§ 3.35 p.m.
§ Lord Trefgarne
My Lords, I beg to move that the Dentists Bill be now read a second time. It is 25 years since your Lordships' House had before it the Dentists Act 1957, the last major piece of legislation regulating the dental profession in the United Kingdom and, while one can say that the provisions of the Act have stood up remarkably well to the test of time, there are inevitably some modifications and additions which need to be made to it. This is very much the purpose of the Bill which I bring before your Lordships today.
For more than 10 years the dental profession, as represented by the General Dental Council and the 1150 British Dental Association, have been seeking to have the 1957 Act updated and improved, and in 1979 they joined with the department to discuss and draw up a list of provisions which might be included in new legislation. It has largely been due to pressure on the parliamentary programme since then that we have not hitherto found time to introduce the Bill, but I am very glad that we are able to reward the profession for their patience.
The broad purpose of this Bill, which covers the whole of the United Kingdom, is to make a number of updatings and improvements to the Dentists Act 1957 and to provide some additional powers which experience has shown us to be desirable. As we have been able to involve the General Dental Council in our preparatory work for this Bill and the British Dental Association was involved when we drew up our list of provisions several years ago, I believe I am able to say that the profession sees nothing in the Bill to which it would wish to object.
One other point I would like to make by way of introduction is that a number of clauses are parallel with parts of the Medical Act 1978. It might be said broadly that what the Medical Act did for the medical profession then is being reflected in this legislation for the dental profession today. None of the provisions can be regarded as politically controversial and I would like to record our appreciation of the constructive response to our proposals which we have received from honourable Members on the Opposition Front Bench in another place. The noble Lord, Lord Wallace of Coslany, is doubtless aware of the discussions that have taken place.
Turning now to the contents of the Bill itself, there are several provisions to which I should like to make specific reference. First, and most important, is the power for the General Dental Council, through a newly constituted health committee, to suspend the registration of dentists whose fitness to practise is seriously impaired by reason of their physical or mental condition. The council, which is an independent statutory body, has had the task of regulating the affairs of the dental profession since 1956. It is sometimes regarded as a body for protecting professional interests and for supervising and improving dental education. But because it keeps and publishes a register of duly qualified dentists and takes disciplinary action whenever required in cases of criminal convictions or serious professional misconduct, the council rightly regards itself—and acts—as an independent and impartial body whose first task must be to protect and serve the best interests of the public. I shall be saying more in a moment about the General Dental Council's role in the field of education, discipline and maintaining the dental register, but for the moment I should like to talk about its role in protecting the public.
Hitherto, when a dentist's fitness to practise has been seriously affected by physical or mental ill-health, the General Dental Council have had to wait until the dentist had committed a disciplinary offence before they were able to take any action to prevent him from continuing to practise. This is clearly most unsatisfactory, in that action cannot be taken until the damage has been done. Part III of the Bill before your Lordships rectifies this state of affairs by providing for the establishment of a health committee of the 1151 council. There is provision for the appointment of legal and medical assessors and for an appeals machinery. The council will have powers to suspend a dentist from the register if fitness to practise is seriously impaired by reason of physical or mental condition and in urgent cases to direct his immediate suspension. It also provides for conditional registration when the health committee thinks that this would be sensible. The provisions in Part III broadly parallel those in the Medical Act 1978, and I know that the General Dental Council and the British Dental Association welcome them.
Clause 13 of the Bill includes a new power of suspension of registration of a dentist on disciplinary grounds as an alternative to erasure from the register. This is included on the recommendation of the Judicial Committee of the Privy Council, which not long ago considered a case in which it felt that such a power might have been useful.
At present, when a dentist has been convicted of a criminal offence or has been found guilty of "serious professional misconduct"—which is the new formula the Bill proposes should replace the somewhat archaic expression "infamous or disgraceful conduct in a professional respect"—the council has power only to strike his name off the register. I am aware that the General Dental Council, while by no means opposed to this provision, sees it as giving it a power which it feels would rarely if ever need to be used. The point has been made that the circumstances in which a power to suspend a dentist could in practice be most useful are those where immediate suspension is needed.
Your Lordships will have noted from what I have said about the provision for suspension on health grounds that this incorporates the power to direct immediate suspension in urgent cases. Section 9 of the Medical Act gives the General Medical Council power to suspend a doctor on health or disciplinary grounds where necessary with immediate effect. The Government are therefore considering tabling amendments in Committee so that, where the public needs to be protected, a dentist can similarly be suspended on disciplinary grounds with immediate effect. This would put the Medical Act 1978 and the Bill on all fours as regards suspension on disciplinary or health grounds. The effect of suspension on disciplinary or health grounds is that the dentist is treated as unregistered during the course of his suspension.
One of the other main purposes of the Bill is to enable an increase in the number of members elected by dentists to the General Dental Council. Clause 1 increases from 11 to 18 the number to be elected by registered dentists and from 7 to 14 the number among those 18 who are to be elected by dentists in England. English dentists and dentists from the Isle of Man and the Channel Isles are at present under-represented in relation to dentists from Scotland, Wales and Northern Ireland. There will continue to be 27 nominated members of the council (20 by the universities and Royal Colleges, and 7 by Her Majesty on the advice of her Privy Council), so the proportion of elected members will be increased. This is, I believe, a move in the right direction, for the General Dental Council needs to be broadly representative of the 1152 dental profession as a whole if it is to fulfil its functions and continue to have the support of the profession as well as the public.
Clause 26 also provides for the necessary legislative measures to be taken for the termination of the now out-dated agreement of 1927 with the Republic of Ireland, relating to the mutual recognition and control of dentists. This provision again mirrors the Medical Act 1978.
Turning now to the powers of the General Dental Council, Clause 3 confirms that the council's interest extends beyond undergraduate education to postgraduate dental education. Section 1 of the Dentists Act 1957 was perhaps ambiguous on this point and we propose to amend it to show clearly that the council's concern shall be to promote high standards of dental education at all it stages. There are powers in this connection in Clauses 8 and 9 to enable the council to supervise examinations and visit postgraduate institutions. Postgraduate dental education has expanded over recent years—a development which I am sure we all welcome—and I believe it is clearly right that there should be no doubts about the General Dental Council's powers in this important field.
The 1957 Act enabled the General Dental Council to prescribe titles which may be used by practitioners in a distinctive branch of dentistry. Clause 11 of this Bill adds the natural corollary—which it is perhaps surprising was not added in 1957—that the council may keep a list of dentists so qualified. The General Dental Council has never in fact used its power to prescribe titles for dentists practising in distinctive branches of dentistry, but it seems logical that, if at some future point it decided to do so, it should be able to maintain a list of such practitioners.
Clause 13 of the Bill does away with the provision in the 1957 Act that the General Dental Council must keep separate lists in the register of dentists: one of those registered as United Kingdom or European Community graduates; one of Commonwealth graduates; and a third of persons registered as holding some other foreign diploma. I understand that it is the intention of the council to keep a single register. The main purpose of having a register of dentists entitled to practise is to enable members of the public who wish to do so to check the list. A single list would certainly make it easier for the public to find a dentist's name in the register, or, more importantly, to find that it is not there.
The other provision to whch I would refer specifically now is Clause 24, which would, subject to several important constraints, enable the circumstances in which dental auxiliaries can work to be extended. I should explain that by dental auxiliaries we mean dental therapists and dental hygienists. Dental therapists are permitted to fill teeth or extract deciduous teeth at the prescription of a dentist, but they may only do so in the National Health Service community or hospital dental services. We are now proposing that, subject to the approval of both Houses and to the Order in Council amending the 1957 Act being made, the General Dental Council will be able to make regulations to allow dental therapists to carry out their present types of work under the direction of a dentist in general dental practice also.
1153 A similar enabling provision is contained in Clause 24, which could eventually permit the General Dental Council to amend its regualtions, again subject to the approval of both Houses. This would permit dental hygienists, the majority of whom at present work in general practice, to undertake their duties under the direction and prescription of a dentist who had examined the patient, but without his direct personal supervision. This is potentially an important development for the future, but I would stress at this stage that the Government are not intending to take any immediate steps to extend the fields of activity of dental auxiliaries in the way enabled by this clause, Nor, so far as I am aware, does the General Dental Council wish the Government to do so. However, the practice of dentistry is developing, and the role of the dental auxiliaries grade is something which will need to be carefully reviewed in the years to come. It therefore seemed right to us that this clause should be included in the present Bill.
I have mentioned only a few of the clauses in this Bill to which we attach particular importance. Much of it is devoted to a large number of minor and drafting improvements to the Dentists Act 1957. It is an important Bill embodying a number of major improvements in the regulation of the dental profession, which I believe will be supported by all sides of your Lordships' House, as it is by the dental profession themselves. It is, as I have said, politically non-controversial, though I have no doubt that there are a number of points which we shall need to discuss in some detail in Committee. I very much hope that in these circumstances your Lordships will see fit to give this Bill a Second Reading. I beg to move.
§ Moved, That the Bill be now read a second time.—(Lord Trefgarne.)
§ 3.48 p.m.
Lord Wallace of Coslany
My Lords, I want first to thank the noble Lord the Minister for the very detailed and friendly way in which he has explained the provisions of what is quite an important Bill. I very much appreciate also the remarks he made in paying tribute to the help given by Opposition Members in another place. If I may say so, this help underlines the non-controversial nature of the Bill. As the noble Lord has stated, this is generally an agreed measure but, nevertheless, it is very important as well. I personally regard the Bill as being in the public interest. It is a little complicated in parts but the Bill does safeguard the consumer—if, on the subject of teeth, that is the right word.
In my candid opinion, it is not a Bill which calls for a wordy speech on Second Reading. In other words, to put it bluntly, there is nothing that I can get my teeth into at this stage. Amendments may be necessary at the Committee and Report stages. At this stage may I say that the Bill deserves the support of the whole House, and I have not the slightest doubt it will receive it. Before I conclude, I notice there are two notable dentists in the House and no doubt they will give us the benefit of their experience. I am sure both of them will welcome the Bill.
§ 3.50 p.m.
My Lords, I, too, must join with the noble Lord, Lord Wallace of Coslany, in thanking the noble Lord, Lord Trefgarne, for the clarity with which he has explained this Bill. I agree entirely with the noble Lord, and with the noble Lord, Lord Wallace, that this is very largely a non-controversial measure, an agreed measure, but I also agree with Lord Wallace that it is an important measure. As a doctor I think I am right in saying—I intend to say it, right or wrong—that we are a little too fond of separating health into little compartments. I believe that dental health is an essential component of health in general, and I have always thought that there are many medical conditions which arise from dental ill-health. Therefore, as a doctor, I take an interest in what goes on in the dental field.
Of course, the Bill merely does what has already been done in the 1978 Act in relation to doctors, and as I did not object on that occasion in relation to doctors it would clearly be illogical and perhaps impertinent if I were to raise any objections now that the same things are being done in relation to dentists. But, despite that, I do not think I shall be quite as brief as noble Lords may hope, because there are important matters in this Bill which I would like to mention in order to ventilate them, and also so that the noble Lord will know that I may wish to follow up some of these matters at later stages of the Bill.
In general, it has always seemed to me that the dental Acts of 1921 and 1957 have been very much more protective of patients' teeth and mouths than have the corresponding medical Acts. Noble Lords perhaps realise that it is not an offence to treat medical conditions and that anybody can give medical treatment. Of course, a person would be acting unlawfully if he said he was a qualified doctor when he was not; he would be acting unlawfully if he said he was a registered medical practitioner when he was not. But I think there are only two areas in which it is illegal for a lay person to treat: pulmonary tuberculosis and venereal disease—otherwise anybody can treat patients; whereas the dental Acts make it an offence for people to undertake manoeuvres within a patient's mouth. Perhaps that is entirely right.
It does appear to me that the Bill, if anything, marginally tightens the monopoly still further. It increases the number of dentists and dental surgeons on the General Dental Council, and that I am quite sure must be entirely right. But, in spite of what the noble Lord said about the new moves in relation to dental therapists, it seems to me marginally further to restrict what ancillary workers can do and the way in which they might operate. I think I am right in saying—no doubt I will be corrected if I am wrong—that there is no legislation in relation to dentistry which can be regarded as strictly parallel with the Professions Supplementary to Medicine Act, which gave certain ancillary professions in medicine a status of their own whereby they are supervised, from a professional point of view, professional standards, discipline and so on, by their own councils. That applies to chiropodists, radiographers, physiotherapists and so on. We do not appear to have anything corresponding to that.
1155 It seems to me that, if anything, this Bill moves in the reverse direction. That strikes me as rather odd having regard to the general mood and climate of opinion in this country in relation to medicine; on all sides we get clamours for alternative medicine, for getting away from the stranglehold which doctors have over medicine. Recently, we have had strenuous efforts in your Lordships' House to do something about the monopoly exercised by opticians. I am constantly being invited to conferences about alternative medicine, to assist the chiropracters and the osteopaths and various other people, who perhaps do valuable work. Here I think we are going in another direction in relation to dentistry; I am not saying it is wrong.
In the Republic of Ireland the whole question of the operation of the monopoly in relation to dentistry— this had particular reference to those engaged in dental prosthesis and dental technicians—was referred to the Restrictive Trade Practices Commission in the Republic, who then referred it to the Director-General of Fair Trading, who I understand has held a public inquiry into the exercise of that monopoly. It is interesting to note that at present there is a proposal before the European Parliament, put forward by Belgium, with regard to a loosening of the monopoly in relation to dental technicians; that is, the dental mechanics, as lay people tend to call them, the people who make artificial teeth and so on. It is a move sponsored by Belgium to copy the pattern which exists in Denmark, which I think is rather looser than is our own.
It is interesting to note, going back to the Act of 1957, that this matter was raised then in your Lordships' House. I believe I am right in saying that the reply then on behalf of the Government was given by the noble Lord, Lord Home, who was acting in a ministerial capacity. He said that that was not the time to do anything about that particular monopoly situation—at the time I think that the Association for Dental Prosthesis were making very loud noises—but perhaps it was something that should be looked at when the climate of opinion had changed. It seems to me that perhaps the climate of opinion has changed a little, in that it has become marginally more restrictive.
I am not for a moment recommending any kind of uncontrolled freedom for dental technicians, but I think it might be helpful on this occasion, since it appears that we discuss the subject in relation to an Act only about every 30 years, if we looked at what is actually happening. In the old days, when I worked more closely with my dental colleagues than I now do, it was the practice for almost all dental surgeons to have their own staff of dental mechanics, under their own eyes—doing expert work under supervision by the dentist. We have now moved to a situation where the bulk of that work is sent out to commercial laboratories, and I am quite sure it is done very effectively. But it means that the dental technicians are now working in a slightly different atmosphere.
The information given to me—I do not know whether it is correct, but the dental experts we have here, the noble Lord, Lord Colwyn, and the noble Baroness, Lady Gardner, may be able to comment—is 1156 that many members of the public are now going direct to dental mechanics who are practising illegally and privately. Of course, they can go direct for dental repairs, but there has been a temptation on occasion for certain of those dental technicians to carry out work which might be regarded as rather more than repairs, sometimes taking impressions of a patient's mouth, which would under the Act be illegal, and perhaps rightly so. I just wonder whether one ought to look at this question while we have this opportunity, which seems to arise only about every 30 years.
I am also informed that there has now been a reduction in the training of dental ancillaries, which reflects a move in the opposite direction from that going on at one time, at a time which I remember clearly—and I know the noble Lord, Lord Colwyn, remembers because he suffered from it—when the dental workload was far in excess of the resources to cope with that workload. Then there was a clear move towards the increased employment of ancillaries and auxiliaries of one kind and another, dental therapists, dental hygienists and various people of that kind, who were doing something to take some of the workload from the dental surgeon who had too much to do. It now appears that the move in the dental profession, and perhaps in the Government, is in the opposite direction.
In part that may be explained by what I, as a doctor, see as a change in the work pattern. The dental profession has had quite extraordinary success in bringing about a sensational reduction in the amount of dental caries in our society in Britain. For that all credit should go to them, though much of it has been achieved, I believe, by patients swallowing fluoride in toothpaste. But, however it has occurred, there has been a sensational decline in the amount of dental caries in our population, and that is something very beneficial from which medicine will benefit and the whole community will benefit.
I think that many of my fellow professionals in the dental profession have tended to feel that they have been so successful that they have almost done themselves out of work and that their workload will be reduced. That has perhaps tended to make them think about reducing the number of ancillaries that they employ, about the training of ancillaries or auxiliaries, or whatever one wishes to call them, and perhaps an even more restrictive attitude to the possible aspirations of the dental technicians who, as your Lordships will know, have been trying to get more freedom to do a little more for some time.
It is my considered belief that that pattern will change and that within a very short period of time—long before we debate these matters again in this House—my dental colleagues will find their workload increasing because it will change as a result of their success. They will have new problems to cope with. They will suddenly find themselves coping with the problem of a 70-year-old with a full set of teeth. That did not happen years ago when everyone's teeth were taken out in their teens or early twenties. They will suddenly be confronted with the problem of having to fit artificial teeth in elderly people, and that is a very different proposition to fitting them in quite young people. I honestly believe—the noble Lord, Lord Colwyn, and the noble Baroness, Lady Gardiner 1157 of Parkes, will correct me if they think I am wrong—that the workload in years to come will increase. There will then once more be the need for an increased employment of ancillaries of one kind or another, so that we are making better use of the highly professional technological ability of the professional people. We will need more ancillaries, not fewer. It is for that reason that I was alarmed at what seemed the general mood of the Bill in that it appears to be looking in the other direction.
I am sorry that I have gone on for a long time but at least I have indicated the areas of the Bill into which I might want to inquire further at a later stage. In the meantime, may I say that the Bill has the support of my noble friends on these Benches.
§ 4.1 p.m.
§ Lord Colwyn
My Lords, may I too thank my noble friend Lord Trefgarne for his clear and lucid explanation of the Bill. I also thank the noble Lord, Lord Winstanley, for making his points. My problem in replying to them is that the profession as a whole is so pleased with the Bill as it stands that we do not want to get too involved with the more contentious issues now. We shall be happy to see the Bill go through quickly and perhaps deal with the other matters later.
As a general practitioner I must declare an interest. I welcome the introduction of the Bill. The dental profession, through its regulating body, the General Dental Council, and its professional association, the British Dental Association, has been urging the introduction of these measures since about 1978. The profession is most grateful to the Government for finding time this Session to see the Bill into legislation. We hope it completes its remaining stages without any major setbacks.
As my noble friend the Minister said, the primary purpose of the Bill is to give the General Dental Council the powers to enable it to deal with the problem of dentists who, for health reasons, have an impaired ability to practise their profession. The Bill enables the establishment of the health committee with powers to suspend an individual's registration. This facility has been available to the medical profession since, I believe, August 1980, and the General Medical Council has had similar powers to take action in cases where the question arises of whether a doctor's fitness to practise is seriously impaired by a physical or mental condition.
I am glad that we, as a caring profession, can now have a similar mechanism to help our colleagues who are themselves in need of care and counselling. The suspension of their names from the register will safeguard the public and it will give us an opportunity to offer help and encouragement to those who ought to seek medical advice. There is one aspect, however, which is not too clear. This is in connection with the power of suspension by the health committee. I admit that, as with many other Bills in your Lordships' House, I find the reading and comprehension of the Bill very difficult. I may be incorrect in my interpretation, but it seems to me, under Clause 19(1), when taken in context with Clause 21, that a single-handed practitioner who may be suspended will be unable to employ another dentist or make use of a locum to ensure that his practice will remain viable as a business and to continue to provide care and 1158 attention for his patients. If I am right and the suspension prevents him from being an employer of another dentist, I feel that the penalty is perhaps too severe. In large practices this would not be a problem as there would be other employers available, but for a single-handed practitioner the period of suspension would see the complete breakdown of his practice and a loss of dental services to his patients.
I think I am correct in saying that if a general practitioner dies his estate, which is not on the dental register, is allowed to employ dental personnel to carry on the business of dentistry and keep the practice going for a period of three years. If I am right in my interpretation of the wording, I feel that we should insert a provision in the Bill to enable a dentist who has been suspended by the health committee to be able to organise his practice as an employer only. This would ensure continuation of the dental service to his patients and allow the practice to continue until his treatment was satisfactorily completed and his suspension ended. I should be grateful if the Minister could let me know whether I have read this matter correctly, and how he feels that these problems could be overcome for the single-handed practitioner.
It is now 25 years since the present legislation was enacted and this is only the third occasion in 100 years that the regulation of the dental profession has been considered in depth. I think that it is vital that we take this opportunity to include in the Bill some minor and, I feel, uncontentious matters which are of great importance to my profession. The General Dental Council and the British Dental Association made requests to the Department of Health and Social Security in 1978, and again in 1980, that provision should be made for possible future introduction of obligatory pre-registration post-qualification training. We are slightly disappointed not to see this enablement included in the Bill. Although the exact requirement of the General Dental Council and the profession is not clear, we feel that this period of supervised training will eventually be of enormous benefit to the profession, and that when our requirement is clear it would be a great shame to have the progress hampered by a need for a further amendment to the Dentists Act. I hope that the Minister will indicate whether he is prepared to accept an amendment from me at a later stage, or even that he is prepared to include the provision that we require as a Government amendment.
There are four further small points that I wish to make, and I ask that they be given the Minister's attention. In 1980 the Council and the British Dental Association requested removal from Section 15(2) of the 1957 Act the words,and which is indicated by particulars…in the register in respect of him";and from Section 41(5) the words,and which is indicated by particulars in the roll or record of the class in respect of him".The General Dental Council takes the view that dentists and enrolled ancillary workers should be permitted to use qualifications which they in fact possess and not be limited to those which are registrable. I am sure that this is a change that should be permitted, to allow some relaxation of the rules affecting registrable qualifications in the future.
1159 I now come to a minor legal point that needs clarification. The General Dental Council and the British Dental Association feel that in Section 25(3) of the Dentists Act 1957 the words,or any other Court",should be inserted after the words,Court of Session".This is merely a technical point in that matrimonial proceedings are not now limited to the High Court or Court of Session but can also be tried in both Crown Courts and county courts. This is entirely a matter of interest to the General Dental Council to facilitate the work of the disciplinary committee, in that the committee would hope to be allowed to accept as conclusive evidence of fact found in matrimonial proceedings in whichever court they took place.
With General Dental Council approval, the British Dental Association would like to change the number of elected members of the quorum of the disciplinary committee so that, as well as the change in the Bill in Clause 2(3)(b), a further change would be made to Schedule 1, Part II, of the Act, in paragraph 12(5) so that it shall include at least two elected members. Whether it be true or false, most practitioners feel that the elected members of the council, who are usually dentists in practice themselves, are more closely in touch with the workings and problems of general practice and, therefore, more likely to understand the difficulties that may have led to an appearance before the disciplinary committee.
Finally, the General Dental Council would be grateful for an explanation of the need to retain Section 36(2)(c) of the Dentists Act. They feel that it can now be left out of the Act as the point covered has now been overtaken by existing regulations that govern ancillary workers.
I repeat that I welcome the introduction of this Bill and I look forward to hearing the words of my noble friend Lady Gardner of Parkes. We hope that the Bill proceeds through the House without any setbacks.
§ 4.10 p.m.
§ Baroness Gardner of Parkes
My Lords, I, too, should like to thank the Minister for bringing this Bill before us, and I, too, must declare my interest as a practising dentist. I find the Bill most interesting. There are some points in it that I think are excellent, and there are other points of minor worry that I should like to raise.
The principle that the dental council should always be assured of the good health, both physically and mentally, of anyone practising is something that I strongly support. Moreover, I think it very important that it should have the right to suspend or to deregister someone who is not physically or mentally capable. However, I would seek an assurance from the Minister that those elderly dentists who wish to remain on the register—and who, indeed, have been enabled to do so by the General Dental Council allowing them to continue their registration at £1 per year after the age of 65—should not be harassed, worried or obliged continually to produce medical certificates to remain on the register. I hope it would be the intention of the Minister that this health ground would be invoked only where someone was treating patients either 1160 unsatisfactorily or even dangerously, perhaps, in which case those provisions would be important.
However, many older dentists greatly value the right that they retain of witnessing documents or signing people's passports. There are a number over the age of 80 who are still on the dental register, and I should like to be assured that that position will be able to continue. I know that this provision is in some way tied in with EEC regulations. However, I hope that our General Dental Council will be able to retain the right to extend that courtesty to the respected retired practitioner.
I should like to comment next on Clause 12. I must say that I welcome the change from a number of separate lists to a single list. I am personally affected by this change because I have always been on the Commonwealth list, and frequently people who have not understood how to look up the dental register have said to me, "You do not seem to be registered". That has caused a degree of discomfort, and I am therefore only too pleased that I shall now appear on the normal list.
There is one aspect about which I am rather sorry. I understand that even if I become British in January, I shall still not have the right of practice within the EEC, as that is related to being an EEC national and having a qualification gained within the EEC. I do not think that anything can be done about that in this particular Bill. However, the Australian dental section numbers 1,000 out of the approximately 12,000 dentists in England, and that 1,000 will still not have any right, as I understand it, to practise in the EEC.
I should like to revert to Clause 11. I have spoken to the General Dental Council, and this clause apparently covers specialist lists. I was slightly concerned about that because I thought that if the General Dental Council was so opposed to advertising, what would a specialist list be but a way of advertising who were specialists? The council has assured me that it would not be a published list but merely a list kept by the General Dental Council in line with the qualificaitons that people had attained.
I am most concerned about "suspension of registration" under Clause 13. I am concerned about the cases that have come before the court—and I am speaking in a medical sense—under a similar Act. As I understand it, suspension is meant to be a lesser penalty than removal from the register, and if you suspend someone it is because you think that whatever they have done—I am thinking particularly of disciplinary suspension—is not bad enough to merit erasure from the register. In medical cases it has been found that because—and I quote the words—he,shall be treated as not being registered in the register",then "suspension" means exactly the same as "deregistration".
Therefore, I appeal to the Minister to correct in our Bill what went wrong in the principal Act and to amend the wording in such a way that the name would be retained on the register with perhaps some mark beside it indicating suspension, or even perhaps some dates. I do not want to go into the details of my ideas. However, if the person is retained on the register, even in a suspended state, rather like a suspended sentence in court—one does not want to send a man to jail and so one gives him a suspended sentence—there would 1161 be no harm in publishing that note of suspension because he will have merited suspension on health or on other grounds. Someone would presumably have to go back to the General Dental Council to ask why the suspension was marked in a particular year. However, it would enable one to go on employing another dentist to retain the care of one's patients, as my noble friend Lord Colwyn has mentioned, which is a problem for the single-handed practitioner.
It would also enable that person, if he were in employment with a hospital or had a national health contract, to retain his employment. I understand that, otherwise, the moment he was treated as not being registered he would lose all rights of employment under his contract. That, of course, applies not so much to a general dentist—a point covered by my noble friend Lord Colwyn—as to those employed in the hospital service or in any other way who would lose all their rights immmediately because the suspension,shall be treated as not being registered in the register".Therefore, the present wording makes no difference between "suspension" and "deregistration". In my view it is very important that the Bill should in some way cover that significant point so that it can be dealt with.
Clause 24 was mentioned by the noble Lord, Lord Winstanley. I may surprise him by taking his view to a certain extent as regards this clause. I think that he has misunderstood it because it is really a relaxation rather than the reverse. Until now, dental auxiliaries (as they are to be called under the Bill) have had to be under the direct supervision of a dentist. At present we are all receiving a large number of letters from dental hygienists who are evidently due to graduate in January next year. There must be a shortage of jobs, because they are all writing and asking whether we can possibly employ them. Many dentists, whose time is fully committed looking into the mouths of their own patients, feel that they cannot possibly directly supervise.
However, under the wording of this clause they will be allowed to employ a person, still in the same practice but with not quite the same degree of necessary supervision. That will be to the benefit of the patients and the profession. I am sorry to see that, under the proposals in Clause 24, in order for the General Dental Council to agree to this they must bring an Order in Council before Parliament. I would have preferred to see it passed in such a way that the General Dental Council themselves could then proceed to implement it if they thought it right. Bringing it before Parliament may be onerous and it might be difficult to find parliamentary time. Perhaps the Minister can comment on that point. I understand from the General Dental Council that this is one of the issues upon which the profession is so widely divided—almost 50: 50—that it thinks that it is rather easier for Parliament to decide than the General Dental Council. In my view that is merely trying to avoid the duty which should belong to the General Dental Council of deciding what the dentists want.
There are only a few other points I wish to raise. One arises under Clause 22—and here I must declare interest, in that I am a director of a body corporate carrying on dentistry and have been so for 20 years. 1162 These bodies corporate are rather strange, in that they have this historic origin in dentistry and seem to be quite unique. I should like to read out the assessment of the British Dental Association of the meaning of Clause 22(2)(6). It makes many other comments on it, but it says:Clause 22 also ensures that a body corporate shall cease to carry on the business of dentistry if any one of its directors is erased from the register.I am told that that is quite different from any other body corporate carrying on any other sort of business, and that, if it happens that one director is a criminal or is deregistered—let us go so far as to say that he goes to jail—that does not stop the business continuing. The present arrangement for a body corporate is that there must be a majority of dentists, so there could be two dentists and one lay person or three dentists and two lay people. If one is deregistered, the company would, of course, have to appoint another registered dentist to retain the qualification of a majority of qualified dentists; but, if one was deregistered for any reason, it could be a great hardship on both the business and the other pratitioners, and it is not in accordance with normal British law that the penalty would extend to the whole company, even though it was one director only who was involved. I should be very interested in my noble friend's comments on that.
I should also like to ask the Minister whether he can reconcile that clause with Section 40(5) of the old Act, which, as far as I can see, he does not propose to change. It may be that the British Dental Association has misinterpreted this, because under Section 40(5) it says that:A body corporate shall not be liable under this section to be deprived of the right to carry on the business of dentistry in consequence of the erasure of the name of a director or member of the operating staff or in consequence of a conviction of the body corporate or of a director".My noble friend does not propose deletion of that, and that seems to me to say exactly the opposite. So it is possible that the British Dental Association has misunderstood that section. It is certainly a very obscure field and perhaps the association is not so well-informed on that.
I think that I have covered most of the points I want to raise. I have a note on a point made by the noble Lord, Lord Winstanley, who raised very many important matters. He viewed this Bill as tightening the dental monopoly. As I explained, I do not think that it will do that. I believe that the auxiliary situation will ease the restrictions rather than tighten them.
I personally think that the day must come within the next few years when the auxiliaries will play an important part in the provision of dental services, particularly in the large cities. The present national health structure is based on a national fee scale, with no recognition whatever of the very much higher overheads applicable in the large cities. Today a dentist receives £2.27 for examining a patient and you are meant to be able to carry out enough examinations in one hour to meet surgery overheads of perhaps £40 an hour, and that is not high by London standards. I consider that there is no way in which any dentist could physically examine enough patients in one hour to survive on that rate of pay. Over the next few years we must endeavour to keep the services in the inner cities going. Every time a lease comes up for renewal 1163 in my area, the dentist closes and goes. Patients will tell you that it is extremely hard to get national health dental treatment, and those dentists who give it in the city areas are hard-pressed.
This leads me to another point. The dental profession is rather short of work at the present time because of the remarkable drop in dental decay. In some parts of England they are having to "bus" children to dentists in order to have enough child patients even to meet training needs. Therefore, I believe that the whole of dentistry is in the melting pot at the moment. It is said that we may have a greater workload relating to the teeth of 70-year olds. We may, but it is a difficult transition time within the profession and that is why this Bill, which has come after 25 years and which is very welcome, gives us an opportunity to make a number of enabling provisions which will allow the General Dental Council to protect not only the dentists but the public in the future and ensure that the best dental services are provided. I hope that we shall make the most of the opportunity. I thank the Minister for bringing forward this Bill and I support its Second Reading.
§ 4.26 p.m.
§ Lord Trefgarne
My Lords, am obliged to all noble Lords and to my noble friends who have spoken in this debate. A large number of points have been raised and we can perhaps deal with a good many of them more effectively at the Committee stage. However, perhaps I may touch on one or two now. The noble Lord, Lord Winstanley, complained that perhaps we were further restricting the activities of dental auxiliaries. I do not think that that is so; it is certainly not our intention to do so. Indeed, in some areas we are loosening the controls on the work of dental auxiliaries, and I hope that, when the noble Lord studies the provisions again, he will reach that conclusion as well.
The noble Lord also raised the question of a reduction in training of auxiliaries. I can assure him that the Government are, of course, aware of this matter. It is true that, largely because of over-supply of newly trained dental therapists and, therefore, difficulties for many of them in finding employment, a decision was taken earlier this year to close the Dental Therapists Training School, but arrangements are being made to provide new training centres attached to dental schools. Following a recommendation of the Dental Strategy Review Group Report, we are proposing to increase the number of dental hygienists to be trained. I hope that that will reassure the noble Lord.
My noble friend Lord Colwyn asked whether the Bill means that a dentist suspended on health grounds cannot keep his practice going while under suspension. It is clearly an important issue because it does, indeed, seem undesirable that a dentist who is so suspended should not be able to keep his practice going while that is so. It seems undesirable because his financial position as far as possible needs to be protected and, equally important, as my noble friend pointed out, his patients need to be provided with dental treatment while their own dentist is recovering his health. Further, I am sure that none of us would want to erect any barriers to dentists who are sick being suspended 1164 for their own good and for the good of their patients. I cannot say categorically now whether the Bill, as drafted, has the effect suggested by my noble friend, but if it does, I shall certainly consider whether amendments would be appropriate.
My noble friend also asked whether evidence from any other matrimonial courts could be taken into account in proceedings of the General Dental Council's Disciplinary Committee. This is a matter which we can perhaps discuss in the Committee stage on the Bill, but I shall certainly think about it between now and then.
My noble friend Lady Gardner asked whether dental practitioners over 65 years of age could be relieved of the burden of producing medical certificates annually. Again, if she will allow me, this is something which I should like to examine. I think we shall find that the Bill as drafted requires such certificates to be produced only upon first registration, but I shall take some further advice on that matter and certainly we can discuss it again when we reach the next stage of the Bill.
My noble friend Lady Gardner also expressed concern about the contractual and employment position of suspended dentists. I can assure her that, either by an amendment to this Bill or to the Health and Social Services Bill, we propose to cover the point that she has raised. My noble friend also asked about carrying on the business of dentistry by corporate bodies and the erasure of the name of a director from the register. Clause 22(2), in adding a new Section 40(6) to the Dentists Act 1957, does not alter the principle which has been expressed in Section 40(1) for the last 25 years, that a corporate body, any director of which is convicted or erased from the dentists' register, shall be liable; in other words, may be closed down by the direction of the Disciplinary Committee of the General Dental Council. But there is an existing Section 40(5) of the 1957 Act which provides that erasure before 4th July 1956 should be overlooked. The new clause merely relates the directorship to the time when the offence was committed and not to the time of the erasure or conviction. This is so that the disciplinary committee's action shall not be forestalled by early resignation of the director. There are more points with which we can deal at a later stage of the Bill and, in the meantime, I beg to move that it be read a second time.
§ On Question, Bill read a second time, and committed to a Committee of the Whole House.