I agree with the hon. Member. No doubt the Minister will have taken note of this point. When he replies he will doubtless recommend measures of this kind, and will also assure us that he will devote even greater energy to his campaign to persuade local authorities to proceed more quickly.
The most important recommendation of the Estimates Committee was Recommendation No. 19, to which hon. Members have referred and which has been rejected—the question of the transfer of the school dental service to the Ministry of Health. Again and again we are told that we cannot interfere with a situation which involves two Government Departments. Empires are established within Ministries, and we are told that we cannot move responsibilities from one to another because it would be so complicated. We get a whole string of words such as"integration","joint consultation","arrangements", and"lines of communication that would have to be cleared", but we do not get away from the basic problem upon which the Estimates Committee put its finger.
Dental health must not be divided between two Ministries if we are ever to have a service which does its job really well. If the Government are sincere in giving first priority to conservation, it is obvious that the teeth of children should be accorded higher priority than the teeth of old-age pensioners. It is at that stage that the greater weight of effort should be placed in order to ensure that absolutely first class dentistry is available to care for children's teeth at the time when habits of oral hygiene are being established and the teeth are being formed.
The trouble is that the whole cash incentive is on the other side. A dentist is encouraged to go into general practice and to do his work as quickly as possible, and those who are prepared to serve in the school dental service have to do so at a financial disadvantage. If we are to maintain the right priorities the financial incentives should go to those who do the work of conservation at the point where its importance is greatest. This means not only that Recommendation No. 19 should be accepted by the Government but that, at the same time, there should be a complete reorganisation of the career structure and pay scales within the school dental service to put it at the top of the tree. The integration of the school dental service with the general dental practitioner service can be achieved only if both come under the one Ministry.
My hon. Friend the Member for St. Pancras, North, referring to Recommendation No. 22 on the extension of the dental hygienist service, spoke of the rather disappointing results so far. It should be possible to have a very rapid extension of this service. Married women who would be prepared to do the work on a sessional basis because their children are, perhaps, at school could be trained for this purpose and could give a service which might help a lot in reducing the enormous number of people—one in every two at the age of 18—who are not prepared to clean their teeth. Has the Minister considered employment by session?
Perhaps the classical example of nice phraseology is to be found in the Government's observations where, in connection with teeth, it is said that"inquiry is on foot". I hope that these inquiries will be pressed forward, but with reference to another part of the anatomy, perhaps the Government will get its teeth into it. As my hon. Friend the Member for St. Pancras, has rightly said, the Government's attitude to the recommendations in the Report is no tribute to the excellent work of the Estimates Committee. There is too much of this sort of response, saying that inquiries are on foot or that there will be further discussions. When hundreds more teeth have been pulled and hundreds more cavities have been filled, there will still be inquiries on foot between the various Departments about what should be done.
Turning to Recommendation No. 3, one wonders how the Government reconcile the half-hearted welcome they give to the suggestion that executive councils might cover a wider area for certain specific purpose with what they propose to do in London. They have produced a London Government Bill which will have the result that, instead of there being six executive councils, there will be 32. I hope that the Minister will tell us whether this will, in fact, take place.
I think that it will be a tragedy for the whole organisation of dental practice in the community if it does. I know that he is having discussions on the matter, and I hope that at some time dentists and doctors who are responsible to their executive councils through their local committees in London will be put out of the agony of not quite knowing what the future of their administrations will be.
The Committee spotlights the fact that the ordinary dentist working in the community is subject to many anomalies in his pay structure because of the items of service method of payment. The dentist has his top earning capacity, alas, only between the ages of 30 and 44. The older he becomes, the more experience he gains, the more he can expect his earning capacity to drop because, of course, there is a considerable amount of physical effort and concentration required in dentistry and the burden becomes greater after a man reaches 44. Plainly, this is an anomaly. A man should be entitled to expect that, as he gets older and gains more experience, his earning capacity, if anything, will rise.
The items of service system militates against a dentist taking adequate time to do good work. The pressure of the present system means that, between the ages of 30 and 44, the more people the dentist can put through the chair the more likely will he be able to put away some savings for his later years when he cannot do the same amount of work. There is, in consequence, a pressure upon him as a younger man to work quickly, to work, perhaps, without fully considering the very complicated jobs which take a long time. He will tend to prefer to do work which will give him the quickest possible turnover.