§ 12.4 p.m.
§ Mr. R. E. Winterbottom (Sheffield, Brightside)
On 6th April I addressed a Question to the Minister of Labour and another Question to the Minister of Health in connection with the dearth of dental technicians in the country.
§ Mr. Winterbottom
The National Joint Council for the craft of dental technicians decided in 1947 to alter the description after a royal battle about what they should be called. Therefore, I must correct my hon. Friend in that respect, and I must call these people by the description which they themselves have chosen, which is that of dental technicians.
§ Mr. Pannell
They do the same work as the dental mechanics used to do. Do they get more pay because they have a better-sounding title?
§ Mr. Winterbottom
I am afraid not. Their duties relating to prosthetic treatment are much wider than in the days when they were called dental mechanics.
My Question to the Minister of Labour asked for the number of dental technicians who were then employed compared with three years previously. The Minister of Labour said that he regretted that the information was not available. I can well understand that reply. I understand that the Minister of Labour has, in terms of statistics, the whole of dentistry grouped together, and, therefore, in his records dental prosthetics, dental nurses, dental receptionists and even dentists and dental surgeons themselves are part and parcel of a whole collection of dentistry, and he cannot segregate the branches.
On the same day I put a Question to the Minister of Health asking him whether he was aware of the loss to the craft of dental technicians of numbers of highly-skilled dental technicians and what steps he proposed to ensure that that trend would not destroy the possibility of having a comprehensive dental service. I received the following reply:I am not aware of any loss of dental technicians likely to lead to a serious difficulty 1345 in the future."—[OFFICIAL REPORT, 6th April, 1954; Vol. 526, c. 31.]I quarrel with that reply. It conveys that the Minister does not know very much about what is happening to the craft of dental technicians, or it is a very impolite way of telling me that he could not care less, or it may be that he neither knows nor cares about dental technicians. I hope that the matter which I am now raising, the employment of dental technicians in the National Health Service, will inspire him and the Parliamentary Secretary to give it the fullest possible consideration.
The problem is that large numbers of highly skilled dental technicians are now unemployed. Figures given to my hon. Friend the Member for Wolverhampton, North-East (Mr. Baird) on 16th April, 1953, indicate the situation since the cut in the dental services about two and a half years ago. In reply to my hon. Friend, the Minister of Health gave figures relating to applications for dental treatment during the last three months of 1951 and the last three months of 1952. They related to applications to the Dental Estimates Board by which applications have to be approved before treatment is given and appliances are provided. The reply showed that there were 42,000 fewer applications in the three months 1952 in compared with the corresponding period in 1951. This indicated that there were 160,000 fewer applications for dental prosthetic services in 1952 than in 1951.
Although it is difficult to got official confirmation, I believe that this decline was intensified in 1953. These figures are such as to cause distinct alarm, because, in effect, they show that dental health is now at a discount. They also reveal a serious situation of unemployment in the highly-skilled branch of dentistry—the craft of dental technicians.
In the absence of official figures—and that is why I began by referring to my Question to the Minister of Labour—I have to fall back on facts and figures collected in my own investigations and those of my trade union, and I may say that my trade union represents the whole of the dental technicians throughout the country, with the single exception of London. The following are some of the figures to which I would call the attention of the hon. Lady the Parliamentary Secretary.
1346 In Preston, in 1949, 39 dentists were employed—and I am now speaking of dentistry as it was as a result of the 1921 Act, and including both dentists and dental surgeons, as well as others. In addition to the 39 dentists in Preston, there were four laboratories for the profession of making dentures, and that meant, collectively, a total of 36 dental technicians. There were also 27 apprentices. In 1953, there were 27 dentists, one laboratory to the profession, 14 dental technicians and 10 apprentices, which represented a loss of nearly 60 per cent, to the craft. This is the direct result of cheeseparing within the National Health Service in respect of the dental services.
We now have highly-skilled men out of work, and I call the attention of the Minister to this fact, because seemingly, in his reply to my Question, he was completely ignorant of it. I could go through most of the towns and cities of this country and show that there has been a loss of technicians. In Bournemouth, the loss is 50 per cent.; in Coventry, 15 out of 29 technicians have lost their jobs; in Dundee and in Hull, the loss is also 50 per cent. The situation is the same in Newcastle, Norwich, Nottingham and in Scotland.
I should like to call the hon. Lady's attention to an extract from the "Yorkshire Evening News," of Tuesday, 11th November, 1953, in which it was stated that Mr. Frank Drew, secretary of the Leeds branch of the British Dental Association, said:In some cases, dental workshop staffs have been reduced by half and even three-quarters. It is said that some of these highly-skilled people were compelled to find work in other walks of life. In some cases, they have become milk roundsmen, in others fish and chip shop proprietors and things of that description.These occupations are honourable in themselves, but when a person has been trained in the craft of dental technician, I think there is some obligation on the health service of this country, and particularly the dental health service, to provide him with something in the nature of permanency in his employment. Mr. Drew also said:I know of travellers in dental supplies having to give up their work because of the serious falling-off in business. Large numbers are having to develop side-lines.The situation in the whole of dentistry is in line with that concerning the dental 1347 technicians, although I am speaking in the main for the dental technicians. The effect of the cuts in the dental service have not only been to create unemployment amongst dental technicians, but, in so far as they do that, they also create a loss of work to dentists and to all those ancillaries in the dental profession, and consequently affect the dental health of the country.
I do not know whether the hon. Lady has primed herself with any of the history of this craft, but we have to remember that this is a highly-skilled job, and if one wants proof of that statement, one has only to refer to the examinations which take place in respect of the craft of a dental technician. Very intense practical and theoretical study is imposed on a dental technician for a period of five years before he can be looked upon as being even in the initial stage of craftsmanship. Though I am not a dental technician myself and have never been directly concerned with the profession, I remember, as a trade union organiser actively associated with the National Joint Council for the craft of dental technicians, having had something to do with the rather elaborate and very effective schemes which were capable of real development from the point of view of dealing scientifically with dental health.
At that time, we had effective schemes of registration and apprenticeship. I want to tell the hon. Lady that it takes at least five years to teach a dental technician the rudiments of his job in terms of both practical and theoretical knowledge, and even then I have never known a technician with only five, six or even 10 years' experience who was very proficient in certain types of work, particularly ceramics.
I ask the hon. Lady whether it is wise, right or good for this country that we should have men who have been trained to do this highly scientific and technical job facing the dangers of unemployment, with a consequent loss to the dental health of the country? These people are necessary to dentistry. There are dental surgeons and dentists who came in under the 1921 Act and who know something about appliance treatment, but very few of them have the necessary time to do the highly-skilled work in the workshop or laboratory. It takes a lot of time to teach 1348 them extraction, X-ray work, remedial treatment, orthodontics and things of that kind, and they just cannot devote long hours to this painstaking work, which is wholly dependent on the dental technicians of the country.
These are some of the conclusions which have already been arrived at by fully representative bodies in this country which have made a study of the problem, and I should like to call attention to the fact that an Inter-Departmental Committee, presided over by Lord Teviot, pointed out the absolute necessity of dental technicians developing their craft to a very highly organised degree in order to be of the fullest service to the dental profession. That Committee not only deplored the insufficiency of dental technicians in 1946 or 1947, but, as a result of their excellent report, the craft itself advanced both technologically and in other ways. Tremendous advances have been made in the efficiency of the craft, but all this is now going to waste.
Today it would be very unwise on the part of any parents to apprentice a boy of 16 as a dental technician, because they would be placing him in a blind alley job. After five years' apprenticeship, in most cases, they are taken into the Army, and when they return from the Army they are dependent on their craftsmanship pay at the lowest rate. They find that they have six months' work, which the Army guarantees, and then they are pushed out into the street. The result is that many dental technicians serving in the Army never come back to the job for which they were trained, and that the highly-skilled, scientific experience they acquired in five years' training, as well as the money spent on it at places like the City and Guilds of London Institute, is wasted. While they are protected to a certain extent, very few of the technicians who are now employed in the laboratories, or by dentists and dental surgeons, are just out of their time. Only the older craftsmen are now employed. Those who have finished their time and have done their Army service find that there is no prospect in the craft. They are being dispensed with as fast as possible and are having to find other jobs.
What will happen if this country develops a dental health service, as it should? We shall be back in the position which existed in 1945 or 1946, when there 1349 was a shortage not only of dentists and dental surgeons but a grievous shortage of dental technicians. We must remember that many dentists are going out of the job as well.
I wonder whether the Minister cares. That is suggested by his reply to me a week last Tuesday. That is why I have raised this matter on the Adjournment. I called his attention to the very serious situation in respect of dental technicians and asked him to examine the position and see what could be done. It is wrong that modern society should say to highly-skilled craftsmen, "You are redundant these days, when scientific dental health is progressing at such an increased tempo."
The debates on the 1921 Dental Act proved that dental prosthetics are an integral part of dental surgery. So accomplished were these dental technicians in 1921 and so able to do their job that they were recognised in the 1921 Act to the extent that for 12 months they were allowed to enter the profession of dentistry. The dental health of the community demanded it.
When we have a dental health service in this country, we shall need both dentists and craft technicians who can do the work required, yet we are losing the skill of the people on the prosthetic side. I hope that the Minister will look urgently into the matter and protect this craft, which must not be wasted. We must take care that the people who have spent time and money studying the prosthetic side of dentistry do not do it in vain and that their highly-skilled services are not lost to the community.
§ 12.25 p.m.
§ Mrs. Freda Corbet (Peckham)
I have a long and abiding interest in this subject. It arises largely from the conception of the dental health service that I have, and the vital part it can play in the ordinary life of the individual. I have long wanted to see a thoroughly satisfactory dental health service.
Even at the time of the passing of the National Health Service Bill, I made it my business to bring to the attention of the House the part that these dental technicians, these prosthetists, might be able to play in a nationally-organised dental service. I was fortified at that time by 1350 the Minority Report of a Royal Commission which advocated that the dental service should be treated on all fours with the medical service.
In exactly the same way as a doctor examines a man with a damaged limb, finds out what the patient requires and then sends the patient to a skilled man, the dentist would treat the patient who required artificial dentures. The dentist ought to be able to pass the patient out as fit to receive the dentures. Then the prosthetists, about whose highly skilled craftsmanship we have just been hearing from my hon. Friend the Member for Brightside (Mr. R. E. Winterbottom), would be able to deal with the case, just as the fitter does with an artificial limb.
I look at the matter from that point of view because I understand the position with regard to the supply of dentures. Dentists were very scarce in 1946 and were quite unable to cope with a comprehensive dental service. Looking at that dismal failure, I came to the conclusion that it would be necessary to bring certain other skilled people to our aid so that the dentists we had might be able to do the more important work.
The job of the dentist, in the view of many of us, is to prevent the decay of the natural teeth and to preserve them for as long as possible. Owing to the shortage of numbers to which I have referred, the dentists could only contemplate dealing with the enormous job of a dental service if they were helped out by ancillary workers, who could get on with part of the job. I had the pleasure the other day, in company with the Parliamentary Secretary to the Ministry of Health, of seeing this job being done by hygienists now in training. They should be able to deal with some part of the work relating to children. I hope that scheme will prosper, and I wish it the greatest success.
I wish to draw the attention of the Minister to the point made by my hon. Friend that here among the prosthetists is another type of ancillaries to the dentists. The skill of this body of men ought not to be lost, and we ought not to be in danger of losing them from the profession owing to lack of work.
There is every case for a very careful inquiry into this matter. We realise that when the charges were introduced, there was a temporary setback to the service 1351 and that the number of people applying for artificial teeth diminished considerably. We realise that, but we do not suppose that such a state of affairs will persist. Indeed, we are very hopeful that people will again come to realise how important it is to rid their mouths of poisonous teeth and to substitute for them clean, hygienic artificial teeth which are nearly as good as those with which nature provides us.
It is the declared policy of the Labour Party that when returned to power they will remit the charges so that the people who need these things will be able once again to receive the complete service which they require. It would be a tragedy if we allowed ourselves to drift into the same situation with regard to these dental technicians as we have in regard to the dental surgeons themselves.
I know how interested the Parliamentary Secretary is in this matter, and how anxious she is to help. I can sympathise with her in so far as the dentists are a very highly organised body of people who are naturally loth to lose any of the privileges which they enjoy. But I ask the Minister to consider the needs of the nation rather than the needs of this small section of the community, and to consider carefully whether it would not be possible to set up an independent inquiry into the whole question in order to see if it is possible to utilise these dental technicians within the framework of a comprehensive dental service and thus enable us to make up for the lack of qualfied dental surgeons Which threatens the efficiency of the service.
§ 12.34 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
I am grateful to the hon. Member for Brightside (Mr. R. E. Winterbottom) for raising this matter, because there are several points which require clarifying. While I appreciate the very real and sincere concern felt by the hon. Gentleman for members of this profession, I simply cannot accept many of the allegations he has made. I hope to be able to answer some of them in the course of the debate.
The Ministry of Health recognises the importance of the work of the dental technician, which is to fabricate or to repair 1352 dentures or other dental requirements to the prescription or design of the dentist. It is a skilled and important job, and we fully recognise that it is essential to the National Health Service, although in only a very few cases are we in direct relationship with that service.
The majority of dentists come under the general practitioners' service and the dental technician is not directly employed or paid by us. Payment, as the hon. Gentleman knows, is made direct to the dentist who employs or contracts with these men to do this technical work. Therefore, the Ministry as such has no control over the entry of people into this profession, nor, in the main, any control over their direct employment. I think that should be made clear, because from what the hon. Gentleman has said it might easily go out from this House that these people are directly contracted or employed by us and that we have far more control over their option to enter the service or over their employment than, in fact, we have.
§ Mr. R. E. Winterbottom
I readily agree that most dental technicians are employed in private practice. There are also the dental laboratories which, in the main, serve private practice in the country. The services in the hospitals are distinct and separate. I agree with all that. Probably 95 per cent, of the dental technicians are employed in private service, but my point is that the cuts in the National Health Service are directly responsible for the resultant unemployment among these skilled people. That, surely, is the responsibility of the Ministry, even if the dental technicians are actually employed in private practice.
§ Miss Hornsby-Smith
If the hon. Gentleman will allow me to develop my argument, I am ready, and I hope effectively, to answer that point.
I think it fair to make plain at the start that these technicians are, in the main, privately employed by individual dentists and laboratory companies. They are trained in private workshops under apprenticeship agreements drawn up by the National Joint Council of the dentists and the trade unions concerned.
The real problem—and I say this quite frankly—is that we believe that at the present time there are more dental technicians than work for them to do, and 1353 I think that a fairly dispassionate study of the figures of people who entered the industry would prove that.
In 1948, 437 people entered the industry and applied for apprenticeships. In 1949, that number increased by 768 to 1,205. I think any dispassionate observer would agree that unless abnormal conditions were to continue, that tremendously increased number of people could not possibly anticipate full and continuous employment.
In 1950, owing to the immediate and high demand, five million dentures were supplied under the National Health Service. At that time, a large number of the apprentices were not sufficiently trained to be able to do this work, and, therefore, at the highest peak of demand, there were probably fewer dental technicians than in later years when the demand decreased.
I am sure the hon. Gentleman will agree that a jump in the numbers from 437 to 1,205 in one year, an addition of nearly double the existing number in 1949, is such a tremendous jump that any practical person must recognise that there are now more trained dental technicians than can reasonably be provided with full employment on this specialised work.
The hon. Gentleman made a great point about the charges, but I think it fair to remind him that those charges, which accounted for the most dramatic drop in demand for dentures, were imposed by his colleagues. I want to be fair about this matter, but I do not think that without the charges the level of 5 million dentures—the number supplied in 1950—could possibly have been maintained. In 1953, the number of dentures supplied was 2 million, and I think that this figure will represent the average annual demand.
§ Mr. Winterbottom indicated dissent.
§ Miss Hornsby-Smith
The hon. Gentleman is entitled to disagree. I think that that will probably be the level for some years. I hope that it will get steadily less. I do not agree with the hon. Member that if the service is a success we shall need more of these people. Rather, I think that if it is a success it will mean we shall want fewer because we want people to be encouraged to look after their teeth, to keep their own teeth longer, and to require fewer dentures. That is our goal.
1354 The hon. Member's forebodings as to the numbers of dentures provided are not, in fact, substantiated by the figures which I have here. He himself gave a figure of 346,000 in the last quarter of 1952. In the last quarter of 1953 the figure was 380,000, and in the first quarter of 1954, 394,000.
§ Mr. Winterbottom
Can the hon. Lady give corresponding figures? Can she give me the figures in terms of corresponding periods? I used October, November and December of 1951 and 1952. As there is something in the nature of a seasonal effect in this, one gets a better indication by using corresponding figures rather than periods which do not correspond with the term I used.
§ Miss Hornsby-Smith
The hon. Gentleman used October, November and December, 1952, and gave the figure of 346,000. I have given him the figure of 380,000 for the last quarter of 1953. I do not know what he is grumbling about. The latest figure I have, naturally, is for the first quarter of 1954–394,000—so the figures are getting better and not worse.
There is also the very reassuring fact that, as a result of the treatment charges which were imposed by the present Government, there has been a vast increase in conservation work, particularly with children and adolescents. That bears out the very determined policy of my right hon. Friend, which is that, as far as we possibly can, we should save people's teeth, and bears out the priority he wished to give to children and young people. I cannot accept the accusations made against my right hon. Friend by the hon. Member for Brightside, that my right hon. Friend desires either to cheesepare on this service or that he could not care less. In reply to a Question put by the hon. Member on 5th April, 1954, my right hon. Friend said:I am not aware of any loss of dental technicians likely to lead to a serious difficulty in the future."—OFFICIAL REPORT, 6th April, 1954; Vol. 526, c. 31.]In other words, my right hon. Friend is convinced that there is an adequate number of technicians to deal with the situation. I do not think that there is anything unfair in his reply or any could-not-care-less attitude in any way. I think that the hon. Member was less than just to my right hon. Friend's very 1355 real concern for the service. We acknowledge the fact that there was this great inflation in the numbers of apprenticeships, and we say, quite frankly, that we do not think the demand can absorb that number.
As regards technicians directly employed by the hospitals and local authorities, there are between 200 and 250 employed in the hospitals. All except about 80 are in the teaching hospitals. They have been less affected by the reduced treatment. The hon. Member will know that under the amending Act, 1952, the Minister, if he was satisfied that it was expedient in the interests of dental training to remit the charges for dental services at training hospitals, was empowered to do so. That has been done at eight dental teaching hospitals.
At the present time the Whitley Council is drawing up an apprenticeship scheme with reference to the training programme provided in hospital and local authority laboratories to see that there is comprehensive training, that the facilities are adequate and the staff sufficiently technically qualified. It is not for us to say, but I am quite sure that that body must also have considered in its calculations the number of apprentices whom it is practicable to train and whom in the future it will be possible to absorb into this industry.
§ Miss Hornsby-Smith
That is a matter for the Council and is not within our control.
Generally speaking, this matter is one of supply and demand. Our goal is first, preservation; secondly, repair; and, as a third and ultimate stage, the replacement of natural teeth. I cannot accept the attitude of gloom of the hon. Member, which seems to be almost as if the goal of the dental service should be that people should have artificial rather than real teeth. Our goal is to see a lessening in the need for dentures. I say, quite frankly, that there will be no dramatic drop in present levels. That is because of the increasing years people are living—and they are getting older. There is also the increase in population. I therefore do not think there will be any 1356 dramatic fluctuation around that annual demand of two million-odd.
There were one or two points raised by the hon. Lady the Member for Peck-ham (Mrs. Corbet). I do not know whether she is aware of the fact, but I think she may find herself in conflict even with her hon. Friend. She made some far-reaching proposals. She suggested that the dental technicians should be permitted to do prosthetic work. That, I believe, has been rejected by the very union which her hon. Friend represents.
§ Mr. Winterbottom
Does the Parliamentary Secretary mean that the hon. Member for Peckham (Mrs. Corbet) was suggesting that dental technicians should have access to the mouth and should do prosthetic work? It is true that the union of the dental technicians has rejected the idea of approach to the mouth by dental technicians, but said that they should concentrate on the craftsmanship side. That, of course, includes one thing which the hon. Lady has not taken into consideration, which is appliances for children's teeth.
§ Miss Hornsby-Smith
The hon. Gentleman is not disagreeing with me but rather confirming what I said. Under the Dentists Act, 1921, the performance of dentistry is limited to registered dentists. That, at the present time, includes the fitting of dentures. I do not propose now—and I hope that the hon. Lady will forgive me—to go into that highly controversial topic of whether or not there should be any extension there. She will be only too well aware of the controversy that arises on that point within the profession. I must say that to authorise dental technicians to fit dentures would be not only contrary to a very considerable body of opinion in this country—including many dental technicians themselves—but contrary to the practice in many other countries where we accept that they have established a very high standard of dentistry.
§ Mrs. Corbet
The hon. Lady is aware, of course, that there is quite a body of opinion among dental surgeons themselves that this work can be done adequately by the dental technicians without any harm to the patient. I am suggesting that it really ought to be looked at because, apart from the shortage of 1357 dental surgeons, I maintain that dental surgeons should be employed almost entirely on the work of preservation.
§ Miss Hornsby-Smith
I do not think that the hon. Lady and I are really in disagreement on this. I know how very wide is her interest in the dental service generally, and how great is her desire to see dental standards raised in this country. But whilst we have a shortage of dentists and a backlog of work to deal with, I think that my right hon. Friend has been more than justified by the results of putting the priority on conservation—we have seen the figures mount—and ensuring that there is certainly an adequate pool of technicians for the work likely to be available.
I am sorry that I am not able to give the hon. Gentleman any cast-iron assurance that it will be possible in the immediate future fully to employ this inflated number of available technicians. It would be unfair and unrealistic not to tell the House exactly what the true position is. I do not think we can ever anticipate a demand like the demand that immediately followed the introduction of the 1948 Act, but I would say that my right hon. Friend watches all these matters very closely. His responsibility is to see that there is the machinery by which the dental health policy can be carried out.
The numbers are available—alas, more than are necessary are available—but we do not feel that removing the charges would necessarily increase the number of pepole requiring the treatment which the hon. Gentleman anticipates. Nor do we believe that it would be correct policy to reverse the present trend of conservative treatment and, at considerable expense to the Exchequer, put the accent on dentures as opposed to conservative treatment. There is ample conservative work for any dentist at the present time. It is not a case of the dentist being denied employment because of the charges; there is ample work to be done. Therefore, we feel that the priority to which I have referred is right and proper.
While I have every sympathy with those members of this profession who entered in the peak year of 1950, I am afraid that I cannot hold out any hope that the demand for dentures will grow to anything like the peak figure, nor will it be possible fully to employ the large num- 1358 bers of people who have taken this training, beyond what I believe is necessary to comply with the normal law of supply and demand.