DENTISTS (ANCILLARY WORKERS) (Hansard, 10 July 1957)

§ The Parliamentary Secretary to the Ministry of Health (Mr. J. K. Vaughan-Morgan)
I beg to move, That the Draft Ancillary Dental Workers Regulations, 1957, a copy of which was laid before this House on 31st May, be approved. I do not think that I need detain the House for very long in explaining these Regulations. These are the first set of Regulations laid under the powers conferred on the General Dental Council. The nub of the Regulations is the provision for the establishment of a class of ancillary dental workers to be called dental hygienists. The duties as set out in Regulation 24 are the duties they will be permitted to carry out. I feel that we should wish this experiment the greatest success in the future. We all have great hopes about what it may do to help in the shortage in dentistry generally and we should congratulate the General Dental Council on its statesmanlike approach in bringing forward these Regulations along lines which meet the wishes of Parliament.

§ Dr. Edith Summerskill (Warrington)
We all welcome these Regulations, but I wish to ask the Parliamentary Secretary why so much time has elapsed between the passing of the Bill and the making of these Regulations. They are quite simple and elementary. No new principle is introduced and most of the matters were raised during the debate on the Bill. In view of the urgency of this matter, I should like an explanation.
I suspect that there has been some obstruction and I speak rather strongly about this, because we all know that there is a shortage of dentists and that those who are particularly suffering are the small children who are in need of conservative dental treatment. Although this was well known when the Bill was being discussed these Regulations have been delayed and I think it deplorable that people have had to suffer in consequence.
It will be recalled that the whole question of dental hygienists was raised many years ago and it was decided by the hon. Gentleman's Department to send a number of officials to New Zealand to examine the clinics there, which, for the most part, 507 were conducted by women dental hygienists. I was in New Zealand in 1944 and I visited the clinics there. I was particularly impressed by the treatment of the children. There were rooms in which perhaps 20 children were all being treated by these well-qualified women and there was not a murmur from the children.
As a consequence the child population of New Zealand was afforded excellent dental service, whereas the child population of this country is denied it. The officials came back and reported to the hon. Gentleman's Department and it was decided that a service such as is embodied in the Regulations before us tonight was desirable in this country. The children in the clinics in New Zealand not only had their teeth cleaned, polished and scaled, but also they had them filled and extracted. I am not pressing that extractions should be included, but I ask the Parliamentary Secretary why filling has not been included.
It is astonishing that a dental hygienist, a qualified woman, has to ask a qualified dentist whether she can clean and polish a child's teeth. It seems such an elementary thing that she should be allowed to do that. I accept that there should be a qualified dentist there, but if a qualified dentist is to be in attendance let her do something which the child needs, and that is filling. Otherwise, these Regulations will not serve the purpose that I am sure all of us wish them to serve. I ask the Parliamentary Secretary if he would consider whether the Regulations can be amended.

§ Sir Keith Joseph (Leeds, North-East)
I want to add only one word more of welcome for the Regulations, which go some way towards putting into effect one of the recommendations of the McNair Committee. We all recognise that there are not sufficient dentists in this country, even for the public demand that exists, and that the Committee stressed that the demand from the public is not high enough for a high standard of dental service. There is a problem here of public education as well as of providing enough professional men and assistants.
I very much welcome the Regulations. I would point out to the right hon. Lady the Member for Warrington (Dr. Summerskill) that it is by nature an 508 experiment and was recommended as such in the McNair Committee's Report. It may well be that if the experiment is successful it will be possible to extend it. I would like to correct any impression that the right hon. Lady may have given that the priority free service given to children and to nursing mothers has not been very much extended in the last few years. During the past year, one was able to welcome the fact that conservative treatment for children had very much increased, something which we all welcome.
I do not think that the right hon. Lady's words of gloom were fully justified. I welcome this step, modest though it is, in carrying out this McNair recommendation.

§ Mr. Somerville Hastings (Barking)
I would like to add my welcome to the Regulations, but not because the condition of teeth of the younger children is so very much better. The last Report of the Chief Medical Officer of the Ministry of Health said that it was considerably worse.

§ Sir K. Joseph
I was talking about the amount of conservation treatment given, and not about the quality.

§ Mr. Hastings
I was talking about the results of the treatment.

§ Mr. George Thomas (Cardiff, West)
Which is even more important.

§ Mr. Hastings
I welcome the Regulations, which will extend the scope of the rather limited dental manpower by a certain amount of dilution. Like my right hon. Friend the Member for Warrington (Dr. Summerskill), I would have been far happier if the dilution had been a little greater, and if the dental hygienists, after proper training—I have seen the training going on at the Eastman Dental Clinic—and in the presence of a properly qualified dentist, to whom the hygienist could refer at any time, were allowed to undertake a certain amount of stopping, or, at any rate, preparation of the teeth for stopping.
I cannot help feeling that that would be a very good thing. I would always insist on having a properly qualified dentist to look after my teeth, but some of the preliminary work of stopping could 509 be done by a less skilful or less highly trained individual.
I wish to refer to paragraph 6, "Fees payable for enrolments, etc." On enrolment the dental officer, who is called a dental hygienist, has to pay £ I have no objection to that. Investigation has to take place to make quite sure that there is proper qualification and I do not think that is very much, but what I do object to is that every year that individual has to pay another £1. Half a century ago I paid a fee—I cannot remember what it was—and got on to the medical register and I have never had to pay a bean since.
I do not see why the work of these dental hygienists should be considered so much greater in value than that of a doctor and that they should have to pay £1 every year. All they have to do, as is stated definitely in this Order, is to write to the registrar not later than 14th March each year and send their £1 and they are put on the register again. It seems a lot of money for that. I do not see why their retention on the register should not be continued for, say, 10s. I know it is statutory that they have to pay each year, and that they cannot be in my happy position, hut, although it is statutory that they have to pay each year, the Dentists Act does not say the amount they have to pay.
I should like to deal rather carefully with the question of the third fee which is mentioned in paragraph 6: For restoration of a name under regulation 5 of these regulations another £1 has to be paid. There are two reasons for a name being temporarily removed from the register of dental hygienists. It may be that the individual, for a good reason, no longer desires to practise her profession for a time. Generally, the person concerned is a woman. She may get married and then her financial circumstances change and she wants to come back on to the register.
Another reason may be that for some misdemeanour her name is taken off the register. In the first case, when she does not wish to practise for a time and then wants to come back on the register, we are told that she has to send to the registrar (a) The tee for restoration, of £1, and (b) The fee for retention in the roll … 510 and then certain certificates, if they are necessary. A total of £2 has to be paid before that individual, who for very good social reasons has allowed her name to lapse from the register, can have it restored.
In the case of a person who has had her name removed it has had to be a serious misdemeanour. If the individual has been convicted of an offence which if committed in England would be a felony or misdemeanour or she is alleged to have been guilty of any misconduct the registrar calls together the Ancillary Dental Workers Committee, which tries the case. The individual can be represented by counsel and can call witnesses.
If the case is proved, the individual is put off the register. The time may come, however—and it must not be until five months later—that he or she desires to be placed on the register again. What is the procedure? Again, the Committee has to be called and again careful inquiries have to be made.
I should like to read paragraph 20: 20. If, upon consideration of the application and of the evidence furnished in support of it, the Committee are satisfied that the name of the applicant should be restored to the roll, they may direct the Registrar accordingly, and, upon payment, where applicable of the fee prescribed in regulations 6 of these regulations for retention of a name in a roll, his name shall be restored to the roll. In other words, if a person misbehaves and is guilty of a misdemeanour, under the Regulations he can be placed back on the register for a single fee of £1, whereas if he has gone off the register at his own wish for a year or so for social or other reasons, he must pay £2 in order to get back on the register.
I do not know whether this has occurred to the Minister who framed these regulations, but it seems to me to be very unjust and I hope that he will give very careful consideration to this point, which seems to me important from the individual's point of view, before the Regulations are confirmed.

§ Mr. Vaughan-Morgan
I am grateful to the hon. Member for Barking (Mr. Hastings) for having given so much attention to the Regulations and having done so much homework in reading them. He 511 must be one of comparatively few hon. Members who have done so.
I cannot give the details of the point which he has raised, but the Regulations are, of course, made by the General Dental Council, and I have no doubt that his observations will be noted by them. I do not think he need be very worried. As I understand, there is no breach of tradition, because these Regulations are based on similar regulations which are used in other ancillary professions. I do not doubt, however, that the General Dental Council and the Privy Council will take note of his remarks.
The right hon. Lady the Member for Warrington (Dr. Summerskill) referred, first, to what she called the delay and, secondly, asked why the fuller duties of the ancillary workers have not been included. I agree with her that that was the intention of Parliament, but what Parliament said about the filling of teeth was that there should be an experiment; under the Act there was to be an experiment. I understand that the Privy Council has obtained preliminary information from the General Dental Council on the case for an experiment, based on the New Zealand 512 experience, but has not yet directed that an experiment shall be undertaken. I have no doubt that note will be taken of her feeling, which I think is shared by many hon. Members, that some haste should be displayed in this matter.
I do not think that I want to go into the delay in the laying of the Regulations. The fact is that they are brought before the House with the approval of the General Dental Council. Perhaps we may wish that they had been tabled a little earlier, but they are here now and I think we ought to express our appreciation of the fact that the will of Parliament, as expressed in the Dentists Act, 1956, is being carried out in these Regulations.