HL Deb 21 February 1956 vol 195 cc1133-47

3.5 p.m.

Order of the Day for the House to be put into Committee read.

Moved, That the House do now resolve itself into Committee.—(The Earl of Home.)

On Question, Motion agreed to.

House in Committee accordingly.

[The EARL OF DROGHEDA in the Chair]

Clauses 1 to 15 agreed to.

Clause 16 [Registration in Commonwealth and foreign lists]:

On Question, Whether Clause 16 shall be agreed to?

LORD SILKIN

I should like to say a word or two upon this Clause 16, which relates to the registration of Commonwealth and foreign dentists. The Committee will remember that on the occasion of the Second Reading I suggested to the noble Earl in charge of the Bill that it might be possible to provide for foreign dentists to participate in practice for a short time as assistants to registered qualified dentists, under the control of the qualified dentists, and that that service might be accepted, if their other qualifications were in order, as a period of probation which would enable them thereafter to practise as British dentists. I do not wish to-day to repeat the discussion we had on the Second Reading about foreign dentists, except to say that I believe that on every side of the House there was considerable agreement that we should facilitate the entry into the profession of these dentists with foreign qualifications. I was particularly grateful to the noble Lord, Lord Webb-Johnson, for the support that he gave to my suggestion, and for the slight encouragement I had from the noble Earl, Lord Home. I should be grateful if the noble Earl could say whether this suggestion has been considered, and whether, in his opinion, if it were decided to adopt it, it could be done without any Amendment to the Bill. I have not put down an Amendment because, in my view, it is open to the General Dentists' Council, which is being set up under the Bill, to make such an experiment. I should be grateful if the noble Earl would let me know whether this point has been considered, and if an Amendment is necessary, I should propose putting it down at later stage of the Bill. However, if he assures me that this suggestion has been, or will be, sympathetically considered, and that it can be carried into effect without amending the Bill, then I shall be content to leave the matter as it stands.

LORD HADEN-GUEST

I should like to ask the noble Earl, Lord Home, whether he can tell us how many dentists with foreign qualifications have been added to the register within the last convenient period, how many are still applying, and how many have been refused entry because it is considered that their qualifications are inadequate. It seems to me that there is an important point here. We do not want on the register people who are inadequately qualified, but we badly need dentists who are properly qualified.

THE EARL OF HOME

As I read the Bill—I should like to confirm this—I do not think it would be necessary to put down an Amendment. If I may, I will communicate again with the noble Lord on this before the Report stage. The intention is, I think, that these examinations shall be practical examinations, but a suggestion that any person should be permitted to practise as a dentist before he is registered is opposed to the principle in Clause 1. As I say, I do not think it is necessary to put down an Amendment. As I read the, Bill, I think—though again I should like to confirm this—that the Dental Council could adopt this practice if they so wished. In answer to the noble Lord, Lord Haden-Guest, I think there are between fifty and sixty of these dentists.

LORD HADEN-GUEST

Is that the total number?

THE EARL OF HOME

The first question the noble Lord asked was how many had been taken on to the register. That figure I have not got, but I think we are dealing here with about fifty or sixty dentists—I will confirm that later on this afternoon—who might be able to be brought in to reinforce the dental profession.

Clause 16 agreed to.

Clause 17 agreed to.

Clause 18 [Power of Council to create classes of ancillary dental workers]:

LORD AMULREE moved, in subsection (3), to leave out "materially." The noble Lord said: I was rather puzzled by Clause 18, because my impression was that one of its objects was to increase the total number of qualified dentists and, therefore, the total number of dental students in the country. The clause says that the training of dental and ancillary students must not "materially impair the facilities for the training" of students for full dental qualifications. I wonder whether the Bill would not be improved if we took out the word "materially." I agree that there must be some interference with the training of the dental students if we are to have a large number of ancillary students, but I cannot help feeling that if we left out the word "materially" it might be possible to take more advantage of that point. I beg to move.

Amendment moved— Page 13, line 26, leave out ("materially").—(Lord Amurlee.)

LORD WEBB-JOHNSON

The noble Earl, Lord Home, will understand the basis of the anxiety felt that this training of ancillaries might interfere with the training of students over the whole curriculum of training in dentistry. Although I understand that anxiety, I reflect that, to my knowledge, the training of nurses has not interfered with the training of medical students. We must not be too exacting in this matter. At the same time, there is a little cause for the anxiety in the noble Lord's mind by the introduction of the word "materially". I also accept that the fact that that word is there does ensure that there will be no frivolous use of the clause. The noble Earl, Lord Home, with all the wealth of legal advice behind him, and all the paraphernalia for carrying these things in his memory (which he has accused me of not being able to carry for myself) will perhaps be able to satisfy the noble Lord on this point.

LORD SILKIN

I should not have attached any particular importance to the word "materially" but for the fact that it has attracted the notice of the noble Lord, Lord Amulree, who wants to leave it out. For that reason, it assumes some importance. Your Lordships will bear in mind what Clause 18 seeks to do. It seeks to carry through an experiment for a limited period, to enable ancillary dental workers to come in and help relieve the shortage of dentists to do work which they are capable of doing, under supervision and without doing any injury whatever to the profession. If we are to give this experiment a fair chance we must not put difficulties in the way. If the word "materially" had not been put in, I should not have worried about it and should not have put down an Amendment to put it in. I think that if the Dental Council take what is written literally they will never be able to carry out any training at all, because it can hardly ever be said that it will not in some way affect the training of students. I suggest, therefore, that the word, "materially" is a sensible word to put in, so long as it does not do any real damage to the students, and it will give opportunities for these ancillary dental workers to be trained. I hope, therefore, without attaching undue importance to the word "materially," that the noble Lord will not press his Amendment.

LORD AMULREE

May I intervene for one moment before the noble Earl replies? I thought it would be possible to overcome the interference by providing for facilities for the training of students by leaving out this word.

THE EARL OF HOME

This is a debatable point but, I think his Amendment would have an effect which the noble Lord does not wish to achieve. It would make this clause very rigid. For instance, it would lay upon the Dental Council the obligation in every case to make sure that no dental students anywhere were short of anything. That is an impossible obligation to lay upon them. As the noble Lord, Lord Webb-Johnson, said, this is a matter of controversy and it would open the way to frivolous objection which might stultify the whole experiment. I think the noble Lord, Lord Silkin, really gave the answer to this matter. If there is a responsible Dental Council—and the noble Lord, Lord Amulree, will remember that on this Dental Council there will be representatives of every single school for the training of dentists—there is considerable protection against abuse. Therefore, I hope the noble Lord will not seek to make this subsection more rigid, but will see fit to withdraw his Amendment.

LORD AMULREE

The noble Earl has gone a long way to relieve my anxieties on this point, and I therefore beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

On Question, Whether Clause 18 shall stand part of the Bill?

LORD WEBB-JOHNSON

I want to call the attention of the noble Earl to subsection (5), which provides for a maximum penalty of £50 should an ancillary worker claim a status or qualification which he does not possess. Is the sum of £50 quite consistent with the new clause which the noble Earl is proposing later in the debate as a new clause following Clause 26? Here again, he has the full armaments of expert advice, but it looks to me as if this "fifty pounds" ought to be "five hundred pounds," to be consistent with the proposed new clause. Perhaps if that is a matter of post bellum adjustment we may leave it now. At the moment it does not seem consistent.

THE EARL OF HOME

I thank the noble Lord for drawing my attention to this matter of an extra nought. Perhaps I might look into it between now and Report stage.

Clause 18 agreed to.

Clause 19:

Restrictions on employment of ancillary dental workers

19.—(1) Regulations under the last foregoing section shall not permit an ancillary dental worker of any class to undertake— (c)the fitting, insertion or fixing of dentures or artificial teeth. (2) Regulations under the last foregoing section shall be so framed as to secure that dental work amounting to the practice of dentistry carried out by an ancillary dental worker in the course of the provision of national and local authority health services is carried out under the direction of a registered dentist, and it shall be the duty of the General Dental Council to secure, either by provision in the said regulations or otherwise, that, so long as they think, it advisable, such work is only carried out after the registered dentist has examined the patient and has indicated to the ancillary dental worker the course of treatment to he provided for the patient.

3.22 p.m.

LORD SILKIN moved, in subsection (1), to leave out paragraph (c). The noble Lord said: I beg to move the Amendment standing in my name. The noble Earl will remember that on the Second Reading I drew attention to the provisions of Clause 19 (1) (c)—that is, the question of not permitting ancillary dental workers at any time to carry out the fitting, insertion or fixing of dentures or artificial teeth. I do not at this stage wish to argue the merits or demerits of creating a body of ancillary dental workers to carry out this work. I think that, properly trained and forming a kind of profession in the same way as the medical auxiliaries, there is a part for dental prosthetists to play in dental work. I recognise, however, that at the moment it is controversial and possibly it would be a major change in the Bill if we were to provide for the recognition of them straight away. But I want to know why it is necessary in this Bill, in terms, to exclude, them, apparently for all time.

There are plenty of safeguards—I referred to them in my Second Reading speech. There are ample safeguards against: their being forced on the profession. It is entirely in the hands of the General Dental Council as to whether at any time they wish to include these dental prosthetists. Suppose the General Dental Council has a change of heart, that the dental prosthetists one day really become a serious profession with a course of training which is satisfactory to very-body, and that all the safeguards are there—supervision by dentists and so on —why is it necessary, even in those circumstances, to say that these prosthetists, of all people, must never become dental ancillaries? I should be glad of some elucidation on that point.

I realise that at the moment the General Dental Council is not likely to ask for them to become dental ancillaries, but times may change and, in any case, there is a shortage of dentists and the work that they could do would be a great help. I understand they would save something like 20 per cent. of the time of the dentists, and we have only half the dentists we require. Therefore, even though I am not advocating that they should be accepted here and now, I want to know why they are pointedly excluded. It is for that reason that I put this Amendment down.

Amendment moved— Clause 19, page 15, line 13, leave out paragraph (c).—(Lord Silkin.)

LORD WEBB-JOHNSON

Here we get something over which we can have a real tussle. It is a tussle which has gone on for many years. I maintain there is every reason for excluding this particular class of experts from this Bill. They should be excluded. They are an absolutely different class from all the specialist grades we are planning to drain as ancillaries. Here we are introducing into the patient's mouth an ancillary worker who is not qualified to do work inside the mouth. Moreover, in spite of the expert work these people may do in the workshop, they can do in a short trial untold and irremediable harm, by some interference with natural tissues by an artificial denture or any ether appliance introduced. I wish the noble Lord, Lord Silkin, would appreciate, and I hope, my Lords, you will all appreciate, that a little mistake made at that stage can produce a cancer which is beyond the wit of man to eradicate or to treat. If any cancer does arise there, it arises in one of the most difficult situations in the body for the undertaking of successful treatment. It is near the bone. It cannot be treated successfully with radium. A removal by surgery is disfiguring and ghastly and generally fails. I beg the noble Lord not to press for the introduction of prosthetists under this Bill, but to let the sleeping dog lie for the present.

LORD HADEN-GUEST

I agree with the noble Lord, Lord Webb-Johnson, in this matter. I think this would be an extension of the work of the ancillary worker at the present time, and, for the reasons Lord Webb-Johnson has given, which I will not recapitulate but with which I agree, I consider it would be a very serious step indeed. I think it would be much better to leave prosthetists out at the present time.

LORD BURDEN

We have had a discussion on the employment of ancillaries and the Government took a stand. We accept that stand and I feel it would be a profound misfortune, as the noble Lord, Lord Webb-Johnson, has said, if what has now been accepted were extended in the way which my noble friend, Lord Silkin, suggests. May I call his attention to the fact that under the terms of the Bill as it stands these people will operate only in the National Health and the School Medical Services? I am not going to recapitulate the arguments I used in that connection during the Committee stage. I know that to argue from analogy is sometimes misleading, but I am sure there are a number of solicitors' clerks who could do the job of a solicitor quite as competently as many solicitors. I am sure my noble friend would be the first to object if a solicitor's clerk could act as a fully qualified solicitor without undergoing the prescribed training for a solicitor. Therefore, although analogy is sometimes dangerous, I suggest that, in the dilution of any profession, one has to be extremely careful that harm is not done in the long run.

3.30 p.m.

THE EARL OF HOME

The noble Lord, Lord Silkin, probably now sees why we have this subsection in the Bill. I do not think I can give him an answer which will satisfy him or which possibly satisfies reason. This is a highly contentious matter. The Government, in framing a Bill of this kind, want to take into account what is possible. There is so much feeling on this question of the admission of these prosthetists to the dental profession that we have thought it wise that, if at any future date they are to be brought into the dental profession, it should be the subject of a separate Act of Parliament. To try to include it in this Bill would mean that we should not get the Bill at all, and none of us wants that. I am afraid that that is the best explanation I can give to the noble Lord.

LORD SILKIN

I now know the best explanation that is given of the provisions of this subsection. I do not think the noble Earl himself has great confidence in it. It is just for the sake of peace. But I would say to my two noble friends and to the noble Lord, Lord Webb-Johnson (whom I hope I may also call a noble friend), that one of the ways of dealing with something one does not like is, first, slightly to distort the argument, and then to answer the distorted argument. I did not advocate that dental prosthetists should practise; I advocated merely that that should hereafter be made possible if it is desired by the dental profession, and that they should not in terms be excluded; they should not be forced to have a special Bill introduced for their benefit if it should be thought desirable at some time in the future that they should be included. Nor did I suggest that untrained people should have access to the mouth and thereby cause this horrible disease of cancer. My suggestion was, in any case, that they should be working under close supervision, and that the mouth should be examined by a dentist and, if you like, even by a doctor before it is treated; but, once the dentist is satisfied that the mouth is suitable for a dental set, then the dental prosthetist, properly qualified, is a far better person to tit a set of teeth than are many dentists, as I know to my cost. However, I know the reason why these people are excluded, and, for the sake of peace, I am perfectly prepared to withdraw the Amendment.

Amendment, by leave, withdrawn.

3.34 p.m.

LORD AMULREE moved, in subsection (2), to leave out ",so long as they think it advisable,". The noble Lord said: The reason why I put down this Amendment is that these words do not seem to me to tie up with the words in the following subsection. There, a dental auxiliary can be working with a private dentist and there is no question of the private dentist being allowed to permit the auxiliary to do work which he does not supervise; whereas, if a dentist is working under the National Health Scheme or under a local authority scheme, the Dental Council can, if they think fit, take him away from the supervision altogether. That must mean that the type of work to be done in a National Health Service clinic or a local authority clinic may suffer if the dental auxiliary is to be allowed to treat patients not supervised by a regular dentist. It is because I wanted to see that patients treated privately and those treated (if you like) publicly get the same kind of proper treatment that I put down the Amendment. I beg to move.

Amendment moved— Page 15, line 22, leave out ",so long as they think it advisable."—(Lord Amulree.)

THE EARL OF HOME

Again this Amendment raises the question whether or not one trusts the Dental Council. They are a responsible body of people who will supervise this scheme. But, of course, in the early stages, all the work undertaken by these ancillary dental workers will he undertaken under the direct supervision of a dentist who will previously have looked at each individual patient and instructed the ancillary accordingly. As time proceeds, however, we visualise that there will be senior ancillary workers who will have gained wide experience and who could, therefore, under general direction, be safely left to carry out en their own initiative some of the simple treatments for which they have been trained. They are rather a parallel with senior hospital nurses who have the confidence of the doctors. The doctor lays down the general nursing plan but he does not supervise the nurse at every stage to see how she is carrying out her work. It will rest with the General Dental Council, who are predominantly a professional body, to see how these additional safeguards are to be applied. We ought to trust that body to make reasonable regulations. I hope the noble Lord will not think it necessary to press this Amendment but that, as we are setting up this responsible body, he will allow them this amount of discretion.

LORD ANIULREE

I certainly do not want to press the Amendment to a Division but there are two points I should like to put to the noble Earl. Although I entirely agree that the General Dental Council will be a very proper and responsible body. I cannot help feeling, that, if this wording remains, a certain amount of temptation will be put in their way and they may not be able to resist it. The second point which I do not understand is this: if we are to trust the General Dental Council when they are dealing with the local authority dentist under the National Health Scheme, why cannot we trust them when they are dealing with a private dentist, too? If the noble Earl will give me a reply to that, I shall be grateful.

THE EARL OF HOME

Part of the functions of the General Dental Council will, I hope, be to resist temptation; that will be part of their duties. What was the second point that the noble Lord raised?

LORD AMULREE

I was wondering why the same cannot apply (I think I am right) under the next subsection, where the same privilege will not apply to the private dentist. The dental auxiliaries working under him cannot treat patients unless the private dentist supervises them. Is that not a trifle inconsistent?

THE EARL OF HOME

I will consider between now and the next stage whether there is any inconsistency. I do not think there is. There may be a different practice. However, I will look into the point.

LORD AMULREE

In those circumstances, I have much pleasure in withdrawing my Amendment.

Amendment, by leave, withdrawn.

Clause 19 agreed to.

Clauses 20 to 23 agreed to.

Clause 24 [Restrictions on bodies corporate]:

THE EARL OF HOME

I do not know whether I am in order, but perhaps in moving this Amendment I may reply to Lord Haden-Guest, who asked me for the number of foreign dentists on the register. There are about 260 foreign dentists now on the register. As for those who are not yet on the register, I thought the figure was between fifty and sixty, but it is actually between forty and fifty.

LORD HADEN-GUEST

Have the qualifications of these men and women—I presume some of them may be women—been carefully examined, to see how far they come up to our standards?

THE EARL OF HOME

I think it is known, or hoped, that a good many of them would come up to our standards, given a simple practical examination.

I now beg to move the next Amendment in my name. On the Report stage in another place Clause 24 was amended so as to allow societies which obtained registration under the Industrial and Provident Societies Acts, 1893 to 1954, to carry on the business of dentistry notwithstanding that they were not doing so at the date of the introduction of the Bill. The purpose of this Amendment is to include a corresponding reference to Industrial and Provident Societies Acts relating to Northern Ireland. This is really a formal Amendment.

Amendment moved— Page 19, line 4, at end insert ("or the Industrial and Provident Societies Acts (Northern Ireland), 1893 to 1955").—(The Earl of Home.)

On Question, Amendment agreed to.

Clause 24, as amended, agreed to.

Clauses 25 and 26 agreed to.

THE EARL OF HOME moved, after Clause 26 to insert the following new clause:

Use by unregistered persons of titles and descriptions connected with dentistry

"27.—(1) No person shall take or use the title of dentist, dental surgeon or dental practitioner, either alone or in combination with any other word, unless he is a registered dentist or a registered medical practitioner, and no person shall take or use any title or description implying that he is a registered dentist unless he is a registered dentist.

(2) A person who acts in contravention of the provisions of this section shall be liable on summary conviction to a fine not exceeding one hundred pounds, or on conviction on indictment to a fine not exceeding five hundred pounds."

The noble Earl said: The purpose of this new clause is to protect the titles of "dentist," "dental surgeon" and "dental practitioner" from use by persons who are not registered dentists. Subject to the point raised by the noble Lord, Lord Webb-Johnson, as to penalties, I beg to move.

Amendment moved— After Clause 26, insert the said new clause.—(The Earl of Home.)

On Question, Amendment agreed to.

Clauses 27 to 32 agreed to.

Clause 33 [Rules, regulations, orders and other instruments]:

THE EARL OF HOME moved to leave out subsection (1) and to insert instead: (1) The Statutory Instruments Act, 1946, shall apply to a statutory instrument containing regulations made by the General Dental Council under this Act in like manner as if the regulations had been made by a Minister of the Crown. The noble Earl said: This is a technical Amendment. The Statutory Instruments Act applies only to statutory instruments made by the Crown. The object of the Amendment is to apply it to instruments made by the General Dental Council. I beg to move.

Amendment moved— Page 24, line 41, leave out subsection (1) and insert the said new subsection.—(The Earl of Home.)

On Question, Amendment agreed to.

THE EARL OF HOME

This is a consequential Amendment. I beg to move.

Amendment moved— Page 25, line 1, leave out from ("document") to ("issued") in line 2.—(The Earl of Home.)

On Question, Amendment agreed to.

Clause 33, as amended, agreed to.

Remaining clauses agreed to.

First Schedule:

The General Dental Council and its Committees

15.—(1) The Ancillary Dental Workers Committee shall consist of the President and eight other members of the Council and six persons who are not members of the Council.

(3) Three of the six members of the Committee who are not members of the Council shall be appointed by the Minister of Health, the Secretary of State and the Minister of Health and Local Government for Northern Ireland acting jointly and two of the said three so appointed shall be registered dentists who are or have been employed in the course of the provision of national and local authority health services.

THE EARL OF HOME

This Amendment represents an improvement to the Bill in that it leaves out some words which are clearly unnecessary. I beg to move.

Amendment moved— Page 29, leave out lines 48 to 50.—(The Earl of Home.)

On Question, Amendment agreed to.

3.46 p.m.

LORD AMULREE moved to add to sub-paragraph (3) of paragraph 15: within the five years immediately preceding the appointment. The noble Lord said: The point of this Amendment is to make sure that the people appointed to serve on the Dental Committee will be dentists who know something about the practice in their profession. Under the wording of the Bill it might be possible to appoint someone who was just retired from a life in the Government service, where he might have been doing purely administrative dentistry, or somebody who had been retired from the practice of dentistry for a long time. I feel that if we are going to set up a Committee of this sort we want people who are fairly closely in touch with the actual practising side of the profession. It is for that reason alone that I put down this Amendment, which I now beg to move.

Amendment moved— Page 31, line 32, at end insert the said words. —(Lord Amulree.)

LORD BURDEN

I should like to say a word in support of my noble friend Lord Amulree. This is an experiment and now, having reached this stage, I think we may do ourselves and also Her Majesty's Government the honour of saying that we wish this experiment to succeed. I think the only way it can succeed is to bring in those in recent close contact with the work rather than someone who has long since passed out of active connection with the profession. This is an Amendment which I am sure will help the working of the scheme, and I hope that the noble Earl will be able to accept it.

THE EARL OF HOME

I should like to be able to accept this Amendment because it expresses the intentions of us all. The Minister will be responsible for making these appointnents, and it is the intention of the Minister to appoint people with recent practical experience. But the effect of the noble Lord's Amendment—en effect which I had not appreciated, and possibly he has not—is that, as these appointments are held only for periods of three years, if his Amendment were accepted, it would make it impossible to appoint the same man, however good he was, for a second term. I do not think the noble Lord wants to achieve that object, nor do any of us. If he will accept my assurance that it is the Minister's intention to appoint people with practical experience, perhaps he will not press the Amendment.

LORD BURDEN

Could the Amendment be so amended that the first appointment should be within the terms of the Amendment? We accept the statement that the Minister will try to appoint people with recent experience, and one can understand that after three years these people may not be so closely connected with the profession; but they have had the experience of work of the Council behind them, and one would not like to debar them from continuing in office. Perhaps the Minister would consider that in every instance the first appointment should be of someone who has been working actively within the last five years.

LORD SILKIN

Before the noble Earl responds to these very soft words I would beg of him not to fetter unduly the discretion of the Minister. Once provisions are put into an Act of Parliament, such as that the Minister shall appoint certain types of people, with certain qualifications, he lays himself open to the possibility, however remote, of having an action brought against him because he has appointed the wrong people without the proper qualifications. It does not tie his discretion. I have been responsible for a number of measures where a Minister has had to make appointments, and I have always felt that one either trusts the Minister and accepts his outlook on the matter of these appointments, or one does not. If one does not trust him, I doubt whether merely putting words in the Bill will ensure that we get the right type of person. I feel that on matters of this sort, if we have the assurance that the Minister will appoint the right kind of people, it is better to leave it to him rather than try to tie him down by an Act of Parliament.

LORD AMULREE

I am glad to accept the assurance that the Minister will always wish to appoint people who have in fact had recent experience. I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

First Schedule, as amended, agreed to.

Remaining Schedule agreed to.

House resumed.