§ Motion made, and Question proposed, That this House do now adjourn.— [Mr. Clegg.]
§ 10.40 p.m.
§ Mrs. Renée Short (Wolverhampton, South-West)I am delighted to have the opportunity to raise this very important subject. It goes far beyond the whole question of increased dental charges and affects general health as well as the health of teeth. Dental caries can cause other health problems. Pain can make people feel ill and depressed. It is an expensive matter to put right. I do not know whether the House is aware that dental caries and dental disease causes about 70,000 people a year to be off work, for which sickness benefit must be paid, and about 2 million working days are lost each year as a result of dental disease.
The office of Health Economics has pointed out that dental disease is the second most costly disease, exceeded only by mental illness. There is very great concern about the treatment of the large numbers of people who suffer from mental illness. We should be equally concerned about those suffering from dental disease. Dental disease is more expensive to treat than heart disease or bronchitis, both of which are widespread.
I therefore suppose that the Government might say, with their turn of philosophy, that it is a blessing that more than half the population aged over 45 have 1860 lost their own teeth, because they are therefore immune from dental disease: they will not make any more demands on the dental service and will not cost the National Health Service any more money.
On April Fools' Day, which is perhaps a significant date for this Government to do anything at all, an additional charge for dental treatment is to be introduced which will make what I have described, which I consider to be a serious health hazard for the nation, much more serious and alarming. The state of the nation's teeth will become much worse.
In my view this is a mean, niggardly, class-biased decision. If it is allowed to continue for any length of time what it will mean is that those who can afford it will have conservation and restorative treatment and the poor will have their teeth extracted. We will be putting the clock back to the situation as it was before the National Health Service was introduced in 1948. This is a very grave burden for the hon. Gentleman to shoulder. I had hoped that the Secretary of State would be here tonight because this is a very serious matter, when the Government decide to tamper with existing arrangements within the National Health Service.
The Minister will say that these charges will not be too bad, because the charges will rise to a maximum of £10 and originally, when the White Paper was introduced, patients were to pay for half the dental treatment, with no limits. Now, because of considerable pressure from dentists and the general public, the ceiling of £10 has been introduced. It means that those who cannot afford treatment will get it free if they apply to the Supplementary Benefits Commission and, according to the Minister recently, there a[...]e plenty of exemptions.
When the £1 charge was introduced, again by a Conservative Government, in 1952, dentists reported that there was a drop of something like 30 per cent. in attendances at dental surgeries. This was temporary, obviously. People eventually went back. When a Labour Government, after devaluation, raised the £1 charge to 30s. there was a slight fall, although not so great as in 1952. On 2nd February I pointed out to the right hon. Gentleman that this fall had taken place in 1952 and he said that that was true but that it was only temporary.
1861 Does the right hon. Gentleman think that it did not matter if, for a short time, thousands of people were denied the dental treatment they needed and had to put up with dental disease and possibly pain for longer than they should and, when they were finally driven, by the pain perhaps, to see a dentist they had to have much more work done than would have been necessary if they had gone earlier?
These proposed charges are greater than the last increase of 10s., and the right hon. Gentleman is saying that a good deal of the treatment will be free. But the number of people exempt from charges will rise. If a patient has only a scaling and a small filling he might get away with a charge of less than 30s. It depends on the size of the filling and the state of the patient's mouth. To be as fortunate as this, to get away with the minimum amount of treatment he has to be a patient who visits the dentist every six months. We know from statistics, from the hon. Gentleman's Department and from the B.D.A., that less than a quarter of all adults go to their dentists as regularly as this.
This will create a backlog of work and a good deal of difficulty for patients and dentists. It is not necessarily neglect that creates dental caries. Many conscientious people, who look after their teeth and go to the dentist regularly, still need a large amount of work done because they have the sort of teeth that decay easily. They may well have to pay considerably more to keep their teeth in reasonable order. But anyone needing major work after the new charges will get a real kick in the teeth.
I should like the right hon. Gentleman and the Chancellor, who is the man behind this disgraceful scheme, to bear in mind that, in the North of England where money is tight and where there is a high level of unemployment, and where families are already getting into difficulty because of the Government's policy, half the adult males have lost all their teeth by the time they are 45. I wonder what the right hon. Gentleman thinks working people in Leeds will do. Will the increased charges persuade them that they should go to the dentists more regularly? Will they choose more expensive conservative treatment? Or will they say, "Pull it out and let's have done with it"? 1862 That is what I am afraid will happen. Very few of these people will be able to afford the cost of having a tooth crowned. It costs a patient £5 or more, though the price which the dentist will claim will be double that. It is not surprising that when the charges were announced one dentist said, "This means the end of dentistry and back to butchery".
On 10th November the Minister said in the House that a family with two children and an income of £1,100 a year would be exempt from dental charges. That was, of course, very generous of this Government. It means that a family with two children and earning £22 a week, well below the national average wage, will be exempt from these charges. Of course, the take-home pay from £22 a week is considerably less than £22. On the national average wage, which is £28. the take-home pay is only about £22 19s. 2d., after all deductions have been made. I wonder how the Minister thinks families of this kind can afford to go to the dentist and pay the increased charges.
Then, of course, pensioners will have to pay, unless they are on supplementary benefit. Many pensioners are just above the supplementary benefit level, and they will have to pay the charges. There will be the cost of administration of the exemption scheme and the cost of inspection and policing of all the additional exemptions. Instead of getting £14 million out of the deal the right hon. Gentleman will find that he has much less in the end. This is just another of the literally thousands of means tests which are now being imposed on the poorer people of this country by this Government.
Then there is the possibility that the Minister will in due course introduce legislation which will make it necessary for young people above the age of 18 to have to pay the charges. The argument of the Government is that they are old enough to be married and to vote at that age, so they can pay to have their teeth attended to. The Minister ignores the advice of the profession, which is concerned because young people, between 18 and 25, tend to have an incidence of dental disease. The Minister says there is no proof that this is so, but he ignores the advice of the dental profession. The nation will have to judge who is right, and time will show.
1863 The Minister says children will continue to be exempt, and that, again, is very generous of this Government. I am glad that children will be exempt from at least some of the viciousness of this Government, but they are to lose school milk when they are above the age of 7, and milk is a source of calcium which is essential to the teeth of growing children. Many children just above the poverty line will not be able to claim free school meals and will take sandwiches to school and will lose a balanced meal which for many children is the one balanced meal they get, and, besides milk, a balanced diet is important for dental health.
These proposals which the right hon. Gentleman has put forward have been opposed and condemned not once but many times by the British Dental Association, the Socialist Medical Association, by individual dentists, by dentists in private practice, and those working in the university dental schools. Not a single voice in the dental profession or in the national or provincial Press has said a single word in support of the right hon. Gentleman's proposals. Dentists are very much afraid that people will neglect their teeth even more than they do now. The Minister claimed to me in the House about three weeks ago that the increased charges will give an added incentive to look after teeth. That is just a joke, and I think the profession sees it that way.
Dentists have improved their techniques and their practice very considerably since the introduction of the National Health Service. They have increased their productivity as well. Individual courses of treatment are cheaper than in the early days of the National Health Service. They are genuinely conscientious people who are trying to do the best they can for their patients.
Are the charges being introduced because the Government want to wreck the National Health Service by ignoring the basic philosophy of the Opposition, that treatment should be free to the patient at the time of need?
I beg the hon. Gentleman to take urgent steps to save the situation before serious damage is done to the nation's teeth. He should tell his right hon. Friend that the House requires him to think again about increased charges, which will 1864 erect a barrier between patient and dentist. I suppose it is too much to ask him to remove charges altogether, but at least he should leave them as they are. If he wants more money for the dental service, he should ask his right hon. Friend the Chancellor of the Exchequer to swop the purchase tax on sweets and chocolates, which is 22 per cent. and the purchase tax on tooth paste and dentifrice, which is 36⅔ per cent. It is nonsense that the purchase tax on articles causing damage to teeth should be at a lower rate than purchase tax on preparations which preserve the teeth. If the dentists' arithmetic is right. the Government would get £40 million more for the dental service by swopping round this purchase tax.
If the B.M.A. in its recent advice to married couples about marital happiness had given thought to dental matters it would probably have advised people that there is nothing more off-putting to social and sexual intercourse than a bad mouth smell arising from dental caries, tobacco or drink—they are all equally unpleasant.
The Minister should embark on an energetic programme to educate children and adults on the care of teeth, the need to clean them regularly and to forswear the sweet-eating habit. The necessity for regular visits to the dentist should be stressed. I ask him to bear in mind that it will be difficult for him to persuade people to go to the dentist more often if he is increasing the charges. Psychologically, it is just not on.
The Minister must also give attention to the recruitment and training of more dentists. In the whole country there are only 10,250 dentists, with an average patient load of 4,474 per dentist. In the North, including Yorkshire, there are only 536 dentists, who have 6,222 patients each. We are just as badly off in the Midlands. We have slightly more dentists but a larger population. We have more than 6,000 patients per dentist. Only in the South-East is the position satisfactory. There are more than 5,000 dentists with 3,367 patients each.
The scale of charges of dentists needs to be examined. Dentists can claim little, if anything, for treating gum conditions. A dentist cannot claim for treating teeth with fluoride. This again is very important and needs looking at. The whole bias of the charges proposed is in favour 1865 of extraction rather than conservation. I hope that this will be looked at as well.
Finally, how does the hon. Gentleman propose, if the Secretary of State is determined to push this dangerous Measure through the House, to advise all those people who are entitled to free treatment that they are so entitled? It will mean another means test, another batch of forms to fill in, another set of questions to answer in addition to the mounting number of similar hurdles which have to be got over by the poorer section of the community.
I am sorry for the hon. Gentleman. I think that he has a rotten job defending the indefensible. If he feels that this is a rotten position and quite indefensible, I think that he should resign and tell his right hon. Friend and the House why. We think very well of him and I think that such an action on his part might well deter the Government and cause them to think again before embarking on this wretched and unwise step, which is bound to cause damage to the nation's health—damage we shall greatly regret in a few years' time.
§ 11.01 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)I am glad that the hon. Member for Wolverhampton, North-East (Mrs. Renée Short) has had an opportunity, through her success in the Ballot, to raise this important subject. I assure her that I have very great pleasure in defending the position and have no intention of resigning on this issue.
The hon. Lady mentioned the purchase tax imbalance. This has already been drawn to the attention of my right hon. Friend the Chancellor of the Exchequer by my right hon. Friend the Secretary of State for Social Services.
When, in the course of the review of public expenditure that we initiated on taking up office, the Government came to examine the present system of charges for general dental services, we found that most patients who took care of their teeth—and therefore rarely needed more than one or two fillings at a time, together with scaling and polishing—were paying the greater part of the cost of their treatment. The taxpayer, on the other hand, was bearing most of the burden of those who neglected their teeth, and who put off going to the dentist for as long as 1866 possible, secure in the knowledge that—however long they delayed, irrespective of the treatment they might need, short of dentures—the cost to them would be limited to £1.50.
Quite apart from the fact that neglect of one's teeth can have serious consequences for general as well as oral health, any system that does nothing to encourage regular attendance must, since a good deal of dental disease is progressive, result in the taxpayer having to meet the disproportionately higher costs of delay in seeking treatment. The system of charges we are introducing seems to us to be much fairer—both to patients and to the taxpayer—because it provides a positive financial incentive to patients to keep themselves dentally fit by visiting their dentists regularly. The Government will continue to pay the full cost of up to two examinations a year, so no one need be frightened about the cost of consulting his dentist and finding out what treatment he needs for dental fitness, the Government will also pay half the cost—in some instances more than half—of any treatment necessary for dental fitness, and in no circumstances will any patient have to pay more than £10 for a complete course of treatment involving possibly several visits spread over several appointments.
Although we cannot be sure precisely how much adult patients will have to pay for dental treatment in future, we do know that if our proposals had been in force in 1969 at least half of all non-priority patients would have paid £1.30 or less—26s. or less—and only 1 per cent. the maximum of £10. Although I do not suggest that these figures are anything more than a general guide to the probable effect of the new charges, after allowing for, first, an increase since 1969 of about 20 per cent. in dentists' fees; secondly, for some variation in the pattern of demand; and, thirdly, for the fact that many low-cost estimates—for which since the dental treatment charge was first introduced in 1952 patients have had to pay the full cost—will once again be brought within the ambit of the general dental service, I am satisfied that at least half of those who have to pay for dental treatment other than dentures will pay no more—and in many instances less—under the new system than they do today. And I would remind the House 1867 that only about half of all courses of treatment provided in the general dental service last year were for adults.
Indeed it is not, I think, sufficiently widely realised that the changes we are proposing will make no difference to the arrangements for treating children and young people under 18 or expectant and nursing mothers. These alone account for about 40 per cent. of all courses of general dental service treatment provided. For the present too the changes will not affect young people between the ages of 18 and 21, though we shall later be placing before the House proposals to reduce the age limit for exemption to 18 in line with the current age of majority. There will be ample opportunity for discussion of this proposal at that time and I do not, therefore, propose to say more about it at present, other than to urge all young people who have not been to the dentist for some time to make an appointment with their dentist now so that they can be made dentally fit. Thereafter, so long as they go back regularly—at least once a year, though twice a year would be better—the cost of keeping themselves dentally fit is unlikely to be great.
Next, the system of charges will involve no significant difference in the basis of charging for dentures. Since it was first introduced in 1951—and the hon. Lady will recall that the conception of charges was that of the Labour Government, although the delivery was that of the successor Government—the charge for dentures has been roughly equivalent to 50 per cent. of the total cost. Under our proposals it will continue at the same rate. Repairs to dentures will continue, as in the past, to be free of charge to the patient. The provision and repair of dentures accounts for about 10 per cent. of all courses of dental treatment.
At the same time we are raising the level of income below which people who find difficulty in meeting dental charges can get help from the Supplementary Benefits Commission, so that no one will be denied treatment because he really cannot afford it.
It has been suggested that, because the patient's charge for an expensive course of treatment will be much higher than at present, patients generally will be deterred from going to the dentist. I be- 1868 lieve on the contrary that a great many patients, when they realise this, will appreciate the importance of going at the right time, before they need so much treatment.
Reference has been made to the experience of the dental profession in 1952 when charges for dental treatment were first introduced, and it has been suggested that at that time the attendance of patients at dentists' surgeries dropped by 30 per cent. The effect of the charges on demand for dental treatment was discussed at considerable length in the Annual Reports of the Ministry of Health for 1952 and 1953. The 1952 Report concluded that the real fall in the volume of conservative treatment for adults between 1951 and 1952–that is to say, before and after the charge for treatment was introduced—was in the region of 5 per cent. In the latest increase from £1 to £1.50 there was no dip. By the end of 1953 it was possible to show that the decline in the number of courses of treatment for adults had been more than balanced by an increase in the number of courses provided for children. In other words, the effect of the initial imposition of the dental treatment charge in 1952 was a temporary dip in demand, followed by a small but significant change in the pattern of treatment. The changes we are proposing are not strictly comparable with the introduction of the treatment charge and in general we do not expect the effect on the demand for dental treatment to follow the same pattern, but if in some parts of the country we find, in a year or two, that dentists are spending more of their time in treating children, I do not think any of us would find this development unwelcome.
In short, after a temporary dip, we expect demand for dental treatment from all sections of the community to reassert itself and as more patients get into the habit of going regularly to their dentist fewer extensive courses of treatment attributable to persistent neglect.
Another fear which has been expressed is that some patients, faced with the prospect of a substantial bill to make good the defects of long neglect, will choose to have their teeth extracted rather than conserved. We do not share these fears. Patients have for many years now been used to having various forms of conservative treatment in preference to extractions and dentures; and before any 1869 patient has his teeth out his dentist will have ample opportunity to explain, if this is the case, the advantages of retaining his natural teeth and looking after them by becoming a regular attender. The cost of extractions is in any case by no means negligible, especially if a general anaesthetic has to be given and if the patient also needs dentures. However, my right honourable Friend has given an undertaking to the British Dental Association to watch the treatment statistics carefully under the new system of charges.
A good deal of criticism has been levelled at the proposal to fix the maximum charge at £10. We have given a great deal of thought to this and my right hon. Friend has discussed it with representatives of the British Dental Association. We concluded, however, that the decision must be entirely a matter of judgment. Various alternative figures have been suggested, but I know of no particular argument in favour of any of them and in general, having regard to the improved arrangements for preventing hardship which I have already mentioned, any reduction of the maximum would primarily benefit those people who have neglected their teeth and who can afford to pay the higher charges.
In conclusion I should like to say something of what we have in mind for publicising the new arrangements. My right hon. Friend the Secretary of State for Social Services has told the House that he intends, jointly with the British Dental Association, to mount a publicity campaign to explain to people the advantages, the immunities, and the probable cost, of dental treatment under the new system. My Department is preparing a leaflet which dentists can hand to their patients during the first few weeks after 1870 the new system is introduced, explaining how it will operate and emphasising the financial advantages—as well as the benefit to health—of attending the dentist regularly for a check-up and for any treatment which is needed to keep them dentally fit. We are also considering what other forms of publicity it would be worth while initiating, particularly in order to reach and influence those people who have not hitherto been regular attenders. Only this afternoon my right hon. Friend and I met representatives of the British Dental Association to discuss certain ideas they have for publicising the advantages of regular attendance. Although the changes we are introducing were resisted initially by the profession, I have always believed that, in time, most dentists would come to realise that our proposals, far from undoing the good work of the past, are designed to stimulate progress towards still better dental health. That is why I was glad to read in the leading article in the British Dental Journal for 15th February these words:
Patients must be encouraged to go on visiting their dentists and it must be made absolutely clear to them that regular attendance will mean the truest economy and a real contribution to general well-being. They must be encouraged to pass on this advice to their relatives, their friends and their acquaintances, and the public at large must be informed again and again of the benefits of dental health in the hope that irregular attenders may be persuaded to seek treatment. The message that examination and treatment at regular intervals are best for his health and lightest on his pocket needs to be conveyed to every one of his patients that the dentist's records show to have visited him within the past few years".
§ Question put and agreed to.
§ Adjourned accordingly at eleven minutes past Eleven o'clock.