HL Deb 07 February 1956 vol 195 cc776-98

2.43 p.m.

Order of the Day for the Second Reading read.

THE SECRETARY OF STATE FOR COMMONWEALTH RELATIONS (THE EARL, OF HOME)

My Lords, this Bill is approximately the same Bill which went through all its stages in your Lordships' House in 1952. It contains most of the improvements—in fact, I think all the improvements—which your Lordships made in the Bill then. You will remember that the only reason why it did not become law was that there was not time for it to be taken in another place. But I think the time between then and now has not been wasted, because the Minister has been able to achieve certain modifications which have met with acceptance by the dental profession and which I think, on the whole, have improved the Bill.

Before I deal with the changes which have been made, it may be convenient to remind your Lordships of the background against which this Bill is introduced and of its main purposes. Of course, the background to the Bill is a serious shortage of dentists. I think perhaps the most vivid illustration which I can give to your Lordships of the need of our country at this time for dentists is that the Committee presided over by my noble friend Lord Teviot recommended that, if this country was to have a complete and satisfactory dental service, the annual intake into the dental schools should be somewhere about 900 students. The fact is that to-day the Minister tells me, we shall be lucky if we get 450—or only about half the figure which the Teviot Committee regarded as essential. When my noble friend Lord McNair comes to speak, he will be able to tell us more about recruitment, but I have said enough to show that the position is serious indeed.

The main provisions of the Bill, I think, are four. The first is to grant self-government (a phrase much in the air to-day) to the dental profession, to give them independence, and to set up a General Dental Council with a status and functions comparable to those of the General Medical Council. The second is to modify the procedure for the admission of foreign-trained dentists to the British register, by allowing the General Dental Council, if they cannot accept the diploma which an individual from overseas is able to present to them, to test the competence and skill of the individual in different forms of examination.

The third main provision, which has attracted a good deal of attention, is to establish under the control of the General Dental Council grades of ancillary dental workers and to experiment with a new type of ancillary worker. The proposal is that this new type of ancillary dental worker should be able to extract what I believe are called, in dental jargon, deciduous teeth. I am glad that this horticultural nomenclature is carried no further: the opposite of deciduous teeth are permanent teeth, and not evergreen teeth, as one might suppose. But there is this proposal that there might be an experiment in the establishment of ancillary dental workers under the direction of a registered dentist, who would conduct their operations in hospitals, clinics and health centres. Their work would be the extraction of deciduous teeth and the filling of both permanent and deciduous teeth. Lastly, among the main provisions of the Bill, there is one to introduce restrictions on the carrying on of the business of dentistry by individuals or bodies corporate, other than those who are registered dentists.

My Lords, I think that the granting of self-government to the profession will be generally felt by your Lordships, as it has been felt by others, to be long overdue. The Committee presided over by my noble friend Lord Teviot recommended this self-government as long ago as 1946, and the fact that it is being introduced in this Bill, is, I think, a matter for general satisfaction. As far as the ancillary workers are concerned, the intention at present, as expressed in the Bill, is that we should go no further than an experiment. The conditions are contained and explained in Clauses 18 to 22 of the Bill. The experiment would have to be framed by the General Dental Council; it would have to be initiated by the Privy Council and it would have to be conducted by a committee specially set up for the purpose. I think, therefore, that the experi- ment contains safeguards for the public which are both comprehensive and sensible. In another place the Minister give an undertaking—perhaps, if that is too strong a word, I might say, an intimation—that this experiment would not be started until we had had the benefit of the Report which is being prepared by Lord McNair.

Having dealt with the four main provisions of this Bill, perhaps it would be convenient for your Lordships if I now mentioned the main changes which have been introduced into the Bill since 1952. The first is that in this country at the present time there is a small number of foreign dentists. I think the number has been put at between 40 and 50, which figure contains a number of extremely skilled persons. But under previous legislation the Dental Board and the General Medical Council had to decide whether or not they would accept a Commonwealth or a foreign diploma, and beyond that there was no discretion if they felt they could not accept it, they could not employ the individual. This Bill provides a little more elasticity, and if the General Medical Council feel they cannot accept a diploma presented by an individual foreigner they can, nevertheless, by the use of examinations, test the capacity and skill of the individual and, if they are satisfied, allow him on to the British register of foreign dentists.

The second change is that there is a prohibition on the establishment of a class of ancillary concerned with the fitting of artificial teeth. There have been two schools of thought about these dental technicians. One holds that it might be advantageous to bring them into the profession now. The other school of thought believes that, whatever the future may hold, there is at present no justification whatever for bringing this class of what is known as dental prosthetists into the dental profession where they will have direct access to the patient, and that to bring them in would do nothing to help recruiting to the profession. The proposal to bring in these workers is not supported by the unions which represent them. The weight of opinion seems to be that the time is not yet ripe for their inclusion. This class of person is, therefore, excluded from the Bill.

The Bill concentrates on those ancillaries whom we conceive to be most needed and who will contribute to conservative and preventive dentistry, which seems to be the great need of our time. Clauses 23 to 26 contain certain modifications in respect of individuals and bodies corporate carrying on the business of dentistry. The Bill proposes that those individuals who were carrying on the business of dentistry on July 21,1955, but were not registered dentists or doctors, should be allowed to carry on until they die out in the natural way but that in future no one shall be allowed to start a business unless he qualifies under Clause 25 as a registered dentist or doctor. Roughly the same rule applies to corporate bodies, dealt with in Clause 24, but there is a slight relaxation of the ban for new bodies practising the business of dentistry. It is thought safe to lift this ban in respect of societies registered under the Industrial and Provident Societies Acts, and in respect of the Co-operative Dental Association. By any standard their record of skill and performance is very satisfactory, and it is thought right to allow these corporate bodies to practice, always subject, of course, to the disciplinary powers in subsection (4).

There has been some difference of opinion in another place, and expressed outside, over the composition of the General Dental Council. As a result of representations that have been received, changes have been made and practising dentists elected by their own profession (known as "elected dentists") will now form a larger percentage of the Council than had originally been proposed. Their number has been raised from nine to eleven of the thirty-seven members. At a later stage I shall move a new clause which will give additional protection to the titles used by dentists, by which they set considerable store, but this will not be a matter of any controversy. I hope that, after this brief outline of the general purposes of the Bill and with the clarification which I hope I have made of the changes introduced since it last left this House, your Lordships will give the measure a quick passage into law, and that what I consider is a beneficial and helpful measure to the profession and the public will receive a Second Reading to-day. I beg to move.

Moved, That the Bill be now read 2a—(The Earl of Home.)

2.56 p.m.

LORD SILKIN

My Lords, we are this afternoon welcoming an old friend, somebody whom we have met before and with whom we spent a considerable number of days in 1953. The time we spent with this old friend has not been wholly wasted because it had the effect of shaping the measure which now comes before us, so that we can now dispose of our old friend in a considerably shorter time than otherwise would be the case. It also had the effect of enabling both sides, when the Bill went to another place, to deal with it in a mutually helpful way, and the discussions on this Bill in another place have been generally conciliatory and helpful. The Bill, therefore, comes before us as a considerably improved measure.

The noble Earl was perfectly right in saying that the main problem which we have to face is the considerable shortage of dentists in this country. We are becoming considerably more conscious of teeth and of the need for preservation as against extraction. To some of us this comes a little late in the day but for others there is still the opportunity of making use of the new conception of dentistry. To carry this out effectively, however, it is necessary to start right at the beginning and the treatment of the child is a most important factor which involves a considerable increase in the number of dentists. One of the purposes of this measure, or the hope maintained for it, is that it will result in an increase in the number of persons entering the dental profession. I believe a Committee is now considering, among other things, the grave falling off in the numbers entering the profession. I have not the slightest idea whether that Committee is to make recommendations or not, still less what those recommendations are likely to be.

My own view is that the dental profession does not at present enjoy the status essential for a profession of its importance to the community. The members of the dental profession are doubtless as highly remunerated as members of the medical profession. Status cannot, therefore, be entirely a matter of remuneration. Further, I would say that the work of the normal dentist is less arduous than that of the normal general medical practitioner. The dentist has his set hours, and generally he works in his own place; he is mater, to a considerable extent, of his own time—which is just the reverse of the conditions under which a doctor works. I have come to the conclusion, therefore, that the question is largely a matter of status, and I believe that this Bill goes a long way towards improving the status of the dental profession.

I would not, however, go so far as the noble Earl in saying that it gives the profession complete self-government, still less self-determination. The profession is restricted in a great many ways, and I am not completely happy about the position of the General Dental Council, not so much from the point of view of not giving dentists a considerable measure of self-government, but because it introduces members of another profession, the medical profession, as members of their governing body. While one can make a very good case for this step, that case would be even stronger if members of the dental profession were on the General Medical Council—though that, of course, has never been contemplated. That is a matter which I hope we shall be able to talk about in the course of the passage of the Bill. I say frankly that, while I think it is a factor to be borne in mind, I do not put it as a factor of supreme importance. This Bill goes a very long way towards giving the profession self-government, and should make a substantial contribution towards recruitment in what is otherwise, I believe, a very attractive profession.

There are one or two points that I should like to raise but they are only a few, because, as I have said, this Bill has been the subject of a very helpful discussion in another place. A great many of the points which were nude on both sides of the House have been met so that there is not a great deal that we, as a revising Chamber, shall need to say on this measure. Indeed, I would confine my remarks to two particular subjects. One is the question of the registration of Commonwealth and foreign dentists. It seems to me that the Commonwealth dentists do not constitute so difficult a problem as the foreign dentists, and I want to say frankly that in this matter I believe the problem is not so easy of solution as some people appear to think. I believe that in the past, where the foreign dentist has arrived here (and we are told that many of these people have come here as a result of oppression in their own countries), with a diploma or other qualification which is recognised and well-known, it has not been too difficult for him to enter the dental profession, provided that not too long a period of time has elapsed between his coming here and his application for registration.

The problem arises (the noble Earl is quite right, I believe, in saying that there are some sixty of these foreign gentlemen in this country) where either a long time has elapsed since they first came here, and they have, possibly, lost some of their skill and perhaps even their knowledge of the profession in consequence, or where they come her—and I say this in no spirit of disrespect—with alleged qualifications which we have no means of checking. It is a serious matter to entrust the dental health of people to practitioners of whose qualifications we have no specific or precise knowledge. I make no complaint that in the past we have, perhaps, been rather careless in accepting these qualifications, sometimes at their face value and sometimes on very little more than the statement of the individual who makes the claim to be put on the register. Nevertheless, there are sonic sixty people in this country who have claimed that they were dentists in their own countries and that they possess the appropriate qualifications. I think this Bill goes a little stage further towards providing these people with the possibility of receiving a British qualification. And, in these days of considerable shortage, sixty extra dentists would be a welcome addition to the number of professional dentists practising in this country.

One suggestion I should like to make (because I do not think the provisions of this Bill go far enough in this respect) is that these people should be permitted to practise under the supervision of practising qualified dentists for a specified period—say a year—and that thereafter they should undergo a simple examination—the very simplest kind of examination. I think that that would be acceptable, and would enable us to satisfy ourselves that these people were suitable persons for registration. I do not want to develop this point at this stage of the discussion, but it may be that I shall put down an Amendment at the next stage, so that we can have a more detailed debate on the point.

The next point I want to deal with is the question of the dental prosthetist, who is the same person as our old friend the dental mechanic. When we were last discussing this matter, we all knew of whom we were speaking, but to-day the dental mechanic has become the dental prosthetist. With the situation arising from an extreme shortage of dentists, I do not believe that merely by improving the status of the profession in the way we contemplate doing in this Bill we shall get the required number of people. To do that we should have to more than double the number of persons entering the profession each year. I am afraid that we have not the necessary capacity in our dental schools, nor do there appear to be the students available for entering the profession on that scale.

On the other hand, I imagine that one of the reasons why the Government have been persuaded to accept the principle of the ancillary dental worker is that an efficient ancillary dental worker can save the time of the dentist to a greater or less degree and so enable the dentist to devote more of his time to the really professional side of his work. The dental mechanic is the person who actually makes the false teeth. It is a job—I will not call it a profession—which requires great skill. I am given to understand that it takes, normally, some seven years of training before a person regards himself as a skilled dental prosthetist. For my part, I can see no reason why we should deliberately go out of our way—as it seems to me we are doing—to prevent such people from being allowed to do the things for which they have been trained—namely, to fit teeth in the mouth of a patient, under the supervision of the dentist himself.

In dealing with this matter of ancillary dental workers, the Bill contains a great many safeguards against abuse. First, ancillary dental workers must not be introduced into the profession at all unless their introduction is authorised by the General Dental Council, who have to make regulations for that purpose. There is a provision in the Bill which prescribes the qualifications for becoming a member of any of the ancillary dental workers sections and it permits the General Dental Council to prescribe the exact dental work which they may undertake. It also provides that there shall be no interference with the training of dental students. Any training that may be required for ancillary dental workers shall in no way impede the facilities for the training of dental students.

Furthermore, before any regulations are made—and as I have pointed out these have to be initiated by the General Dental Council: if they do not initiate them, nobody else will—they have to be submitted in draft to the Privy Council for their approval. But even that is not the end of the story. The regulations have then to come before both Houses of Parliament, and each House has to pass an Affirmative Resolution. Then, after all that, the work which these ancillary dental workers are permitted to carry out must be carried out under the direction of a registered dentist, and the Bill says that it shall be the duty of the General Dental Council to secure, either by provisions in the regulations or otherwise, that such work is carried out only after the registered dentist has examined the patient and has indicated to the ancillary dental worker the treatment to be provided.

In view of all those safeguards, I am puzzled to understand why it should be necessary, under Clause 19(1), to exclude specifically from the work which they may carry out under the regulations the fitting, insertion or fixing of dentures or artificial teeth. I should be interested to know why the Government are so specific on this point. Why is it necessary in such definite terms to exclude this work when all these safeguards are embodied in the Bill? I am not suggesting for a moment that we should here and now accept the dental prosthetists as ancillary dental workers. They have to undergo a certain amount of training; they have to get themselves accepted by the profession generally, and they must be recognised. I accept all that, and I would leave the timing entirely to the General Dental Council; but I feel that it is quite unnecessary in the Bill itself to say that they shall not do this particular work. I should have thought that all these safeguards were adequate protection both for the dental profession and for the general public, who are, after all, most concerned.

These are the main points that I propose to make or this Bill. Perhaps I ought to make it clear, at any rate on the last point I have made on dental prosthetists, that there is a certain amount of difference of opinion, as the noble Earl himself indicated. I have no idea whether I am speaking for all of my noble friends or most of them, or for any at all; but at any rate I am speaking for myself on this point. Generally speaking, we welcome this Bill, and we will do everything we can to give it a speedy passage into law.

3.15 p.m.

LORD AMULREE

My Lords, I should like to join warmly in the general welcome which has been given to this Bill. I can speak not only for noble Lords on these Benches but also for the bulk of the members of the profession to which I belong, in saying that we welcome the recognition of the dentists as an independent body. I am sure that the fact that they are becoming independent will lead to a great improvement in their status and at the same time I trust it will result in more people joining the ranks of the dental profession. The present Bill is a great improvement on the Bill which we discussed in 1952. There are, however, one or two points which I should like to raise, not as any kind of objection, but from the view that we have to be careful to see that we do not go wrong. These points apply mainly to Clauses 18 to 20, which deal with the ancillary dental services.

Clause 20 refers 'to the possibility of establishing an experimental scheme for training ancillaries to do certain work. I assume that their training will he short, perhaps for about two years—I cannot tell. They are to be allowed to undertake the stopping and filling of teeth not only of children but also of anybody who attends a clinic run by a local authority or by one of the national institutions, under the control, of course, of a qualified dentist. I wonder whether we have thought about that seriously enough and about whether it is going to encourage recruitment to the dental profession. I am told that around 40 per cent. of the work of the average dentist, who constitutes about 90 per cent. of the profession, consists in the filling of teeth. If people with a short training—say, two years—are to be allowed to take up that kind of work, would it not make people think that a dentist's work is something that can be done by a not-so-well-qualified or so well-trained person, because the bulk of the work that he does can be done by a partially trained person? This is a point which is worthy of a good deal of consideration. When this experimental scheme is put into force, it should be watched to see whether it will have any deleterious effect.

Another point about which I am concerned and which needs consideration is the permission to be granted to dental assistants, after a short training, to cope with first teeth or deciduous teeth. There is a great deal of wrong thinking about that matter. Because these teeth fall out gently by themselves when one reaches a certain age, because they get loose when the time has come for them to go and they can be pulled out by a mother in all sorts of ways, we assume that they can be dealt with easily. But suppose the teeth are affected by decay or some kind of trouble before the time they are due to come out, then they are just as difficult to extract as the most complicated teeth one can find. They have rather large, widespreading roots that can be broken off, and if they are not carefully extracted they can cause great damage to the permanent teeth which follow them. Moreover, if they are taken out too irresponsibly or too frequently they can lead to a permanently deformed jaw, which, when the permanent teeth come along, will be a cause of considerable difficulty. Although one welcomes this experiment, we trust that it will be carefully watched, because there are so many possibilities of things going wrong.

The last point I want to mention is that the Bill does not encourage the recruitment of dentists. We have been told by the noble Lord, Lord Silkin, and I believe it was mentioned in the Committee presided over by the noble Lord, Lord Teviot, that there is a great shortage of dentists in the country; we are told that there are about 12,000 in practice now, and we need another 6,000 to make it a properly functioning profession. What I should have liked to see in the Bill would be some form of encouragement for expanding the number of dental schools, or, at least, the amount of accommodation in the present schools. I am led to wonder whether it would not have been advisable to postpone the introduction of this Bill until the Report prepared by my noble friend Lord McNair was published, so that we should know the recommendations of that Report before the Bill was introduced. These are only a few passing observations that I desire to make. I welcome the Bill, and assure the Government that noble Lords here will do their best to ensure it a speedy and comfortable passing.

3.22 p.m.

LORD MCNAIR

My Lords, I must begin by declaring an interest in this matter. As the noble Earl, Lord Home, has indicated, I am Chairman of the Committee appointed by the Minister of Health and the Secretary of State for Scotland with the duty of ascertaining the causes of the lack of candidates for training as dentists, and to suggest remedies. That fact must cramp my style somewhat, although I am speaking in a purely personal capacity and nothing that I may say could in any way prejudge the findings of my Committee. I am unable to say anything on the subject of dental ancillaries, but I wish to say a few words upon the establishment of the General Dental Council, and its implications.

I venture to commend the establishment of this Council to your Lordships as the final stage in the progress of the dental profession towards complete self-government. It is now nearly a hundred years since the first dental qualifications were granted in this country, when the licensing authority was the Royal College of Surgeons. In 1878 another stage was reached when the affairs of the dental profession were put under the control of the General Medical Council; and by the Dentists Act, 1921, a Dental Board was constituted whose activities were subject to the approval of the General Medical Council. Now, if this Bill becomes law, there will be a General Dental Council similar to and parallel with the General Medical Council. That will mean that the dental profession must stand on its own feet and acquire direct responsibility for dental education and research and the discipline of the profession. I do not doubt that this profession has gained greatly from the tutelage of the medical profession during the past hundred years, but I am sure that the passage of this Bill, by emancipating the dental profession from that tutelage, will carry with it wider recognition of the national importance of the profession and in that way improve its status.

Two things are now necessary. The first is to bring about a great awakening of the public consciousness of dental health so that the need for treatment may be translated into the demand for treatment. The second thing is that the profession should be both technically and numerically competent to deal with the present and any future demands that the public may make upon it. At present, as your Lordships well know, the public is lamentably ignorant of the importance of preventive dental treatment; most of us still think that there is no need to go to the dentist until we are driven to him by pain. The interest of the public in the arrest of decay in its early stages, and the prevention of decay, is incredibly small when you compare it with the interest taken in the prevention and cure of other diseases far less common but more dramatic. At the moment the profession is numerically inadequate to deal with even the present demands made upon it. What are known as the priority services—that is, the care of mothers and young children, and the school dental services—are greatly hampered through lack of dentists in performing their essential work. In round figures, there are now about 1,000 dentists serving in these priority services, when at least 2,500 are needed. These two services are capable of doing a vitally important piece of work but for the shortage of dentists to man the service. The consequence of this shortage is deplorable, because if children can only leave the schools in a good state of dental health and with good dental habits a large step will have been taken towards ensuring their future general and dental health.

But, quite apart from these priority services, there is abundant evidence of shortage both in the general dental part of the National Health Service and in private practice. I could give your Lordships the figures showing the ratio of dentists to the population in a number of countries, but I shall content myself with giving three. In the year 1954 in Great Britain there was one dentist to every 3,273 members of the population, whereas in Norway the ratio was one to 2,000 of the population, and in the United States of America there was one to every 1,677 of the population. There are long waiting lists in many parts of our country. We are spending many trillions of pounds every year on a general National Health Service, but a bad mouth is one of the commonest causes of bad general health, and so long as dental disease is widespread and so inadequately attended to, the expenditure of this money on general health is just like pouring water into a bucket that has a hole in it.

The serious aspect of this general shortage is that our dental services are not able to cope with the preventive work, particularly at the age when it is most effective and durable. Far too much dental manpower is now devoted merely to patching up the patient's health when it has already broken down, instead of being available for its conservation. Now it is true that the dental profession has to compete for its members in an educational pool in which there is intense competition at the present time on the part of all the professions, services and universities. At the same time, dentistry affords a good livelihood to any suitable young man or woman who wishes to do work of first-class importance, and much opportunity for research to those who are scientifically minded. My hope, then, is that this Bill will open a new chapter in the development of the profession by drawing public attention to the national importance of the work performed by its members, and by placing fairly and squarely upon the profession the duty of meeting the needs of the nation.

3.32 p.m.

LORD WEBB-JOHNSON

My Lords, it is a particular pleasure to me to follow the noble Lord, Lord McNair, and to congratulate him on his maiden speech, and, indeed, to congratulate the House on receiving a recruit who can speak with such valuable authority on several questions not confined to teeth but. I doubt not, extending also to other parts of the alimentary tract. He has given us valuable guidance to-day, and it is obvious that we shall benefit from his presence the more he takes part in our debates. I am glad that this Bill has had such a long and lonely sojourn in the corridors of the other place for nigh on four years, because it has given me the opportunity of hearing the noble Lord making his maiden speech.

I should like to give a warm welcome back home to this Bill, in which the noble Earl, Lord Woolton, played such a helpful part when the earlier Bill was under debate in this House. There are improvements in the present Bill. Representation of different branches of the profession has given more satisfaction. More has been done for foreign and Commonwealth dentists who wish to qualify to practise in this country. Those in charge of the Bill might, however, give serious thought to the suggestion made by the noble Lord, Lord Silkin, that work under the supervision of a qualified British dentist for a time might he just as satisfying and just as helpful as passing an examination. It is not easy for men, after they have reached a certain age, to go back to the examination frame of mind, or the frame of mind of examiners.

The primary object of the Bill, apart from its being a pathway to deal with this difficult question of ancillaries, is to create a General Dental Council to make dentistry into a self-governing profession. That is a great step forward, but sometimes I wonder whether those responsible for drafting Bills and those who are so watchful for the safety of the people do not sometimes become a little inconsistent. They set out to make a self-governing profession and then they engage "Big Brother," in the shape of the Privy Council, to take care that the new infant does not do anything without his steps being carefully watched. The Government set out in the Bill to create a self-governing profession and then proceed to say that the Privy Council, after consulting the General Dental Council, shall come to a certain opinion. They do not say whether it is to be consistent with the advice The Privy Council received at the consultation. Of course, the Scotsman gets over that, because he does not pay if he does not take the advice. But it seems that the Privy Council are to act regardless of whether the advice given is what they are prepared to carry out. I would suggest generally to noble Lords that, when they create professional bodies, committed to conduct business with a sense of responsibility, the more the bodies are trusted, the more responsible action will be taken. I would ask them to bear in mild that the more the General Dental Council is given confidence, the more zealous it will be for the honour and standards of its profession, and the keener will be the sense of responsibility it will have to the public.

There is just one small question. A difference may have revealed itself in regard to prosthetists. They have ingenuity and their work is skilled work. It would, however, be a backward step to bring the prosthetist back into the patient's mouth; his place is in the workshop. It is just the same as if I deal with a deformity of the lower extremity: it is my business to see that any pros-the tist's work to improve the patient's condition is suitable in every way. Friends of the prosthetist—as we all are; we all admire their skilled work—should bear in mind that the ancillary workers dealt with in the Bill are going to do conservative work, which is rather different from the prosthetist's remedial work. In view of the past history of the dental profession, one can understand the difficult time the profession went through in trying to raise its standards to a reasonable height by means of the earlier Act. In view of that past history, is it any wonder that the British Dental Association are genuinely anxious? I want noble Lords to realise that the British Dental Association are still opposed to the creation of these ancillary groups. The idea is generally accepted all round but they still register an opposition because they know the past history and the possible dangers. Your Lordships have satisfied yourselves in the past on the safeguards, and your Lordships will take due care at the present stage.

There is one thing that perhaps the general public do not fully understand—even Members of your Lordships' House, in conversation, make me realise that they do not fully understand. We harp on school children; we harp on looking after the children. We gaily accept the idea that deciduous teeth in children should be removed by an ancillary worker, and then mention fillings. But it is not the whole population who will realise that, under the Bill, fillings can be done for any member of the population. I only want them to realise that point fully, so that there shall be no misunderstanding. I hope that, if conferences are sought, the noble Earl in charge of the Bill will give free opportunity for conference with those who hold strong views, perhaps different views from those dealt with in the Bill, so that, as happened during the passage of a similar Bill through the House four years ago, when enormous improvements were made by quiet talks between the Second Reading and the Committee stage, further improvements can be made. Finally, I should like to repeat my welcome at the return home of the Bill, and to add my hope that it will have an easy passage for its Second Reading, which I heartily support.

3.43 p.m.

LORD BURDEN

My Lords, I should like to have the privilege that my noble friend Lord Webb-Johnson had of offering congratulations from these Benches to the noble Lord, Lord McNair, for his most informative, wise and courageous maiden speech. We hope that on many occasions to come we shall have the benefit of his ripe wisdom in these debates. The Bill we are considering this afternoon is, as my noble friend Lord Silkin said, a Bill which comes back to us. We held prolonged debates upon it in your Lordships' House, and it has been improved in a considerable measure. It is a Bill in which I understand a broad general measure of agreement has been reached with the professional associations who are interested in the matter—perhaps "matter" is the wrong word to use in connection with this most important problem.

It is a pity that the Bill should be marred by one feature which is the object of intense opposition by the British Dental Association, a body representing an overwhelming proportion of practising dentists in this country: I refer, of course, to the one class of ancillary worker mentioned in the Bill. On the other provisions of the Bill, broadly speaking, we congratulate the Government and are in general agreement with them. Let us face the fact quite frankly that this is a dilution of a profession, however much we disguise it. The very fact that it is a dilution is indicated by the elaborate series of precautions which the noble Earl mentioned in his opening speech. If it were all plain sailing, if it were all to the good, why these elaborate precautions, and so on? I have little sympathy with any professional person who would fight to the last ditch against any dilution in his own profession but would be willing, without protest, to see dilution in any other profession.

In addition, for whom is this dilution? I beg your Lordships' attention for a few moments to Clause 19, on page 15 of the Bill. Regulations can be made which will allow of or prevent the extraction of teeth other than deciduous teeth, or (b) except in the course of the provision of national and local health services, the filling of teeth or the extraction… and so on. I ask your Lordships to consider for a moment or two the meaning of that provision. It means, first of all, that it would be illegal for a dentist engaged in private practice and taking fees for his services to employ an ancillary worker for the filling of teeth. That means that the parents of children who are able or willing to afford the cost of dentistry and go to a private dentist and pay him for his services can be sure that they will not get an ancillary worker on the job so far as their children's teeth are concerned. But, in the case of the children of a parent who cannot afford or is unwilling, maybe, to find the cost of the dental treatment, an ancillary worker can be set to do the job so far as those children's teeth are concerned.

I will not go to far as to say "One law for the rich and one law for the poor"—that would probably be an overstatement—but I remember that children of parents who could afford to pay the fees for a secondary school were either admitted without examination or subjected to an examination far less stringent than that of the children of the poor people who were going into free places. This clause in regard to the ancillaries brings back to my mind that simile.

As the noble Lord, Lord Amulree, has said, and, speaking with some knowledge of local authority dental services, I too am bound to say, with the acute shortage of dentists in the school medical service, whatever be the regulations, the scope of the work of these ancillaries in the education service will be extended. It is inevitable that that should happen. The noble Lord, Lord McNair, said that dentists are now emerging from a tutelage under the medical profession. No doubt it has been profitable. But, the profession having emerged from that tutelage, the Government, under this Bill, delivers a shrewd body blow at the dentists by introducing this possibility of dilution. We must face up to the fact that this dilution in the service will not lead to an increase in recruitment, profoundly necessary as that increase is. Parents will be deterred by the presence of these ancillaries from sending their boys or girls for a long and expensive course of training in order to become qualified dentists. Drawing on my own industrial experience, I call attention to the trouble that I here has been in professions which I know something about because of the problem of trainees.

Let us face the position frankly. What is wrong so far as the school medical service is concerned and what is wrong so far as the hospital service is concerned applies not only to dentists but to many other professions: it is that we are not paying adequate salaries to the men and women engaged in those services. Until that problem is faced we shall not have the services to which the men and women of this country are entitled—if the objects of the National Health Service are carried out as hid down in the first section of the Act.

3.54 p.m.

LORD HADEN-GUEST

My Lords, I must begin by saying that I find myself in considerable disagreement with my colleague in his attitude towards this question of the employment of ancillaries. I may say that I know something about the business of dentistry, especially as applied to children, by reason of the fact that for many years I was a school medical officer of the London County Council. One of our greatest difficulties in medical inspections was to get the teeth looked after at all, in any way, by anybody. There were not enough dentists then and there are not enough dentists now. The Bill before us to-day proposes a three years' trial of a scheme which I think is likely to be of great value for the country. No doubt there are defects—I should be extremely surprised if there were not—but I do not think they are the kind of defects referred to by my noble friend; they are defects inherent in the situation.

There are not enough dentists. There are now a number of people who are, in effect, ancillary dentists, but they are not under control and they are not linked up with the registered members of the dental profession: they can do this or that as they please, and there is no more to be said about it. This Bill, as it were, organises the dental manpower both of the qualified dentists and of the ancillary dentists, some of whom do their work skilfully, and it makes them of use to the population of the country. There may be defects to be found—no doubt they will be found. But the fact that ancillaries can in the future be employed in close contact with, and to a considerable degree under the control of, dentists who are adequately qualified, will make all the difference in the world; it will be of great value.

I do not think it is possible to do more than say that probably in this scheme the plan for employing ancillaries is one of the keystones of the building of a new dental service. Conditions will eventually improve, and finally there will be set up a service of fully qualified dentists, and the better dentists' profession will be given a much better status than it has at the present time. May I remind the House of the figures given by the noble Earl? They were that the number of dentists supplied was a little less than half the total required to do the actual work. If I am wrong, no doubt the Minister will correct me. I have looked into this matter for a long time. In the London area I had under my control at one time a dental clinic, and from the view of the non-dentist professional man who actually supervised the work of the clinic over a considerable number of years, I know something of the great value of dentistry. I also know the tragic need for proper dental treatment. I welcome the plan in this Bill to allow dental ancillaries, under proper supervision and recognised, to carry on work which they are now doing not under proper supervision and not recognised. I believe that it will be found in the future that this experiment, which, I would remind the House, is to last for three years, will be able to give us the information upon which we can build with complete confidence a professional dental structure comparable in every way with that of the general medical profession. It will be of great advantage to the dentists and to the general public.

There was a time when the medical profession was not so well organised. I can remember my father, who was also a doctor, telling me how in his youth he knew of people who had very slight experience of bandaging and of giving people doses of this, that and the other, who set up as medical assistants. The qualification for setting up and acting as a medical assistant to a doctor was not of a very high grade. The status of the medical profession has been raised from a condition I will not say comparable with that of the dental profession in the past. Now, incidentally, the dental profession is improving itself very much indeed. I say that it is only a question of the acceptance by the dental profession of the conditions which will be brought into existence by the provisions of this Bill, which I sincerely trust will not be opposed in any way at all.

The medical profession will find themselves with a company on equal terms, going the same way in the work of building up a national health organisation for both treatment and prevention. The dentistry in schools at present is very valuable. I know that from my own experience, for a year and a half ago I induced the London County Council to give me a temporary appointment as one of their inspectors to see how things were going. I found conditions were very much better than they were twenty years ago, when I last did that work regularly. This Bill gives the dental profession a standing and an organisation comparable in every way with that of the medical profession, so that there will no longer be people without qualifications and sometimes, I regret to say, without skill, performing such work. We must remember that if we do not allow ancillaries to be employed we shall be short of more than fifty per cent. of the dentists necessary to do essential work on children's teeth.

4.2 p.m.

THE EARL OF HOME

My Lords, I should like to express the gratitude of Her Majesty's Government for the general welcome your Lordships have given to the purposes of this Bill. My noble friend Lord McNair, who made such a valuable contribution to our discussion in his maiden speech to-day, expressed the point very well when he said that the Bill is intended to give wider recognition of the importance of the profession. It is our hope that this wider recognition and improved status, coupled with reasonable remuneration, will lead to increased recruitment to the profession. May I echo the hope which so many of your Lordships have expressed, that Lord McNair will give us the benefit of his very wise advice in future on this and kindred subjects. We shall look forward to the Report of his Committee on recruitment to the dental service.

Various points have been raised to which, as the noble Lord, Lord Silkin, said, we may return on Committee. The noble Lord raised the question of the examination which foreigners might have to take. He suggested that they might be permitted to Practise under registered dentists, and that that requirement might do as well as an examination. I should like to look into that suggestion. I believe it is intended that the examination should be largely practical. As is natural, the main difference of opinion in this House, as in another place, was on whether or not ancillaries should be employed. The noble Lord, Lord Amulree, did not object to the experiment but thought there should be careful safeguards. The conditions of this experiment are such that they have to be framed by the General Dental Council; regulations then require the authority of the Privy Council; and there has to be a statutory Committee to supervise the actual working of the scheme. I hope, therefore, that the noble Lord will have no misgivings upon that point.

The misgivings were perhaps the other way, as I understood questions from the noble Lords, Lord Silkin and Lord Webb-Johnson, who asked whether it was wise to set up a new body of this authority and then to subject it to leading strings. I rather agree with that general criticism, but in this case the part allotted to the Privy Council corresponds to that which it plays in relation to the General Medical Council, and I do not believe the General Medical Council have found the procedure unduly irk-some. An uncomfortable aspect of official memory is that it is very long. The appropriate clause, as at present drafted, was it troduced following a suggestion made by the noble Lord, Lord Webb-Johnson, when the Bill was debated in your Lordships' House two years ago. But we shall not hold it against him—it was a very good point.

It is clear, even from this short debate, that there is still a difference of opinion about ancillaries. The noble Lord, Lord Silkin, was in favour of bringing in the prosthetists; other noble Lords have been against doing so. Reforms of this kind must come with general consent. Prosthetists are excluded from the Bill. There are several reasons for that. The claim for their inclusion was not supported by the unions; it was strongly opposed by the dentists; and, moreover, the Minister made up his mind that, whatever the future may hold, the time was not yet ripe for prosthetists to be included. Perhaps it is remarkable that in a matter such as this, which arouses considerable feeling, we have general consent to the experimental use of ancillaries in the field in which it is generally agreed they are most needed—that is, in preventive dentistry. Your Lordships will not wish me to say more at this time, as we can return to questions of detail in Committee.

On Question, Bill read 2a, and committed to a Committee of the Whole House.