§ Motion made, and Question proposed, That this House do now adjourn.— [Colonel J. H. Harrison.]
§ 10.1 p.m.
§ Mr. Norman Dodds (Erith and Crayford)
In raising the matter of the highly unsatisfactory situation in the school dental service, I start by expressing my regret that the Ministry of Health is not represented on the Government Front Bench—I apologise to the hon. Lady the Parliamentary Secretary to the Ministry of Health, who has just taken her place, and I congratulate her on the speedy way in which she came to her seat. The problem is a dual one, between the Ministry of Health and the Ministry of Education. I had to make a choice, and I chose the Ministry of Education, but I am pleased to see that the Ministry of Health is now re-presented also.
My speech will be divided into two parts, the first being devoted to the shortage of dental manpower in schools, the second part being devoted to the need for greater attention to dental health in schools. The latter, education in dental health in schools, is probably more important in the present situation than the former.
This matter arose as a result of several Questions asked in the House, but it was obvious that Question Time was not a satisfactory occasion for dealing with this very important subject. I shall, in the first place, draw attention to the exchange of questions and answers which took place on 12th November. In a supplementary question, I asked:Is it not a fact that the situation has worsened? … How can he"—that is, the Parliamentary Secretary to the Ministry of Education,and his right hon. Friend be so complacent?The Parliamentary Secretary, in reply, said:The fact is that there are now the equivalent of about 300 more whole-time school dentists than there were in 1951. That is not a deterioration in the service.Is it not a fact that 1955 was the best year for the ratio of school dentists to school children, and has not the situation worsened ever since? Is it not a fact 162 that the official figures show that, in 1956 and 1957, the situation deteriorated?
My right hon. Friend the Member for Ebbw Vale (Mr. Bevan) asked:How many dental hygienists are now in employment?and he went on to say that… the decision, taken after very considerable investigation, to employ dental hygienists in New Zealand, which was adopted when I was there, was aimed at saving the work of skilled dentists. Therefore, the one has a direct relationship with the other.The Parliamentary Secretary replied:I have already informed the House that both the hygienists and the auxiliaries are being prepared for the service.Then my hon. Friend the Member for Cannock (Miss Lee) said:Will the Parliamentary Secretary give some indication of the scale of operation now taking place."—[OFFICIAL REPORT, 12th November. 1959; Vol. 613, c. 571–3.]and she asked what the number of dental hygienists was.
On 9th November, my right hon. Friend the Member for Warrington (Dr. Summer-skill) asked the Minister of Health:In view of the serious position, could the Minister tell us whether dental hygienists are now being employed?The Minister replied:Yes, dental hygienists are being employed, I do not say universally, but in certain dental hospitals, such as the Eastman Hospital which the right hon. Lady will well know."—[OFFICIAL REPORT, 9th November, 1959; Vol. 613, c. 29.]At no time did we get the figures. What I think are the latest figures show that, after all this number of years, only 109 names are on the Register of Dental Hygienists. Of these 109, a few work in dental and general hospitals, a few work in local authority clinics—in which we are interested—and approximately twenty-five assist dental surgeons in private practice. At least forty, however, are not in employment. I suggest, therefore, that the picture is a black one and that these figures probably explain why neither Minister has given figures from the Dispatch Box.
Those who are concerned for this service have in mind that not only has the situation deteriorated, but that the age of dental officers in schools reveals a worrying state of affairs. On page 177, the Report of the Ministry of Health for the year 1957 gives an analysis of replies 163 to a staffing questionnaire about the age groups of full-time officers. To summarise, it gives the information that there were 267 up to the age of 39 but that the total from the age of 50 onwards was 404. People are concerned at the growing age of the officers in the dental service. It is obvious that there will be a big wastage because of age and it is felt that insufficient preparation is being made to meet this wastage.
In getting some sort of guide to the number of school dentists who are required, I referred to "The Health of the School Child", the Report of the Chief Medical Officer of the Ministry of Education for the years 1954 and 1955. On page 57, it states thatthe Minister in recent years has indicated that a ratio of at least one dentist to 3,000 children would be required for a complete service.It is alarming to get the latest official information, because the Report of the Chief Medical Officer of the Ministry of Education for the years 1956 and 1957, published in 1958, shows on page 202, in Table IV, the number of dental officers on the staffs of local education authorities in June, 1957, per 10,000 children. The figures for the English counties show that Westmorland was the best with one dental officer to 3,400 children. Derbyshire was the worst with one dental officer to 23,000 children. Durham had one dental officer to 15,000 children and not far behind came Leicester, Huntingdon, Peterborough and Shropshire.
In my own county of Kent, the figure works out at nearly 8,000 children for one dental officer. I know from speaking to knowledgeable people in Kent what a sorry state of affairs we have there. It seems that, because of the shortage of dental officers, the main thing that can be carried out is examination, but without proper treatment, and that much of the time of the dental officers is taken up with emergencies. This is simply not good enough when the children's health needs to be looked after.
In the county boroughs, Eastbourne is by far the best with one dentist to every 3,226 children, and Southend is the worst with one to every 23,260 children. Not far behind come York and St. Helens. I think that this official 164 information, which is the latest that is available in the Library, shows what a hotch-potch it is and what a sorry state of affairs exists, proving that the figure of 3,000 children to one dentist is far from being achieved.
It seems to me that, with the amount of money that could be provided, even if it were, that would not be the only answer to the question. We could get plenty of dentists in time if the money was made available, but it seems that there is a greater need for education, particularly in the schools, on the greater care of the teeth. I would say that many men in middle age today have a better set of teeth than they would otherwise have had, no doubt as a consequence of being called up into one of the Services. To appreciate that one only needs to look at the way in which the teeth of men and women who go into the Services are looked after. It is not always because the men themselves want it, but because of the discipline. I believe that in consequence of that discipline the state of the teeth of many people is infinitely better today as a result of the training and treatment they received while in the Services. Not in all cases, but in many, the treatment and care which they have received has been followed up in civilian life.
It seems to many of us that many good habits in this respect should be brought to the attention of children at school; and while it could not be claimed that this care would continue after school life, it is felt that more could and should be done about health education, particularly with regard to the teeth.
There can be no doubt that a considerable sum of money has been spent in the National Health Service in catering for this need, and it seems that greater attention by education authorities to the care of the children's teeth might be a very good investment. The biggest factor responsible for the present incidence of dental decay is faulty diet. In this country, we eat about 8½ oz. of sweets per week each, more than the people of any other nation in the world. From the information which I get from the experts, it seems that sugar causes dental decay, and therefore the aim should be to educate children to restrict their intake of carbo-hydrates, or at least persuade them 165 to remove the fermentable carbohydrates from the mouth at the end of of a meal.
I suggest that there is much more that education authorities could do in that respect. Those who are concerned about the dental health of the nation, those whose responsibility it is to assess it and to seek ways to improve it, are appalled. From the information I have been given it seems that there are only two people in every 100 in the adult population who do not suffer from dental decay, and it is felt that is in the schools where the first real job should be done in education on the care of the teeth.
I should have liked to have had much more time in which to develop my case. I would add only that ways and means should be devised for greater action in the interests of school children, and I further suggest that more information should be available to children, not only at school, but through newspapers, magazines, the cinema, radio and particularly television.
Films and film strips should be made available to women's organisations in an attempt to make war, if only a wordy war, on lollies. Brand the ice cream and ice lolly vans that cluster daily around the school entrances as a menace to the health of the children. Expound the advantages of apples in place of some of the lollies consumed in ever-increasing quantities by the average child. In the county of Kent there are loads of apples and these should be eaten instead. The Minister may say it is not practicable; but has an attempt been made to introduce teeth-cleaning drill at the beginning of the morning and afternoon sessions? In the interests of economy I suggest using common salt on the toothbrushes.
Finally, I say that the key factor in all this—and I have discussed this problem with dentists, who appreciate that it will take a long time to get over the shortage—must be the dissemination to school children, by all the means of mass communication, of simple oral hygiene messages repeated over and over again arid, of course, toothbrush drill morning and afternoon.
§ 10.17 p.m.
§ The Parliamentary Secretary to the Ministry of Education (Mr. Kenneth Thompson)
I intended to preface my 166 remarks by accusing the hon. Gentleman the Member for Erith and Crayford (Mr. Dodds) of himself being devoid of suggestions, in view of our exchanges in the House a week or so ago. Clearly, however, I should be doing him a great deal less than justice if, after his assault on the sweet-eating and lolly-sucking habits of our children, and his suggestions for preserving and protecting the younger generation from the horrors of sweets of all kinds, I pretended that he had not made some suggestions.
At the same time, I must take a great deal of what he said with much more seriousness than that, because this is a serious question and it has caused my right hon. Friend the Minister of Education, my right hon. and learned Friend the Minister of Health and my hon. Friend the Parliamentary Secretary to that Ministry a great deal of concern for a long time. So what I say will rest on two main assumptions. The first will be complimentary to the hon. Gentlemen, because I will assume that he knows that I know that he knows much more about this problem than some parts of his speech reveal. The second is that I will ask the House to accept my assurance that there is no complacency either in the Ministry of Education or in the Ministry of Health on this matter.
At the beginning of my speech I want to pay my tribute to the dentists and their assistants and the lay staff in the service for the way in which they have kept things going during what has been, and will continue for some time to be, an extremely difficult period. They have given much valuable and devoted service to the children and to the dental service although working under considerable pressure. Indeed, I hope that nothing that the hon. Gentleman has said tonight, in his not unfounded criticisms of the state of the service, will deter any who may be thinking of coming into it to help in what is a worthwhile job. There is a great deal that can be done here in a very specialised part of the dental service which will be of great benefit to future generations.
When all is said and done about all the criticisms that can be raised of the school dental service, we reach the simple fact that there are not enough dentists. There are not enough dentists in the general dental service, and we 167 have not been able to attract from that limited pool into the school dental service enough dentists to provide for our needs.
I am sorry to say that there is nothing new in all this. The hon Gentleman, I am sorry to say, has not stumbled across a new and startling revelation. This situation has been with us for a very long time. It has bedevilled the school dental service from the very beginning. Even before the war, at the very best in 1938 we had only 783 whole-time school dental officers, or, adding together the part-time sessions which some dentists perform for us, the equivalent of full-time school dental officers.
The hon. Gentleman is wondering when was our best year. I am not sure that that is either really important or relevant to the argument, but if he would like some figures I am not without information that might interest him. In 1938, as I have said, we had 783 whole-time equivalents. In 1947, the year before the National Health Service made dental service free to everyone, there were 753 whole-time equivalents, representing some recovery from the end of the war. In 1956, the figure had risen to 1,008 whole-time equivalents, and in 1959 the figure is 1,032. The figures show a progressive, very slow increase in the number of whole-time dentists or whole-time equivalents working in the service.
I am sorry to confirm what the hon. Gentleman says about the increasing average age of those remaining in the service. It represents a problem of the not very distant future which we must face. To some extent it is being met, or the position is being held, by an increase in the number of sessions which outside dentists are prepared to give.
The really important figure for us to consider is that of school children per whole-time dental officer. In 1951, the figure was 8,089 and in 1959 it is 6,761, an appreciable improvement over previous years. These figures represent an unsatisfactory position resulting from the fact that there are just not the dentists available.
The hon. Gentleman is right to ask upon what other resources we are drawing. I am sorry if I gave him the impression the other day when we were exchanging 168 points of view about this subject that I was inadequately provided with answers. The fact is that he was addressing to me questions which were not my concern. However, I hope that he will not go away hungry from tonight's debate.
There are some hygienists in the school dental service, but only 17, I am sorry to say. There are in the school dental service 1,140 full-time chairside assistants, the nurses who look after the children, prepare them for the clinic, show them in and make sure that they are given every opportunity to recover afterwards.
The hon. Gentleman and the House will be very familiar with the exchanges that we had some years ago when we were discussing the Dentists Bills that came before the House, in 1956 and 1957. The hon. Gentleman will know that the training and employment of hygienists and ancillaries was not without complications arising from the situation within the profession itself. My right hon. and learned Friend the Minister of Health has now reached the stage when some of these difficulties are being put behind us. More hygienists and more dental ancillaries are now being trained.
§ Mr. Thompson
When some of the courses which are just about to start are under way the number of hygienists being trained will be 40 in the first year, and the number of dental ancillaries who will be taken into the new course at the London Hospital, when the premises are fully prepared and ready for use, will be 60.
I want to say a word, on the advice of the Minister of Health, about the steps that are being taken to improve the supply of dentists, which is the real heart of this matter. A great deal of work is being done following the recommendations of the McNair Committee. The Committee recommended that we ought to be able to produce for service in this country about 800 dentists per annum, which was an increase of about 200 a year over the capacity of the existing dental schools and colleges.
169 This increased number of dentists calls for a great expansion of the training hospitals themselves. That cannot be done overnight. There are two new dental hospitals at present under way and there is expansion going on or in the planning stage in six other cases. In addition to that, it is proposed that there should be a new dental hospital as part of the new Cardiff teaching hospital.
Steps are being taken now which, we hope, will increase the number of dentists available in the years to come, but this represents no easy, early solution to the problem, since the training of the dentists themselves takes a number of years. What we are trying to do now is to make the best use of the dentists we have.
Their salary scales are not a matter for my Ministry, nor even for the Government, and have to be negotiated under Whitley Council arrangements between the dentists themselves and the local education authorities who employ them. Recently, their salary scales were improved by about 10 per cent. as a result of negotiations of that kind. Although it is excluded from dealing with public authority dentists and doctors, I imagine that the recommendations of the Royal Commission on Doctors' and Dentists' Salaries will be bound to have some repercussions on the service.
There are these three partners in all this business, which makes progress perhaps slower than we would like, in moving forward on this very wide front of the training of dentists, ancillary workers, the hygienists and chairside assistants, and so on, and the local authorities themselves who have to carry out the work. It is our job to give local authorities advice on how they can make the best use of the dentists they have and how they can do some of the things which the hon. Member has suggested might be done best in our schools in teaching children the importance of looking after their teeth. There is no shortage of advice to the local authorities on what they might best be doing to use their resources to the full, or to the children on how to look after their teeth, or to parents on what to tell their children to do.
If the hon. Member is thinking of starting a campaign to ban sweet eating 170 or lolly sucking or ice cream eating, I wish him well. I do not say that he would not be rendering a great public service, but he would probably be destroying his personal political career, which he might well think worth sacrificing in such a cause; that is not for me to say. This advice is available to the parents, to children and to local authorities. I should like to see us making more use of some of the instruments of mass communication to which the hon. Gentleman referred. There is at present a Committee on Dental Health Education, which was set up as a result of the recommendations of the McNair Committee. I have no doubt that that Committee will fully consider the suggestions which the hon. Member has put before the House tonight, but I hope that he will not think that it will be popular or easy to carry out some of his suggestions.
It is easy, attractive and, in some ways, exciting to think of 30 little children cleaning their teeth in front of the teacher and under instruction at the beginning of the morning and afternoon sessions. I can imagine 30 little brushes and 30 little faces and 30 little pots of water and a little supply of salt.
§ Mr. Thompson
But I hope that the hon. Gentleman will consider what that would involve in the life of the school. After all, we are often under criticism, under fire, for overloading or confusing the school curriculum. Nevertheless, his suggestions are not unwelcome and I am sure that they will be considered by the Committee on Dental Health Education when it gets round to taking up all the various suggestions put before it.
Finally, if the school dental service is, in fact, so badly understaffed as we recognise it to be, that is not the end of the story. There is a responsibility on parents to see that their children are properly looked after. The resources of the general dental service are available for children, just as they are for adolescents and adults. I hope that parents will read into what has been said tonight the feeling that we are doing the best we can with limited resources and that, when all is said and done, they can help themselves and help 171 their children by taking steps to see that teeth are well cared for.
I hope that parents, teachers, local authorities and hon. Members, when they have the chance, will give all the 172 help they can in instructing children in the preservation of what is a precious gift, a good set of teeth.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes to Eleven o'clock.