Dental Services (Estimates Committee's Reports)

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

Alert me about debates like this

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West 12:00 am, 12th July 1963

The evidence is that the composition of the total volume of treatments given is moving in an advantageous way. As I pointed out, the element of emergency treatment is diminishing, while the element of conservative dentistry, which on the whole tends to be the more elaborate procedure, is increasing. So I think there is no reason to fear that the increase in volume is being accompanied by a deterioration in quality. Indeed, there is good reason to believe the contrary.

Before I come to look at the dental health and the dental treatment of school children and other priority classes against this general background of the increasing volume of dental treatment in the general dental services, I should like to refer, since reference has been made to it by a number of hon. Members, to the Dental Estimates Board, which plays so important a part in the control and management of the general dental services. I was glad that the Estimates Committee, after its careful investigation—and it certainly was a careful and probing investigation—gave the Board what the hon. Member for St. Pancras, North (Mr. K. Robinson) described as a"clean bill of health".

A number of the aspects to which the Estimates Committee drew attention certainly engage my continuing concern. The schedule of treatments requiring prior approval is something which is continually and critically examined, so that it can be kept to a minimum. The question of mechanisation—of maximum efficiency in the handling of the great mass of statistics and material with which the Board has to deal—is not one which is left without frequent reconsideration. My hon. Friend the Member for Bristol, North-East (Mr. Hopkins) referred to orthodontic treatment and to the question whether there was delay in the approval of estimates for orthodontic work. I think it is not an unreasonable situation where 92 per cent. of the cases with adequate information from the dental practitioner are cleared in two to three weeks. It was, therefore, justifiable for my right hon. Friend and myself to say that, upon the whole, orthodontic cases appear to be dealt with by the Boards with reasonable rapidity I should also like to correct a slip on the part of my fellow burgess for Wolverhampton, the hon. Member for Wolverhampton, North-East (Mr. Baird) by making it clear that an estimate is never disapproved by the Dental Estimates Board except on professional advice.

I feel, however, that the recommendation of the Committee for merging the two Boards would not produce the practical results which they hoped from it. Indeed, I am sure that it would, at any rate in the short run, have very much the reverse effect, because, whichever of the three theoretical possibilities that were earlier deployed was adopted, there would certainly have to be a big changeover of staff and a great dislocation in the work of the Boards. I think, too, that it would inevitably have the effect—particularly if the Scottish Board were to be moved over the Border—of reducing the intercourse and common understanding which is so necessary between the Board and the dental profession who have to work with it.

I come now to consider, against the general background which I have depicted, the treatment of the priority classes, the nursing and expectant mothers and children, whose treatment—this I emphasise—is shared between the general dental services and the local authority dental service. The developments in this field during the past five or ten years have been striking and point to big changes taking place.

I take, first, the expectant and nursing mothers. In the local authority service, in 1956, 51,000 such mothers were treated; in 1962, only 33,000 were treated. But in the general dental services, in 1956, they received over 500,000 courses of treatment and, in 1962, over 750,000.

For children, that is, children under 5 and children between 5 and 15, I must use England and Wales figures, because, although the figures for Scotland are available, they are divided at a different age-point and it is impossible, without unendurable complication, to give Great Britain figures. In England and Wales, in 1954, 65,000 children under 5 were treated in the local authority service, and this total had fallen to 54,000 in 1962. But in the general dental service the number of treatments had doubled, from 184,000 to 364,000. Again, the number of children of school age, that is, between their fifth and fifteenth birthday, treated in the local authority service fell from 1,494,000 in 1953 to 1,252,000 in 1962, But in the general dental service courses more than doubled—from just under 2 million in 1953 to approximately 4 million in 1962. A particularly gratifying feature relating to children of school age is that the proportion of emergency treatments—an indication that children have not had timely treatment or dental supervision—fell from one-quarter to one-eighth of the total number of courses of treatment.

These figures for dental treatment of school children show that in England and Wales, in 1962, well over 5 million courses of treatment altogether were given, in one service or the other, to the school children of this country. We know from general experience that about two-thirds of the children of these ages who are inspected are found to require dental treatment. Therefore, having in mind the fact that the number of children of those ages was 6·7 million in that year, it. is evident that a very high proportion of such children who need dental treatment are in fact receiving it from one part of the service or the other.

The situation which these statistics disclose—I apologise for their laborious character—is this. There has been overall a tremendous improvement in the dental treatment of the priority classes. Taking all treatment together, each group of the priority classes is receiving a far greater volume of dental attention than it was receiving relatively few years ago. But of this treatment, a minority only—and a declining minority—is being given by way of the local authority services.

It is dear, therefore—this was very fairly recognised by the Committee in, for instance, paragraph 70 of its Report—that the whole future and function of the local authority dental services has to be looked at carefully in the light of the changed and changing background. Before I suggest what may, in future, prove to be the main objectives of the local authority dental service, I want to discuss its manning in a little detail.

The manning of that service reached its lowest point in 1951, with only 808 whole-time equivalents in the local authority dental service of both countries together. In 1962, the figure had risen to 1,336—much more than in proportion to the increase in the number of school children. In fact, the increase has been particularly rapid in recent months. There was a big jump between 1961 and 1962, and the impression I have from visiting clinics in many parts of the country is that recruitment is continuing at an improved rate.