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 James Boyden Mr James Boyden , Bishop Auckland 12:00 am, 12th July 1963

If I were to follow my hon. Friend the Member for Glasgow, Govan (Mr. Rankin) in his argument about the location of the Dental Estimates Board, I should soon be in trouble with my constituents. If it is to be concentrated, I hope that the suggestion put forward by the hon. Member for Aldershot (Sir E. Errington) might be followed and that it might be located in the North-East, but I do not think that on the Floor of the House at this moment we could come to a very satisfactory conclusion about a matter of that sort. Indeed, it is a comment on the sad state of our economy that my hon. Friend and I might be at cross-purposes over this.

I want to congratulate the members of the Committee and the hon. Member for Aldershot on the painstaking, thorough way in which they have gone into this very serious problem of the dental services. I should like to follow the hon. Member for Aldershot in his strictures on the Ministry of Education. Before I do so, I should like to say that wherever the school dental service is located and whatever steps are taken to improve the service for children, this is a matter which calls for the co-operation of a great many Departments, and that if it were to be allocated to the Ministry of Health that would by no means solve the problem.

The past record of the Ministry of Education in this respect is absolutely deplorable. When a witness was asked what staff the senior dental officer had, the answer to the Committee was,"He has not got a staff; he works on his own". Is it surprising, therefore, that local authorities, which are criticised by the Ministry of Education for not doing their stuff, do not consider the position of the senior dental officer of very much importance?

The facts are that about two-thirds of the chief dental officers in local authorities do not even attend the meetings at which their professional matters are being discussed. I think that the hon. Member for Aldershot was right when he said that there was very serious lack of drive in the Ministry of Education, both in regard to the way in which they look towards their professional staff, and the way in which they encourage dental officers in the local authorities. I am glad to se that the Parliamentary Secretary to the Ministry of Education has come in, because I was saying some nasty things about his Department. It is on this matter of encouraging dental health and encouraging publicity and propaganda that the comments of the Estimates Committee are very scathing.

In question No. 1460 a witness said to the Chairman of the General Dental Services Committee: The whole picture of the dental health of schoolchildren is…a national scandal… He goes on to say, …we cannot get anyone to appreciate how bad it is. I would think that qualification was a little hard. I and other hon. Members have raised this matter in the House many times. I asked the Library to find out how many times hon. Members had raised the matter of dental shortages. I find that in the last two years on no fewer than 10 occasions, by Questions, by Adjournment debates and so on, hon. Members have drawn attention to these problems. The balance is three Conservatives, five Labour Members and one Liberal twice, which was a fair arrangement for the Liberals. This statement by responsible professional officers that the dental education of school children is a national scandal, demands far more of the Minister of Education than he has shown even in his answers to the recommendations of the Estimates Committee.

The Estimates Committee refers to the fact that if there were more nurses employed to support the school dental officers about 30 per cent. more work could be obtained from them. About a year ago there was a great fuss when the former Minister of Education, then Sir David Eccles, talked about auxiliaries in the schools. He diverted a whole debate to that subject, quite"off the cuff" without consultation with anyone concerned. It was purely a red herring. Had he concentrated attention on the use of auxiliaries in spheres where they were already being used he would have put his talents to a much better purpose.

I mentioned the question of nurses. Other hon. Members have referred to the need for more dental hygienists and the position there is laughable. There are only 11 employed in the school dental service and 24 in the general dental service, and there was a very cool response to Recommendation No. 22 from the Estimates Committee that the Health Department should work out with the dental schools means of considerably increasing the training facilities for dental hygienists. The observations are: Inquiry is on foot to establish whether any further increase in output would be matched by reasonable prospects of employments. The expansion of training facilities depends on the outcome. I should have thought that the Minister of Education would have made strong observations to the Minister of Health and told him that, of all the services where dental hygienists could be satisfactorily employed, the school service provided a situation where there would be a concentration of dental work and the utilisation of dental hygienists. Generally the same position applies in respect of dental auxiliaries and hon. Members have referred to this I have a feeling that even in the profession of clerical assistants to the school dental service there is a far from adequate supply of clerks. The Estimates Committee refers to the inadequate organisation within the service and suggests that the hours during which school dentists operate in the holidays, surgery hours and supervision arrangements are far from satisfactory. It is not surprising that this is so when, just as in the general field of education, only recently has much regard been paid to statistics.

The same sort of thing operates in the Ministry of Education and the Ministry of Health in relation to the dental health of school children. The Estimates Committee was surprised that the Ministry of Education had no precise idea of the cost of the school dental service. There was an approximate figure of £4 million. In the statistics of the Ministry of Education regarding dental health there is a tiny paragraph tucked away, in which some basic figures are set out. But there is no attempt to make a refined statistical analysis to bring information to bear, at any rate on one side of the problem, in order that it may be isolated and a solution attempted.

The Estimates Committee referred to the absence of statistics regarding equipment. One witness said that most dental officers had the use of high-speed drills. But there was not a survey available so that the Ministry of Education could tell at once what sort of equipment there was in local authority clinics. I agree that the Ministry has accepted that it will review this matter and obtain information. But it is too bad that the information is not available and that the staff at the Ministry are not in a position to give advice to chief dental officers about equipment and to bring them up to date. I shall be glad if I can be told that I am wrong, but I cannot see how one chief officer at the Ministry can supervise 146 local authorities and make the necessary contacts.

I doubt whether the Estimates Committee is right in suggesting that it should be outside the scope of the Ministry of Eduction. I should have thought that the Ministry ought to be looking at this part of the service as a means of promoting officers in local authori- ties. One of the charges often levelled against the Ministry of Education—not so much in relation to inspectors, but chief administrative people—is that these people have no practical experience of local authority work. Here is a way in which a number of senior dental officers in counties and boroughs could be promoted to extremely useful jobs in the Ministry of Education. I hope that the establishment will be looked at and the whole system reorganised from the centre.

I must refer to the comments of the Estimates Committee relating to the productivity of dental officers in the school dental service. Here again, just as in education generally, one needs statistics about the situation to show what it really is. It would appear to be unsatisfactory. The Estimates Committee comment on it, but all the Committee can say is that it looked at the figures and found that there was extreme inequality between the efficiency of one local authority and another and that the general indication was that in the normal health service the productivity of dentists was improving. Yesterday I asked an official of the Dental Estimates Board to give me some indication of how the productivity of ordinary dentists had improved so that I could make a comparison. But I got only a vague answer and I was referred to an out-of-date Annual Report by the Ministry of Health. Both in the Ministry of Education and the Ministry of Health there is a greater need for an accurate appraisement of what the dentists are doing. It is quite scandalous that the number of children not receiving treatment is not known.

I wish to refer to what is the heart of the problem—the shortage of dentists. This has been known to the Ministry of Health and the Ministry of Education for a very long time. About a couple of years ago the University Grants Committee said that dental education had not progressed so far or so rapidly as it would have wished. This has been known for along time. Although the McNair Report was published in 1956, and although this situation is of longstanding, only now are the numbers of dentists entering the schools showing any improvement. One figure which I find alarming is that the proportion of dental students is a declining proportion of the total number of students and the number of women dental students is a declining proportion of the total number of women students.

This indicates a complete failure on the part of the Ministry of Education and the Ministry of Health to solve the problem. It is not a question of lack of recruits. One witness told the Committee that there is a long waiting list for the dental schools. The potential manpower is there, if the training could be provided. Training is the bottleneck. So we are in the position that the first McNair students will be coming out in 1968 and the target which was set in 1956 is likely to be reached only in 1973.

The University Grants Committee in another report drew attention to the inadequacies of dental research. I am told that those progressive dentists who wish to get into the academic field almost always go to the United States in order to get into the swim. There are nothing like enough hospital appointments for people who do this research and the hospitals are not doing enough dental research. In the Report of the University Grants Committee for 1960–61, which is the comparable period with the Report of the Estimates Committee, the number of advanced students in dentistry, dental surgery and orthodontics was 54. In the same year there were over 550 advanced students in history and archaeology. It is obvious that this country regards looking into the past as ten times more important than the study of the teeth of the children of the country.

Whatever organisation may be employed, whatever may be the arguments between the Ministers of Health and Education about the location of the dental service, there is no question that a radical improvement is required. One of the improvements lies with the Ministry of Education whatever organisation is adopted. Although I imagine that the Parliamentary Secretary will not be able to reply today, I hope that in the near future we shall get a report from the Ministry of Education about a more efficient organisation of the school dental service, more adequate statistics to illuminate the problem and a far greater drive in relation to the dental education of school children.