Dental Services (Estimates Committee's Reports)

Part of the debate – in the House of Commons at 12:00 am on 12th July 1963.

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Photo of Mr Laurie Pavitt Mr Laurie Pavitt , Willesden West 12:00 am, 12th July 1963

I do not suggest that at all. I am pointing out that the financial incentive and pressure is for the dentist to do the maximum amount of work in the shortest possible time. A good dentist, just like a good doctor, needs time; he should not feel under pressure because of financial incentives. If he decides that he would prefer to do the classical complicated job which takes a considerable amount of time—and which will give him great satisfaction in the standard of service he gives—he should have the opportunity.

But the present system of payment does not give him that opportunity. It pushes him in the opposite direction. Indeed, it pushes him in the direction where it is possible, if someone wishes to adopt a completely commercial outlook, to organise the practice in such a way that there are six chairs in a row and a sort of conveyor belt system with patients being brought in in a constant stream, a filling here, an extraction there, and so forth, the whole business being organised in a mechanised way when it should, of course, be treated as a very human subject.

As the hon. Member for Bristol, North-East reminded us, dentistry involves all kinds of emotional considerations apart from the purely physical one of having one's teeth attended to. Our aim is to improve the quality of work. I make no criticism of the dentists. As my hon. Friend the Member for St. Pancras, North has said, there are too few of them trying to do too much, and, in the circumstances, one can only commend them for the excellent standards which they maintain. But it is our job to see that they have better opportunities within the Service.

I was very pleased to read Recommendation No. 23, drawing attention to the vital need for refresher courses. But, here again, the items of service payment system leads to a financial disincentive against a dentist taking a refresher course. This should not be so. I have in mind particularly the great growth of information recently in periodontology. Research is yielding greater knowledge each year. One cannot separate the health and care of the gums and mouth from the health of the teeth. In present circumstances, we tend to concentrate purely on the teeth, dealing with cavities to be filled, decayed teeth which require extraction, or gaps to be filled, if necessary, by dentures rather than devote study to the whole subject of oral hygiene, the way the gums react, and the supporting nerves and tissues within the mouth.

I think, perhaps, insufficient thought is being paid—although my hon. Friend the Member for St. Pancras, North did give some forward-looking ideas—to what one might envisage if one were seeking reorganisation of the dental service, but I think that one possible way which might be examined with a great deal of care is an extension of the Health Service into an occupational health service—treating a man's teeth at work, by a dentist attached to an occupational unit. That might be a way of meeting some of the anomalies which exist at present.

I had the privilege recently of going over a unit at Unilevers, not far from this House, and seeing the standard of work. There were three dentists who were doing an absolutely first-class job with every possible facility available to them, and, of course, every encouragement to the workers at Unilevers to go to them at the first sign of any trouble, to have regular check-ups and to have troubles prevented. The dentists were able to do their work with ample time, in their own way, with complete vocational satisfaction.

I think that in these Health Service debates, no matter on what particular subject, we suffer from a similar kind of approach, in that we think in terms of production, as in an industry, in which success is measured by the number of dentists we have, the number of teeth we pull, the number of beds occupied, and the number of hospitals we build, whereas the time we are looking to is the time when the dentists are, so to say, out of work because so many dental troubles have been eradicated and when there are fewer and fewer demands arising from dental ill-health or any other ill-health.

It is because it is the Minister's declared policy that conservation has priority that I think that the Estimates Committee deserves far more support than it has received for its work which has gone into the excellent First Report. It makes the Ninth Special Report, which side-steps so many of the important issues, a totally inadequate commentary.