§ Motion made, and Question proposed, "That this House do now adjourn."—[Mr. Kaberry.]
§ 9.24 p.m.
§ Mr. John Baird (Wolverhampton, North-East)
It was rumoured that the debate on the Prayers would finish between 6 p.m. and 10 p.m., and I have had to deny myself sustenance while waiting here. Someone suggested that as I proposed to discuss dentistry; I might have taken part in the general discussion on butchery. I do not know whether that is relevant.
I wish to deal briefly with the question of the school dental service. We all know that this has been one of the major headaches within the Health Service during the last five or six years. I think I can say that, on both sides of the House, very considerable interest has been shown in this problem, but that there has been the fundamental difference between us that we on this side have never believed or suggested that there was a quick solution to the problem of the priority dental services, and especially the children's service.
I have always argued that, while we have dentists in general practice paid on an itemised scale of fees and dentists in the public service paid by salary, there would be more attraction outside the public service than within it, and that the 566 best way to have solved the problem, from my point of view, would have been to have introduced a fully salaried service in 1946. At that time, the opposition to a fully salaried service came from hon. and right hon. Gentlemen on that side of the House, and not from those on this side.
The supporters of the present Government, who were then in Opposition, were making speeches, month after month and year after year, about this problem, and they really led the people up the garden. They seemed to suggest that, if they were in power, they would have some method of solving this problem or of getting dentists to treat school children. I remember the present Minister of Health suggesting that it was the introduction of the National Health Service in 1946 which had made the biggest contribution to the withering away of the school dental service.
I also remember the claims made by hon. and right hon. Gentlemen opposite that, by imposing charges on the Health Service, they would institute a kind of social priority that would encourage dentists to go back into the school dental service. Indeed, the Minister justified the recent charges for dental treatment by saying that they were socially and ethically justified for that very reason. That was only a short time ago—six or 12 months.
Let us examine the position today. There can no longer be the argument that the Government have not had time to do anything, because, when they were in opposition, they then said that they had a solution. What is the position today? It is true, as I think will be admitted, that there have been some improvement in the school dental service, and I am not going to deny it at all. In December, 1938, we had the full-time equivalent of 783 dental officers. On 1st January, 1952, we had 712, and that was when it reached its lowest ebb. In October, 1952, the figure had risen to 827. I had these figures from the Ministry of Education this morning. Therefore, there has been a rise of nearly 100 in the number of dentists in the school dental service over the last 12 months.
I should like to point out that the main increase was between January and May, 1952, when the figures rose from 712 to 793, and that was before the 567 charges imposed by the present Minister had come into effect. Therefore, the main increase came before the present charges became effective, and, if anyone wants to claim the justice of this matter, then it must be said that the Labour Government were more responsible for this increase than right hon. Gentlemen and the Parliamentary Secretary to the Ministry of Health.
Secondly, the major point which I have tried to emphasise time and again, but which the Government have not faced, is that, as a result of these charges, we have scraped the barrel in regard to getting more dentists into the school service and have increased the number of dental officers by something like 100. We now have 827 school dental officers, and the present Minister of Health and all dental authorities have admitted that we cannot run an efficient school dental service until we have between 2,000 and 3,000 full-time dental officers. At that rate it will take at least 50 years to get an efficient dental service. That will be by imposing further and further charges each year to force more and more dentists into the school dental service.
The Parliamentary Secretary may say that there is still a likelihood of more dentists coming into the service. I do not think she has any grounds for that optimism at all. As I say, she has already scraped the barrel. It is true that at the present time there is considerable under employment of dentists in industrial areas, but the dentists underemployed are, first of all, the older dentists, and second, those dentists who have concentrated most of their practice on industrial dentistry and are not a suitable—I do not want to offend any professional men when I say this—type likely to become good recruits to the school dental service. I do not think there is any possibility of our getting any further recruits, unless the hon. Lady imposes further charges on dentists in private practice. I think she dare not do that. If she did, she would destroy the whole basis of the Health Service.
The main point of my argument is this. The dental profession are very worried about this situation. I am speaking here with the full authority of the dental profession as a whole—the British Dental Association. They are 568 not putting forward any long-term solution, but they believe they have a short-term solution while plans for development of a new priority dental service are built up. I think the Minister should pay more attention to the British Dental Associations' suggestions.
This question of the long-term solution of the priority dental service has still got to be tackled. I have been pointing out in this House for seven years now that we shall not get an efficient priority dental service for school children until we take it away from the Ministry of Education and base it on the Ministry of Health. At present it depends on the amount of money available to local authorities and varies very greatly between, for instance, London and Cambridge, where it is efficient, to other areas of the country where there is almost no dental service existing at all, apart from inspection.
I have emphasised this time and time again, and to my right hon. Friend the Member for Ebbw Vale (Mr. Bevan) as well as to the present Minister of Health. We have to face up to redirecting the school dental service under the Minister of Health. Apart from that, I say again that as long as we have the great bulk of dentists working under itemised scales of fees outside the public service we shall not get an efficient school dental service. We have to face up to the question of having a fully salaried service for all dental practitioners as being the only ultimate solution.
However, we are now talking about a temporary solution. There is no one who can argue that we have an efficient school dental service today. There is no one who can argue that there is any possibility of getting an efficient dental service within the next five years, unless we do something drastic, and therefore all talk of treating school children within the clinics is simply pie in the sky.
The British Dental Association have put a memorandum to the Minister, and this memorandum is based on a questionnaire sent to every dentist in the country. I want to quote figures. The British Dental Association circularised every local dental committee set up under the Minister of Health to administer the National Health Service dental service. They sent out a questionnaire, asking dental practitioners to treat children in 569 their own surgeries, to 165 local dental committees, of whom 102 agreed to carry out the scheme and circularised the dentists in their areas. The questionnaire was sent to 6,768 practitioners, of whom some 2,230 replied; the number willing to set aside a given amount of time each day to treat school children in their own surgeries was 1,743, and the total number of hours available for treating those school children in the dentists' own surgeries each week was over 10,000.
This was a genuine offer by the dentists to get a temporary amelioration on this matter of the priority dental service for school children. I cannot understand why the Ministry of Health should have adopted the attitude they did. The Ministry simply turned down this offer completely, and I believe it was one of the most scandalous and shameful decisions that Ministry has ever taken on this problem.
A Press statement issued the other day by the British Dental Association sums up the position very fairly, and I will read only one quotation from it:The British Dental Association, as a result of nation-wide inquiries, found that nearly 2,500 dentists"—that does not quite agree with the figure I quoted earlier, because other figures have since come in—were ready immediately to treat 20,000 children a week in their own surgeries as a first step, with a possibility of many more in the future. The reply by the Minister of Health and the Secretary of State for Scotland is, 'No, thank you.' The attitude of the Ministries is that school children should only be treated in school clinics by salaried dental officers. They try to justify this attitude by claiming that clinic treatment is more effective and uses less manpower, and is cheaper. Clearly they would rather save cash than children's teeth.Then this is the important point:They ignore the fact that under present conditions there is no hope of getting enough dentists into the clinics to do all the necessary work. Dentists have offered to do the work in their own surgeries, and this is the only way that an immediate service can be secured. Any alternative scheme would take years to establish, and in the meantime the teeth of another generation will be ruined.
§ Mr. Frederic Harris (Croydon, North)
Could the hon. Gentleman tell us what basis of charging was proposed for that scheme? What were the charges to be under the scheme?
§ Mr. Baird
The charges which would be imposed were the charges already in existence under the National Health Service for the treatment of children. Perhaps I might digress here to say that this is a point which should be given more publicity. The fees at present paid to a dentist for treating children's teeth under the National Health Service are quite inadequate. If a grown-up person comes to a dentist's surgery for a filling, the fees range from 15s. to 22s. 6d. per filling. As a professional man I argue that to treat children properly takes longer; it is much harder work to get a child at its ease in the dentist's surgery and to treat it properly than an adult. Yet the fee we get at present for filling a child's tooth is 10s. 6d., less 10 per cent.—something like 7s. per tooth.
Therefore, when dentists offer to set aside a considerable amount of time each week to treat children they are not doing it because they will get any financial gain. They would lose considerably under this offer, and it is scandalous that the Ministry should turn it down in the way they have done. Let us examine why the Ministry turned this down. The Ministry have given reasons in a letter. I believe that the real reasons the Ministry have turned down this offer are narrow and doctrinaire reasons. Why do I say that? The present Minister of Health—and I am sorry that he is not here tonight—climbed into power a few months ago because of one or two clever speeches which he made. He is one of the few men on the opposite side of the House who know anything about the Health Service.
The basis of his arguments over the last few years in this House—and they seemed to be acceptable to hon. Members opposite—was that if only we imposed charges on the Health Service we could then build up a priority dental service. We all remember one argument which he put forward then to the House. He said that if only we made charges on the general Health Service, the dentists would be encouraged to go into the school dental service because there would not be so much money in private dentistry.
If it is now true that that argument was a fallacy and that the charges made under the Health Service have not built up an efficient school dental service, where is his argument? It is washed completely away, and as a result 571 of all these charges we have a paltry increase of 100 dentists in the school dental service, and today we have 900 when we want 2,000. His argument has been blasted sky high, and he dare not admit it.
The Minister has turned down the genuine offer of the dental profession of this country to provide fixed dental hours each week in their own surgeries. I am quite certain that it is only to save his own political face that he has taken this decision. What arguments are used in the Minister's reply to the dentists? I should like to quote some of them. Remember that I am not arguing on behalf of a lot of doctrinaire Socialists; I am arguing on behalf of the dental profession which I have attacked in this House often enough, the majority of whom, I should think, are Tory. They made this offer, and the Minister has turned it down in the following terms:It has been shown by experience that the most effective way of providing treatment for school children is in clinics closely associated with school routine, so as both to ensure the attendance of children in need of it and to cause the least interruption of their education. Treatment for younger children can be most effectively provided by a clinic service forming part of the local health authorities' general arrangements for the care of mothers and children.…Very few people would deny that. For the last 20 years it has been argued that the best way to treat children is in the school dental service where they are under a certain amount of authority from the teachers, and where we can encourage them to have their dental treatment carried out. No one can deny that.
But the hard fact of the matter is that we have not the clinics in this country which can efficiently treat the school children. Why use this argument that we must not treat the children in private dental practitioners' surgeries and that we must treat them in school clinics, when the school clinics are not there? It is simply hypocrisy to put forward that argument, and we know that it is only to cover up the other real truth.
I should think that I am one of the few people who disagree with the majority view held in Ministerial and professional circles. It is true that in the old days when the majority of the working class in this country could not afford dental treatment 572 and were ignorant of the value of dental treatment, we could not expect them to encourage their children to go to the dentist, and therefore, by encouraging them to go through the school service, we were doing some good.
Today, under the National Health Service, the great majority of people are receiving dental treatment, and as a practising dentist, who should have declared his interest, I should say that one of the most gratifying feelings of a professional man is to see these working-class people coming in week after week and bringing their children with them.
Rather than have the children marched in by the school teacher, it would be far better to encourage them to come along with their parents and gradually develop their treatment in the way the parent is treated by the family dentist. The National Health Service has killed the argument that we must have a comprehensive school dental service. I am a heretic to put that point of view, but as time develops we shall find that, while we should still have a school dental service for inspection, the larger part of the treatment of children will be carried out in the general practitioner service.
The second, and main, argument in the Minister's reply to the British Dental Association must be treated very seriously indeed, for it raises a fundamental point. The letter says:Secondly, it is imperative, particularly in present economic circumstances, to achieve the utmost economy in expenditure and here again experience has shown that children can be treated in clinics at a substantially lower cost than when treated by private dentists remunerated for each item of treatment on the scale of fees in operation under the general dental service.What does that mean? The school dental service cannot treat all the children and many can only be treated in the general dental service, but the Minister argues that the children cannot be treated in the general dental service because it would cost too much. We are arguing not about the ultimate solution, which is a fully salaried service, but about how we can treat school children who require dental treatment, not in 10 years' time, but tomorrow and next week. The clinics are not available, and yet the letter says that the children cannot be allowed to go to the general dental service because it would cost more to have the treatment carried out in that way.
573 Will the hon. Lady the Parliamentary Secretary allow the children's teeth to rot simply because that method would cost a little more? It appears to me that she would. But I doubt very much if the cost would be so much more. The hon. Lady is apt to forget that dentists in general practice are receiving a very low fee for the treatment which they give children at present. Even if it would cost more as a temporary measure, there was no justification for turning down the offer which was made in the manner in which it has been turned down.
The truth of the matter—as my right hon. Friend the Member for Ebbw Vale has so often argued in the House—is that too much of the planning of this country is done by the Treasury. This is a struggle between the local authorities and the Treasury about who shall pay for the school dental service. Children's teeth are allowed to decay while the Treasury and the local authorities argue who shall set up an efficient school dental service. It is ridiculous.
I appeal again to the hon. Lady. It is not too late to reconsider the matter. This is not a party political issue. This is an issue in which the whole of an honourable profession is trying to make a contribution towards the solution of a problem which is worrying all of us. Yet the Ministry, for narrow doctrinaire reasons, has simply shut its eyes to the offer, and said, "No, we cannot do anything about it."
I cannot do any more than I am doing tonight. I appeal to the hon. Lady and to the House to look at the matter again. We all have our political differences. The Minister made some very clever speeches in this House which have been proved completely hollow. Never have more crocodile tears been shed in this House than by the Minister and the hon. Member for Luton (Dr. Hill) about the neglect of children's teeth. Here is an opportunity to do something about it. But the Government say, "No, let the children's teeth rot because we have not enough money to pay for the proper treatment."
§ 9.50 p.m.
§ Mrs. Eveline Hill (Manchester, Wythenshawe)
I should be much more impressed by the remarks of the hon. Member for Wolverhampton, North-East (Mr. Baird) if they had been made about 1948 or just after it. They are being uttered 574 now at a time when dental practitioners are not so busy as they were. In fact, it is only a week or so ago since we read a case in the paper of a dentist losing about £4,800 of his income because of a decrease in the number of patients. He put this down to the fact that there were now these dental charges.
We in the local authorities have been most anxious about this service and still are. We are looking to the Minister to help us in that direction, and I think he can. It is true that in the local authority service we feel that having the children dealt with in the school clinics is a surer way of ensuring that their teeth are treated, but we cannot always rely upon parents taking them to the clinics.
I want to emphasise that we are being urged, under a scheme propounded by the British Dental Association—again I say, at a very late date—to take this matter in hand, and I sincerely hope that the Minister will adhere to his idea that the school dental service is the best means of securing that attention for the children that we desire. I hope he will be able to help the local authorities in that direction.
§ 9.52 p.m.
§ Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)
This debate provides an opportunity to say a word or two about some of the very real problems in the dental service, not necessarily those created during recent months but the problems which have always been in that service and which today, no doubt, the Ministry are having to face.
It would be unfair to the dental profession, although I hold no brief for many of the things that they have done in the past, to suggest that this particular proposal is a wholly new one. It is, indeed, one we have heard of in the past, and I think it would be right to say that both my right hon. Friend the Member for Ebbw Vale (Mr. Bevan) and I took the view, unlike that of the heretic behind me, that the clinic service was, in this particular case, likely to be more valuable and that we were anxious to see it developed.
We were not altogether happy about the way in which treatment might be given in a private dental surgery. It is true, of course, that if there is no alternative 575 and no way of ensuring proper treatment for the children, then we must look again at the problem.
I wish to raise one or two particular issues, and I will not necessarily expect an immediate answer this evening, because I have not given notice of them. They are quite valid points that arise from the discussion we have already had. The Parliamentary Secretary would agree that the first fundamental problem in the dental service which we have is that of far too few dentists in the profession. A professional committee that was set up earlier examined this problem and estimated that we were many thousands of dentists short for a fully effective service.
§ Mr. Blenkinsop
Yes, a fully effective, free service.
It is true that many dentists are not operating full time, not because the need is not there—that is obvious—but because of the fact of the dental charges that have been imposed. That is one of the dangers today. The effect of the dental charges is to cloak the real demand for treatment that still exists. The matter is likely to become worse rather than better. I understand that already the effect of the charges, and the depression in the dental profession as a whole, has been to cut down the number of new entrants into the profession. That is a very serious matter indeed, from the long-term point of view.
Another serious factor is the falling away in conservation work. That is the very point that many of us raised from this side of the House when the new, additional dental charges were imposed by right hon. Gentlemen opposite, and it has been fully proved by events. There has been a falling away in the early treatment, and a tendency to pile up much more serious dental decay later; and figures have been given which show this to be true. We fully admit that the figures cover only the simple treatment given under the Health Service.
Nowadays, the full charge is very often imposed for all treatments costing up to the maximum figure. Many people are said to be taking their treatment privately for the less expensive items. That may be true; nevertheless, all the contacts that 576 I have with the dental profession suggest that there is a very serious falling away of the most vital part of dental treatment because of the charges that have been imposed.
An effect of the rather peculiar system of charges has been to bring to light a number of very serious criticisms about the way in which some dentists are tackling the problem. It is alleged, in many cases which have been sent in, that if patients come in for relatively small items of treatment the dentists are charging the full £1. Some patients say that they cannot get any treatment today from a dentist for under £1. This is a matter that needs investigation.
I am not expecting the hon. Lady to be able to reply to this point tonight, but I hope she will be willing to say she will investigate any cases that may be sent to her. There is no hold over a dentist, who is completely at liberty to make what charges he wishes up to the £1 maximum. I do not know that we can do anything—[Interruption]—except to withdraw the charges.
§ Mr. Baird
The hon. Member for Croydon, North (Mr. F. Harris) interjected a remark into my hon. Friend's speech. I hope he is not suggesting that I am carrying out the unethical practice of charging up to the £1. I do not know any dentists who do it. It is true that dentists may charge anything up to £1, but I do not think there are many dentists who carry out that practice. Certainly, I do not.
§ Mr. Blenkinsop
My hon. Friend the Member for Wolverhampton, North-East (Mr. Baird) is absolved, but there is no doubt that these complaints are made, and I shall send in those of which I have information, illustrating what fees can be charged under the £1 maximum.
I will briefly mention one or two other points. I fully agree with my hon. Friend the Member for Wolverhampton, North-East that the only solution to the problem is a long-term one.
§ It being Ten o'Clock, the Motion for the Adjournment of the House lapsed, without Question put.577
§ Motion made, and Question proposed, "That this House do now adjourn."—[Mr. Kaberry.]
§ Mr. Blenkinsop
The only long-term solution of this problem is the institution and development of a full salaried dental service, with the addition possibly of some sessional work. In that field I believe we could make a start by developing the existing service plus possibly the utilisation of some efficient private dental surgeries again on a salaried or sessional basis. I agree with my hon. Friend that many of the problems in the dental service have arisen because of the fee basis.
In our long-term consideration of this problem we should seriously think about whether we cannot gradually replace that itemised fee service by a salaried or sessional service which would not only protect the general public, but the dental profession itself, against the abuses we have come across in the past and which we find even today within the dental profession.
§ 10.1 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
We have had an interesting debate on a subject which, as the hon. Member for Wolverhampton, North-East (Mr. Baird) has said, is of great concern to both sides of the House. In principle, there is no difference between us in that the greatest possible priority should be put upon dental treatment for children. We are on common ground that any time the dentists have available can best be devoted to the treatment of the teeth of children.
However, I think the hon. Gentleman was a little unfair in his criticism of the result of the charges. Although they may not have been effective until half-way through the year, many dentists knew that they were impending, and the rise from 713 to 827 is a substantial one in view of the manner in which the number of dentists in the school dental service dropped during the years from the appointed day until January this year.
Where we differ is on the best method of using the spare time which some dentists admit they have, and the most efficient method of using their skill for the betterment of the teeth of the children. The treatment of children under the general dental services since the appointed day, has always been available in private 578 practice for parents who accepted the responsibility of taking their children to the dentist and seeing that their teeth were properly seen to. It is true that there is more readiness to accept children now than there has been by some dentists in the past.
So far as the local authority service is concerned, which includes the school dental service, my right hon. Friends the Ministers of Health and Education firmly believe that by far the best method is to arrange with dentists to treat children in school or in local authority clinics on a full-time or part-time basis.
For this, there are four main reasons. First, we believe that the dental treatment of children can most effectively be provided in the clinics closely associated with school routine. A class or a section can be sent with the minimum loss of school time to one approved centre and with the least possible interruption of their education. The alternative offered is that a group of children should be sent to several surgeries of varying dentists in the general practitioners service.
So far as the younger children are concerned, they are provided for in the local health authority dental service arrangements for the care of mothers and young children. There, attendance is encouraged and provision for treatment is made to meet the convenience of the mothers.
§ Miss Hornsby-Smith
I will deal with that point.
The difficulty, which has been admitted on both sides of the House, is a shortage of dentists in the local authorities' dental service. If the time of skilled dentists is available we believe that the most efficient use of that dental manpower and skill will be in school clinics rather than in the dentist's own surgery.
The British Dental Association recognise that the public dental officer, working in a clinic, can make the best possible use of ancillary help, chair-side assistants and oral hygienists, as is being done in many school dental clinics today. In such a system the dental officer can play his full part and can achieve a most useful and satisfying position with responsibility for the full care of the children's teeth and for ensuring the children's attendance.
579 What are we offered in the British Dental Association's proposals? The responsibility will be divided. The volume of treatment which the public dental officer will do will be materially reduced. In the Association's own words, he becomes a co-ordinator. He will inspect and decide the treatment and will then tell the child or the parent to go along to a certain dentist. He will provide the child with a chit. From then on, his responsibility ends. The responsibility for seeing that the child goes to the dentist is that of the parent.
But if a parent wants his child to go to the dentist, there is nothing to prevent him from taking the child along now—and it is one of our regrets that more parents do not do so. Under these proposals, the public dental officer in the education or health authorities' service will be a co-ordinator, a glorified appointments officer. There is no doubt that the suggestion contained in this alternative scheme would seriously undermine the present local authority dental service. The children would go not to one centre, but to many dental surgeons. The times would have to be arranged not to suit one class or one group of children, but to suit the various times of the sessions offered by a host of individual dentists. This would involve many breaks in school hours and in the educational system.
Worse than that, the onus for keeping an appointment with a general dental practitioner would not be on the school authority, who, under the present system, can see that the whole of the treatment is completed. Once the child had been directed to a general dental practitioner, responsibility would rest with the parent. Surely such a plan is administratively cumbersome. It will increase the administrative work and dislocate far more the education of the child than does the present system. Indeed, it would go a long way towards wrecking what we admit is by no means a perfect system, but which we are taking determined steps to build up—the local authorities' priority dental services.
§ Miss Hornsby-Smith
I have not forgotten that point.
The fourth point with which I should like to deal in considering the question of the local authority dental service is that of the necessity for reasonable economy. If the most efficient means of using dental skill is in one centre or in a school; if that makes the minimum inroad into the child's education; and if the skill of the dentist—which is just as great when he is practising in a clinic as when he is practising on his own—can be more efficiently applied in the school dental clinic then, obviously, there will be greater economy in the service by using that method.
The treatment of children in clinics provided by dentists remunerated on the basis of the time they devote to the work costs substantially less, as the hon. Member pointed out, than would the treatment carried out in their own surgeries. I think the hon. Member was a little unfair when he laboured the point of the 7s. 6d. charge which, he knows, applies to milk teeth, since those for permanent teeth—which apply to a great many school children and adolescents—are the normal charges in the adult service.
The B.D.A. are asking the Ministries of Education and of Health to pay more for an outside service than they need pay for the same, or I believe a more efficient, service which could be conducted in the clinics. The hon. Member himself has suggested that the only reason why dentists will not go into the school dental service is a financial one. He said that at the start of his speech and twice reiterated it. If that is the case and there is this available time, is it asking too much that dentists should give part-time service, even one session a week, to the school dental service if it is their aim and intention to build up the teeth of future generations?
My right hon. Friends the Minister of Health and the Minister of Education feel that an improvement in the special priority services for children must be sought on the lines of expanding local authority clinic services rather than transferring part of those services to private surgeries. To this end, there are two Clauses which affect this project in the Education (Miscellaneous Provisions) Bill, now before the House. I believe that by the terms of those two 581 Clauses, making the provision of local authority clinics compulsory rather than permissive—
§ Miss Hornsby-Smith
Perhaps I might at least say, Mr. Deputy-Speaker, that it is the intention of my right hon. Friends the Minister of Education and the Minister of Health to take steps to ensure that there are increasing facilities for the treatment of children through the local authority clinics. My right hon. Friends the Ministers of Health and of Education put out a very strong recommendation to local health and education authorities to invite dentists to work in their clinics, either full-time or part-time. In some areas there has been a very welcome response, even to the extent of asking dentists if they will do one session a week.
With regard to the questionnaire which the British Dental Association have sent out, they informed us that a total of 583 practitioners were willing to work part-time not in their own surgeries, but to work for school dental clinics. I believe that the service would be more efficient if the provision of that skill could be made in a clinic. Surely, in the interests of the children, in the interests of the most efficient use of dental skill available, in the interests of the maximum return for public expenditure, those dentists could give that part-time service in the school dental clinics and best serve the children of this nation by seeing that they made their contribution—one session a week if they like—to build up the local authority clinics.
To that end, on 17th October, the Minister of Health invited the British Dental Association to supply the names and addresses of the high-minded gentlemen who are ready to help us solve the problem of the care of children's teeth. We could certainly absorb in existing clinics that number and the time which has been offered us, and we would probably soon require more. So far, our request to be supplied with the 583 names of the gentlemen who were prepared to help has been met with a cold silence.
§ Mr. Baird
That is a little dishonest. The British Dental Association offered a co-ordinated scheme—some of the dentists 582 to work in clinics, some in their own surgeries. It was a co-ordinated scheme, and I do not think it is fair of the hon. Lady to ask some dentists to accept unless she accepts the whole scheme which was worked out. A questionnaire went to every dentist.
§ Miss Hornsby-Smith
I am not challenging what the hon. Gentleman has said. I am merely suggesting that if the first concern of these 583 volunteers was the health of the children of this nation, if they were so anxious that the children's teeth should not rot in their heads, as the hon. Member suggested we wished them to do, their first concern would be to make a contribution to that service.
My right hon. Friend would have been remiss had he not seized the opportunity of asking for the names of those gentlemen in order that an approach can be made to them to see if they will carry their desire to see the children's teeth preserved to the extent of giving even only one session per week to the school dental service. If the first principle of the dentists is the future dental health of the nation, I believe that these names will be forthcoming. If—and I do not believe it is so—financial advantage ranks higher than child care we shall not get the names. I am content to leave the decision to the British Dental Association.
The public, rightly concerned about the deterioration in the school dental service from the appointed day until the beginning of this year, feel with us that the best service can be provided—I stress again with the least dislocation to the education of the child and with a maximum use of the dental skill available—in the local authority clinics. One paragraph in the memorandum sent out by the British Dental Association states:The first charge upon the resources of the profession for a service providing full and comprehensive treatment should be directed to the children, adolescents and expectant and nursing mothers.No one on either side of the House will quarrel with that. I believe that the public will judge the claims of the British Dental Association by their willingness to co-operate in the tried and proven method of the local authority service, where there will be a ready welcome for the service of any qualified dentist prepared to give, as I have already 583 said, as little as one session a week to the care of children's teeth and the future well-being of the nation.
Other points were raised by the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop). The first point he raised was that of dentists who were charging more than the normal set fee for fillings when that fee should be under £1. There is this power of redress in such matters: we would be very ready to investigate but, as the hon. Member knows, the procedure is that the patient should make a complaint to his or her appropriate executive—
§ Mr. Blenkinsop
There is, as far as I can see, the difficulty that there is nothing illegal about this practice because the work can be done outside the Health Service.
§ Miss Hornsby-Smith
Yes, I appreciate the hon. Member's point, but I believe that patients, knowing the charges—these are becoming more widely known—can point out what the appropriate charges are, and if they find that they are being heavily overcharged, they can, if they so desire, change their dentist. I believe most dentists are maintaining the fees which have been laid down, and which apply to the general dental services. I am trying now to think of the other points which the hon. Gentleman raised—
§ Miss Hornsby-Smith
Yes. There were two other points which were raised by the hon. Gentleman. The first was, as he claimed, the cutting down of conservative work. One result which already has been seen as a result of the changes in the priority given to the children and adolescents this year, is an increase in the work in private surgeries on the under 21's. This is now in a greater proportion than hitherto when there was a general free service. We are achieving the result that more adolescents are obtaining treatment than did previously.
§ Miss Hornsby-Smith
No. I can only tell the hon. Gentleman that there is a greater proportion being treated now than hitherto, and from his own experience the hon. Gentleman knows that to be true.
So far as new entrants into the profession are concerned it is not wholly a matter of them being put off. As the hon. Gentleman will know, a high standard and a high calibre of entrants is required. It is not so much a question of applicants not coming forward as not all of them being suitable or able to qualify and take the training. There is no very substantial falling off in the number of people seeking to enter the profession, as was suggested by the hon. Gentleman.
§ Mr. Blenkinsop
Would the hon. Lady agree that it is still one of our urgent needs to recruit more dentists into the profession and that there is still an enormous demand?
§ Miss Hornsby-Smith
I do not deny that for one moment. I fully agree that we need far more dentists in the profession, but not at the expense of dropping the standard of entry.
I find it a little surprising that the hon. Gentleman should be so fully in support of a salaried service now when, presumably, from his experience and that of his right hon. Friend the Member for Ebbw Vale (Mr. Bevan) he must know that it must have been impossible so to persuade the profession. Or perhaps they themselves did not then believe in that principle and for this reason did not initiate that method when they introduced the Act in 1946.
I believe that the local authority service is expanding, despite the criticism of the hon. Gentleman, and can still further expand and that with the co-operation of the dentists we can meet the needs of the school dental service and preserve the teeth of the children in the coming generations.
What, in our view, is essential is that the children should have a chance to have their teeth attended to under the ægis and authority of their school dentists, as 585 we believe that this is the surest way of seeing that treatment is adequately and properly carried out.
§ Mr. Blenkinsop
Would the hon. Lady agree that while it is true that at the time of the introduction of the service, because of the attitude of the dental profession, and so on, it was not possible to introduce it on a salaried basis, all experience seems to suggest it would have been far preferable if it could have been done? Indeed, it might now be 586 possible, with some change in the climate of opinion at least to make some start on it.
§ Miss Hornsby-Smith rose—
§ Adjourned accordingly at Twenty-five Minutes past Ten o'Clock.