HC Deb 21 January 1982 vol 16 cc515-24

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

10.26 pm
Mr. Guy Barnett (Greenwich)

I am grateful for the opportunity to raise the subject of the future of the school for dental therapists at New Cross. The school lies not in my constituency but in the neighbouring constituency of Deptford. However, I have the full agreement of my right hon. Friend the Member for Deptford (Mr. Silkin) to raise the subject on the Adjournment. He and I—and my right hon. Friend the Member for Lewisham, East (Mr. Moyle)—discussed the issue of the school and of dental therapists with the Secretary of State early in November and we were all grateful for the courteous way in which we were received.

On that occasion the Secretary of State undertook to make an early decision about the future of the school at New Cross. He accepted the difficulties which would arise for the director and his staff if his decision were long delayed.

There can be little doubt of the interest and concern that the subject has aroused among hon. Members. Early-day motion 38, in support of dental therapists, was signed by 58 right hon. and hon. Members. My amendment to that motion, in favour of the continued existence of the school for dental therapists, was supported by 68 Members of this House. The abnormal presence of hon. Members at the Adjournment debate this evening is some indication of their interest.

The origin of that concern, both inside and outside the House, lies in the passage in the report of the dental strategy review group entitled "Towards Better Dental Health", published in September last year. Referring to dental therapists, the report seriously questions the long-term viability of the Group and … concludes that … further entry into this class should be discontinued and the New Cross School closed. The decision was based on three propositions: that dental manpower has increased; that dental caries among school children and children generally is not as prevalent as it was when the class of dental therapists—or auxiliaries, as they were then called—was first established; and that dentists now take more interest in the treatment of children than they did. It is noteworthy that the review group, in reaching this conclusion, did so without inviting evidence from the New Cross school, and at no time during its deliberations did it visit the school.

I am glad to say that at least the Under-Secretary of State visited the school a fortnight ago and thus made amends for the serious failure to seek evidence from those best qualified to provide it.

The review group appears to ignore, and indeed to contradict, all previous findings about the work of dental therapists and the school which trains them. First, in 1976 the report of the committee on child services, the Court report, was so impressed by their contribution to child dental health that it recommended the establishment in the provinces of two new schools like the New Cross school.

In 1979 the Royal Commission on the National Health Service endorsed the recommendation to increase training facilities. In 1980 a report on dental education to the Nuffield Foundation called for an increase in the number of auxiliaries in all branches of dentistry.

At present the employment of dental therapists is restricted by law to the community and hospital dental services where they work under the direction of a dentist. They are competent to undertake straightforward fillings, deciduous extractions, cleaning and polishing, the use of all preventive materials and dental health education. It is interesting to note that the Court report and the Nuffield inquiry recommended that their work, far from being phased out, should be extended to all branches of dental services. The review group, which took no evidence from the school, chose to ignore the weighty evidence which I have just described.

I wish to quote Mr. Kenneth Robinson, not least because of the personal regard that I have for him. As Minister of Health he said: I am confident that the dental auxiliary will make a significant contribution to the improved dental health of our children. I ask the House particularly to note the following words: I am sure that one of the best economies we can make is to ensure that all our professional groups exercise the skills for which they are trained and leave to others the lesser skills which require a lesser degree of training."—[Official Report, 15 February 1968; Vol. 758, c. 1717–24.] I do not know what the Secretary of State will decide, but I shall take the opportunity to get rid of some of the spurious arguments for phasing out the profession and closing the school. First, it has been suggested that health authorities do not wish to employ therapists, but when the 108 health authorities in England, Scotland, Wales and Northern Ireland were contacted, 60 replied and only three expressed a definite disinclination to employ dental therapists.

Incidentally, the British Association for Dental Therapists says that only 12 health authorities have never employed them. Many health authorities express support for the employment of therapists and state that they are a valuable part of the health service.

It is also interesting that a survey has been conducted amongst dentists to see whether, if the law were changed, they would be in favour of therapists in general practice. No less than 41 per cent. responded that they would be in favour. Surely that is a demand that should not be ignored.

Next, there is the argument in the report that we are not now short of dentists and that, as auxiliaries were trained to fill the gap in the community and hospital service, we do not need them. Apart from the wise words by Kenneth Robinson that I quoted earlier there is an economic argument. Therapists are cheaper—an argument that surely finds favour with the present Government.

The area dental officer for Lambeth, Southwark and Lewisham estimates that if his dental therapists were replaced by dental officers the increased annual cost per clinician would be £4, 901. It is also reasonable to compare the cost of training. Figures submitted to the Department covering 1975 show that it cost £36, 427 to train a dentist and £4, 577 to train a therapist. That means that one can train almost eight therapists for every one dentist. Obviously we are talking about different levels of skill and professional ability.

For good measure, the review group also says that dentist training should be longer than it is. Incidentally, the Under-Secretary may have seen figures about recent years which show that the costs have risen. However, those figures are erroneous because they do not spread the capital cost of the school over the whole period. There have been exceptional capital costs lately. The Under-Secretary is also bound to disagree with that argument.

Thirdly, it is argued that the New Cross school is isolated and that that is a reason for closing it, and that if dental therapists are needed in future, dental schools will train them. No dental school has yet offered to train therapists and I know of no dental school in the world that does. Indeed, they are unlikely to do so, for the very good reason that it may interfere with their supply of clinical material for trainee dentists.

There could be good legal arguments against those schools wishing or being able to train dental therapists. Section 4(3) of the Dentists Act 1957 states that the arrangements for training ancillary dental workers must not materially impair the facilities for the training of dental students. There are grounds for believing that it would be extremely difficult to ensure that they would not do so if they were trained on the same premises.

It is false to argue that there is any necessary merit in training therapists alongside dentists, because the working situation is quite different from the training situation.

No one at New Cross has complained to me about isolation and no one would have complained of it to the review group if it had asked them. It is geographically close to Guy's and King's hospitals and has links with both. Indeed, the closure of New Cross would mean the total loss of expertise, which is unique, and a loss of resources built up over 22 years in the training of therapists.

In a short time, I have come to admire the school and the work that it does and I also wish to pay tribute to the director and the senior lecturer for the assistance they have given me in preparing for the debate. The school has a high reputation, there is no shortage of suitable applicants and the majority of those selected possess more than the minimum entry requirements.

There are currently 567 enrolled dental therapists and all the evidence suggests that the quality of their work and the productivity is good. Enthusiastic support has come from many quarters. The Secretary of State received a letter from the chairman of the Association of Community Health Councils giving strong support for retaining the New Cross school. A headmistress of a nursery school in my constituency writes: I can vouch for the usefulness of this service, which is really appreciated by both children and parents. She refers, of course, to the work undertaken by students in training. The school treats about 10, 000 local school children annually. Therefore, the Under-Secretary would have to deduct, from any savings that he hopes to make by closing New Cross, the cost of continuing the school's service in my area.

The review group has made two suggestions which the Secretary of State may be tempted to regard as easy compromises. The first is to close the school but to allow therapists to continue. Let it be quite clear that such a decision must mean the end of the dental therapy classes. It should be a slow rather than a quick death because there is nowhere else that therapy students could benefit from the sort of expertise which the New Cross school possesses.

The other suggestion is that therapists could be encouraged to retrain as hygienists. One therapist said: If I had wanted to be a hygienist, I would have trained as one, but I wanted to be a therapist. A therapist has two years' training and a hygienist nine to 12 months, and employment is less of a problem because they can work in general practice.

Women are being asked to accept lower status and pay. It has been suggested that there is an unemployment problem among dental therapists. However, the school informed me that of the 1981 leavers, 30 out of 47 are now employed as dental therapists. That is not a bad position when cuts are imposed on public services and where there is, because of the state of the law, nowhere else they can go as therapists but the community and hospital services.

Before I conclude, I wish to put to the Under-Secretary two questions of which I have given him notice. First, is he satisfied that the lack of consultation by the review group was not the reason for the inconsistencies between its recommendations and those of the three earlier reports that I quoted? Secondly, is he satisfied that the fact that the review group was comprised almost entirely of dentists did not lead to a report which places a great deal of emphasis on safeguarding the interests of general dental practice?

As the Under-Secretary will have noted, the report refers to the concern that in the near future dentists may not be able to maintain their standard of living and some may even be unemployed". I do not mean to disparage the report as a whole. It is a laudable document with many welcome recommendations for the improvement of dental services in this country, but it was produced in something of a hurry. The odd thing is that so much that the report says about a preventive strategy, the changes needed in the administration of the service, education and the development of the service, points to an increasing role for the dental therapist in future and not a diminishing one. I hope and trust that the Secretary of State will not make a hasty or irrevocable decision about the future of dental therapists or of the school at New Cross which trains them.

10.41 pm
The Under-Secretary of State for Health and Social Security (Mr. Geoffrey Finsberg)

I am grateful to the hon. Member for Greenwich (Mr. Barnett) for the way in which he raised this matter and for giving me notice of the points that he mentioned. I assure him that I shall deal with them.

The debate stems from an important recommendation in a report by the Dental Strategy Review Group—one of the first documents that landed on my desk when I arrived at the Elephant and Castle. I took great care to read it in full. It said that further entry into this class should be discontinued and the New Cross Training School closed". My right hon. Friend the Secretary of State and I are well aware of the strength of feeling that the recommendation has provoked. More than 600 letters, many parliamentary questions, several deputations and the number of hon. Members present for the debate are ample testimony to that.

I regret that many of the representations that we have received are based on the misconception that a decision to accept the recommendation to close the New Cross school would mean the end of the dental therapist class. That is not so, and I welcome the opportunity to put that part of the record straight.

The professional status of every qualified therapist is guaranteed by the provisions of the Dentists Act 1957 and as long as a therapist continues on the roll she will be permitted by regulations to continue to undertake the work which the law permits. Many therapists would not retire from active practice until well into the next century. There is also no question of stopping students in training at New Cross from completing their course. Therapists will continue to qualify from New Cross in both 1982 and 1983.

Mr. Nigel Spearing (Newham, South)

What about after that?

Mr. Finsberg

Having seen and heard a wealth of comment on the role of dental therapists, I am convinced that they have done work in the community and hospital dental services which is a credit to themselves and to the training school. Hon. Members know that I visited the New Cross school earlier this month and they will not be surprised to hear that I was impressed with what I saw. But the quality of work was never in doubt.

We must face facts, and it is a fact that since it was set up in the early 1960s the New Cross school has trained more than 1, 000 dental therapists, of whom little more than half are currently enrolled with the General Dental Council. Of course, it may be that some have retired temporarily to raise families, but the fact that less than half of those trained with such care as dental therapists are at present employed as such in the whole of the United Kindom is, to my mind, most worrying.

Dr. Roger Thomas (Carmarthen)

Will the hon. Gentleman give way?

Mr. Finsberg

No, I am trying to cover as many points as possible—as the hon. Member for Greenwich asked me to do.

We must also face the fact that the New Cross school is equipped to train up to 60 new therapists each year at a time when many qualified therapists cannot find posts as therapists and when there are very few vacancies. I understand that only 31 of the 54 students who qualified in 1979 are currently employed as therapists. Only 30 of the 49 qualified in 1980 and 30 of the 47 qualified in 1981 have managed to find posts as therapists. I believe that few of the remainder are unemployed, as such, and that many have jobs as dental surgery assistants, while some work as dental receptionists or as secretaries. I suggest that for fully trained dental therapists to find themselves in jobs like those cannot by any stretch of the imagination imply a good or proper use of resources.

Mrs. Gwyneth Dunwoody (Crewe)

rose—

Mr. Finsberg

If the hon. Lady will permit me, I am trying to deal fully with the points that were raised.

Mr. Spearing

The hon. Gentleman is not.

Mr. Finsberg

I have not even finished answering what was said. Hon. Members would hear more if they would be kind enough to allow me to answer what has been said.

As I said, we are convinced that there has been and will continue to be an important role for dental therapists in the NHS. I am, of course, aware that the present role of therapists is limited and that there may be scope in the future for expanding it, but the precise role of dental therapists in future will need careful consideration alongside the role of the other auxiliary grades and dentists. That is a matter that we shall be looking at carefully when we come to make decisions on the new Dental Strategy Review Group report. However, we are convinced in principle that there will be a continuing role for the dental therapist class, and we have been looking at the reports of the Royal Commission on the NHS and the Nuffield inquiry, to which the hon. Member for Greewich referred.

Mrs. Dunwoody

A bit belatedly.

Mr. Finsberg

I am trying to do the hon. Member for Greenwich the courtesy of answering his questions seriatim.

The report of the Royal Commission on the National Health Service and the Nuffield inquiry saw a role for dental therapists in the future but pointed out the desirability of training dental therapists alongside dental students and student hygienists and dental surgery assistants. We entirely agree that it is wrong in principle for therapists to be trained in isolation, and that it would be much better if therapists' training in the future were to be arranged alongside that of the other dental professions—probably in several dental schools.

Mr. Spearing

Is that a guarantee?

Mr. Finsberg

I listened carefully, to the views put forward tonight by the hon. Gentleman. As he says, we had intended to announce a decision before the end of 1981, but it was postponed so that I could visit the school and so that we could give the greatest possible consideration to all the issues involved.

However, a decision must be made now—in advance of our decisions on the other recommendations of the dental strategy report—if only to be fair to the staff, students and potential applicants of the New Cross school. Nothing could be worse than the sword of Damocles hanging over them for another year; and a decision is essential by the end of this month if we are to clarify the position of the autumn 1982 intake.

We have decided that the dental therapist class will continue; that its precise role and size will need to be considered further with other aspects of our dental strategy, and that dental therapists should in future be trained alongside other dental professionals. The New Cross school has produced well-trained therapists, but in numbers too great for and not sufficiently sensitive to the demand for their services. The school will therefore be closed at the end of its summer term in 1983. [HON. MEMBERS: "Disgraceful."] We shall, meanwhile, be making arrangements whereby several dental schools around the country can train small numbers, of dental therapists to meet local demand. I cannot be precise at this stage about where the centres will be or what detailed arrangements will be needed, but I can assure the House that several dental schools, at least one in London and others in the provinces, have already shown an interest and willingness in principle to train dental therapists.

I should like to reassure hon. Members—including my hon. Friend the Member for Woolwich, West (Mr. Bottomley), who raised the matter with me—who have constituency interests in the New Cross area—the right hon. Member for Deptford (Mr. Silkin), has made this important point to me—that arrangements will be made to ensure that children's dental health does not suffer because of the closure of the school. I acknowledge that there has been considerable benefit to the child population from the presence of the school in New Cross—a benefit that children in other parts have not been lucky enough to enjoy. The loss of an advantage will naturally be deplored by the loser. However, I understand that the local community dental service has been considering how it would cope if the school closed and it thinks that, given access to the surgery facilities at the school, it will be able to manage well, and that should be possible.

The great majority of the representations that we have received have expressed the gravest concern about the future of the dental therapist class. If the future of the class were assured I feel that the bulk of the objections to closure of the school would disappear. This future is now assured—[Interruption]—though the precise size and scope of the therapist's role are still to be worked out. The Royal Commission and Nuffield reports—as well as many of the professional people who wrote and spoke to us—favoured future training of therapists in dental schools alongside other dental professionals. We also accept that and we shall be looking urgently at the prospects for at least one or two centres to be ready well before the New Cross school closes in 1983.

The closure of the New Cross school is part of a positive strategy for the dental therapist class. I cannot let this occasion pass without, like the hon. Member for Greenwich, paying tribute to the management, staff and students of the New Cross school. It is unfortunate that they should have been providing an excellent training at a time when the demand for their students has been flagging. I assure all concerned at the school—[Interruption]—that everything possible will be done to safeguard their interests.

The hon. Gentleman asked me about the composition of the committee. With the benefit of hindsight, which was not available to the chairman and members of the Dental Strategy Review Group, I venture to say that it is a pity that there was not a dental auxiliary member of the group and that before recommendations were made with potentially such serious effects on dental therapists the proposals, reasons and implications could not have been discussed openly with the school management and the British Association of Dental Therapists. However, that was the situation that I found. I do not know—

Mr. Spearing

Why take the advice?

Mr. Finsberg

If the hon. Gentleman listened instead of shouting he would know that I have not accepted the advice. The trouble is that the hon. Gentleman does not seem to realise that.

I do not know whether the recommendations, which of course it was the group's duty to make to my right hon. Friend the Secretary of State, would have been any different, but misunderstandings might have been avoided and a consensus might well have been reached that much more quickly. I hope that the exhaustive and meaningful consultation that has taken place since the recommendations reached the Department have to some extent made up for the fact that only the dental profession was represented on the group and the opportunities for taking oral evidence were not more extensive. All the professional deputations that I have seen have expressed themselves satisfied that their point of view was carefully listened to.

In the time available this evening I have not been able to do other than summarise briefly the thinking behind our decisions and to answer—I hope fully—the hon. Gentleman's points. My right hon. Friend and I feel that in view of the very many hon. Members who have written and spoken to us on this issue and the strength of feeling it has aroused we should make a longer statement setting out our thinking in a little more detail. A copy of the statement will be placed in the Library.

That will help the House and the many hon. Members who have written saying that they are unhappy that dental therapists will cease to exist. That has never been the proposal, and it is not what I have said. As hon. Members will appreciate, any proposal to stop training dental therapists would mean primary legislation, and that is not at issue. Our suggestions tonight will benefit the patients, who will be able to look forward to being treated not only by those who have been trained with such dedication and care at New Cross but by the generation from dental schools, who will be part of a dental team. It is impossible to argue that we should take note of Nuffield and the report of the Royal Commission on the NHS, which talk of the need for training as part of a team, and then shout "What about letting them go on in isolation?" That is not right.

What will now happen is that there will be a team approach. There is plenty of time between those who come out in 1983 and the substantial number—about 500—who are available for employment, who can go to the health authorities which the hon. Gentleman says want them. In fact, he did not actually say that they wanted them. He said that very few had said that they did not want them. The fact is that there is not the demand. Year by year, before the Government came to power, the intake at New Cross had been reduced because the school realised that it was unfair to train many more students than could find the opportunity for work.

I suggest that that brings the House to the reality of the situation. I do not believe that it would have been possible to take any other decision that would have been fair in the interests of the children and of the dental profession, including the therapists. The hon. Member for Greenwich, who raised the issue, and who has certainly studied it and has not been jumping up and down making interventions, realises in his heart that the case that I have put is fair and has to be accepted. From the letters that we have received I believe that the overwhelming majority of people who were clearly worried about this will be reassured that the class of therapists is to remain, that those who remain on the roll will be able to go on practising, and that we are making provision with dental schools which, as I have said, have agreed in principle to start the training of therapists as part of a team.

I suggest that that is a positive result and that the House should be very pleased at the outcome.

10.55 pm
Mrs. Gwyneth Dunwoody (Crewe)

This has been a very shabby little episode—

The Question having been proposed after Ten o'clock and the debate having continued for half and hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at four minutes to Eleven o'clock.