleman, who is one of the joint tripartite Under-Secretaries of State for Scotland, should, of all people, come to the Box and argue this case. One of the outstanding facts about dental expenditure in Scotland since the general scheme was brought in is that the money spent on dentures, in the year before last, was over 60 per cent. of the amount spent in dental services generally. Why were we spending that amount of money in Scotland? Because in the past the Scottish people had been in need of dental treatment. The hon. and gallant Gentleman spoke about his not being able to understand why people could not afford to go to the dentists regularly. The fact is that people in industrial areas could not afford to go to their dentists regularly. Malnutrition and poverty in the past created the need for dentures.
In the past five years, and particularly since the Health Service came in, providing a general dental service, we have had good nutrition. That is stated in the Scottish Report in case any hon. Gentleman would like to oppose my statement. In addition, we have the introduction of regular dental habits by which 1741 people are going to their dentists and getting their teeth dealt with at the right time.
I think that the point made about the school dental services is a little irrelevant. I have always thought so, and I said so on the Committee stage. The point has been made about there being 104 dentists—or 121 when the appointments are made—to deal with the whole of the Scottish school children. In the Secretary of State's own constituency, Moray and Nairn, the number of dentists dealing with schoolchildren is 0.3. One dentist is giving less than one-third of his time to school dentistry for the whole of Moray and Nairn. We have to judge on the facts before us.
The hon. and gallant Gentleman is supposing that the school dental service alone is up. The general dental service in Scotland is also going up. I think that the number was 1,251 against 1,250. I do not know the latest figures. I think that it is important that if the school children are no longer going to the general dental service to be dealt with, that now, more than ever, the Scottish dentists should be able to deal with conservation work; but they are not to get the chance. The Government are now going to come in between these dentists and the work they should be doing. The Front Bench opposite has the idea that people in Scotland have plenty of money to go to the dentists every six months.
The hon. and gallant Gentleman, the Secretary of State's assistant, when speaking to his own Conservatives, looks at the Scottish people and says, "There are far too many who are loafers; far too many getting help who do not really need help." The people who are loafers will still be covered under this Bill. What have the Government done during the past three months to help the people over 21, the young folks of 23 and 24 who are just getting married, to make their money go further?
Never was it less truthful to say that people had plenty of money to go to the dentists. The position is getting worse every day. People will need dentures in future because conservation treatment is being denied them by the Front Bench opposite. That is the reason for that 60 per cent. expenditure in 1950. I leave the facts there, but they are shocking from 1742 the Scottish point of view. We were just beginning to get dental health, when along come the "Stuarts," with three able assistants, plus one from the House of Lords, and Scottish dental progress is negatived and we start travelling back along the hard road of Toryism.
§ Amendment negatived.
Amendment made: In page 2, line 26, leave out "or," and insert:
(4) No charge shall be made under this section.—[Mr. Crookshank.]
§ Mr. Crookshank
I beg to move, in page 2, line 32, at the end, to insert:if (in any such case) a declaration to that effect is made by or on behalf of that person in such form and manner as may be prescribed.This Amendment deals with cases on the dental side where there are exemptions, which we discussed on the Committee stage. This Amendment seeks to provide that a declaration should be made either by the person or on behalf of the person claiming the free service in a manner which may be prescribed. Our intention is to have a very simple process. Obviously, the person coming for treatment would have to give his name, address, age and number.
§ Mr. Crookshank
We have abolished that; the National Health Service number. We are not talking about identity cards; we are talking about the evidence of identity which the claimants for the free service are to give.
For example, in the case of an expectant mother I imagine that it would be necessary to make a declaration as to when the confinement is expected, and in the case of the mother who has borne a child within the previous 12 months, as to the date of the birth. It is proposed to make it as simple as possible to identify the person, and leave it at that I do not think that we can ask for less. I think that it is right to put this in the Bill, and I hope the House will agree with me.
§ Mr. Baird
A large number of dentists already have a very complicated form to fill in for ordinary treatment. I quite understand that there must be some declaration, but I appeal to the Minister to use his influence to see that the form to be used is made as simple as possible. 1743 My hon. Friend raised a point which the Minister seemed to think was frivolous, but will a mother have to state whether she is married or unmarried, and things like that?
The Minister is quite wrong, because, in the dental service a patient has to produce his identity card number. This is already causing a great deal of trouble. People were advised to thrown away their identity cards but cannot get dental treatment without their identity card number.
§ Mr. Crookshank
I said that the form would require only elementary information, name and address, date of birth, and so on, and that the question of motherhood—legitimacy or illegitimacy—would not arise. The expected date of confinement is necessary to show whether the woman is an expectant mother.
§ Amendment agreed to.
§ Mr. Powell
I beg to move, in page 2, line 36, to leave out from the beginning, to "as," in line 38.
This is a paving Amendment to the next Amendment, in line 39. Perhaps, therefore, I might deal with the two at the same time. I am greatly encouraged to see the addition of my right hon. Friend's name to those appearing on the Amendment and I am led to hope that it may be inserted in the Bill.
The purpose of the Amendment is to deal with two unintended results which the Clause, if not amended, would have. First, it deals with cases where a dental practitioner visits the patient in his home. In most cases the dentist earns an additional fee for the visit. Unless that fee is placed outside the definition of "current authorised fee," the result would be that the patient would have to pay that visiting fee in addition to whatever else he has to pay under the Clause, unless the amount he has to pay thereunder is £1 or more. Therefore, to avoid this additional unintended charge upon a patient, it is proposed to exclude the fee for visiting a patient from the definition of "current authorised fee."
The second type of case which is covered are those where more expensive appliances or treatment than is provided under the National Health Service, are given under the system which is known as "grant in aid" by means of Section 44 of the 1946 Act. Unless the payments 1744 which a patient makes under that section were also excluded from the definition of "current authorised fee," he would be exempted by the Clause, or would usually be exempted in most cases, from the payment of that additional sum.
It cannot be the intention that patients who had to pay previously under Section 44 of the principal Act should cease to have to pay by reason of the Clause. I hope, therefore, that the House will accept the Amendment and thereby exclude the two types of fee specified from the definition of "current authorised fee" in subsection (4).
§ Mr. Iain MacLeod
I beg to second the Amendment.
I want to add only a sentence or two in supporting the Amendments, because I think that their point is quite clear to the House and is a genuine one. Obviously, we should not put any difficulties in the way of a dental practitioner visiting a patient, as sometimes is necessary, if bleeding or anything else occurs.
It also is important that if we do not make it as easy as possible for a person to call a dentist in these circumstances, when a dentist probably ought to be called, and if such a fee was entailed, it might well be that extra and unfair and unnecessary work might be put on the local doctor who, if a fee had to be charged to the dentist who attended, might conceivably be summoned in his place.
§ Mr. Crookshank
It will be no surprise to the House to hear that I am prepared to accept the Amendment, because I put my name to it, but I thought that in the circumstances, as my hon. Friends had thought of the point for the Committee stage and as the Amendment had reappeared and was selected, it was only courteous—I should do the same had it been from the other side of the House—to let my hon. Friend move it. I put my name to it because, under the procedure by which we work under the time-table, that is the only way to secure that Amendments which we all want to see inserted can be inserted if time does not allow of debate.
I think that it is a good Amendment and that it meets the point. Both of my hon. Friends have explained it quite adequately, and I hope that the House will agree with them and with me.
§ Amendment agreed to.1745
Further Amendment made: In line 39, at end, add:
but does not include—