I beg to move
That this House takes note of the First Report and of the Ninth Special Report from the Estimates Committee relating to the Dental Services
I think that I should make one or two comments of a general nature before I deal specifically with the matters contained in these Reports, Although this is the first time that an investigation has been made by the Estimates Committee into the dental service, it is not in any sense comprehensive. It does not deal with the problems of remuneration of dentists. It deals only to a limited extent with one of the general problems that afflicts the dental service, namely, the shortage of dentists, and it does not deal with matters of the character of fluoridisation, because that does not come into the remit to the Estimates Committee.
One of the problems of dealing with dental matters is the nomenclature of the various bodies which are concerned with the administration of the service. The first body is the executive council, which operates as a health organisation, and which is not only concerned with dental matters but also medical matters. The point that is made about the executive councils is that they vary considerably in size, and it is recommended that those councils should be reviewed. When we find, as we do, that there may be as small a number as seven or eight dentists in one executive council and a number as great as 300 in another executive council, it seemed to the Committee that this matter ought to be reviewed with the idea of rationalising the situation.
It is, of course, realised that that could have implications on the medical side with which we are not directly concerned. The executive council has a duty to appoint a dental service committee which deals in the main with cases of those who are in breach of the terms of service. Generally, there has not been an extended amount of work in connection with these breaches.
The dental service committee comprises a chairman, three lay members and three dental members. At first sight, one would think that that was an adequate organisation to deal with the problems of breaches of terms of service. But there has been grafted on to the service procedure under Regulation 19 of the National Health Service Regulations, 1956, which may operate through what is called a local dental committee. This committee is composed entirely of members of the dental profession.
If any question of over-prescribing of dental treatment arises—which one would think a breach of the terms of service—it may be reported to the Minister who may decide to deal with the matter either through the regional dental officers or through the local dental committee. The Estimates Committee considered that this was a duplication of the work done by the dental service committee and as there is another alternative method which enables these matters to be referred to the regional dental officers, procedure other than Regulation 19 would be adequate to deal with cases of over-prescribing.
As I have said, the executive councils are very small. A situation may arise where only five or six dentists are available to serve on the local dental committee and they would know only too well the gentleman whom it was suggested was over-prescribing. There is an additional and fundamentally an estimate reason why the Regulation 19 procedure should be abolished. Twenty-seven people are employed in connection with that compared with 31 employed on the normal investigations. As a result of their research only 8 out of over 100 cases have been referred to the local dental committee under Regulation 19. In those circumstances the Estimates Committee feels strongly that this is only complicating the nomenclature of the service. It achieves no useful purpose and, to some extent, involves unnecessary expense.
I do not propose to go in detail through all the recommendations. But I should like to say something about the Dental Estimates Boards, the bodies which sit in Eastbourne for England and Wales and in Edinburgh for Scotland. A considerable amount of evidence was placed before the sub-committee which investigated this matter, and a visit was paid to Eastbourne. Quite a large amount of work goes on there. Over 15 million cases were dealt with at Eastbourne and 1½ million at Edinburgh. Although a substantial amount of money was being spent we were satisfied that on the whole it was being well spent. But the Committee was anxious that, if a commuter system could not be provided, there should at any rate be some sort of system arranged to save the work being done manually by the servants of the Board.
The fact that 15 million cases are dealt with makes it clear that this is a big job and worthy of careful investigation to see whether some form of mechanisation could be used. We ask that further consideration be given to some mechanical arrangement, i.e., punch card, etc. We did not feel competent to make any detailed recommendations. But we thought it appropriate to make a recommendation that there should be outside help to deal with this matter, which would appear to raise more unusual commutation problems than usual.
In addition, and perhaps more fundamentally, we take the view that consideration should be given to the amalgamation of the Edinburgh and Eastbourne bodies. We consider that the addition of 1½ million to the 15 million to 16 million cases dealt with at Eastbourne would not involve any great increase in overheads at Eastbourne. Obviously, there would be a saving in the total by such an amalgamation. The best situation for a joint board would have to be considered. It was thought by some that the North-East Coast might be an appropriate place. There was a suggestion that the saving would be small. But the Committee was of opinion that it would be quite substantial. It would, of course, be even more satisfactory to have the boards joined if some system of mechanisation such as I indicated just now could be employed.
Finally, I wish to deal with what I consider the most important part of our recommendations, putting dentistry into the position which it ought to occupy. Generally speaking, we found that the National Health Service dental work was reasonably satisfactory. I am pleased that the suggestion has been accepted that more information should be given on the medical cards of those who come to the National Health dental service for treatment. The Committee heard of a number of cases where there was doubt whether someone coming for attention would get an advantage if his teeth were not attended to under the Health Service, but privately.
This is a problem which I believe is inherent in the present set-up on the Health Service side. But suitable statements on the medical cards of those who go to the dentist under the Health Service might very well deal with that. That, however, is really not what seemed to the Committee to be the unsatisfactory aspect of the service.
What deeply concerned the Committee was the school dental service. It seemed that almost everywhere we turned there was evidence of lack of drive and knowledge of the responsibility and importance of this work. A memorandum on the service in England and Wales said that the aim was
…to inspect every child annually, to offer treatment to those who need it, and to provide treatment for all who accept the offer.
This ideal cannot be attained under present conditions. Table B shows about half the number of children in maintained schools are inspected each year, and that rather more than half of those who are found to require treatment actually receive it through the school dental service. Table B also shows that the percentage of pupils treated as compared with the number of children in maintained schools has fallen. In 1938, it was 32·1 per cent. but perhaps the 1947 figure would give a better picture. Then it was 29·7 per cent. Now it is 17·4 per cent. This is very disturbing in itself, and it is particularly so because there is no tie-up at all with the Health Service.