Dentists Bill

Part of the debate – in the House of Commons at 12:00 am on 4th November 1955.

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Photo of Mr Ronald Ledger Mr Ronald Ledger , Romford 12:00 am, 4th November 1955

I too, with other hon. Members who have spoken, welcome the Bill. There is, however, one part of it which gives me considerable concern, not so much for what it contains but for what is left out. The Minister appears to have given the impression, at any rate, that his attention to Clauses 18 to 22 is such that he is not likely to allow the General Dental Council to contract out of its obligations. It is only because the Minister appears to have given an assurance of that nature that I feel there is the possibility that the Bill will deal with the most important problem in the dental service today.

Most hon. Members who have spoken have stressed that the biggest problem is the shortage of dentists. The figures given by the Minister were alarming enough in that it is obvious that the Teviot Committee completely underestimated the possibilities of establishing a comprehensive dental service. That Committee suggested that the schools would require an intake of 900 pupils a year to provide for a comprehensive service in twenty years' time. Now the Minister tells us that the schools are not managing to take in half that number.

It is not sufficient to content ourselves by saying that if we bring in a Bill which will grant a higher status to dentists, that will necessarily help in recruitment. There is a lot to be said for the fact that status is probably much better when earned than granted. It may be that in the profession we could find one or two things which tend to reduce a dentist's importance in the eyes of his patients. It is an astonishing fact that people rarely put their dentist on the same plane as their doctor, yet in so many instances the dentist can save the doctor a considerable amount of work if he can engage upon conservative dentistry. Many of the sore throats and upset stomachs that doctors have to deal with derive from the fact that patients have not been able to receive adequate dental attention.

The Minister could be wrong in saying that the most important part of the Bill was the fact that dentists are to be given self-government. If the dental profession does not succeed in bringing into its ranks sufficient numbers of dentists to deal with its problems, it might be simply a question of having passed the responsibility for failure to the General Dental Council.

Clauses 18 to 22 relate to recruitment. I should like to refer to a figure which was given by the hon. and gallant Member for Macclesfield (Air Commodore Harvey), a figure which was not given by the Minister but which, I think, would have underlined his argument considerably as to the crisis in the dental profession. The Minister gave figures to show that we were short of dentists and that the intake in the schools was far from satisfactory.

Dentistry is an ageing profession. The average age of a dentist is about 55. The Minister did not give us the number of dentists who may—not those who necessarily will—retire by 1958. The fact that they represent one-third of the number of dentists in practice and that their number cannot be made up by the number of entrants into schools and other sources of recruitment, underlines the seriousness of the situation which we may face in three years' time.

I do not think that the provision in the Bill for an experimental scheme even scratches the surface of the problem. Even if the scheme is a good one and is successful, it would appear that at the end of three years we may have a minimum of eighty ancillaries who have been trained to do a limited amount of work. We must bear that in mind when considering the number of dentists we are likely to lose in that time. It will be agreed that although the experiment is probably worth while, and we must continue with it, it does not deal with the problem of establishing an adequate dental service.

Therefore, it is right that hon. Members should have said that the dental profession may have to look into itself—it is better for it to do it itself—to see whether or not it can make far more use of the ancillaries, the dental technicians who already exist. There is a feeling on the part of the members of the dental profession that they will lose a certain amount of authority if they pass on important work to the ancillaries. There is the argument put forward by my hon. Friend the Member for Wolverhampton, North-East (Mr. Baird), that the attitude of the two unions which represent the ancillaries is not necessarily—I think that that is the strongest he could say—in favour of the approach that has been made to many Members by a grade of ancillaries who want to have access to the mouth.

I have here a telegram received at the House today, which says: To supplement the shortage of dentists a resolution was passed at the U.S.D.A.W. Midland Conference for dental technicians for ancillaries from selected technicians to have access to the mouth under supervision. I think that this attitude within the unions has always been there, but as they have had to negotiate with the dentists on wages and conditions of work, it was hardly likely that they would have pressed too early without full consideration for any sort of encroachment on to the previous preserves of the dentists themselves. However, I think that that argument has been dispensed with.

I want to deal with what I think might be a useful suggestion for consideration by the Minister. The hon. and gallant Member for Macclesfield pointed out that there were ancillaries, highly-skilled and artistic men, in the profession whose job it was to produce the dentures. These men serve five years apprenticeship and two years as an improver, but there are considerable weaknesses in the present scheme under which they work. They are not allowed into the surgery and they are not allowed to see the patient for whom they make the denture.

It seems a peculiar situation that a person should make dentures and never see the mouths for which they are made. That reflects the considerable skill of these technicians, in that more often than not they are successful in making a very good denture. But, as they are highly skilled and do the job so satisfactorily, would not it be a logical step to allow them, under supervision, to approach the patient at the point at which the dental surgeon has completed what he might call the cut of the bone and tissue? That is a phrase they use. The surgeon has extracted the teeth, the gums have been prepared and then it is simply a matter of making the denture.

It seems a logical step, in view of the skill of the technicians and bearing in mind the acute shortage of dentists, that they should be allowed access to the mouth, under supervision. What exactly would it mean? Apart from the fact that the status of the dentist will have been raised by the Bill, the status of the technician will have been raised, and we will in two cases and not one effectively have increased recruitment to the profession. The effect on the actual dental work will be considerable, because if it is true that the dentist spends 20 per cent. of his time on the making and fitting of dentures, then to relieve him of those duties would be equivalent to adding to the service 2,000 or 3,000 dentists.

Then the time factor comes in, and that is important. We understand that the crisis in the profession is upon us and that the difficulty will increase and reach a peak in three or four years. If there is to be a remedy it should be one that will come into effect at the quickest possible time. I hope that the Minister is comparing what I am suggesting with his suggestion for bringing ancillaries under the Bill—the selected technicians who have received seven years' training. Such people may have been in the profession for forty years and they have considerable skill. A relatively short period of training would be required to enable them to go into the surgery and work from the very beginning on the fitting of dentures.

I have been given an estimate based upon a course which has been approved by dental surgeons. I use that phrase guardedly—not approved by an organisation of dental surgeons but by dental surgeons. It is a course which would fit selected ancillaries for work as prosthetists in six months. In six months 1,000 to 2,000 of these ancillaries would become available for this work. I suggest that, if there is this serious crisis, it would be difficult for the Minister to ignore a suggestion which would produce such a comparatively quick remedy.

Perhaps I should make it clear at this stage that neither I nor any other hon. Member would be agreeable to the introduction at any time of any ancillary to do work which would not be supervised by a dental surgeon. That is not intended; it is not wanted. It would be suggested that the dental surgeon would say when the mouth was ready for the work of the prosthetist, and when the work had been completed he would have to sign a certificate of clearance. That would be absolutely essential. Because I should not like people to think that on this nonpolitical issue I was being revolutionary in any way, it is as well to draw a comparison between this branch of the medical profession and other branches.

The comparison is that of Roehampton, where the medical prosthetists there make and fit artificial limbs and then go further—and this is required sometimes in the fitting of dentures—and help the patients to get used to the limbs and advise them on how best to wear and use them. There are many difficult factors involved. It would be wrong for anyone here to say, "Here is a scheme; all you have to do is to put it into the Bill, and all your problems are solved." I am certainly not suggesting that, but I suggest that the serious nature of the problem merits the attention of the Minister to any of the suggestions which would appear to offer help in the situation. The acceptance of a scheme such as this would not help to solve the whole problem, but in adopting a Measure of this kind we can, in fact, raise the status of the dental surgeon in an effective way. Having completed his work he will then be able to delegate certain of the work and his patients will be aware of the fact. The very fact that he has ancillaries working with him will tend to raise his standard.

Because of the nature of a dental surgeon's work, it is always very difficult to feel any sort of real affection for him. Memories of a dentist's surgery are not the sort of memories which lend themselves to affectionate thinking. But I feel that we should all appreciate far more the skill of the dentist were we assured that far more of his work was concerned with preserving our teeth rather than repairing them.

I wish to finish on the note that was introduced by my right hon. Friend the Member for Warrington (Dr. Summerskill). She said that if we do not solve this problem, the children will suffer. I suggest that not only the children, but adults are already suffering. It was my own experience recently that, twelve months after receiving treatment, I applied for an inspection and I found that I could not have one for a month. When I attend, and if there is anything which requires to be done, I shall probably be told that I must wait another month. If there is any considerable degree of work to be done—say one or two fillings—it may be another month or two before the work is completed. It is possible for a comparatively small amount of treatment to take three or four months to complete, because 20 per cent. of the working time of the dental surgeon is taken up with fitting and measuring for dentures.

To underline the importance of this matter with regard to the children, I wish to draw the attention of the House to the report of the principal School Medical Officer of the Nottinghamshire County Council. He requires twenty-two dentists for his service and he has only five of them. On the figures given by the Minister, and from the conclusions we should draw if we accept them, and if 50 per cent. of the 5,000 due to retire in three years do retire, we can only say that this medical officer can not only not expect to maintain his present level of 50 per cent. of requirements, but that the chances are that the percentage will fall. He says that he has 85,000 children in his area and that of those only 32,000 could be inspected. Of that figure, over 28,000 were found to have defective teeth, and 23,000 were referred. Minor dental defects were not referred. This suggests that the situation with regard to schoolchildren is very serious, not only because there are no dentists for the service, but also because the teeth of the children appear to be in a rather bad state.

Unless we do something now to see that the dentists perform the conservative task for which they are trained, it will appear that the day may well come in the very near future when almost all of their work will be concerned with the fitting of dentures. I therefore make a serious plea that the Minister give consideration to the further proposals in connection with Clauses 18 to 22. If the Minister wishes to assure us of his concern that we should have a comprehensive dental service, the only way in which he can do it is to show us, or tell us through this Bill, how it is possible to fill in this gap and supply us with the two-thirds of the necessary number of dentists who are missing and who are required for this comprehensive dental service.