HC Deb 14 October 1976 vol 917 cc820-30

Motion made, and Question proposed, That this House do now adjourn.—[Mr. John Ellis.]

1.28 p.m.

Mr. Laurie Pavitt (Brent, South)

I present to the House a scandal—an appalling state of affairs and neglect and indifference to the pain and suffering of the weakest sector of Britain's population—the mentally and physically handicapped—comparable to the inhumanity of the last century when the high walls of lunatic asylums out of sight to the ordinary citizen shrouded the eyes from scenes of intolerable squalor and the ears from the animal cries of pain and despair that brought into the English language the word "Bedlam".

I plead guilty too. I thought that there was little about the NHS services, the delivery of health care and treatment and the manifold problems this presents that I did not know.

It is only in these last few months that I have discovered a state of affairs in dentistry which shows that after 25 years of a comprehensive dental service, it has failed to cover those for whom a caring and compassionate society should have given the highest priority—those unable to care for themselves without our help.

I welcome the Minister's presence tonight. If there is one person who knows more about the chronic sick and disabled than anyone else in the country, it is my hon. Friend the Minister who is concerned with the disabled. In appealing to him tonight I know that I am pushing at quite an open door, but unless he can get some degree of urgency into the solution of these problems, my own Government will attract an odium in respect of this neglect that will outweigh the praise that it—and especially my hon. Friend the Minister—deserve for the progress made in other fields.

The fact is that the more severe the handicap, the more difficult it is to get dental treatment. The pain of the mentally handicapped can go on and on and on. I quote from an article in New Society: Two years ago in Corby, an elderly mother pushed her 20 year old, in his wheelchair, from one dental practice to another. She was searching for dental treatment for his painfully abcessed tooth. Having failed to get an appointment, she came in tears to our school mobile dental van to ask for help. This was not a case of man's inhumanity to man. The simple fact was that every surgery in Corby, including the recently built health clinic, was on a first floor—up a long flight of steps and inaccessible to wheelchair users, a fact that hardly meets the requirements of the Chronically Sick and Disabled Act 1970. In the ultimate limbo are the housebound handicapped—for example, a person with an advanced case of multiple sclerosis who can be treated only at home.

Theoretically, one of the five categories of NHS dental treatment should cover the handicapped. First, there is the general dental practitioner, but in practice there is no time for him to work for the handicapped, and it is difficult, in the circumstances of ordinary dental practice, to be able to cope with those who are mentally handicapped. At the end of a very full and hard day's work, only a very few dedicated dentists are prepared to go out to those who are housebound.

Secondly, there are the hospitals, but in practice they do very little else for the mentally or physically handicapped than straightforward extractions under anaesthetic.

The third possibility is a subnormality hospital which will give fillings and also other treatment under anaesthesia, but only for its own patients—Only those who are in the institution are covered for dental treatment.

Fourthly, there are the dental hospitals, but in practice there is a geographical handicap, because the more remote a dental hospital, the more difficult it is to treat this very worthy section of our community.

Finally, there is the Community Dental Service, and it is in this area that I see most hope for the future. Here I quote again from the article in New Society: Northamptonshire began in 1973 a service that crossed the hospital community boundary in what we believe to be a unique way. A team, consisting of one of us as dental surgeon, a dental hygienist and a dental nurse, was appointed jointly by the local authority and the hospital service to provide dental treatment for all handicapped children. The service was based at the Princess Marina Subnormality Hospital, where a surgery was provided. The special schools in the county were catered for with a mobile dental van. I commend to my hon. Friend the use of these vans in which further surgical treatment can be carried out. Children were brought to the hospital for treatment, the article points out, under general anaesthesia by the same team. The article goes on to state that The handicapped were of all types—physical, sensory, mental and emotional. After April 1974, when reorganisation of health services was undertaken, the adult handicapped were included in the project. This sets a pattern, and the Government should now seek to take positive action in this direction.

I am well aware of the present financial difficulties, and I am not even asking the Government to make this service mandatory for the Community Dental Service to treat the handicapped now. But I am demanding that area dental officers who, after considering all their needs and resources, wish to treat the adult handicapped shall be permitted to do so. If this means secondary legislation, let this House see it.

The fact that at present they are not allowed by law to extend this help is leaving clinics unused in some areas, and dentists are standing idle at times when school children are not around. In the case of dentists on handicapped children in day centres, the children go home at 3 p.m., leaving dental teams and surgeries unoccupied until 5 p.m. That is a tremendous waste of resources at a time when the NHS is looking for more and more resources.

I put this specific question to my hon. Friend. If there is still delay in reaching a decision, will my hon. Friend ask the Prime Minister to put this problem to his Senior Policy Adviser in the so-called "think tank"? Then, perhaps, we might get some more direct opinion and the facts weighed up so that the Government might reach a speedy conclusion.

I commend dentists such as Charles Curry of Northampton, whose services I have been quoting, and also the team of A.S.T. Franks of Birmingham, A. Crawford MacFarlane of Bedford, Deirdre Pool and G. B. Winter of London, who together have formed a new British Academy of Dentistry for the Handicapped. I ask my hon. Friend to look at this organisation with a view to giving the kind of support from the Government that he has already done for the deafened and other sections of the disabled community.

I conclude my plea with a moving quotation which ends the article from which I have taken much of my information, and my hon. Friend knows even better than I do the colleague who provided me with this information. It reads: What sort of motivation would drive anyone to work in a confined caravan, with children often doubly incontinent, frequently sick, with nasal discharges and little means of communication? … Is it religious motivation—a desire for some great reward in the next world? No, one relates to a need. The handicapped child responds—honestly, and brutally truthfully. Only a mongol child, awake all night with toothache, would bestow in gratitude after the tooth was extracted the final, generous accolade of a bloodstained kiss. I hope that this plea will not be unregarded, and I look for speedy action from my hon. Friend in persuading his Department to take the necessary steps. This will not cost a lot of money. It can be done, and the resources are there. It will not require a lot of fresh cash, contrary to what people sometimes think, and, because this area is a blot on a very good record, I hope that it will be remedied speedily.

1.38 a.m.

The Under-Secretary of State for Health and Social Security (Mr. Alfred Morris)

I am grateful to my hon. Friend the Member for Brent, South (Mr. Pavitt) for raising this important subject for debate. The House as a whole is well aware of the deeply humane and abiding concern for the welfare of handicapped people which has prompted him to do so. My right hon. Friend and I have read with considerable interest the report, "A Challenge for Change in the Dental Services", which was prepared by a working party under my hon. Friend's chairmanship. I congratulate my hon. Friend and the working party on such a thorough, stimulating and comprehensive review.

The Pavitt Report covers the whole range of dental services and makes more than 30 recommendations to my Department, some of them far reaching, about the organisation of dental services. We are currently considering the implications of these recommendations. While this is proceeding, my right hon. Friend the Secretary of State feels that it would be premature to single out and react to any specific recommendation in advance of the Department's conclusions on the report as a whole. As my hon. Friend will confirm, however, I have twice discussed with him the suggestion in the working party's report of an extension to include disabled people in the scope of the Community Dental Service at present provided by area health authorities. My hon. Friend knows how happy it would make me if I were immediately able to accede to his suggestion.

The primary function of the Community Dental Service is to fulfil the statutory duty laid on my right hon. Friend the Secreeary of State and exercised on his behalf by area health authorities to make provision for the dental inspection and treatment of children at maintained schools. This work forms by far the major part of the duties of clinical dental staff employed by area health authorities. Yet, over the country as a whole, the resources of the Community Dental Service do not enable that statutory duty to be fully discharged.

The unmet needs of children for dental treatment were emphasised in the report of a survey of the dental condition of a representative sample of children of compulsory school age which was published last year. The survey was carried out for my Department and the Welsh Office by the Office of Population Censuses and Surveys.

Among other alarming statistics, that showed that about 90 per cent. of the children surveyed needed dental attention of some kind, and that about two-thirds of them needed treatment for dental decay. By the age of 15, one-third of the sample had lost at least one permanent tooth, and nearly one-tenth had list at least four permanent teeth because of dental decay. Such teeth are, of course, lost for ever, and cannot be replaced except on a denture.

To deal with that situation, in addition to the more extensive facilities of the general dental services, which I hope to mention later, the school dental service in England has the equivalent of only about 1,400 full-time clinical dental officers, who in 1974 inspected about 4.7 million and treated about 1.3 million of about 8.5 million children in maintained schools in England. In addition, area health authorities continue the arrangements made before National Health Service reorganisation by the former local health authorities for the dental treatment of pre-school children and nursing and expectant mothers.

However, these groups occupy only a small fraction of the time of the authorities' community dental staff. To extend those services to other groups, my right hon. Friend the Secretary of State would need to make a specific direction to the health authorities under the National Health Service Acts. I am sure the House will recognise that it would be difficult for him to do so when the limited resources of these services are not meeting existing statutory obligations.

Mr. Pavitt

Does my hon. Friend agree that if that were made permissive and not mandatory the position would be the same as it is now? If they did not wish to carry out those arrangements they would not need to do so, but if they wished to do so they would have the necessary facilities.

Mr. Morris

I am particularly mindful of the point made by my hon. Friend. When we met we discussed the question of considering the recommendations of the Pavitt Report, especially those that relate to the problem of handicapped people. My hon. Friend can be assured that the point he is making is well understood in the Department and is being considered sympathetically. I said that it would be a source of considerable happiness to me if I could say immediately that I accede to his suggestion. I shall do everything I can to help, and I will keep all that my hon. Friend has said tonight very much in mind.

Dental health in later life is impossible if the foundation is not laid in childhood. As even the few figures I have quoted from the recent survey showed so strikingly, the nation's children are far from achieving this ideal. We must also consider the possibility that recommendations affecting the present child dental services may be made by two committees whose reports are now awaited These are the Child Health Services Committee under Professor Court, and the Social Services and Employment Sub-Committee of the Expenditure Committee of this House, under the chairmanship of my hon. Friend the Member for Wolverhampton, North East (Mrs. Short). It would be wrong to disregard the likelihood that one or other of these bodies will make recommendations affecting the community dental services, with the purpose of raising the admittedly deplorable dental standard of our children.

There are various reasons for the present staffing levels in the school dental service. Not all of these are financial, although I recognise the pressure on the financial resources of area health authorities for health services of all kinds. There is also a manpower problem in this service, although there is some hope of improvement from the continuing and welcome rise in the number of dentists on the Dental Register following the expansion of the dental schools.

I am in total agreement with my hon. Friend in his concern to emphasise the importance of dental care of disabled people.

All sections of the community, whether adults or children, handicapped or not, are eligible for treatment in the general dental services of the National Health Service, in which most people are accustomed to receiving dental treatment and in which some 80 per cent. of practising dentists are engaged. In England alone, well over 11,000 dentists take part in the general dental services. Both their numbers and the number of courses of treatment they provide continue to rise steadily.

A proportion of children who are inspected in the school dental service have always obtained treatment in the general dental services. The children's survey I have mentioned found that by the age of 14 about half the children in the sample had been treated only in the general dental services, about a quarter only in the school dental services and the remaining quarter in both. This is not surprising when one considers the great difference in the numbers of dentists engaged in the two services. However, I have quoted this information to illustrate the pervasive nature of the general dental services and the extent to which they cater for all sections of the community.

I emphasise at this point that handicapped children are eligible for treatment in the community services for as long as they remain at school, and I am glad to learn that many area health authorities make special provision for them.

We must bear in mind that there are more than 1,250,000 severely disabled people in this country with varying degrees of disability. Not all of them have dental problems. But where such problems exist the hospital dental service provides consultant advice and treatment for cases of special difficulty referred by general dental practitioners.

One particular problem that faces many disabled people is mobility. Nobody appreciates this more than my hon. Friend. Many disabled people are unable to get out of their own homes, and many more are restricted in the places to which they can go by obstacles such as stairs and narrow doorways.

Of particular interest to the handicapped, therefore, is the provision in the general dental services for dentists to visit patients in their own homes, up to five miles from the surgery, if the patient's condition so requires. This provision, which can be of great value to disabled people, is not widely known, and I welcome this opportunity to draw public attention to it. Where any necessary dental treatment cannot be carried out at home the ambulance authority is required to provide or arrange for suitable transport, if the patient is considered medically unfit or unable to travel by any other means.

I am sure that area health authorities and family practitioner committees will be glad to help any patients who may be having difficulty for any reason in obtaining treatment in the general dental services. I shall, of course, consider any specific cases of urgent need both speedily and sympathetically. I know that my hon. Friend will let me have any firm evidence of shortcomings in the present arrangements which result in any particular group of handicapped or disabled people being unable to obtain treatment in the general dental services.

There is no escaping my right hon. Friend's duty, laid on him by Parliament, to provide an inspection and treatment service for children in maintained schools. For the time being, any improvement in the resources of these services must be used to benefit children, whose dental health, as I have explained, determines the dental health of the population in later life. My right hon. Friend must also have regard to future demands which may be made on these services by the recommendations of forthcoming reports, in the one case by a committee reporting directly to him and in the other by a Committee of this House.

My hon. Friend mentioned the possibility of this matter being considered by the Prime Minister's special policy advisers. As I know my hon. Friend appreciates, my right hon. Friend the Prime Minister takes a sincere and sustained personal interest in the problems of disabled people. I am sure that no action on my part will be necessary to draw this debate to his attention.

Some of the patients mentioned in the article to which my hon. Friend referred were treated at a hospital for the mentally handicapped and others in a mobile surgery attached to the hospital. It seems that the adult handicapped were treated as patients of the hospital service, not of the Community Dental Service. We understand that the hospital dental officer mentioned in the article also undertook part-time work in the Community Dental Service, and in this capacity treated child patients from special schools as, of course, he was fully entitled to do.

The article is concerned partly with pre-reorganisation conditions, under which the Community Dental Service was the concern of local health and local education authorities and hospital services were managed by regional hospital boards and hospital management committees. Where such schemes are justified by local circumstances they may be facilitated by the reorganisation of the National Health Service, under which the hospital and community services are managed by the same authorities with the aim of integrating previously separate services. It does not follow, however, that it would be practicable at present to expand the Community Dental Service, provided primarily for schoolchildren, to include groups of adult patients.

My hon. Friend made a very moving reference to what was said in the article. He can be assured that I am giving it extremely careful attention.

I fully appreciate my hon. Friend's reasons for initiating this debate. I hope that my remarks have helped to assure him that facilities are available in the National Health Service for treating the people with whom he and I are so concerned. As my right hon. Friend said in his letter to my hon. Friend on 10th August, the Department will continue its consideration of the implications of my hon. Friend's recommendations in the light of the needs of particular sections of the community and the financial and manpower resources for dealing with them.

What my hon. Friend has said tonight about the special problems of the handicapped will be kept particularly in mind. We shall be in further touch with my hon. Friend as soon as possible about the recommendations in the report that bears his name.

Question put and agreed to.

Adjourned accordingly at six minutes to Two o'clock.