We are really getting down to business now.
Dentists (Amendment) Bill, 1983: Second Stage.
That is one the Deputy can really get his teeth into.
This is a major programme of legislation.
I move "That the Bill be now read a Second Time".
Under the provisions of the Dentists Act, 1928, the term of office of members of the Dental Board is five years. The current five-year term will expire on 13 November 1983.
The Government recently approved the preparation of new legislation for the regulation of the dental profession by way of a Bill to replace the Dentists Act, 1928. This legislation will provide for the abolition of the Dental Board and its replacement by a body to be known as the Dental Council. Until such time as the Dental Council are established it will be necessary for the Dental Board to continue in existence.
The principal functions of the Dental Board are to maintain and publish the dental register each year and to investigate allegations of professional misconduct by members of the profession.
The board have nine members: one nominated by the Government, three nominated by the Medical Council and five, who must be registered dentists resident in the State, elected by the registered dentists so resident. Elections of registered dentists to the board are held by the board itself and if this Bill is not passed it would be necessary for the board to hold an election now. The setting up of a Dental Council under the proposed new legislation to replace the Dentists Act of 1928 would involve a further election. As I anticipate that this new legislation will be introduced in the current session there would be no great interval between these elections.
The Dental Board has represented to me that an election of members to a new Dental Council, if it were to follow shortly on one for the board, could well generate only a limited response from the profession. This would clearly be an undesirable beginning for the new council. The board also drew my attention to the financial implications. For their income they rely on registration fees from dentists and their current financial situation is not entirely satisfactory. They must meet the not inconsiderable costs of holding elections from their own funds. Since the new council would take over the assets and liabilities of the board these funds would have to bear the costs of two elections within a comparatively short period, thus worsening an already unsatisfactory financial situation.
In view of the circumstances outlined the board asked me to examine the possibility of extending the term of office of the current membership until such time as the new council has been established. The Dentists Act, 1928, provides no mechanism by which this term of office can be extended beyond the specified five years. Having considered the matter I am satisfied that it would not be appropriate to proceed with the appointment of a new membership to the board now. I am proposing, therefore, to provide, by way of this Bill, for a two-year extension of the term of office of the current membership. The members will not, of course, necessarily serve out this period of two years in full since the board will be abolished on the establishment of the new council. I would expect that the proposed new legislation to replace the Dentists Act, 1928, which will, inter alia, provide for the setting up of the Dental Council, will be enacted well before the expiry of this extended period of office.
I hope that the House will accept that for the reasons outlined this legislation is necessary and I would ask for the co-operation of Members in its passage.
The Minister has just said that he is providing for a two year extension of the term of office of the current membership of the Dental Board. While we are not opposing the extension one would have to question the necessity to extend their period of office for two years. The Minister said earlier that the Government had recently approved the preparation of new legislation for the regulation of the dental profession. Indeed on 20 October he stated to a meeting of the Irish Dental Association in Galway that the heads of the new Dentists Bill—which had been on the cards for many years—were then with the parliamentary draftsmen whose job it is to put it into legal language. He said further that that should not take very long and would probably be completed within the next two weeks, that barring some totally unforeseen circumstances the Bill would be introduced in the Dáil in the current session.
If it is the intention of the Minister of State to introduce that Bill in the current session, presumably it will go through this House in the normal way and should allow for elections to the new Dental Board. It is difficult to understand why the Minister has come in here this morning and sought an extension of two years. One would have expected that one year would have been sufficient. Indeed there is a sense of urgency in legislation to deal with the dental situation in this country, because very serious dental problems exist. This has been recognised by various boards. The National Health Council in 1979 stated:
... the existing service was most unsatisfactory and inadequate to deal with the demand from eligible persons. It was estimated that only one third of the 600,000 eligible children estimated to need attention were examined each year under the scheme. Adults receiving treatment under the scheme number about 50,000 a year out of an estimated 570,000 eligible adults not catered for by other schemes.
That is an indication of the magnitude of the problem that exists and, while the Bill is very specific in what it deals with, it is disappointing that the Minister did not go on to state what plans the Government have to deal with the very serious situation that exists.
Obviously the main emphasis and thrust must be on prevention and we are fortunate here that fluoridation was introduced by Deputy McEntee when he was Minister for Health because that has made its own contribution in preventing dental caries. There is a need for education and while some effort is being made through the Health Education Bureau and the Dental Health Foundation, I appeal to the Minister to look at the work of the Dental Health Foundation to see if more funding might be available to them.
I understand that the new Bill will deal with the use of auxiliary personnel in the dental profession. Dental surgery assistants already exist and hygienists will be available for education. For that reason it is important that this Bill should be passed rapidly through the House. The situation that exists in schools is intolerable. It is estimated that only 50 per cent of the school children who are entitled to service get it and there must also be serious concern at the ratio of dentists throughout the State. The World Health Organisation recommend one dentist to 1,500 children and one dentist to 3,500 adults. The ratio in this country is one dentist to 6,000 and in your county, a Cheann Comhairle, the ratio is one to 8,000 persons. That is totally unacceptable.
The health boards should tell people they are not in a position to provide the service which they are statutorily obliged to provide. When children need fillings parents should be told honestly that the boards are not in a position to provide the service rather than have children going on a waiting list for a long period of time.
There is also a long waiting list for orthodontic treatment——
I do not wish to be disorderly but basically this Bill was only asking for an extension for the dental board. I have no objections to the Deputy making his views known but I think they would be more appropriately made on the forthcoming Bill which it is anticipated will be before the House in the current session.
I accept that this is a short Bill merely to extend the period of office of the present dental board but I believe the time the Minister is asking for is too long and I am giving reasons why I think it is necessary to introduce this Bill very rapidly and to have it brought before the House.
The Chair understands there will be another opportunity for a wider discussion on the subject.
As you can see, a Cheann Comhairle, I am merely touching very briefly on the areas I should like the Minister to consider. Perhaps he will be able to deal with some of them in advance of the Bill and maybe some of them will be in the Bill itself.
The regulation of the dental profession is a matter for the dental board as it exists and indeed will be a matter for the new dental board. It is important that posts should be filled. There is already a 25 per cent vacancy rate in a number of health board areas and an effort should be made to fill these. One must also look at the remuneration which is paid to dentists in the public service. Where posts are filled and there is still an insufficient number of dentists, the embargo on public service posts should be removed to ensure that there will be sufficient dentists to carry out the work for which the health boards are responsible.
The training of dental mechanics should also be looked at by the Minister. We have a new dental school in Cork and I should like to know the position about the new dental school in Dublin. When will that be commenced and what training facilities, if any, will be available there for dental mechanics?
The ad hoc scheme raised the expectations of eligible persons but it is grossly under-funded and I appeal to the Minister to see if something can be done to ensure that eligible persons get the service to which they are entitled.
I mentioned briefly the orthodontic service and I should like to compliment the Minister for allowing five orthodontists to be appointed to five privileged health boards. The other three were not mentioned, including yours and mine, a Cheann Comhairle, the North Eastern Health Board. At present the work there is being carried out on a consultancy basis and it might be more economic if a full-time appointment were made.
I should like to ask the Minister to look at the question of extending the service to those in the 12 to 16 year age group because prevention is by far the most important aspect of the dental service. Young people particularly should have a service and those in the 12 to 16 year old age group are not eligible for free dental service.
The other area is dependants of those who pay social welfare contributions and perhaps the Minister could do something for those people, for example, women who stay at home and who are not eligible for treatment on their husband's contributions. I should also like to know if the Department have any intention of transferring the administration of the dental services from the Department of Social Welfare to the Department of Health because dentistry is a health service and it would be more appropriate to have it administered through the Department of Health.
In relation to the forthcoming Bill, I should like to ask the Minister if he has had consultations with the dental profession and if he could give us some indication of when he hopes to bring the Bill before the House.
I will make a very brief contribution on this Bill. The original Dentists' Act of 1928 was an Act to make provision for the registration and control of persons practising dentistry or dental surgery and for other purposes relating to the practice of dentistry or dental surgery and the persons engaged in such practice. I should like to suggest to the Minister, since he is extending the period of office of the Dental Board, that he should take into consideration the national scandal that there is in relation to wives of insured persons who work in the home and who are not covered for dental care. I would ask him to consider appointing a representative of the housewives to the board and to extend the terms of reference of the board to provide for membership of such a representative. There are tens of thousands of housewives many of whom have paid stamps up to the time they were married and whose husbands pay stamps but who are not entitled to receive benefit in any shape or form. This is a scandal. The amount of money available should be spread evenly between husbands and wives, and if the amount available is limited the husbands should share in the sacrifice. I would ask the Minister to consider providing for representation of housewives on the board, if not at this time, at some future date.
The terms of reference of the Dental Board and the regulations should be extended to ensure that there is justice in the administration of the profession. I do not believe that that exists at the moment, and I use this occasion to highlight that point. I would ask the Minister, if he cannot do it on this occasion, to give consideration to the matter in connection with the main Bill. This is a national scandal. It is totally unfair and unjust. It is something that we have to do something about.
I am delighted that the Minister is amending the Dentists Act, 1928. I fully support what Deputy O'Hanlon has said and would ask why the Dental Board should be extended for two years if the main Bill is being introduced within the coming year. I would ask the Minister if he would reduce the extension to one year. I have different reasons for asking for this.
The Minister did say that the principal functions of the Dental Board are to maintain and publish the dental register each year and to investigate allegations of professional misconduct by members of the profession. Presumably that is their sole statutory function, they are a statutory board. They do have another function which may not be part of their statutory function. They are the appeal board for wages within the dental profession.
Every dentist is an employer, and there are approximately 600 dental assistants employed by dentists in private practice and there would be approximately 250 dental assistants, or whatever they are called, in the health boards. The point about what they are called is very important, because they call themselves, possibly, dental assistants or whatever but in the health boards they are regarded as clerks, in the dental hospitals as nurses and by individual dentists as receptionists, cleaners, — they wash the floor, clean the windows — whatever has to be done. My information is that their wages are absolutely miserable. The dentist fixes their wages at, maybe, £30 to £35 for a 44 hour week. The Dental Board is the only place they can appeal to. The Dental Board, as the Minister points out, consists of five dentists, three from the Medical Council and one appointed by the Government. What they say is precisely what the dentist wants them to say.
I would ask the Minister in his review of the Dentists Act to consider the position of employees of dentists who have no appeal to anybody, who are not part of any union, who cannot join a union because they would be fired the following day. In their job they are exposed to X-rays, to mercury, to toxic materials that they know nothing about because they are untrained people. They do any jobs they are asked by the dentist to do. This exposes them to various dangers, particularly dangers to skin, of which they are totally unaware and not informed. No consideration has been given since the Dentists Act of 1928 was enacted as to what those employed by dentists should be doing, what training they should receive or, of course, to the question of of their wages. I would indict the Dental Board very strongly on that score because dentists are getting away with whatever they can in this regard. We all know what dentists earn. As Deputy O'Hanlon pointed out, the few dentists there are in the country seem to keep a closed shop and do not want an increase in their number because they have the market cornered. While they are doing this rip-off themselves, they are paying miserably low wages to their employees.
I would ask the Minister not to extend the term of office of this Dental Board for a further two years but to reconsider the matter and to extend it for one year. If it so happens that the new Bill has not been passed at the end of one year the matter can be raised again this time twelve months and consideration can then be given to extending it, perhaps, for another year. I would appeal to the Minister to provide for a one-year extension when the Bill comes to Committee Stage or to accept an amendment to that effect.
I would like to thank the Deputies for their contributions. I am sorry I had to intervene when Deputy O'Hanlon was speaking but I felt we were expanding a little.
The extension for two years does seem rather long. We were of the opinion that it should be for one year but our legal advisors recommended two years and we accepted the advice. I want to indicate quite clearly that as soon as the Bill is passed the existing board will fall and the new Dental Council will come into being. That is important. There is no question of wanting to defer the enactment of the Bill. We have been guided by the advice that the extension should be for two years, but there is no question of a desire to delay or of the two years being provided in order to ensure that the Dental Board will remain for longer than they might want to remain. It will not remain one day after the Dental Council has been constituted. That is important, and I hope the House will accept that.
Deputy Mac Giolla referred to the question of the Dental Board having some say in regard to pay and conditions of workers within the dental profession. They have no say whatsoever, and there is no court of appeal there at all. I do not see that anything we can do will make it better for the staff of dentists.
Deputy Mitchell raised a point about having on the new council persons who would be interested in the customer, as it were. It is intended to provide for consumer representation on the council. It is important that there would be a positive consumer representation to protect the consumer, because it is the customer, the patient, that this is all about. Any council, board or whatever without that type of representation would be meaningless and would not be representative. We are not talking about just a profession. We are talking about dental health and the whole dental health area and the important people in that are the patients.
Deputy O'Hanlon raised a number of points which will be brought up in the Bill. I am glad they were raised and I will certainly take note of them. We are all concerned about a better dental service and the question of housewives and people on social welfare coming into it. Therefore, it does not come under health, the hat I am wearing this morning; it comes under the social welfare hat. I am well aware of this growing need and of the general air of wanting to do something about it, but the cost will be £5.5 million and all these things must be taken into consideration. I assure the House that I have it foremost in my mind to do something about it at the earliest opportunity.
I take the point about the one year, but I have taken the advice of our legal people and I want to assure the House that there is no reason why it should detain or hold up the Bill in any way. I am anxious that the Bill would be on the floor of the House in this session. I have indicated that the heads are before Government and that is where the matter stands now. As soon as they come back we will have them printed and do whatever must be done and effect whatever changes must be made to it. It is a Bill that is long overdue. The House is looking forward to it and it is important legislation. It will be here in this session.
Question put and agreed to.
When is it proposed to take Committee Stage?
I propose to take it now.
Agreed to take Committee Stage today.