On the question of fees charged by the council — and this is something which Deputy Keating raised also — it should be noted that the Dental Council, like all regulatory bodies of this sort, is intended to be self-funding. Its main source of income will be fees charged to dentists for registration services. The Minister has indicated that if after a period of, say, two or three years operation it became clear that the council had funding difficulties, then the question of some grant-in-aid money for the council could be considered. However, as things stand, no allowance has been made for the provision of Exchequer funds for this purpose. The Minister for Finance would of course have to be consulted in such an event.
On the question of notification of the erasure of a dentist's name from the register to the dentist's employer, if he is an employee, as well as to the Minister, this is unnecessary and would not be altogether practicable in many instances. The Dental Council will not have up-to-the-minute information on the employment of all the dentists on the register and dentists do tend to move about quite a bit, particularly in the earlier part of their careers. In any event the erasure of a dentist's name from the register in a country such as ours would scarcely go unnoticed by those connected with the profession.
Deputy O'Hanlon asked if it would be possible under the new legislation to establish a class of dental auxiliary workers who could extract teeth. The short answer to that question is yes. The Dental Council, with the consent of the Minister, may establish classes of auxiliary dental workers who may undertake such class of dental work as shall be specified by the council. The council shall determine the type of dental work these auxiliaries may undertake and the conditions in which it may be undertaken.
Deputy O'Hanlon was wondering if the Bill as drafted will permit the fitting of dentures by non-dentists since it involves work on gums which he regards as living tissue and would therefore be excluded under section 54 (3). This is a matter which has been gone into in some depth and the Minister is satisfied, following legal advice on the matter, that the fitting of false teeth does not actually involve working on the gums, which are of course living tissue.
Deputies O'Hanlon, N. Treacy and others touched on the dental services themselves and spoke about the manpower problem which we have in the public dental service, particularly in their own constituencies. The problem in Deputy O'Hanlon's area is that dentists cannot be enticed into taking up full-time posts with the health board. Perhaps the recently announced pay award for dentists in the health board service will help to solve that problem in Deputy O'Hanlon's constituency as well as in other areas where a similar problem exists.
The problem in Dublin is somewhat different. No doubt additional dentists could be recruited into the health board service if the number of dentist posts could be increased. However, the embargo on the creation of additional posts in the public service prevents any increase in dental manpower at present. The situation in Lucan, which Deputy O'Hanlon referred to specifically, and about which Deputy Durkan spoke to me, should show an improvement now that the health board have increased the number of clinic days in the local dental surgery from two per week to three per week.
I agree with Deputies that preventive care offers the best prospects in the long term. The value of the fluoridation of our water supplies is already pretty well established but it is expected to be proven beyond doubt when results of the national survey of children's dental health carried out earlier this year are available.
Deputy Keating expressed his concern on the question of regulation of professions generally and, in relation to this particular Bill, at the number of instances in which functions of the Dental Council will be subject to the approval of the Minister. He said that the tendency in some countries is towards de-regulation of professions. I am aware of developments in some other countries to make some of the regulations governing certain professions less restrictive — for instance the restrictions on advertising have been relaxed in some instances. However, I am not aware of any instances of the total de-regulation of a profession and certainly not dentistry. I think the Deputy will find upon looking into the specific provisions of the Bill that in all instances when the approval of the Minister is required there is a reason for it. It may be for the protection of the public, members of the dental profession or perhaps auxiliary dental workers. In fact there was one amendment carried on Report Stage in Seanad Éireann, following representations to the Minister from the Dental Board, which deleted the requirement for the Dental Council to have the approval of the Minister in the matter of how they would dispose of any surplus funds they might have.
I am aware that in certain areas, particularly in relation to the disciplinary powers of the council, the wording of the Bill appears cumbersome, and is repetitive in relation to different types of offences. However, I can assure Deputy Keating that the format is absolutely necessary if the powers of the council, in relation to discipline are not to be successfully challenged on constitutional grounds. It is necessary that the provisions should stand up in law if the Bill is to provide adequate protection for the general public and for members of the profession. The Bill provides in so far as possible for the profession of dentistry being self-regulatory but State involvement of necessity arises in certain areas.
Deputy Keating said that some professional associations have a reputation for protecting their members rather than giving any degree of satisfaction to members of the public who make complaints against them. In the case of the dental profession I would imagine — though I am not aware of any such incidents personally — that there must have been occasions where members of the public felt that their complaints to the Dental Board about individual dentists did not result in any positive response. What the general public in all probability did not know was that under the 1928 Act the only disciplinary power open to the Dental Board was erasure of a dentist's name from the register. Obviously the great majority of complaints, even if upheld, would not warrant this drastic measure and what happened, therefore, was that no action could be taken by the board and the complainant had to be informed accordingly.
This new Bill will rectify the situation by providing also for a number of lesser penalties than erasure from the register. The new Dental Council with their additional disciplinary powers will be in a position to demonstrate to the public that they are as willing to protect their interests as they are those of the members of the profession and I have no doubt that they will not hesitate to do so.
On the question of enforcement of the provisions of the Bill, Deputy Keating said that this could be difficult. I am afraid I do not share his pessimism. The enforcing authority in nearly all instances, backed up by the necessary legislative provisions, will be the Dental Council. The Dental Board were quite successful in enforcing the provisions of the 1928 Act and in those areas where enforcement might have appeared to be lax this was due to the inadequacy of the legislation rather than any reluctance on the part of the board to carry out their statutory functions. I have no doubt that the Dental Council will be quite effective in enforcing the provisions of this legislation.
Though there is specific provision for only two representatives of consumer interests on the Dental Council the Minister will have four nominees and there would be nothing to prevent him increasing the consumer representation if he thought fit.
I dealt with this a little earlier and referred to the various expressions of opinion by Deputies in regard to who should and who should not be members of the council. Deputy Glenn was in favour of having public representatives on the council because of their public accountability. I am sure that when the Minister will be making appointments he will take all these expressions into consideration.
Deputy Keating said it might be desirable to have some form of rolling membership of the council rather than have a complete change of membership every five years. While on the face of it this would appear to be the case, what is likely to happen is that on every new council there will be a number of members of the outgoing council. This is possible by virtue of the fact that members may serve for two periods of office.
Deputy Keating mentioned the desirability of communication between the council and the public by way of regular reports. In fact, there was an amendment to the Bill in Seanad Éireann as a result of which the council will be obliged to publish an annual report.
Deputy Taylor and others thought it was necessary to clarify the situation in relation to the position of dental mechanics. Deputy Keating mentioned a figure of some 250 dental mechanics whose livelihoods may be put in jeopardy due to the powers of the new Dental Council. This is not the case. The great majority of dental mechanics have nothing to fear. It is only the small number who are operating illegally at present in supplying dentures direct to the public who fear the increased penalties contained in the Bill for the illegal practice of dentistry.
The penalties in existence at present have not been updated over the years and are totally inadequate. Incidentally, these penalties are not aimed specifically at any particular group. It is perfectly understandable that there should be penalties for the illegal practice of dentistry. The fitting and insertion of artifical teeth is within the definition of the practice of dentistry. There is provision in the Bill for the establishment of a class of auxiliary dental workers who will be fully qualified and competent to supply dentures direct to persons of 18 years of age and over provided it does not involve work on living tissue.
It is true that the Restrictive Practices Commission came up with a recommendation that the supply of dentures to persons of 18 years of age and over should be subject to no restrictions whatsoever. Dental mechanics would have had no more right to supply dentures under this recommendation than any other members of the public. The fact of the matter is that the Government decided that to create a free-for-all situation in relation to the supply of dentures would not be in the interests of the general public. Instead they opted for the implementation of the alternative option put forward by the Restrictive Practices Commission which was for the introduction of trained denturists. This is provided for in the Bill.
The Dental Council will determine the training and qualifications for entry to this new class of auxiliary workers. The council could, perhaps, make some concessions to those who are practising illegally at present and have been doing so for a number of years, but it is extremely unlikely that all those who are working as dental mechanics at present will be given automatic entry to the new class. The council will have to satisfy itself as to the competency of all persons who are permitted to supply dentures direct to the public.
A number of other matters were raised. Deputy Mac Giolla was of the opinion that the Bill did not mean very much and that the new council will have no teeth by virtue of the fact that it will be totally controlled by dentists. That is not so. Section 55 states:
The Minister may, by order, in any case where he considers the establishment of a particular class of auxiliary dental worker to be desirable, direct the Council to exercise the powers vested in it under section 53 of this Act to make a scheme for the establishment of such a class and, in any case where the Minister considers it desirable, he may, by order, direct the Council to make a scheme for the establishment of a particular class for a limited period in order that the value to the public of the existence of that class may be judged and the Council shall comply with any such direction.
Section 15 states:
If the Council fails, neglects or refuses to perform any function assigned to it under this Act, the Minister may, by order, direct the Council to discharge that function and for that purpose to do such other matters or things ancillary or incidental thereto as may be specified in the order.
In actual fact the Minister can discharge the council. Deputies suggested that it was necessary to establish some class of dental hygienists. It is most likely that this will be done by the council.
Deputy Taylor referred to the poor ratio of dentists to the population. Various figures for other countries were quoted. I should like to clarify one matter. There is no international recognised ratio of dentists to the population. The ratio of dentists to the population in an area would depend on the health status of the population which would, in turn, depend on a number of factors such as whether the water supply was flouridated, the type of diet followed and the level of oral hygiene practised by the people in the area.
I want to thank Deputies for their contributions. If they are not totally satisfied with my reply or with the Bill they will have an opportunity on Committee Stage to put down amendments.