Tonight, I am raising the question of dental facilities in the City of Birmingham with special reference to the difficult situation which has been created by the overcrowded condition of the Birmingham Dental Hospital.
It is now nearly four years since I first drew the attention of the Minister of Health, the present Minister of Labour, to the very serious overcrowding at Birmingham Dental Hospital. In March, 1954, the right hon. Gentleman informed me in this House that the regional hospital board was looking at this matter as one of urgency. Since that time every conceivable method of relieving the congestion has been examined and, on 5th November, 1956, I was informed by the hon. Lady who was then Parliamentary Secretary to the Ministry of Health that plans for a new hospital were under consideration.
The situation became so unbearable that I urged the previous Minister of Health to visit the City of Birmingham and to see this hospital for himself. He did so at the end of last year, and the impression which he gave both to me and also to the authorities in Birmingham was that the provision of a new dental hospital was one of the first priorities. He certainly gave all concerned to understand that that hospital would be included in the 1958 programme. Plans were drawn up in the light of further discussions with the Ministry and all is now ready to be put into action. The site is there, the dental hospital is the first priority in the building programme of the United Hospital Board and I understand that the University Grants Committee has agreed upon the proportion to be paid by the University.
The House will, therefore, appreciate my astonishment when a few days ago, the Minister of Health announced that he was unable to say when the new hospital would be commenced. Each month during each of those years the delay has meant that the new building will cost more because of increased building costs. I ask the Minister to place this hospital in the 1958 programme because it is a matter of considerable urgency and importance to the country.
I have visited the hospital on a number of occasions, both as a patient and as a visitor. The last time I visited it was on Monday of this week. I can only describe this hospital, from the basement to the top floor, as outrageous by any civilised standards and intolerable to both patients and staff.
I give it that description for four particular reasons. The first concerns the position of the patients. I know that the Minister has this information, but it is information which I obtained from the hospital on Monday, when I asked for information, and I should like to give it to the House. On 1st December, 1956, there were 600 adults on a six-months' waiting list for conservation treatment. On 1st December, 1957, that number had increased to 950, not on a six-months' waiting list but on a nine-months' waiting list. On 1st December, 1956, there were 84 children on a five-months' waiting list for orthodontic treatment. It is vital that this work in straightening children's teeth should be done. It is work which ought not to wait as long as so many children have to wait for it today. This figure of 84 was increased to 147 on a six-months' waiting list by 1st December, 1957.
In general anaesthetics and local anaesthetics for emergency treatment, the hospital cannot guarantee to give treatment the same day. Even though they are suffering pain, patients may have to wait for a day. A year ago 270 people were on a waiting list of one day for emergency treatment. That figure had increased on 1st December, 1957, to 351. This is the position from Monday to Friday. The dental hospital closes at the weekend. What happens then?
This brings me to the second reason. This general hospital at Birmingham is flooded out with dental patients, emergency cases, so that on an average there are 200 cases at the weekends, which is an enormous burden upon the casualty department of the hospital. This is the largest casualty department in the whole of the country. It is an intolerable burden upon the General Hospital.
My third reason is the overcrowding of this dental hospital. I have brought some photographs to show the House what this means. I have here a photograph, taken some time ago, which shows one room in this hospital with 25 to 30 dental chairs practically touching each other. That was the state of overcrowding. The position is even worse today. Another photograph which I have here is of the same room where one can see not only the dental surgeons operating but patients waiting and watching in the same room, children as well as adults.
When I was at the hospital on Monday, I saw patients facing each other with blood streaming from their mouths, within sight of many waiting for treatment. A more ghastly introduction to dentistry, I think it would not be possible to witness. The staff of this hospital do a wonderful job and they are to be congratulated, but the best treatment cannot be given to patients for reasons of time and space.
My fourth reason for describing this condition as outrageous, as I see it according to civilised standards, is the intolerable conditions for the staff. There are two lavatories for 40 to 50 staff and only four lavatories for all the patients. In case of fire, or some other calamity, the crowding is such that the building is positively unsafe. I hope that the Minister will accept an invitation by me to go to Birmingham and see the conditions. I should like to accompany him, because I am sure that he will be able to see that what I am telling the House tonight is no exaggeration.
I asked about the clerical staff. It is not possible to find space anywhere in the hospital to employ an appointment clerk, because there is nowhere to put him. The patients' records, which are being housed in the hospital, from what I saw on Monday, constitute a quite serious problem. I was informed that a grant of £1,500 had been allocated with the purpose of putting in a false ceiling with a floor over one room where someone could at least crawl round to get the records, but the architect says that the walls are not strong enough to enable this to be done, even with a grant of £1,500.
I would remind the Minister that this hospital is the only one in the Midlands. It is serving all the major towns in the Midland area and a population of about 4½ million. There is no dental hospital from Bristol in the south to Sheffield in the north, so Birmingham has this great responsibility. I think that the House will appreciate that those facts demonstrate the gravity of the situation.
The hospital is over-full for the training of dental students. It was built to accommodate only 18 students, but this year took 45. That is a record, but I understand that it is giving rise to grave administrative difficulties. On 2nd December, the Minister informed me that 40 places would be allocated for 1958, but I discovered at the hospital on Monday that up to that day more than 140 applications had been received for those 40 places and that other applications were coming in at a rate of six or seven a day. The Minister should know, from the Teviot Report, that 900 students a year are required to produce a register of 20,000.
All the children's services—and nearly all other services—have totally insufficient staff. This morning I asked the Minister of Education to tell me the position in relation to the Birmingham schools. This is the information I obtained:
There is, indeed, a dire shortage of school dentists in the Birmingham area, as they have an equivalent of 18.4 full-time dentists for their whole school population of approximately 184,000—a relationship of one dentist to 10,000 pupils. This is no reflection whatsoever on the efficiency of the Birmingham education authorities. The ideal which the Ministry would like to realise is one full-time dentist to 3,000 pupils; and the proportion throughout England and Wales at present is one dentist to about 6,500 pupils.
But in Birmingham it is one dentist to 10,000 pupils.
I understand that the University Grants Committee has suggested that the new dental hospital should take 80 students—double the intake for 1958. All responsible bodies have agreed to this, but only if and when this new hospital can proceed. The present situation is tragic. Our people and the children need to have their teeth adequately protected. This is a matter of the people's health, and it is a tragedy, when there is that demand for dentists, that young men and women who seek to follow this worthy profession should be denied the opportunity.
I ask the Minister to do something about this, because I am told that last year we lost a lot of potentially fine dental surgeons, and this year we have 140 applications for 40 places. What can we do? We may be able to find a few places in Scotland, but, in fact, the present maximum capacity of the schools is from 650 to 700. I fear that, once again, we shall see these worthy young people who wish to follow this admirable profession denied the opportunity.
It is a bigger tragedy, too, because the world demands dentistry. It is unfortunate that we are lagging behind many countries, both in the West and in the East. Countries like Denmark and Sweden could certainly put us to shame. Having raised this question many times over the past four years, I protest tonight that this hospital, which is situated in the centre of Birmingham should be allowed to continue in this condition. I am sure that there is not a hospital of its nature where the conditions are worse.
In conclusion, I should like to say how much I appreciate the loyalty, patience and tolerance of the staff who are working in these conditions. By all the standards to which I have referred, if the Factories Acts applied to the dental hospital in Birmingham, then the hospital would be condemned. I have the greatest admiration for the staff working in these difficult circumstances. Surely, they could do what many factory workers would do in similar circumstances, namely, object to continue to work in such extremely difficult conditions.
Therefore, I ask the Minister to give new hope to those who wish to help our country in its urgent need and who wish to play their part in protecting the health of the people. I hope that tonight the Minister will say something to give new hope to speed forward the new hospital of which Birmingham and the country can be proud.
The House has heard with great surprise and much disquiet the state of affairs in Birmingham to which my hon. Friend the Member for Birmingham, Ladywood (Mr. V. Yates) referred. It is certainly very unsatisfactory that patients while waiting for treatment should be exposed to the type of scenes that my hon. Friend has described. I fear that this is by no means an isolated instance. Several hon. Members on this side of the House would agree that on the whole dental treatment in this country is very inferior, as my hon. Friend has suggested, to that in the United States and Scandinavian countries. Although my hon. Friend has brought the attention of the House more specifically to the problems of Birmingham, similar problems exist in a very much wider area and in many other towns. I should like the Parliamentary Secretary to indicate what he can do to improve the country's dental treatment.
There is no doubt that the number of dentists available is, at present, quite inadequate. It is generally accepted that, among the countries which have a superior standard of hygiene, the United Kingdom lags behind in dental hygiene. I should particularly like the Parliamentary Secretary to tell us what can be done, first of all, to increase recruitment to the dental profession, and, secondly, to improve the standards of dental treatment that we can obtain in dental hospitals and clinics.
Another serious omission in the National Health Service facilities is in the realm of orthodontics, the treatment of deformities of the teeth, which lags very seriously behind. Under the National Health Service conditions, one can have teeth removed or stopped; one can have elementary treatment, but as for skilled treatment of an orthodontic nature—the correction of deformities of the teeth—we lag very seriously behind the United States and Scandinavian countries, and I should be very glad if the Parliamentary Secretary would indicate what can be done for improvement in the future.
I think my hon. Friends will agree that there is no reason at all why, with our, generally speaking, superb National Health Service, we should not have dental and orthodontic treatment of the same high standard as in, say, general surgery or general medicine in this country, which is of a very high standard indeed.
I should like the Parliamentary Secretary to consider this and to address himself to these two major points: first, how to increase the recruitment of dentists generally in the specialist form of dentistry and orthodontics, and how to ensure that there is generally a higher standard of dental treatment in this country.
I think we are all indebted to the hon. Member for Birmingham, Ladywood (Mr. V. Yates) for raising this matter this evening. We all know his assiduity at Question Time on a matter which is of the greatest constituency interest to him, apart from its importance in the general context of the dental services provided in the country as a whole. If the hon. Member for Loughborough (Mr. Cronin) will forgive me, I shall devote the greater part of my observations this evening to the strictures of the hon. Member for Ladywood because, after all, it was his debate and he asked me to relate my remarks particularly to his local but very important problem in Birmingham.
The hon. Member for Ladywood was, in his usual courteous way, good enough to tell me of the points which he proposed to raise this evening, and, indeed, shortly before the debate started he showed me the photographs to which he referred during the course of his remarks and I was able to look at them rather more closely than I could across the Floor of the Chamber. I very gladly accept the offer of his escort on a visit to Birmingham, which I certainly hope to arrange—I cannot give him a date for that now, but it is firmly in my mind and I know that his help will be very useful to me at that time.
Before I get on to the main points which the hon. Gentleman made, I would point out that he made one or two general observations in which he said, for instance, that in our provision of dental services, particularly in Birmingham, Denmark and Sweden could put us to shame. It is likely that in certain areas of this country they could, but of course we have fought and endured two world wars for which we are still paying, and if we take our services as a whole I think we shall find, considering the things that we have gone through, that we are not making such bad provision. At any rate, I am sure the hon. Gentleman will agree with me that the things we fought for then were well worth fighting for, even if it takes us some time to catch up on all the things we should like to do in the years afterwards. I also agree with the hon. Gentleman in paying a tribute to the loyalty and devotion of the staff, who certainly are working in exceedingly difficult and unattractive conditions in this hospital. There is nothing between us in that.
Turning to the question of over-crowding in the Birmingham Dental Hospital, as the hon. Gentleman knows it was built in 1902 and, particularly since the end of the war, difficulties have arisen owing to the restricted character of the original building. The extension of the original building is not possible, first because of the restricted site and, secondly, because the hospital itself is due to be demolished eventually under a road improvement scheme. Some relief has been provided by the erection of new hutted buildings on a neighbouring bombed site, completed in 1950, and by the purchase and adaptation of nearby warehouse property in Barwick Street, which was brought into use in 1955. I readily agree that these schemes are only temporary expedients to relieve conditions which are highly unsatisfactory.
It is true that my right hon. and learned Friend's predecessor, the right hon. Member for Thirsk and Malton (Mr. Turton) visited the hospital in November, 1956, and saw for himself the state of affairs existing there. I do not deny the overcrowding, and this is due to two factors: first, the rise in the number of students entering the hospital for training; and, secondly, the increasing numbers of patients seeking treatment.
We must devote a little time to the student point because this is a teaching hospital. If we go back to before the war, we find that in 1936–37 13 students were admitted to the clinical part of the dental course. The following year the number was 15 and in 1938–39, just before war broke out, it was 23. By 1952 the number had risen to 39, and in 1954–55 it was as high as 43. As the hon. Gentleman was recently informed in reply to a Question he put down, there will be 40 places available in 1958, although there are more than 100 applicants for these places already.
Turning to the patients, in 1939 patient attendances were about 30,000, and since then, as the hon. Gentleman has pointed out, there have been very great increases. Total attendances were 55,000 in 1948, 83,000 in 1949, 158,000 in 1953 and 153,000 last year. During the first 10 months of 1957 total attendances were 126,867 which, on an annual basis, would work out at 152,000 odd. Although the figures are showing signs of flattening out a bit, I agree with the hon. Gentleman that they are greatly beyond the capacity of the hospital to cope with.
The pressure on the dental hospital is due to the shortage of dentists in the country, which affects Birmingham as it affects other places. The figures I have quoted show that the dental hospital has been doing a great deal to meet the dental needs of the general public, remembering that it is a teaching hospital, which is doing that job in addition to its teaching functions. It is not intended, of its nature, to provide a dental service for all comers. Indeed, preferably it should accept patients only to the extent necessary to provide a reasonable flow of clinical material for the students under instruction. Even when the new hospital has been completed, it will not be possible for it to meet a public demand at the level which is being experienced by the Dental Hospital at present.
The picture with regard to treatment has to be taken into consideration along with the dental treatment available at other Birmingham hospitals. We cannot consider the matter quite in isolation although it is tempting to do so. This is not the only hospital which provides hospital dental treatment in Birmingham. The Dudley Road Hospital has always been prepared to treat emergency patients at night and at weekends, and the Selly Oak Hospital is now helping with emergency dental work every third weekend and during the week.
During 1956 outpatient attendances for dental treatment at Dudley Road and Selly Oak totalled respectively 5,799 and 7,211. In addition, out-patients were treated at the General Hospital, the Queen Elizabeth Hospital and the Children's Hospital.
I know that the hon. Gentleman is well aware of these figures. Indeed, they formed the basis of a good deal of what he had to say. What he is really concerned with is the future and the provision for the new hospital. In many of these projects where existing facilities have ceased to keep pace with the demand and are no longer adequate to the strain put on them, it is possible to improvise, to adapt, to carry out a repair programme and perhaps do a little additional building, and, by one expedient or another, to tide over a difficult period until more fitting accommodation can be provided. However, I agree with the hon. Gentleman that that alternative is not open to us in this case.
I explained at the commencement of my remarks that, because of the difficulties of the site, the size of the site, and the fact that it is proposed in due course to demolish the buildings to make room for a new road, any large sums of money spent on rebuilding, adaptation, repairs and so forth would largely be thrown away because the time will come when the whole building is demolished. Therefore, we are really driven to the point of agreeing that these facilities cannot be improved much on the present site and that we must look to a new building to provide the kind of care which we would wish and which Birmingham undoubtedly needs.
The hon. Gentleman will know that the proposal to build a new hospital was first put to the Department at the end of 1954. At that time a round figure of £500,000 was mentioned as the likely cost. In March, 1955, when some more planning had been done, the board quoted a figure of £610,000, including professional fees. When sketch plans were sent to the Department in July, 1956, the estimated cost had gone up to £1,250,000, including equipment, but excluding professional fees.
Those plans have been discussed with the Board of Governors on several occasions and the Department's officers have made a number of detailed suggestions designed to reduce the cost of the building. Further progress, however, has been inevitably delayed by the need to consider the relationship of the Birmingham scheme to the recommendations of the McNair Committee for increasing the number of students generally. When the Board of Governors first discussed with the Department its plans for the new dental hospital, the Board was thinking in terms of a student entry of 60. It later revised that figure to 75.
Subsequently, however, the University Grants Committee sought information from the universities in the light of the McNair Report. The Committee is now considering the information it has received and the final decision on the size of student entry on which the plans for the Birmingham Hospital must depend cannot be made until the Committee's deliberations have been completed. That is a consideration which must be borne in mind when we are pressing for an early determination of these matters.
The hon. Member asked me quite squarely whether I could say that provision for the hospital would be included in the 1958–59 programme. That was the information which above all else he was anxious to seek from me. I cannot give him the precise answer which he would like since, as I have said, it depends on whether agreement is reached on the plans. The particular consideration which I mentioned—the view of the University Grants Committee on the figure of student entry which it requires—is very material to the matter. I realise that the hon. Member will probably feel that that is less than he could wish from the debate.
The hon. Member for Loughborough wanted me to go into very much wider questions of the provision of additional dental facilities throughout the country as a whole, which were not specifically included in the more narrow context of the debate. I am sure that he will be aware of the principal recommendations of the McNair Report and I can tell him that my right hon. and learned Friend is giving constant consideration to the way in which those recommendations can best be implemented.
On the comparison with other countries, the hon. Member for Loughborough reflected that our provision in these matters was perhaps a great deal worse than that in the United States. Having had teeth out in America, I can say that I found it an exceedingly costly performance and, if we take the two services as a whole, I would back our service against the American service on any occasion.
I and my right hon. and learned Friend are very much seized with the force of everything which the hon. Member for Ladywood has said this evening. I know that he will be satisfied only by a categorical assurance from this Box that plans have been approved and the money sanctioned for an early start.
I have said that I cannot give him this categorical assurance, for the reasons that I have stated, but his initiative in raising this matter and the persistence with which he sticks to it will at least ensure that neither I nor my right hon. Friend will ever be minded to—shall I say—let this most important matter take anything like a back seat in our calculations.
I fully appreciate the extent to which the Minister has gone in dealing with this matter, but as the information which I obtained was so specific, that every responsible body, including the University Grants Committee, had agreed upon this matter, will he make a special investigation, and if he finds that this position is correct, speed this matter forward in the light of his knowledge?
I apologise to my hon. Friend the Member for Ladywood (Mr. V. Yates) for arriving rather late in the debate. It started earlier than I expected.
We all appreciate the problem involved in the training of dentists, but I hope that the Minister will understand that we have to face not only the period required for building the new hospitals, in Birmingham and elsewhere—or for making extensions to the existing ones—but also the fact that before we can have the benefit of these additional entrants, trained and able to be of service to us, we have another six years to wait on top of that.
In addition, all the time we are losing dentists who are getting older and retiring. The critical position that the McNair Committee foresaw is coming upon us very rapidly. It is, therefore, a matter of real urgency, both as regards the project in Birmingham and elsewhere, to try to ensure that this inevitable waiting period of at least six years—even if the new accommodation were ready now—is not extended, as it will be by every month's delay in making extra accommodation available.
I hope that the hon. Member will represent to his right hon. Friend the urgency with which we all regard the matter.