Dáil Éireann debate -
Tuesday, 20 Nov 1984

Vol. 354 No. 1

Dentists Bill, 1984 [Seanad]: Second Stage.

Minister of State at the Department of Health (Mr. Donnellan)

I move "That the Bill be now read a Second Time".

This Bill is being brought in to replace the existing legislation governing the registration and control of persons practising dentistry and the maintenance of standards of dental education and training in this country. The existing legislation is the Dentists Act of 1928 which has served its purpose well over the years but is now outdated.

The changing trends in dentistry, particularly over the past few years, necessitated changes in the legislation governing the profession if we here in Ireland were to keep pace with these changes and maintain the high standing internationally to which Irish dentistry has become accustomed.

This legislation is designed to meet present needs and, in so far as possible, to facilitate anticipated changes in the future. I am, of course, aware that no legislation, no matter how well thought out, can provide for every eventuality, but every effort has been made to ensure that the Bill incorporates the best in modern thinking in relation to dentistry. It does not seek to bring about change for change's sake as will be evident from the fact that many of the excellent provisions of the 1928 Act are retained and are being re-enacted in this legislation. The new Bill is in many ways parallel legislation to the Medical Practitioners Act of 1978 which updated and improved the laws governing the medical profession, but it has, of course, certain provisions which are peculiar to the dental profession alone.

Under the provisions of the Bill the Dental Board, who have served the interests of the general public as well as those of the profession itself over the years, will be abolished and replaced by a new body to be known as the Dental Council. It is appropriate at this point that I should extend my sincerest thanks to all those who served as members of the Dental Board down through the years. They have done an excellent job and are largely responsible for the high standing which Irish dentistry has attained and the esteem in which it is held throughout the world today. The dedication and enthusiasm of successive Dental Boards is quite remarkable, particularly when it is considered that active membership must inevitably result in a certain amount of inconvenience and disruption of routine for the individual member.

The present membership of the Dental Board had an extra burden placed on them when they were asked to serve for an extended period beyond the normal term of office of board members. This was necessary in order to facilitate the smooth transition from Dental Board to Dental Council arising from this legislation. To a man the membership of the board agreed to serve for an extra two years and I would like to extend a special thanks to them for their generous response.

In updating the legislation governing dentistry and providing for future developments it was necessary to consult on a very wide basis, not only with representatives of the profession and others directly concerned, but with all those who might be affected one way or another by the Bill's provisions as well as those who might have an input into the legislation. Naturally enough not every suggestion and view put forward was incorporated in the Bill — that would have been impossible given that differences of opinion exist even among those who profess the same ideals and share the same goals.

However, consideration was given to every shade of opinion put forward by those consulted. The Bill before the House is essentially that which was introduced in Seanad Éireann last March. The Bill generated great interest and was the subject of lengthy debate in the Seanad and there were quite a few amendments to it on Committee and Report Stages in that House.

Nevertheless, its basic provisions remain the same. Not every amendment tabled in the Seanad was accepted by me but I think it is fair to say that I adopted a very flexible approach in the matter and was quite amenable to changes which were considered to be for the betterment of the Bill, regardless of their origin. The amendments to the Bill which I accepted in the Seanad have served to strengthen the legislation, while not detracting from or diluting its underlying principles. Indeed I commended the Members of Seanad Éireann for their interest in the Bill and for the remarkably constructive and lively debate which the Bill generated. I will now give the House a brief run-down on the main provisions of the Bill.

Part I contains the normal provisions for interpretation by defining certain words and phrases which occur throughout the Bill and provides for the fixing of commencement dates for bringing into operation certain provisions in the Bill. It provides also for the repeal of the existing legislation on dentistry, namely, the Dentists Act, 1928 and the Dentists (Amendment) Act, 1983. This latter Act was enacted last year in order to extend the term of office of the Dental Board. The board's five year term of office was due to expire in November 1983.

In order to appoint a new membership of the board it would have been necessary to hold an election of registered dentists to fill their five places on the board. Considering that the new Dentists Bill, which would abolish the Dental Board and involve another election of registered dentists to the new Dental Council, was about to be introduced it was thought preferable to extend the term of office of the existing Dental Board for a period of two years. Under the 1928 Act there was no provision for extending the term of office of board members beyond the stipulated five years period — hence the need for the Dentists (Amendment) Act, 1983. The extension of the period of office of the Dental Board served to avoid two elections of registered dentists being held within a relatively short period — the second election would possibly have generated little response from the profession and this would have got the Dental Council off to a bad start. As well as this, the Dental Board were saved the expense of holding an election of registered dentists. Given the cost of these elections and having regard to their financial position at the time, the board were happy not to have to undergo the expense of an election.

The dissolution of the Dental Board and their replacement by the new Dental Council are among matters provided for under Part II of the Bill. In numbers and in composition the new Dental Council will differ greatly from the Dental Board. The council will have a total of 19 members whereas the existing board have only nine. Of more significance is the make-up of the new council compared with the board. The increased role of the council in the education and training of dentists is reflected in the representation given to educational interests. Four members will represent the undergraduate teaching interests—two appointed by Trinity College, Dublin and two by University College, Cork. The Royal College of Surgeons in Ireland will appoint one member to the council to represent the post-graduate teaching interests. There will also be a nominee of the Minister for Education bringing the total educational representation to six on the 19 member council. The present board have three of their nine members nominated by the Medical Council but there will be only two nominees of the Medical Council on the new Dental Council. The reduced Medical Council representation and increased representation of educational interests reflects the increased independence and responsibility of the new council in relation to the education and training of dentists. The practising profession will have seven representatives on the Dental Council elected by their fellow dentists as against five on the Dental Board.

Although they have increased representation on the new council the elected dentists will not form a majority of members on the council as they do on the Dental Board at present. Nevertheless the practising profession will form the biggest single group represented on the council.

It was suggested in Seanad Éireann that health board dentists should have specific representation on the council. However, since they form approximately 25 per cent of the dentists registered in the State they are almost certainly going to have representatives on the council in any event — as they do at present on the Dental Board. In fact their representation on the council seems assured considering that the elections of registered dentists by their fellow dentists will be by means of the single transferable vote, that is, by proportional representation. This provision was written into the Bill following an amendment tabled in Seanad Éireann and convincing arguments in its favour which I accepted. The remaining four places on the Dental Council will be filled by my own nominees. However, the Bill lays down that at least two of these must be non-dentists who will represent the interests of the general public as consumers of dental services. This consumer representation is something that will be welcomed generally.

Part II also deals with committees of the council and provides that there shall be three particular committees dealing with the functions of the council in relation to education and training, fitness to practise and auxiliary dental workers.

In regard to the make-up of the council there were representations made and, indeed, amendments were tabled in Seanad Éireann to change and extend the membership and to give representation on the council to various groups. These included teachers organisations, students and auxiliary dental workers. Considering that the primary function of the Dental Council is to regulate the dental profession — the actual delivery of dental services is not their function — the proposed make-up of the council is generally regarded as giving a reasonable balance of representation between the various interests involved. These are broadly the educational, working profession and consumer interests as well as my own nominees.

I accept that members of the teaching profession can play a valuable role in promoting dental health care among their pupils, but to have a representative of the profession on the Dental Council would be inappropriate in the light of the council's functions. There would be nothing to prevent me from including a representative of students of auxiliary dental workers among my own nominees to the council but I would not agree with the idea of specific statutory representation for them under the provisions of the Bill. If such groups were to be given places on the council there would be a problem — certainly in relation to auxiliary dental workers — in deciding which particular group of auxiliary workers should be represented and of deciding which organisations should be regarded as representing them. I am satisfied that the composition of the council as detailed in the Bill is just about right in the present circumstances. If at some future time due to changed circumstances it is found necessary to alter the make-up of the council there is provision for this in the Bill also.

Part II also covers the make-up of the three specific committees of the council. There is provision for each class of auxiliary dental workers established under the Bill being allocated places on the committee of the council that will deal with auxiliary dental workers.

The remainder of Part II deals with the setting up and staffing of the Dental Council and the various powers of the council including their power to charge fees for registration.

Part III deals with the registration of dentists. The provisions in relation to those entitled to registration in the basic register of dentists established under the 1928 Act are being changed to meet present day requirements. For instance, the 1928 Act gave access to registration here to persons whose names appeared in the Commonwealth and foreign lists of the British Dental Register. Since this provision is no longer relevant it has been omitted from the new legislation. On the other hand, provision has had to be made for the registration here of nationals, of member states of the European Community who possess the necessary qualifications. We are obliged to recognise certain qualifications in dentistry issued by other member states under directives issued by the EC which came into effect here in 1980. It is also obligatory under these directives to permit those who hold the recognised qualifications to practice dentistry anywhere in the EC.

An agreement concluded in 1927 between this country and the United Kingdom and incorporated into the 1928 Dentists Act already provides for the mutual recognition of qualifications in dentistry issued in these islands. In the light of our membership of the EC and our obligations under the EC directives on dentistry this agreement is no longer relevant and provision is made later in the Bill for its termination.

There is provision also under Part III for the establishment of a register of dental specialists in addition to the basic register, should the Dental Council consider it desirable to set up such a register at some future date. Registers of dental specialists already exist in many countries, for example in France, West Germany, Holland, the USA and Canada. Orthodontists and oral surgeons are among the classes of specialists whose names would appear on such a register. The registration of specialists enables the general public to recognise those who are qualified and who specialise in particular branches of dentistry. It also serves to permit the public to clarify whether or not any particular practitioner possesses the qualifications which he purports to possess. There are persons who argue against specialist registration on various ground but I would like to make it clear that what I am introducing here is not the establishment of a specialist register. What I am doing is providing the enabling legislation which will facilitate its establishment at some future date if the Dental Council see fit to do so. There is also a possibility that specialist registration could become mandatory here due to a directive of the EC and, if it did not already exist, new legislation would be required to put the directive into effect. On balance, it would be remiss of me not to make the enabling provision for specialist registration in this new legislation. There is a similar provision in the Medical Practitioners Act, 1978 but to date no register of medical specialists has in fact been established.

Part IV of the Bill, which covers education and training, sets out the duties of the council in relation to the education of dentists at both undergraduate and postgraduate levels. The council are obliged to satisfy themselves as to the suitability of the education provided and as to the standards of education and clinical experience required for basic qualifications in dentistry in the dental schools in Dublin and Cork — that is to say at Trinity College, Dublin, and University College, Cork. At present the Medical Council have certain powers in relation to undergraduate dental education which the new Bill assigns to the Dental Council so that the educational role of the council will be far more responsible than that exercised by the present Dental Board.

The transfer of responsibility for dental education from the Medical Council to the Dental Council is something which is long awaited and will be welcomed by both professions. The Dental Council are also required under this part of the Bill to satisfy themselves as to the standards of postgraduate education and training in dentistry in the State. It has duties also in relation to compliance with EC directives regarding minimum requirements for qualifications in dentistry in member states. The council's responsibilities in relation to EC requirements regarding specialised dentistry are also set out in this part of the Bill. As I said earlier, the standard of dentistry here in Ireland is second to none and this could hardly have been brought about if the standards of education and training here were not of the highest order also. Attaining the minimum standards laid down by the EC will pose no problems for the council. I know that the target of the council will be standards that are considerably higher than the minimum required by the EC.

Part V of the Bill deals with the discipline of members of the profession. It is indeed a rare occurrence to have disciplinary measures taken against a member of the dental profession. Nevertheless, such provisions must be made in the interests of the general public and indeed in the interests of the profession. The powers in relation to discipline which the new council will have will be far more wide-ranging than those enjoyed by the Dental Board at present. The problem with the existing legislation is that the only disciplinary measure open to the Dental Board is the removal of a dentist's name from the register. Obviously cases will arise where some disciplinary measure is warranted but where the rather drastic measure of removal from the register is not merited. Under the new legislation there is provision for suspension of a dentist's name from the register for a period and the council can also advise, admonish or censure a dentist in relation to his professional conduct or attach conditions to his continued registration. Over the years difficulties have arisen about the constitutionality of the disciplinary powers of registration councils and other such bodies. Part V of the Bill has, therefore, been very carefully drafted to ensure that the powers of the Dental Council cannot be successfully challenged on constitutional grounds. The Bill provides for each disciplinary decision of the council being subject to the approval of the High Court either by means of an appeal by the dentist or by way of application to the court by the council in cases where no appeal is made. As well as disciplinary action arising out of professional misconduct the Bill also gives the council the authority to take disciplinary action against a dentist because of his unfitness to practise due to his physical or mental disability. There is no such provision under the existing legislation.

Part VI of the Bill describes those persons who are entitled to practise dentistry in the State. It excludes auxiliary dental workers from the general prohibition on the practice of dentistry by non-dentists subject to certain provisions which are set out in Part VII of the Bill. The penalties for the illegal practice of dentistry, and for all other offences throughout the Bill, have been updated.

Part VII of the Bill is where provision is made for the recognition and registration of classes of auxiliary dental workers. The Dental Council will have the power, subject to my approval, to determine the nature of the dental work an auxiliary worker may undertake and the circumstances under which it may be undertaken. As Deputies know, we already have dental mechanics and dental surgery assistants working here but neither category can be registered under the existing legislation. There are other classes of auxiliary dental workers in countries abroad who are trained to carry out procedures which it would be illegal for them to perform here under the existing legislation. Dental hygienists, for instance, can perform a very useful service and I would be anxious to see them introduced here. The hygienists carry out certain clinical work such as the scaling and polishing of teeth but they are particularly useful in instructing patients in preventive measures such as oral hygiene and dental health education generally. The dental profession would welcome the introduction of hygienists here. They could provide valuable assistance in private practice and could make a very significant contribution to the health board service by permitting the dentists to get on with the clinical work and not have their time taken up with oral hygiene instruction.

The Bill will permit the establishment of a class of auxiliary dental workers fully trained and competent to supply dentures direct to persons of 18 years of age and over — they will not of course be permitted to perform any work on living tissue. It is important for me to stress that these auxiliary workers will have to be fully qualified in this particular area of dentistry. The Restrictives Practices Commission, following their inquiry in 1982 into the legal restriction of the supply of dentures to the public, came up with alternative recommendations, one of which was that there should be no restriction whatsoever on the supply of dentures direct to persons of 18 years of age and over provided it did not involve work on living tissue. The second alternative of the commission was that the 1928 Dentists Act should be amended so as to provide that the general prohibition on the carrying on of dentistry by a non-dentist should not apply to the provision of dentures by a denturist to a person of 18 years of age or over provided it did not involve work done on living tissue. It suggested that a denturist for this purpose would be the holder of qualifications recognised by regulations which the Minister for Health might make from time to time. The commission opted for the first alternative.

However, the Government felt that the complete de-restriction of the supply of dentures would not be in the best interests of the public and that the second alternative was preferable. Consequently, the Bill has been drafted in such a way as to permit the implementation of the principle of the second alternative of the Restrictive Practices Commission. There has of course been considerable opposition to this on various grounds. The introduction of a class of qualified denturist dealing directly with the public will not, however, result in a lowering of standards. The fact that only qualified and competent persons will be allowed to deal with the public direct will in fact represent an improvement over the existing situation in which it is well known that certain persons are already operating in breach of the law. The increased penalties for the illegal practice of dentistry, combined with the introduction of the new class of qualified denturists, should provide greater protection for the public from the activities of illegal operators. Preliminary moves towards the introduction of the new denturist class of auxiliary dental workers will be made as soon as possible after the Bill is enacted.

There is provision also under this part of the Bill for the Minister, if he sees fit, to make an order directing the council to exercise their powers in relation to the establishment of a particular class of auxiliary dental workers, either on a permanent basis or for a trial period. Any order made by the Minister under these provisions must be laid before each House of the Oireachtas and can be annulled by a resolution of either House.

Part VIII of the Bill contains miscellaneous provisions including, in section 65, provision for the keeping in force for the time being of the agreement between this country and the United Kingdom, which I referred to earlier that is the agreement under which there is mutual recognition of qualifications in dentistry awarded in these islands. The agreement is now obsolete in the light of our membership of the EC and it will be formally terminated as soon as the Bill is enacted. In fact correspondence with the UK authorities towards this end has already been initiated.

There are two Schedules attached to the Bill one of which sets out the rules regarding membership and meetings of the Dental Council and covers such matters as tenure of office of members, resignations and termination of membership, casual vacancies, quorum, proceedings at meetings, etc. The provisions are on the lines of the normal rules governing this type of body.

The other Schedule lists the primary qualifications in dentistry which are awarded in the State at present.

The new Dentists Bill is primarily for the purpose of updating and improving the laws regulating the dental profession so before I conclude I think it appropriate that I should record my appreciation of the enormous contribution which the dental profession has made to our society. Their dedication is not only to the clinical element in the delivery of dental treatment but also to the maintaining of the highest standards of dental education and training. This was brought home to me when I saw the interest which all aspects of this new legislation generated among the profession generally. There were submissions made to me by many individual dentists as well as those which one might expect from such bodies as the Irish Dental Association and the Dental Board. Many of the submissions from dentists in private practice were in relation to matters of an academic nature and this is the best illustration of the genuine interest of the profession in the new legislation.

This legislation is long awaited and its provisions are of a non-controversial nature. I would remind the House that the Bill is not about the delivery of dental services so that criticisms of the dental services, whether valid or not, are not really appropriate in the context of debate on this legislation. The Bill as it now appears is the product of co-operation and compromise following widespread consultations and lengthy and informed debate in Seanad Éireann. In the circumstances I would appreciate Deputies' co-operation in its speedy passage through this House.

Dr. O'Hanlon

This Bill has already been through the Seanad. Some 50 amendments were proposed in the Seanad: the Minister accepted a number of them and he removed some of the more controversial parts from the Bill. The Bill now before us is not a controversial Bill. I join with the Minister in paying tribute to the Dental Board. They have served the public and the dental profession well since 1928. I also join with him in paying a tribute to the dental profession. They are very conscientious in their work and they have been highly regarded in our own country and in the countries where they have worked. If I have one regret it is that so many of them went abroad during the years to work when we would have been very pleased to have them work here. This Bill will update existing legislation and this is to be welcomed. It will bring us into line in the eighties, particularly in view of our EC membership. It is appropriate that the Dental Council should have responsibility for the education of dentists.

Section 4 deals with the establishment day. As in the case of the Bill dealing with medical practitioners and the proposed nurses Bill I wonder why provision is not made to have the new council brought into operation on a specific date? This legislation can go through this House, be signed by the President and yet it can lie there for quite some time. In this kind of legislation there should be a specific time limit after the passage of the Bill, whether it be six or 12 months, when the new Act will come into operation. In legislation like this where there has to be elections to a council it is necessary to allow sufficient time to set up the mechanism for the elections and to hold them, but nevertheless, a specific time limit should be included.

The Bill enlarges the composition of the Dental Council from nine to 19. It is balanced in that there are seven elected members from the dental profession, six representing educational interests, two representing the Medical Council and four representing consumers. There have been representations from the dental auxiliaries that their group be represented. The Minister has pointed out that this is specifically a Bill to deal with the registration and regulation of the dental profession and I accept his reasoning on that. However, in the four people representing the consumers he might consider the possibility of having someone to represent groups that could be considered interested parties. Senator Fallon recommended that the representative of the Minister for Education might be a member of the INTO. While I accept that might not have a direct input into the education of dentists, it would be very valuable in bringing to the attention of the Dental Council the manpower needs in relation to the administration of dental services for children.

Section 9(2) gives the Minister the power to alter the composition of the Dental Council. That subsection states:

The Minister may, by regulations made after consultation with the Council, vary the provisions of subsection (1) of this section.

When a Bill goes through both Houses of the Oireachtas, and particularly on Committee Stage, it is well debated. If the Houses of the Oireachtas decide in their wisdom that the composition is correct, I do not see why it is necessary for the Minister to have the power to change the composition. If it is necessary to change the composition of the council at any time, the Minister could come before the Houses with amending legislation, something similar to what he did when he wanted to amend the provisions of the 1928 Act and to extend the period of office of the present Dental Board. That is a much more satisfactory way of dealing with legislation, rather than giving the Minister power by regulation to make these changes.

There will be three committees of the council dealing with education and training, with discipline, with fitness to practice and with the auxiliary dental workers. It is important that the council should have responsibility for the training and education of dentists rather than as at present where the Medical Council have a major input in that regard. I wonder what will be the future of the postgraduate medical and dental education council in the light of this legislation. Will it have any effect on it when responsibility for education is transferred to the Dental Council?

Our dentists are excellent and compare favourably with any throughout the world. That is to their credit because the buildings in which they worked were in a poor condition for many years. In recent times we have had a modern dental hospital in Cork and we welcome this.

The Minister explained why there is provision for a specialist register and he made it very clear that it will be the Dental Council who will decide if such a decision is made, when to implement that section of the Bill. As the Minister said, there are specialist registers in various countries of the world, in the EC, the USA and Canada, mainly for oral surgeons and orthodontists. The Minister has dealt fairly with that in that it will be a matter for the Dental Council themselves to decide if and when to introduce the specialist register.

On the question of reciprocation, while we will be obliged to register dentists from the EC, I ask the Minister to let us know when he is replying if there is reciprocation with any other country. I understand that our graduates are accepted in Australia and I wonder if we have reciprocation with other countries for the register of dentists, as we recognise qualifications from other countries outside the EC.

Section 25 (f) provides for the council to charge a fee for giving a certificate of registration. I wonder about the need for that section because such a provision appears in other similar legislation, but I understand that the dentist will receive a certificate of registration when he registers. I do not expect that that certificate will be given to anybody other than the dental surgeon. If I were to ask for a certificate for somebody who is a dental surgeon I could not receive one in the same way as one could apply to, say, the Registrar of Births and Deaths and receive a certificate. Therefore, I wonder if this section is necessary.

On the question of the registration of dental surgery assistants, the working party recommended that they should be registered and should have proper training and that we should set up proper training for them in this country. The representatives of dental schools, the Dental Association, the health boards and the Department of Health on that working party recommended that we should have proper training facilities for them.

The section dealing with fitness to practice extends the discretionary powers of the Dental Board. This is to be welcomed because for over the last 50 years they have had the power only to erase a name from the register. It is important both in the interest of the general public and in fairness to the dentists themselves that those powers should be extended to suspend or to attach conditions or to censure. I can see a dilemma for the Dental Board in that if a misdemeanour was not too great but deserved some sort of penalty the name would not be erased and then there would be no punishment, or perhaps somebody's name would be erased where a lesser punishment would have sufficed. Some of the professions who have this type of legislation worry about the power of the fitness to practice committee regarding the alleged unfitness to engage in such practice by reason of physical or mental disability. Perhaps the wording of that sounds stark, but this is new to the Dental Board. That subsection dealing with fitness to practice through physical or mental disability was not in it, but from experience anyone will find that that section is rarely if ever used and generally a person who would through physical or mental disability be unable to work would have given up work long before it would come to the attention of the particular registration council. I do not think that anybody could point to any incident where that section has been used incorrectly in other legislation such as the Medical Practitioners Act which has a similar provision. Another point on that section is that if a dentist's name is erased from the register the council are obliged to notify the Minister, as is provided in section 47 of the Bill, which provides that:

The Council shall notify the Minister on the occasion of—

(a) the erasure of the name...

(d) the termination of a period of suspension...

(e) the attachment of conditions...

I wonder why the employer is not included. If a dental surgeon was working, say, for a health board and his name was erased from the register I would consider that the health board should be notified of such erasure as well as the Minister and that where a dental surgeon is an employee of any organisation or hospital his employer would be notified that the name has been erased from the register. There is the usual provision for appeal to the High Court, which is to be welcomed, and there is an obligation in this legislation on the Dental Council to go to the High Court and make a recommendation to erase the name and have the support of the High Court for such decision.

The sections to which most of the debate in the Seanad was devoted were sections six and seven dealing with dental auxiliaries. The Minister brought in amendments in the Seanad and removed much of the controversy, particularly in regard to the type of work which dental auxiliaries carry out. The Dental Council will have responsibility for the reorganisation and recognition of the dental auxiliaries and the council will determine their training and qualifications. I see no problem about that in the medium to long term. In the short term what would be the position of persons who are working, perhaps some of them illegally, in regard to their recognition by the Dental Council as denturists? Certainly we have no proper training in this country for these people at present. The training in AnCO is very limited and there is need for proper training. It is appropriate that the Dental Council should have responsibility for deciding on the type of training for these people and also the nature of work that they would carry out and to set up a register or licence system. That would be in the interests of the general public and the dentists.

There are various opinions as to the type of work that dental auxiliaries might carry out. The Minister told us that hygienists would polish and clean teeth and give advice on prevention. I am sure that will be welcomed by the health boards who do not have sufficient dental surgeons to cope with the number of people who need dental treatment. A lot of the time of dental surgeons is taken up doing jobs that could be done by the hygienists. I am sure the dentists will welcome that provision.

On the question of the extraction of teeth I wonder, while the Minister removed a controversial section in the Seanad, if in section 55 he still has the power to direct the council to set up a scheme under which the dental auxiliaries can extract teeth. That is not clear in the section and, perhaps, the Minister will deal with that matter when replying.

A former Minister for Health, now Leader of our party, Deputy Haughey, in 1979 when referring to an amendment to the 1928 Act said:

In any amendment which might be made the welfare of the patient must take priority. Dentists undergo a lengthy detailed and highly professional training before they are authorised to operate on the mouths of patients and I would not be prepared to lower legislative safeguards which are there to protect the general public.

That view is as valid today as it was in 1979 and I am sure all the Members will agree with it. That highlights the importance of having the type of work to be carried out by dental auxiliaries governed by a body such as the Dental Council who are broadly representative, and are qualified to look after the interests of patients and to set up the necessary scheme as they see fit.

The Restrictive Practices Commission inquiry in 1982 recommended that the Dentists Bill be amended to provide that the general prohibition on the carrying on of dentistry by a non-dentist should not apply to the provision of dentures to a person of 18 years of age or over provided it does not involve work being done on living tissue. They gave an alternative recommendation which the Minister has accepted. All interests, including those of the auxiliaries, will be best served by having the responsibility vested in the Dental Council for any work the auxiliaries will do. Training and education will have to be dealt with very rapidly after the establishment of the council.

Section 55 gives the Minister wide ranging powers. I accept that he amended it in the Seanad and provided that any regulation he would make would be the subject of an order to be brought before the Houses of the Oireachtas when members would have the opportunity to revoke it if they so wished. I wonder if there is power in the section for the dental auxiliaries to extract teeth.

Under section 54 dental auxiliaries are precluded from doing any work on natural teeth or living tissue. In that regard I wonder about the fitting of dentures. In my view that would involve working on living tissue and I wonder, if the Minister is anxious to give auxiliaries the authority to fit dentures, it will be necessary to change that wording. Gums are considered as living tissue.

In general, we welcome the provisions of the Bill. On Committee Stage we will table the amendments we consider necessary but, bearing in mind that 50 amendments were dealt with in the Seanad and that the Minister accepted a number of them, Committee Stage here will not merit the lengthy debate given to it in the Seanad. The Bill is primarily concerned with the regulation of the practice of dentistry. In the Seanad the Minister accepted that there were points in relation to the administration of the service that were important and interlinked with the establishment of the Dental Council. For example, the emphasis must in future be on prevention. All persons working in the dental service must be motivated by the prevention approach. I accept that dental surgeons are well motivated towards prevention. Dental hygienists have an important role to play in helping to prevent dental decay and they could be engaged to screen children for the health boards.

Perhaps the Dental Council will have a role to play in reconstituting the dental health foundation with the Health Education Bureau. Fluoridation was introduced here almost 20 years ago and there is no doubt that it has resulted in a reduction in the level of dental caries. Some sources say the reduction was as much as 50 per cent. It is unfortunate that there are so many schemes where flouridation is not available due to a lack of funds. That matter should be given priority because of the value of fluoridation although I have read comments recently from Japan that they do not intend to follow our example and fluoridate the water there.

A major problem that is relevant to the setting up of the Dental Council is the question of manpower in the dental services. There is no doubt that the number of dentists registered here has increased considerably in the last 40 years, from 519 in 1941 to 1,048 in 1981. The ratio was 1:5,700 in 1941 and was 1:3,290 in 1981. I understand that the position now is that there is one dentist to 2,234 adults and one dentist per 1,109 children. I regret to say that in the constituency Cavan-Monaghan, which the Chair and I represent, we have only one dentist to 8,081 people. That concerns me greatly.

Mr. Keating

They have better teeth.

Dr. O'Hanlon

In the public health service in 1965 there were 88 dentists while in 1980, 204 were employed. While the number of dentists has increased over the years nevertheless there is still a shortage of them. I understand that in the region of 28 established posts with the health boards have not been filled. This a matter of concern, although in the past the North-Western Health Board sponsored dental students to work in their own health board area. The recent salary increase might make it more attractive for some dentists to work in their own country.

The health boards are not fulfilling their statutory obligations because of the inadequate number of dentists on their staff and because of insufficient funds in the ad hoc scheme in many areas, and there are some areas where dentists do not participate in the ad hoc scheme. The Dental Association have been concerned about the fact that the ad hoc scheme has been in operation since 1979 and no permanent contract has yet been worked out. It would be in the interests of the dental health of the nation if the Minister looked at this to see if a properly drawn up scheme could be agreed between the Department and the Dental Association. That would improve the situation. The ad hoc scheme has been suspended in the Southern Health Board area through lack of funds.

We spend a very small proportion of our health budget on dental services compared with other countries. In 1983 we spent £12.5 million, which represented 1.25 per cent of the budget for the public service, and if we include the private dental service, that figure increases to 2 per cent. Australia spends 11 per cent, Denmark 8 per cent, West Germany 10 per cent and the United Kingdom 5 per cent. We are very far down that list. This is something that should also be looked at.

The extension of the dental services to those between the ages of 12 and 16 years is very desirable. Dependants of insured workers do not have access to dental services on their husband's insurance. This is of concern to all. It would be very desirable if we transferred responsibility for all health matters from the Department of Social Welfare to the Department of Health, especially the dental and optical services which would be more appropriately administered by the Department of Health.

I received a letter on behalf of the parents of pupils of Lucan boys' national school who are concerned about the waiting list for appointments which is so great that a child who requires a filling must wait up to six months to make an appointment. Very often by that time the tooth is beyond saving or the parents have paid to have the tooth filled privately, at great cost. This highlights the difficult situation in the administration of the dental services.

I thank the Chair for his forbearance if I move from the Bill, but because of the implications, particularly in terms of education and manpower, it is important that we make passing reference, as I did, to our existing dental services.

Mr. Keating

I welcome the opportunity to make a few observations on this Bill. In the Minister's words, this Bill aims at the advancement of the standards of the practice of dentistry and the safeguarding of the general public. This is a very comprehensive measure which seeks to regulate practices in this area.

I would like to refer to the area of regulation, but with particular application to this measure. This is an area to which we have not given a great deal of thought but one is struck by the amount of legislation, and the detail of the legislation, which seeks to regulate increasingly almost any area of commerce or human interaction. We should bear in mind that inevitably we are incorporating in legislative statute a philosophy about the way the affairs of commerce and social and economic behaviour should be regulated. There is a philosophic question in that and I am not sure it has ever been properly debated or discussed in this House.

There is a move towards deregulation in other countries. One needs at least minimal regulation, but in this Bill there are a number of references which are hard to justify — the need for approval by the Minister, to seek the consent of the Minister and so on. There seems to be an obsession with the need for central control in an area which in an ideal world would be self-regulated and, even in this less than perfect world, might arguably do with some degree less regulation than is potentially possible in this measure, although I accept in practice that it is probable that the full potential of regulatory power and control will not operate in the normal way. I wanted to make the point that a lot of the legislation coming before us has this desire to regulate, and I wonder about it because it will inevitably pose very serious problems relating to enforcement, the cost of such bureaucracy and individual freedoms.

Provided the Dáil asks and answers these questions I am reasonably satisfied to go along with the conclusions but we should not allow ourselves to slide gently on a raft of legislation over a number of years into a very tightly, too closely regulated area where we find that gradually individual freedoms have been eroded and expenses have soared because of such regulation which may or may not be necessary. That basic question underlies this Bill.

This Bill is the replacement of the Dentist Act, 1928. In the Seanad the Minister accepted a very comprehensive range of amendments which strengthened the measure and sought to bring reasonable order into this area. The Dental Association and other professional bodies should be involved wherever possible in pre-emptive self-regulation. I believe it is far better for professions to regulate their own affairs, to discipline their members and to insist on their own standards rather than bringing the State, with its cumbersome and expensive machinery, into the area.

In this case, for a variety of reasons we are well into the area of regulating the practices and procedures in the dentistry field. The Bill got a very general welcome from almost everybody associated with this subject, but even within this ambit a great deal of responsibility for regulating will fall on the new Dental Council. I am far from impressed with the degree to which other professional associations have managed to order their affairs when dealing with complaints from consumers about members of their own profession. I urge therefore that the Dental Council be very rigorous, through and absolutely just in their dealings with their members and with consumer interests. If they set that example at the outset we will be assured that the composition of the Dental Council is correct and that this Bill is appropriate.

In the Seanad the Minister said that statutory registration is to the mutual benefit and advantage of the general public and the practitioner. That is true to a very large extent, but it is not necessarily always to the benefit of either the practitioner or the public unless the standards and criteria which apply are extremely just and open to some kind of public scrutiny.

When I see a move to have statutory registration and regulation, inevitably I come to the conclusion that costs to the consumer will increase. I hope that will not be the case here. It is reasonable that we should have this type of regulation, because this is an area of medical health or health care. Therefore, the standards which we apply must be clear and precise and there can be no deviation from them. It is fair to say that over the years such standards have applied, particularly in the areas of dentistry. As a practising public representative, unlike the number of complaints received about other professions, I do not remember receiving even one complaint about dentists. That is not to say that there may not have been complaints, but they did not come to me. In essence, a statutory regulation is a good thing to a large extent but there are some dangers implicit in it and I hope that will be borne in mind and that after a reasonable period of time we should look again at the effects of this Bill to see whether fears that some of us, and the dentists' professional association and many individual dentists have are not proved justified. One would be the fear of a closed shop or a monopoly where a Dental Council dominated by the dental profession would draw up standards and insist on criteria which would be principally self-suiting. I know that is not the wish of the dentists' professional association at present and they are taking great pains to spell this out for anyone who wants to listen. They are interested in ensuring that this Bill will work. However, that caveat must be entered, that where one tends towards a monopoly there are dangers about which all of us should be alert and in respect of which we should take appropriate action.

Leaving that small qualification or doubt to one side, the area of statutory registration is important and is welcome if it genuinely seeks — and in day to day operation acts — to protect the consumer and improve, if possible, standards in the general area. I do not know if there are cost implications involved and whether it is likely that because of the relatively new strictures which would apply to the registration of dentists, with all the accompanying bureaucracy, costs would arise which inevitably would be passed on to the public. If there are such costs, I would be grateful to hear about them and would appreciate if the Minister might mention whether consideration had been given to that aspect. It is unreasonable, I presume, to expect the dentists to accept a burden of costs which arises from the State seeking to enforce regulations upon them. If it is unreasonable to ask them to do so, then somebody else must pay the bill and that may be the taxpayer. I do not know if that is a significant matter but I would appreciate some comment from the Minister.

There is another option to this kind of measure which seeks to regulate, in close detail, every facet of the dentist's business, right down to insisting on writing into legislation, for example, that members of the council and people writing to the council are notified by post-paid envelope and all the minutiae and detail contained in the Bill. There is a philosophy which says you could reasonably allow for the operation of what one might call in the economic area free market forces, given strong consumer legislation and extremely severe penalties for transgressions. The old adage of caveat emptor would normally apply in the commercial, retail or certain other areas. It is reasonable to hold it in suspension to some extent in the area of medical wellbeing, where the repercussions of a bad decision could be critical, indeed, in the area of one's health. Under my hypothesis, there would be strong consumer legislation on the books and any transgressions which were proved would be subject to very heavy penalties, indeed. That is another alternative to the idea of very tight regulations as contained in the Bill. I paint this scenario because I worry about extremely closely written Bills of this very comprehensive nature from the enforcement point of view. I do not know how this Bill will be enforced. I do not believe that it is open to easy enforcement. There are so many areas of possible transgression in every section of the Bill that I honestly believe it to be a Bill which will be extremely difficult to enforce. Any measure which is difficult to enforce or which is not likely to be enforced should be brought in here only as a last resort. The other resort is one that I commend for consideration, not in opposition of this measure, which is essentially a good Bill, but there is an alternative method which would work in the area of minimal regulation and the protections previously mentioned. Those protections do not now exist and perhaps the Bill points the right way.

Consumer interest concerns me, even in the context of the make-up of the Dental Council. The consumer interest is represented by the appointment of two nominees of the Minister representing, broadly speaking, that area of interest. Might that be looked at again? It might be in the best interests of the council, the profession in general and the public if that area were to be improved. The council are dominated either by nominees of the dentists themselves or by allied areas of professional interest — one might even say with no sense of hurt involved — of self-interest. That is quite right. Where else would a repository of standards and criteria for application in this area be except among the profession? The council have other obligations. They are charged with an enormous amount of work and I am sure we all wish them well in carrying out that function. To what extent may there be some dissatisfaction about the degree of consumer representation? I wonder if the Minister might like to think about that again.

The make-up of the membership of the new council is comprehensive in some respects. There will be four members appointed by the undergraduate educational institution, one member by post graduate interests and a nominee of the Minister for Education. The number of representatives of the practising profession elected by their colleagues would be increased from five to seven. While this would not give them a majority on the council, as is the case on the present Dental Board, it will nevertheless ensure that the practising profession will form the single largest group on the council. Two members of the new council will be nominated by the Medical Council which has three representatives on the Dental Board at present. The reduced Medical Council representation reflects the increased independence and responsibility of the Dental Council in the matter of the education and training of dentists.

The Minister said in the Seanad that the remaining four places on the new council will be filled by his nominees and that at least two of these would be non-dentists, representing the general public as consumers of dental services. Although this is in line with the provisions of the Medical Practitioners Act, 1978 giving similar representation on the Medical Council to consumers of medical services, I am not sure that it goes far enough. If the Minister is quoting the Medical Council Act, then with respect I think he should be consistent and apply it in relation to matters to which I shall come in a moment.

The Dental Council must be seen to work. One way of doing that might be to consider increasing the two out of 19 specifically consumer orientated representatives. I appreciate that every other one of the other x 17 has, to some extent, an interest in protecting the consumer also, but their primary obligation and the cap which they wear principally is not that of the consumer.

Because of the major responsibilities entrusted to the council, I should like to ask the Minister whether adequate thought has been given to ensuring that the council are facilitated in doing their job. For example, will the council need funding? They will at least need money to pay the travelling and subsistence expenses incurred in connection with meetings. If, as the Bill implies clearly, the council are to become involved in the area of regulating access to their registers and on occasion to deregistering or censuring in some other way, there will be a good deal of expense involved, including the area of legal action and representation in the courts if necessary since the High Court would be involved in one or two areas. I am not aware of provision in that respect for the coming year. While I would not purport to speak on behalf of the dentists, I am sure they too would be interested in this matter of funding. Except in some relatively elite areas, professional associations are operated largely by way of voluntary help, by hard working people who in that way serve both their profession and their country well.

When we are setting up a comprehensive council of this nature and assigning them the range of responsibilities as outlined, we should not expect them to be all dressed up without giving them the expenses involved in travelling to their destinations. Therefore, the question of funding arises and I shall be interested in hearing whether the Minister has given consideration to this aspect.

I note that the term of office for the council is to be five years with no member being allowed to serve for more than two terms. Perhaps there would be an advantage in providing for some kind of rolling membership — in other words, ensuring some continuity. I suggest for consideration the possibility of maintaining some echelon of membership while some members are being changed by regulation. In this way we would eliminate the possibility of an entirely different body being elected every five or ten years. We must have regard to the good relations that those who had been in office for a term would have established with other medical agencies and subsidiary organisations. Perhaps if we regulate for a situation in which three, four or five members would change every number of years, we would overcome this problem. The Dental Council will have to be both strong and effective and we can ensure this by legislating for the necessary funding and power.

Throughout the Bill there are references to such phrases as "with the consent of the Minister", "by direction of the Minister" and "with the Minister's approval". These kinds of clauses in legislation always concern me. In this case they make it clear that if the council do not act as the Minister wishes they may be dismissed. Inevitably the State will seek those kind of central safeguards, but if we were to provide for such control in every piece of legislation we would end up with a very expensive bureaucratic maze whereby every act from the boiling of an egg to the capping of one's tooth would be subject to some regulation which in turn might be subject to a number of different regulations and all adding up to an enforcement problem of gigantic dimensions with the inevitable expensive bill for the taxpayer. We had an example of this this morning in the apparently innocuous legislation relating to the unfortunate potato growers who are now to be regulated.

In the sort of case we are dealing with, regulations and controls should be minimal, no more than what are necessary to safeguard public health. In a democratic and free society we do not need maximum control, but if we are to have such control the case for it should first be proven by the State.

The Bill deals, too, with the registration of dentists. There is provision for the establishment of a register of dental specialists should the council consider that desirable. The registration of specialists is of benefit to the public in enabling them to identify who are qualified and who are not. However that area of control should be monitored carefully because, despite good motives, a professional group, whether dentists, doctors, politicians or others, will often believe that exclusively they have a monopoly of concern, care or wisdom in their area. Either accidentally or deliberately they could slip into a form of regulation which would serve their own interests principally.

I am always anxious in regard to professional groups whose job it is to regulate in respect of people who might be applying for membership of the group. However, this council are to be sufficiently comprehensive to be able to take on board such fears, to ensure that they are without foundation. Any piece of legislation which involves such regulation, where the dominant interest are the profession themselves, is open to suspicion and concern.

I am very pleased that the Dental Council are to be asked to undertake responsibility in the area of education. Their duties are spelled out in relation to undergraduate and postgraduate education. That is heartening. I hope the voice of the council will be strong and effective in that respect. In the Seanad debate a number of important points were made on this important matter of the educational role, including the need for an educational role in the general area of dental health. With the exception of work done by the Health Education Bureau or some particularly interested teachers, the general field is one of attempts at curative action.

I am convinced that the Dental Council, the profession generally and the good interests of the consumer would demand that there be a very strong preventive campaign in relation to dental health. Unfortunately, statistics in Ireland in this respect do not give cause for comfort. In the eight to nine year age group, 60 per cent are found to have dental decay which is untreated while the corresponding figure for 13 to 14-year-olds is 37 per cent. The joint working party emphasised the importance of giving priority to the preventive aspect of dental care. They stressed that the establishment of an improved dental service in the absence of a preventive philosophy was unlikely to bring about an improvement in the overall dental health of the community. Therefore, the area of prevention should commend itself to the council. I do not envisage it as being the prime responsibility of the council but they should have something to say in that respect.

The causes of this dental misfortune are not difficult to ascertain. Basically they are due either to maleducation or to no education in respect of the dietary habits of children. I recall endeavouring, during my teaching days to persuade some schools to give up the practice of having a tuck shop. I have nothing against tuck shops as such but inevitably they are laden with very sugary sweets, which cause decay in children's teeth, instead of being laden with the perhaps less attractive but more healthy foods such as fruit. I wish the council well in their educational role and I appeal to them in advance to take on the job of suggesting to the public generally and to the Government of the day that there is a need for a preventive campaign in respect of dental health.

We need a proper dental service for 900,000 children. We have a service catering for about 600,000 children who are eligible. We need a community dental service for about 600,000 fully eligible adults. Our services are less than satisfactory. Although we have one dentist for about 3,500 people it does not compare well with certain parts of Europe, but I suppose we could take some solace from the fact that there are other parts of Europe and the world which are so undeveloped as to bring home to us the fact that in their estimation dental care is very far down their lists, so we cannot be too negative about it. However, I repeat that £1 worth of prevention would be as good as £1,000 worth of attempted cure. I encourage all those involved to develop that philosophy. There is no reason why school curricula should not be changed to embody as an essential the teaching of proper hygiene and health care. I have often wondered why the root of a Latin verb was considered to be more important to a boy than how to wash himself. That remains the position despite some progress in the general area.

It is very important that from the outset the Dental Coucil would make their ground-rules very clear and act swiftly and with ruthlessness where it is necessary. There will not be any obligation on them to publish an annual report, but I suggest that communication with the public in regard to the work and the standards they will be applying would be good in itself. It would help us all to understand how they will come to grips with their work. I hope they will consider issuing regular reports on their progress. These could embody references to how they will be coping with problems which come to them because such problems will relate directly to the confidence the public and the Government will have in the way they operate.

I spoke earlier about registration. Inevitably it means that by giving these powers we are entrusting the council with responsibility for deciding who will and who will not practise dentistry. We are accepting that some people will not be allowed to register or that they may be deregistered, probably for the best reasons in all cases. However, we should consider very carefully the implications in regard to people's livelihoods, their right to earn a living in their profession.

There is legislation to protect the consumer — possibly it is inadequate — and a strengthening of that might help the work of the Dental Council. It would help if ordinary citizens were given easy recourse to litigation in the event that they felt they had been hard done by by any professional body or individual, whether he be a dentist, a doctor or an optician. Such a framework of law is not available now and therefore the option of a regulating body has been introduced, a reasonable proposition which I support in principle. Consideration has been given to the constitutional implications in regard to registration, and other bodies dealing with the regulation of certain specialists. We know of instances in which the exercise of these powers has been found to be unconstitutional. The Minister has given much thought to that and believes that the provisions in the Bill would not give rise to any constitutional actions.

I am more concerned about the spirit behind this, the matter of ensuring that anybody who is reasonably entitled to do so would be allowed to practice and that the Dental Council would not feel the need to be over-protective about safeguarding the livelihood of their members. I know that is in line with the philosophy expounded at present by the Dental Board. I should like to see the Dental Council referring to this in one of their early reports.

I should like to refer to the setting up of auxiliary dental workers, dental hygienists and all the possibilities which the council will afford to this end — the possibility of drawing up lists of specialists and categories. This debate gives us an opportunity to refer briefly to the only discordant note that has arisen in relation to this measure. It relates to the views expressed by the Irish Association for Dental Prothesists. They have suggested that denturists, as they will be called in this Act, will be put in a vulnerable position. There are about 250 of those whose practice has been to make impressions and to manufacture and fit dentures directly. They fear — it must be put on the record somewhere — that the powers of the new Dental Council may disadvantage them in relation to continuing their livelihoods. It is well founded.

They have suggested, and it is worth considering, a provision in earlier legislation which allowed for people who had been practising satisfactorily for a period, say the last seven years, operate under the general guidelines of the Dental Council. That applied in the Opticians Bill, 1956 whereby persons who could prove that they had been practising for seven years as opticians would be allowed to qualify as opticians. Dental technicians have been asking why they would not be allowed to qualify as denturists in the same way. It may not be possible to do it as easily as that, but they have a point.

When the Minister introduced this Bill in the Seanad he cited earlier legislation as a reason why he could not pursue a certain line of action. I think the case made by the dental technicians is not unreasonable. I am not talking about people involved in extractions or in dealing with live tissue, the expression used here, or crowns or bridges, but people who have made their livelihoods by simply manufacturing and fitting dentures. Those people should get the most sysmpathetic consideration possible from the new council. That body of men and women have been giving a service. Unfortunatley, they may not have the same training and qualifications as their European counterparts. In the Netherlands, for example, there is a training period of five years whereas here it is something like six months. Nobody could approve of that, but when we introduce regulations to ensure a proper standard of public service we should be careful to ensure that people who have practised satisfactorily would not be shut out totally. I ask the Minister to look at that specific point. He has met this group and they say they had a good meeting with him. In support of their claim they said that a restrictive practices inquiry in 1982 found in their favour. It recommended that section 45 of the Dentists Act, 1928 should be amended to provide that the general prohibition on the carrying on of dentistry by non-dentists should not apply to the provision of dentures to persons of 18 years of age or over. They have a case. in the context of the debate here and in the Seanad that case was not put forcibly. I want to put on the record so that the Minister can consider it.

Debate adjourned.