§ 3.54 p.m.
§ Mr. John Hynd (Sheffield, Attercliffe)
I beg to move, in page 12, line 33, at the end to insert:(10) If the Privy Council are dissatisfied with the manner in which the General Dental Council are carrying out the provisions of this section, the Privy Council may give such directions as they think fit as to the manner of carrying them out, and it shall be the duty of the General Dental Council to comply with any such directions.The purpose of the Amendment is to ensure that all the assurances that have been given by the Minister about the registration of foreign dentists shall be carried out in the spirit of those undertakings. I am not casting any aspersions on the future General Dental Council, but I am suggesting that in the interests of the Council itself there should be some means whereby it will be possible for anyone who is dissatisfied with the carrying out of these provisions to bring the position to the notice of the Minister so that it can be considered and, if necessary, put right by the Privy Council.
In Committee and on Second Reading hon. Members expressed the misgivings felt not only by a large number of foreign dentists who have failed to obtain registration in this country, but by a large number of organisations and individuals who are interested in the position. As I said on Second Reading, I do not think that there is any question at all that at least in the late stages of the war and immediately afterwards there was resistance on the part of dentists and doctors to the acceptance of large numbers of foreign practitioners, whatever might have been their qualifications.
Although the Bill seeks to rectify the position which made it impossible for such dentists to become registered on the basis of their previous qualifications and whatever refresher courses and examinations might be provided for in the Bill, there still lingers in the minds of large numbers of people the question of how ready the General Dental Council will be to 382 warmly welcome them to its register, after being satisfied in accordance with the provisions of the Clause that these people have the appropriate qualifications and have passed the practical examination.
I feel that it would be a very necessary reassurance to these people and those who are interested in their fate that there should be this reserve provision if there should be any doubt that the General Dental Council, whatever its quality, was not carrying out the assurances given on Second Reading and in Committee by the Government. After all. there is nothing in the Bill which insists that the Council should carry out the Minister's assurances as to what he thinks would be done. I hope that there will be an assurance to these people that in the last resort a body, independent of the Council, could review the position and ensure that what has been said in the course of debate will be put in practice.
There is one factor which arises out of this situation and which was mentioned on Second Reading, but not made clear in Committee. It is that, in connection with the practical examination which is to follow, opportunity be given to these foreign dentists to practise in hospital so that they can renew their facility in handling equipment; provision should be made for maintenance grants whilst they are so practising. We have not had a firm assurance from the Government in that respect.
I move the Amendment with the greatest good will and appreciation of the readiness of the Minister and the Parliamentary Secretary in Committee to meet practical and constructive propositions. I hope, therefore, that the Minister will refer to this matter and give us some assurance. This is not a controversial issue and I hope that the Government and the House will be prepared to accept the Amendment which has no effect at all on the General Dental Council but gives the assurance which I have suggested is necessary.
§ 4.0 p.m.
§ Mr. F. Beswick (Uxbridge)
I beg to second the Amendment.
During the Second Reading debate, and throughout the different stages of this Bill many sympathetic references have been made to unregistered dentists. There is no doubt that these people are of good 383 character and of proven professional qualifications and skill. They were all practising dentists until Hitler upset all civilised values on the Continent before the war.
Up to a certain date before the war these refugees were permitted to register and there are about a hundred practising today, their standards being of the highest. If any hon. Member wishes to know why I speak with such assurance on this point it is because my family and myself were treated by one of their number for many years. This dentist had a high reputation in Hamburg before the war, he built up a similar reputation in this country, though, sadly, he has now passed away. If we could give some assurance to those of his colleagues who are still not registered we would give satisfaction to many people and we would be helping ourselves at the same time.
It is agreed by all that some refresher courses will be necessary. We have received assurances that facilities for such refresher training will be provided. Where the doubt arises is in the examination which, it is said, should follow that refresher course. The Parliamentary Secretary made the point that if a person needs a refresher course it is also reasonable to see that the need has been satisfied by the course, and that as a result the standard is brought up to the necessary level.
I accept that point, in which there is much substance, but here we are up against the question as to precisely what examination or test will be applied, and it is on that part that there is a good deal of anxiety. Many hon. Members of this House with professional standards, no doubt of the highest, would, if they were asked to pass an academic examination at their present age, experience similar anxiety. During the Committee stage the Parliamentary Secretary made it clear that the examination should be mainly practical. She went further and said that—… everything possible should be done to allow anyone who is qualified to the standard reasonably accepted in this country to qualify here and register."—[OFFICIAL REPORT, Standing Committee A, 15th November, 1955; c. 16.]That seems a fair undertaking, but there remains the doubt about the 384 examination and the additional doubt, to which my hon. Friend referred, as to whether the assurances given by the Parliamentary Secretary and the Minister on this point will be observed after the General Dental Council has been established. So the object of this Amendment is to give additional assurance to these people and to make the assurances binding on those concerned.
We are really asking to be assured that the decision as to whether or not these people should be permitted to register should not be decided solely on the basis of one examination or test, even if it is practical. We want all the appropriate circumstances to be taken into consideration; for example, the fact that these people are already holding diplomas which have been accepted in the case of other dentists practising in this country. We want taken into account the record of their previous experience and their general aptitude during the refresher training as well as the practical test which may be applied at the end of it.
I hope that the Parliamentary Secretary or the Minister will be able to give those assurances. It will give added weight to the assurances already given in good faith if the Amendment can be accepted.
§ Mr. Barnett Janner (Leicester, Northwest)
I rise to support this Amendment and in no spirit of antagonism to the General Dental Council or to anybody concerned with this matter. My hon. Friend the Member for Uxbridge (Mr. Beswick) rightly said that those in professions know well, after having practised for a number of years, that they would now find difficulty in passing examinations for which they sat many years ago. The reason is obvious. There are certain technical points, certain aptitudes for study, which are not as readily available to people who have been practising for years as they are to students.
I would point out, however, that practise is of great importance in a profession and that experience is the main thing. A dental surgeon who has had considerable experience both abroad and here might not be able to pass a test set by so important an organisation as the General Dental Council, which might be rather more exacting about paper work or even practical work than is necessary for dealing satisfactorily with patients.
385 There are two matters involved. First, there is the question of men and women—I do not know how many there are left, but there are some because I have had requests from such people—who suffered heavily under the Hitler regime. They had built up good practices in their own countries but, through no fault of their own, were driven from them and today they are grateful for the hospitable way in which they have been accepted in our own country.
It is not only a question of earning a livelihood. It is a question of the frustration that comes to people who were high in their professional circles and work in their own countries because they cannot carry on their work and yet are anxious to do something to help the situation in this country, apart from anything else. Sometimes the incredible argument is used that the fact that these people had not sufficient practical experience when they were students should now be taken into consideration. In my view, years of practice are infinitely more important to a professional person than the hours spent qualifying for degrees or diplomas prior to the time when they started to practise their profession. In many cases a man only begins to understand his profession after passing his final examinations. That is when he begins to understand what is needed.
The fact that there are still a number of people who have been refused permission to practise indicates that something must be wrong. Men of experience and holding diplomas of a fairly high standard in their own countries ought not to have been kept out of the dental service. In view of that, and knowing the Minister's good will—because of our experience in other directions, some of us know that he is sympathetically disposed towards those who are in difficulties—and knowing that he wants competent people to have a full opportunity to practise in the profession, I ask him to relieve the distress of these people by accepting an Amendment on the lines of the one which has been moved.
If the Minister thinks that a different provision would meet the case, by all means let him say so. It might even be a help to the General Dental Council to know that its decisions could receive reconsideration at some time, because it realises that it is not entirely omniscient 386 in these matters. I urge the Minister to consider our proposal favourably and, if possible, to accept the Amendment.
§ Mr. Stan Awbery (Bristol, Central)
By means of Questions, I have on several occasions during recent years referred to the position of dentists who came from Germany, in particular, during the war or just before it and wished to practise as dentists but were prevented from carrying on their profession in this country. I tried to induce the Minister to allow them to do so, but I was told on almost every occasion that it was necessary to wait for a Bill.
A Bill was prepared in 1950, and the hopes of these people were raised considerably. Then the Government changed, and the Bill was withdrawn, and their hopes were shattered. The present Measure provides a belated opportunity to rectify an injustice which has existed for a large number of years. Although it is belated, it is nevertheless welcome.
The number of people concerned has dropped considerably since I first raised the matter. I understand that there are now in the country only about 30 such people who are fully qualified and possess a German diploma in dentistry equivalent to the qualifications required here. I estimate that our refusal to allow these people to practise has lost us 4 million to 5 million treatments, with the result that the dental health of our people has deteriorated considerably. Some of the people who originally came to this country have since gone abroad because they could not obtain a livelihood here, and some have given up dentistry.
It is almost too late to remedy the effects of our inaction, but I am glad that the Minister is about to do something. I want a definite promise that these people will be dealt with in a human way. In the past, they have been dealt with by the General Dental Council, and they have been turned down for such reasons as those mentioned by my hon. Friend the Member for Leicester, North-West (Mr. Janner).
These people, who have been prevented from securing a livelihood, came here to escape a tyranny worse than that of Pharaoh. They came here seeking refuge, believing that this country was the home of freedom and democracy, because 387 we have always boasted about keeping our doors open for political refugees whether they be kings or paupers. They came here feeling that this was the freeest country in the world. We gave them a very warm welcome, and their faith and 'Confidence in us was great. Crossing the Channel and seeing the white cliffs of Dover they said, "This is our land of Canaan, a land in which we hope to live a life of freedom."
What did they find? They were very warmly welcomed by their friends, but they found that, while we did not deprive them of their lives, we deprived them of the opportunity of earning a livelihood. What is the difference between depriving a man of his life and depriving him of the opportunity to earn a livelihood? What must be the feeling of the thirty men now in this country after their experiences and disappointments here?
Our treatment of these people during the last twenty years has been a blot on our fair name. I am glad that the Bill will do something to wipe out the blot. I should like an assurance from the Minister that the blot will be wiped out, and that it will not be left in the hands of the General Dental Council to put these people through a sieve and to decide, if they cannot pass an examination after having been out of the profession a number of years, that they cannot practise. I want an assurance that if these people hold a German diploma equivalent to the qualifications required in this country they will have an opportunity to practise. I agree that it is necessary for some of them to have a refresher course either in a hospital or with a practising dentist, and I think that they should receive some help towards their maintenance during the short period of the course.
I am afraid that the Bill will transfer responsibility for these people from the House of Commons to the General Dental Council. We know these people, and their qualifications will be known by the General Dental Council, and I want an assurance from the Minister that their qualifications will be accepted after they have had a refresher course. I do not want them to take a further test. It may foe argued that they ought to sit for an examination after having been out of the profession for twenty years. How 388 would some of our dentists who are now 50, 60, or 70 years old like to sit for an examination? They would find great difficulties and it would be even more difficult for foreign people. It may be argued that the standard in Germany is not high, but I have never heard that argued, because the standard of dentistry in Germany, as with that of many other professions in that country, is very high. Our standard is not beyond criticism. Sir Wilfred Fish, Chairman of the Dental Board of the United Kingdom, has himself condemned our standards in strong terms.
In the Press, about a week ago, I saw reports of speeches referring in eulogistic terms to refugee scientists. When scientists come from the Continent to help us in atomic researches they are welcomed and eulogistic speeches are made about the work they have done. That is mainly in the realm of destruction, scientific preparations for the destruction of human life. We are now dealing with scientists who will help the health and well-being of the people. Why stop them from working for health as others are working in atomic research for weapons of death? We accepted scientists before 1937——
§ Mr. Speaker
The hon. Member for Bristol, Central (Mr. Awbery) seems to be going wide of the Amendment. The Clause deals with registration in Commonwealth and foreign lists. Provision is made for that and the purpose of the Amendment is to give the Privy Council supervision over the operation of the Clause. The hon. Member should not bring in the story of refugees, whether scientific or dental. If the hon. Member will direct his argument to the point of the Amendment, I am sure that the House will be much obliged.
§ Mr. Awbery
The point I was making is that people who are qualified dentists will be deprived of an opportunity of earning their living. I hope that the Minister will give us an assurance that they will be allowed to practise.
§ Mr. John Baird (Wolverhampton, North-East)
I have every sympathy with the views expressed by all my hon. Friends. Many of these refugee dentists have had a very hard deal indeed. However, we must recognise that at least the Bill goes a long way to meeting the difficulties of those dentists and the House 389 must also recognise that one cannot allow a foreign dentist to come here, put up his plate and practise dentistry. There must be a body competent to judge whether he is of the standard to be let loose to practise dentistry on the people.
The only ones who can judge that standard are professional people. I should like to know what this discussion has to do with the Amendment. The Amendment simply says that if the General Dental Council does not do the job, the Privy Council can step in and order it to do the job. So far as I know, there is no other registered body, like the General Medical Council, or the Nursing Council, which has had such an Amendment inserted into its constitution.
As the House knows, I have not always been too friendly with my dental colleagues, but with the coming of the Bill 1 believe that the House as a whole has started afresh and that we politicians and the dentists will be friendlier for it. The main purpose of the Bill is to set up a General Dental Council and to give dentists more confidence in themselves and thus to stimulate recruitment. Yet one of the first things we do is to slander the profession by saying that we do not expect its members properly to carry out the job and that we should, therefore, have safeguards to protect foreign dentists. This sounds like a slur and I cannot see the necessity for it.
I am sorry to have used those words, but hon. Members who have spoken have not so far applied themselves to the point of the Amendment at all and I should like them to tell us why it is necessary to have the Amendment, unless they feel that the General Dental Council will not do the job.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
Two points arise from the speeches we have heard. The first is from the general desire of all hon. Members that everything possible should be done to make it practical and possible for foreign dentists who are qualified to the standard required in this country to register on the General Dental Register. That is fully supported by both sides of the House. In Committee and on Second Reading assurances were given that it was the intention that provision should be made for refresher courses and the like 390 so that people in that category could so qualify, if they had the ability.
The main part of the Amendment deals with the method, and I must agree with the hon. Member for Wolverhampton, North-East (Mr. Baird) when he suggests that however charmingly put, and however Members may deny any slur on the new General Dental Council, there is in the Amendment an implied criticism of the Council's integrity and a suggestion that there will be a bias on the part of the Council in carrying out the duties imposed upon it. We have to recognise that the Bill gives the dental profession autonomy and self-government for the first time, very much in parallel with the autonomy enjoyed by the medical and legal professions.
I should like to know what the hon. Member for Leicester, North-West (Mr. Janner) would say if, when a lawyer wanted to practise in this country, the decision was made by a body other than the Law Society. What would the hon. Member for Bristol, Central (Mr. Awbery) say if a certificate of proficiency in a craft were decided by people outside that craft?
§ Mr. Janner
The hon. Lady has drawn my attention to the fact that the various councils of various professions are sacrosanct. Is she aware the whole reason for the Amendment was that the General Medical Council would not allow people to become dentists at a time when they would have been and could have been very usefully employed?
§ Miss Hornsby-Smith
Perhaps the hon. Member will read the Bill. Its whole purpose is to give the General Dental Council permission to include them. The very essence of this Clause is to enable those people who can so qualify to be included within the lists. It would be a very grave reflection on this new and autonomous body if we were to suggest that its members were not as qualified to judge in their own profession as the members of other great professions and if we were to say, "You can judge English, Scots, Irish and Welsh, but not foreigners." That would be a reflection on the members of the General Dental Council which I am sure they would resent.
To deal with the points raised and to give further assurances, if they be needed.
391 regarding what will be the position of those who will apply to be registered, particularly German dentists, who have hitherto not been accepted on the register, I want to make clear one point which has been misunderstood in some quarters. It is not true that all foreign dentists are banned. Certain foreign qualifications are recognised as being of a sufficiently high standard to render admission to the General Dental Register permissible.
There remains the comparatively small number of dentists—mainly those in which hon. Members are so interested—who have foreign diplomas which have not been considered to provide a sufficient guarantee of the holder's ability to practise dentistry in this country. In some cases it has been difficult for the Dental Board or the General Medical Council to obtain details of their training and qualifications. Under this Bill, provision has been made—we understand by refresher courses if necessary, and by a test which we believe will be mainly practical—to enable dentists to establish to the satisfaction of the profession that they have the requisite knowledge and skill. It leaves the decision as to the precise nature of that examination and refresher course in the hands of the General Dental Council, but that is comparable with the practice followed in like professions.
I find myself in some difficulty in meeting the rival requests made by hon. Members who have been pressing the claims of these foreign dentists. Many hon. Members pressed for a practical refresher course. During the Second Reading debate and the Committee stage we gave an assurance that we believed that this was the intention of the Council—and, indeed, it would certainly be made known to the Council that it was the wish of this House. Hon. Members have also asked that after the practical test there should not be any further test.
Even more than the position of these dentists, I think we have to consider the patient. No one has mentioned the patient in this debate.
§ Miss Hornsby-Smith
I apologise to the hon. Member.
392 We have to be practical about this. The hon. Gentleman mentioned people who have not practised for twenty years; people who were 50 years of age when they came to this country. It may well be—sad though it is—that someone who is now rising 70 and who has not practised for twenty years will not be able to regain his dexterity. It is not only a matter of learning from textbooks, it is also a question of the dexterity of a dentist. It may well be that there will be dentists who are not able to pass a practical test and we must face that possibility.
§ Mr. Awbery
Could not that be determined by the refresher course, or by their spending a short time with a practising dentist?
§ Miss Hornsby-Smith
Rival requests have been made. Some hon. Members want a refresher course so that these people can get "up to scratch" and regain their dexterity before anyone tests them. Others want the refresher course to be taken as the test, which might be a reflection on someone who is unlikely to regain his dexterity. We must take a practical view of this difficult problem.
I assure the House that, following our negotiations with those whom we presume will ultimately form the membership of the General Dental Council, we believe that they have a sincere desire—accentuated by their realisation of the acute shortage of dentists—to enrol any dentist who can satisfy them that he has skill worthy of the standard which we require in the dental service. I do not think it fair to ask them to go beyond that, or to suggest that automatically, people who have not practised for years should, because they held a diploma fifteen years ago, be put on the Register when they may have lost their skill and may not reach present day standards.
I think that many of these people will qualify, but it would be over-optimistic to think that all will. We must remember that these new provisions make it possible for foreign dentists with all types and kinds of qualifications, to apply to come on the Register in addition to those whose welfare hon. Members have so much at heart.
§ Mr. Beswick
The hon. Lady referred to foreign dentists, but she might like to 393 be reminded that the people we have in mind are, in fact, British citizens with foreign diplomas.
§ Miss Hornsby-Smith
The Regulations cover not only those who have acquired British nationality, but those foreign dentists who have come to this country and wish to practise. There may be some who will in the future establish British citizenship and wish to practise, having originally acquired foreign degrees or diplomas.
To accept this Amendment would be an affront to the newly established autonomy of the Council. It would put it in a position not comparable with the councils of other professions. Surely, in the last resort only professional people qualified to do so can judge the standard which, after all, they enforce on every British dentist who qualifies to go on the Register. I am sure that the Council will treat these applications sympathetically and that facilities will be provided for the three months' practical training or refresher course, if it is applied for and required. In the hope that the new Council will feel that it has been fairly treated by the House and that no aspersion has been cast on its ability to judge in this matter, I ask the House to reject the Amendment.
§ Mr. Coldrick (Bristol, North-East)
I support this Amendment because I believe it wrong for the House to select a small body of professional people and grant to them special provisions and power which we are not prepared to grant to other people. I am amazed to hear the Parliamentary Secretary speaking so eloquently on behalf of a small professional body when, presumably in common with other hon. Members opposite, she would fulminate against a number of bummarees trying to exercise far more limited powers than those which are sought here so far as the Dental Council is concerned.
I am bitterly opposed to this form of snobbishness which confers on professional people a power to determine certain things which we are not prepared to accord to others. While we are all in favour of laying down the highest possible standards of professional skill for dentists, I do not think we should allow people engaged in the profession to be their own judge, jury and everything else. Instead of the Privy Council being accorded this 394 privilege, I believe it to be one which should be exercised by the Minister.
In other industries we reserve the right of the Minister to issue general directions and I cannot see why we should not limit the power of this body in order that they should be over-ridden, provided the Privy Council deems that an injustice is being done. I am therefore prepared to support the Amendment, which will curtail their power and safeguard the general interest.
§ Sir Frederick Messer (Tottenham)
I am jealous of the authority of a registering body. Probably—I hope at no far distant date—we may be considering regulations to do with the registration of medical auxiliaries. I hold the view that the profession should have a considerable say in the determination of the type of people and the standard which the professional must attain in order to be registered. We cannot expect a body such as a registering authority to be able to carry out its work if it feels that behind it there is another body who can at any time question its right to do so.
That does not mean that I oppose the arguments which have been adduced. I am in favour of an easier access to the register than has been noticeable in the past. We must remember that the registering body for dentists was formerly the General Medical Council, which was very largely inhibited, because it was afraid that it might accept too broad a standard, which the dentists would not like. The Bill gives responsibility to the dentists, but it is not true to say that the General Dental Council is composed entirely of dentists. There is to be university representation, for educational purposes, and there will also be laymen who represent no special interest.
I should be glad of an assurance that a more generous attitude will be shown towards the possession of foreign diplomas and degrees, although I appreciate that, simply because we wish to help certain foreigners, we cannot allow an inferior standard to receive recognition on the register. If that problem can be overcome there will not be anything dividing the House. There is no reason why the argument put forward in respect of the Dental Council with regard to registration should not be accepted in regard to the General Medical Council 395 —and if such a provision were applied to that body the consequences would be powerful.
§ Mr. J. Hynd
I am rather disappointed with the Parliamentary Secretary's statement and with the intervention of my hon. Friend the Member for Wolverhampton, North-East (Mr. Baird). I was hoping that the Amendment might be accepted, thereby providing a reaffirmation of the assurance already given by the Minister and the Parliamentary Secretary. I was surprised to hear my hon. Friend say that because this provision has not been embodied in previous legislation it cannot possibly be considered in relation to any new legislation. If we work on that principle we may go right back to the Star Chamber. We shall not get very far forward.
As my hon. Friend the Member for Tottenham (Sir F. Messer) has Just said. this provision might be applied to the General Medical Council and other similar bodies. I do not think that there would be any objection on the part of the Council if an opportunity were provided of reviewing its constitution, but we are now considering a new legislative Measure and there is every reason why, in doing so, we should be able to benefit from the experience of the past.
I also object to the Parliamentary Secretary's statement—which was agreed to by my hon. Friend the Member for Wolverhampton, North-East—that this may be considered as some kind of reproach to the future General Dental Council. It will be nothing of the sort—or, if it is, the whole Bill is, because it consists of about thirty pages of instructions telling the Council what it may and may not do, and under what conditions. The Bill provides for appeals, under certain conditions, and I do not see why that should be resented, because we are handing to this new Dental Council a very high responsibility and giving it a very honourable position in the professional world. No responsible professional man could have any objection to it being made clear that if an individual felt aggrieved at the ruling of the Council he could follow a line of appeal.
The Parliamentary Secretary said that the Amendment would be an affront to 396 the Council. The wording of the Amendment is copied from an Amendment by the Minister himself in page 17, line 24, in relation to Clause 20 which says:If the Privy Council are dissatisfied with the manner in which the General Dental Council are carrying outcertain obligations, it will be able to give directions to the Council. It is too bad for the Parliamentary Secretary to attack the Amendment on the ground that she has when its wording is taken from the Minister's Amendment to another part of the Bill. If the Government are not prepared to accept the Amendment at this stage, I hope that note will be taken of what has been said in this debate when the Bill reaches its further stages. The terms of the Amendment might be improved, but an Amendment on similar lines should be provided in order to reassure everybody that there is to be fair play all round.
§ Amendment negatived.