Deputy Geoghegan-Quinn reported progress.
Dentists Bill, 1984 [Seanad]: Committee Stage (Resumed).
On the last occasion Deputy Geoghegan-Quinn addressed a question to the Minister as to why it was necessary to have the consent of the Minister for Health and the Minister for the Public Service in order to pay an officer or servant of the council. This has not appeared in other legislation and I was wondering if since we debated this last the Minister has found any answer to that question.
The question as to what?
As to why it was necessary to have the consent of the Minister for the Public Service as well as the Minister for Health in order that an officer or a servant of the council shall be paid out of funds at the disposal of the council. The approval for such an allowance must be the approval of the Minister for Health and also of the Minister for the Public Service. Deputy Geoghegan-Quinn asked the Minister why it was necessary to have the approval of the Minister for the Public Service as well, because this does not appear in other legislation of a similar nature.
In the case of the Dentists Bill the Government decided that there should be provision for joint ministerial control of staff and pay conditions. I said that on the last day when we were dealing with section 17. This decision was taken subsequent to consideration of the Nurses Bill, and it is the intention to continue to apply the principle of joint ministerial control of pay and conditions in future legislation of this type in the interests of control over the uniformity of such conditions for comparable types of posts throughout the public service generally.
This is a relatively small point and I do not think in the whole Dentists Bill the Minister has conceded anything whatever on any issue. I hope he will concede this. Section 18 states:
A person who is a permanent officer of the Council shall cease to be a permanent officer on his attaining the age of 65 years or, in a case where a higher age is fixed by order of the Minister made under this section, on his attaining that age.
I understand from this that the Minister's intention is that only males will be permanent officers of the council. I ask the Minister to alter this Bill to ensure that it is open to females also.
This section is confined to male members. Maybe the permanent officer who is female can continue until any age she wishes, but only males are covered by this section on attaining the age of 65 years. What is the Minister's intention in this regard?
This is the way we have to word legislation of this kind —"his" applies to male and female.
The word "his" does not apply to females and no lawyer would attempt to argue the point that "his" covers "her", because it does not. If one reads the section there is no need for the words "his" or "her". I suggest that "his", which occurs twice, be withdrawn and the section will read "a permanent officer on attaining the age of 65 years or, in the case where a higher age is fixed by order of the Minister made under this section, on attaining that age". If the Minister consults the draftsman he will see there is no need for the words "his" or "her". I ask the Minister to delete those words.
I am informed by the experts that when the word "his" is used in legislation like this it covers "his" or "her".
The experts may have informed the Minister of that but if the Minister with responsibility for Women's Affairs hears of this the experts will have to very quickly change their minds, and I would be surprised if she adopted any other attitude. If the experts adopt the attitude that women do not exist, that is out of date and from now on our legislation must alter that attitude and tell the experts that "his" is not the same as "her".
The Minister for Social Welfare does not regard "his" the same as "her" attaining the age of 65 years or 60 years because the pension rights are granted at different ages. Most legislation, particularly in the social welfare area, has different limits and ages. When you come to the age of 65 years it could be argued that in the case of "her" attaining that age it must be different, because in all other areas the female age limit is lower than the male age limit. It would be much clearer in this legislation, and also from the women's point of view, if the Minister put in "his or her" or deleted "his" altogether. Perhaps the Minister would explain the need for keeping that word in the legislation when there is no need for it. Why is this word necessary?
I have already explained why it is inserted. When "his" is in this type of legislation it covers both male and female. We could talk about this for some time saying that this Government do not recognise women. However, this Government have done more to recognise the rights of women than any other Government. I remember hearing an expression, "What's hers is mine and what's mine is my own." That is a rather greedy attitude.
That is still the attitude.
We are talking about a retiring age of 65 years for permanent officers of the council unless a higher age is fixed by order of the Minister in particular cases, such as hardship cases. There is a similar provision in the Health Act, 1970, in relation to permanent officers of health boards.
The Minister mentioned that this Government had done a lot for women since they came into office, but I will not go down that cul-de-sac. I would be interested if at some time the Minister would enumerate all the different areas in which they did anything for women. There is a case before the courts at this time trying to get equality for women under social welfare legislation which should have been introduced last December.
Between now and Report Stage would the Minister have a look at this section and see if it would be possible to amend it taking account of the points which have been made?
The Minister has not yet realised that he does not have to fight for every single word in this Bill, which is what he has been doing. He will concede nothing. He should have an open mind and speak to his advisers so that they can come up with an amendment on Report Stage.
I do not agree with what Deputy Mac Giolla said. This Bill has been gone through thoroughly. We talked with all the interested parties for a long time and in the view of the Government, while this Bill may not be perfect, it is as near to perfect as we could get. Deputy Mac Giolla may disagree with that and he is entitled to his opinion.
Why is it necessary to have ministerial sanction for borrowing? Is there any limit on the amount the council can borrow?
It is necessary for the new Dental Council to consult with the Minister about borrowing and there must be a certain amount of ministerial control in that area, as the Deputy will appreciate.
Is there any limit?
I presume the Minister would look at each application and a lot would depend on the reason why the council needed to borrow.
Subsection (1) reads:
All expenses incurred by the Council, and any expenses which may be incurred by the Minister in relation to the establishment of the Council, shall be defrayed by the Council out of funds at the disposal of the Council.
What does that mean? Is there any provision for Exchequer funding following the establishment of the board? For example, if the Minister directed the board in relation to education and the board were not able to fund any particular activity from their own resources, is there any provision for Exchequer funding?
No. Subsection (1) provides that the expenses of the council shall be met from funds at its disposal — registration fees, etc.
Is there any provision for Exchequer funding if the registration fees are insufficient? There must be some limit to how much the registration fee can be. If the Minister directed the board in relation to, say, education and the board were not able to fund it from their own resources, would there be any Exchequer funding available to the council?
This is a standard provision to take account of staff costs and possible contingencies incurred in the administration of the legislation. For example, if the Minister wished to have an inquiry into any action of the board with which he is not satisfied, or if he asked the board to carry out an action for him which the profession should not be required to finance, naturally the Minister would have to provide the necessary funds.
Would that include some activity in relation, say, to education?
No. I presume the Deputy is referring to the committees which will be set up by the 19-member council.
The council will have responsibility for the setting of standards and for the training of dental auxiliaries. If the council sets up such a scheme in response to a direction from the Minister and if they do not have the funding from their own resources——
In such a case I presume they will make use of the provision we have already spoken about, that is, borrow some money. It would not come from the vote from the Department of Health.
The Exchequer would not fund such an activity under any circumstances.
Section 25 (f) states: "the giving to any person of a certificate of registration, and". The council may charge for that. I do not understand why that is inserted in the section. Presumably the dentist who is registered will receive a certificate when he or she pays the registration fee. To whom might a certificate of registration be given other than to a dentist?
The initial fee covers both the registration and the issuing of a certificate.
The section states:
The Council may charge such fees as may, from time to time, be determined by the Council, with the consent of the Minister, for—
(a) the registration of a person in any register maintained by the Council,
That is fair enough, but it appears that there is a second fee for the giving to any person of a certificate of registration. That is wrong. If a person applies to be placed on the register of dentists and if that person is fully qualified, presumably he or she will pay a fee and should be entitled to a certificate at that time without being obliged to pay another fee for a certificate.
The initial fee covers the registration and the issue of the certificate.
That is not what the section states. The section states that the council has the power to charge a fee for registration and power to charge a fee for giving a certificate. That is two fees. Surely when a dentist registers on the dental register he or she is entitled to a receipt, if nothing else, to say he or she is registered and should not have to pay a second fee for a certificate of registration.
Any fees being charged by the Dental Council are subject to the approval of the National Prices Commission and the Minister may have a role to play in that as well. We anticipate that the council will not charge fees which will be exorbitant. I will give the Deputy the fees charged by the Dental Board at present. The original registration fee is £22.50. Retention of a person on the register is £30. For restoration of a person removed for non-payment of a retention fee and restored under section 24 (2) of the Dental Act, 1928, the fee is £60.
In reply to Deputy O'Hanlon the Minister appeared to suggest that there would be only one fee and that that would cover all the other costs such as the certificate of registration. Now he says there are a number of fees. Was he suggesting that the registration and retention fee should be a single fee or will there be an annual retention fee as well? If so, is it the intention to have any control over that?
The council is empowered to charge fees for registering dentists and for other services provided. The Minister's consent will be required and the amount of fees determined by the council and increases in them are subject to the National Prices Commission. The Deputy wants to know if there is duplication of charges by the council. There is not.
According to the section there is. There is a charge for registration and a further charge for giving a certificate for registration. Surely on registration one is entitled to a certificate stating that one is registered. According to the section one is not. If one wants a certificate of registration one must pay another fee for it.
The only instance I can think of would be where a person lost his certificate and wanted a duplicate.
That is different from what the Minister of State said.
I presume the council will produce a duplicate. I do not see the point of contention.
If I was satisfied that it was only for giving a duplicate that would be all right.
I said there would be no charge.
The Minister appeared to justify the fact that someone would have to pay a fee to register and then pay a fee for a certificate.
The Minister of State has clarified it so why not insert it in the Bill? If it is the intention to charge a fee for an additional or duplicate certificate why not say that?
It is not the intention to charge an additional fee for a duplicate certificate.
I am lost.
The Minister says that it is not the intention to charge a fee for an additional or duplicate certificate but he has just said that it is in the event of issuing a duplicate certificate that the fee would be charged. If a person lost a certificate and wanted another certificate a fee would be charged. If that is the case why not make it clear in (f). The "re-issue of the certificate" could be inserted. It is not very clear at present. Presumably the only person who is entitled to a certificate of registration is the person who is registered. We are talking now about the re-issue of a certificate and the reason the Minister mentioned is one which I accept, that is, if a person lost a certificate and wanted another one. It should be made clear.
Why not insert that?
Why not amend that line before Report Stage to make it clear?
The initial fee covers the registration and the issue of a certificate.
We are talking about the re-issue of a certificate. I do not think it is necessary. If somebody lost a certificate naturally the name of the individual would be on the books of the council.
On a point of order, is in in order for the Minister to address the House sitting down?
It is not in order to do this but where there are short interventions by Members on Committee Stage the practice has been accepted. However, Deputy Mac Giolla is quite right. It is an undesirable practice and Deputies should address the Chair standing, one at a time.
There is no great problem here. As long as section 25 (f) remains the applicant could be charged two fees. As Deputy O'Hanlon said, the simple way around this is to refer to the issue of a duplicate certificate which would clarify the whole matter. We see no problem about charging for a second certificate.
On that point, the line states "the giving to any person of the certificate". Could the Minister tell us who "any person" is?
Naturally we would not be issuing certificates to anyone except to those who were entitled to them.
I am not very clear in this regard.
I am sure Deputy O'Hanlon knows that the council would not issue a certificate to someone who was not entitled to it.
I accept that and I hope that the council would not issue a certificate to someone who was not entitled to it. However, I should like to ensure that legislation was such that they could not issue certificates freely to anyone, even if they felt like it. For that reason this line should be looked at in terms of the re-issue of certification because it is far too loose at present.
There is an intitial fee which covers registration and the issue of a certificate. Deputy O'Hanlon made the point about a fee being charged for the re-issuing of a lost certificate——
We accept that there should be a fee.
It is possible that there may be a nominal charge by the council for the re-issue of certificates.
We accept that.
I presume the Deputies are talking about the amount of the fee?
No, we are saying that that does not appear anywhere in the legislation. We want it written into the legislation that the council would have the power to charge for the re-issue of a certificate rather than this very vague reference to the giving of a certificate to any person which the council could use to charge a second fee at the time of registration.
Has the Minister any intention of registering trainee dentists? I presume we will be dealing with the specialist register later.
I have no intention of registering trainee dentists.
With regard to the persons who may be registered, will there be reciprocal arrangements with other countries which recognise Irish graduates? Is that written into the legislation or will it be a matter for the council?
Those who are entitled to be registered are those who were on the old register, persons who qualify as dentists subsequent to the new register being established, eligible qualifed dentists from other EC countries and dentists from outside the EC who satisfy the requirements of the council in relation to education and training in dentistry.
Would that allow for a reciprocal arrangement with another country which recognises our qualifications?
There may be a problem in regard to France because they do not allow dual registration.
Could the Minister elaborate on that because our legislation states that we will be obliged to recognise graduates from France although they will not be obliged to recognise ours?
A person working in France can be registered only in that country.
Can an Irish graduate register in France?
Do we only have reciprocity to those who recognise us?
Basically it is a matter for the council.
Could the Minister give the reason for having a separate register for dental specialists?
It enables the new council to introduce registration of dental specialists subject to the consent of the Minister. This would be a higher register than the basic register which covers all dentists. Dental specialities are rapidly developing and gaining acceptance within the dental profession and it is desirable that the council should have powers to register appropriately qualified persons in well established areas such as orthondontics and oral surgery. Such registration would be indicative of special qualifications and it would be of interest to the general public. It already exists in France, West Germany and Holland. There are also registers of dental specialists in the USA and Canada.
Will it be entirely at the discretion of the council as to whom they will include in a specialists register?
What will the position of the Medical Council be? Will the Minister be repealing the section of the Medical Practitioners Act which gives the Medical Council the power to deal with dental education?
The council is obliged to satisfy itself that all courses of dental education and training are adequate and suitable. The effect of this is to transfer the educational function in dentistry to the Dental Council from the Medical Council, which exercises that function under the Dentists Act, 1928. This would make dentistry a self-governing profession here as it became in Britain in 1957.
I asked whether it would be necessary to amend the Medical Practitioners Act.
Will this legislation have any effect on the postgraduate Medical and Dental Board?
Will the council have any powers in relation to postgraduate education and, if so, what powers?
Paragraph (a) refers to the undergraduate training provided in the dental schools. Paragraph (b) refers to the standard of examination at primary degree level which entitles a person to registration. Paragraph (c) refers to postgraduate education and training leading to specialist registration.
I would ask about the question of specialties. Are there any specialties which the Minister can name which will be included in the register of dental specialists?
It is basically up to the council.
Is the question of auxiliary dental nurses included in this section?
Not in this section.
The Minister said it would be a matter for the council to determine the specialties to be recognised, but the Bill specifies that the consent of the Minister must be obtained. Why is the Minister's consent necessary?
This provision runs right through the Bill. It applies to section 37 as it applies to other sections.
The Minister has stated that the Dental Council will be responsible for deciding those specialties to be included in the register. I am asking why it is necessary to have the consent of the Minister. Will he be in a position to tell the council that they cannot register a particular specialty?
Why would the Minister want that power?
Basically because the Minister would not want some obscure type of category registered. The permission of the Minister is needed not just in relation to section 37 but throughout the Bill.
The fact that the provision runs throughout the Bill has no bearing on this question. It is incredible that we should set up a very specialised body to recognise various types of specialties and then provide that when they make a decision the Minister has the right to reject their recommendation. These people are the experts. Why keep a dog if you are going to bark yourself?
The Minister would not want a proposal to register every specialty.
He would feel in his maturity that there is no need.
Why bother setting up the council if the Minister is to have the final say?
It is the right of the Minister to have the final say. What else is he but Minister for Health?
This is a fundamental issue. We are talking about a register of dental specialists and it is important that we should know why the Minister wants this power to veto particular specialties if the council decide to include them in the register. Presumably the Minister does not have the power to tell the council whom they should recognise. Why should he have the power of veto?
It is unlikely that it will ever arise and that the Minister would have to say to the council "Thus far and no further."
Why bother putting it in?
Just in the event of its being necessary for the Minister to intervene. It is there for that purpose.
Is the section agreed?
I am not happy about it. It is important that we should go into some detail on points which are not clear. We should be given some idea as to why it is necessary in this section to have the Minister's consent. Much time was spent in the Seanad and in this House discussing the composition of the Dental Council. Surely we should have confidence in the council to decide what specialities should be included in the specialist register. My concern is that a Minister could veto the decision of the council. Why should the Minister want this power?
We do not anticipate that the Minister will have to take any action. The council might try to register people specialising in extractions and others specialising in injections, but the Minister will see no need for that. It would be ridiculous. We would hope that the council in their maturity would act reasonably, as would the Minister.
I would be disappointed if it were implied that the only function the Minister would have would be to stop the council from doing something. Would he not also intervene if he felt that the council were failing to register any specialities? The council will be composed mainly of dentists and the Minister has power to nominate only four people. Should he not ensure that the Dental Council do not attain a monopoly position and refuse to register a speciality?
That is not in the section.
There are specialities in dentistry but not in dental mechanics. It would be up to the council to recognise these specialities and register them accordingly. The composition of the council was dealt with in section 9.
It is not relevant.
Certain contributions were made in relation to the composition of the 19-member council. The Minister has the option of appointing four members and I am sure those appointed will represent the views of Deputies.
We are dealing with section 37.
The Minister must be consulted. In fact, he must give his consent to the determination of the particular speciality that will be registered in the specialist register. Our contention is that that is not necessary. On Deputy Owen's point, there is nothing in the section which gives the Minister power to direct the council to register any speciality. There is provision that if the council want to withdraw recognition from a speciality, they have to have the consent of the Minister. I do not understand why it is necessary to give the Minister this power of veto over who shall be registered in this specialist register. I believe and the Dental Council believe that orthodontists or oral surgeons should be registered. They should have the power to set up a specialist register. I do not understand why the Minister's consent is necessary.
The Minister would not object to that.
Why not withdraw it from the Bill if the Minister would not object to it and we would all be happy?
It is necessary to have that power there. As I said, we do not anticipate that the Minister will need to use the power.
If we persist in bringing the Minister into all these issues such as the right to veto, I wonder about the necessity for having a council at all. We will select 19 eminent people to represent the dental profession on this board and we are now suggesting that they can make no decision. The Minister said the phrase "with the consent of the Minister" runs right through the Bill. Why bother with a council at all?
I have already replied to that.
Subsection 7 (c) reads:
a person, being in attendance before the Fitness to Practise Committee does anything which, if that Committee were a court of law having power to commit for contempt, would be contempt of court,
Who would try the dentist in such a case?
This deals with the procedures relating to the holding of inquiries. The registrar notifies the person concerned and informs him of the nature of the evidence to be considered. He also presents the evidence to the committee unless the committee agree to some other person such as the complainant or his representative doing so. The committee is empowered to summon witnesses to attend in the same manner as if it were the High Court. The person who is the subject of the inquiry and his representative, if any, shall be given the opportunity of being present at the hearing. These latter provisions are already contained in the 1928 Act. The committee present their report to the council. The power to act in the case of a dentist who is considered unfit to practise for reasons of ill-health follows a similar provision in the Medical Practitioners Act which was recommended by representatives of the medical organisations who reported to the Minister in December 1975.
Have the committee power to try the person and on summary conviction to fine him a sum not exceeding £1,000?
Yes. The Fitness to Practise Committee.
The Bill provides that "such person shall be guilty of an offence and shall be liable on summary conviction to a fine not exceeding £1,000". The Fitness to Practise Committee have the same power as a court of law.
Any decision by the Fitness to Practise Committee in relation to these matters has to be approved by the court.
Subsection (1) (b) refers to alleged unfitness to engage in such practise by reason of physical or mental disability. Who decides on the fitness or unfitness of a person by virtue of physical or mental disability? We had a similar discussion on the Nurses Bill. I accept that it must appear in the fitness to practise section, but there is a grave difference between being declared unfit to practise by virtue of professional misconduct and of being physically or mentally unfit. It is a pity that these two sections are included together. Has the Minister any views on that?
Basically there are adequate safeguards in the Bill to protect the rights of the individual.
Who decides that a person is unfit to practise by virtue of mental or physical disability?
The Fitness to Practise Committee.
What are the safeguards the Minister mentioned?
Any decision made by the Fitness to Practise Committee has to be confirmed by the court. That is the basic safeguard.
It must go before the court?
Any decision they make, even if it is not appealed by the individual in question, has to be confirmed by the court. They would move in that direction to have it confirmed even if it were not appealed.
Under what section?
It is in some section.
It must be under section 38 if we are to discuss it.
What paragraph in section 38?
It is in section 39.
I want to ask two questions on section 38. Where a member of the council and in particular where a member of the public requests the Fitness to Practise Committee to inquire into the fitness of a dentist, the council can overrule the Fitness to Practise Committee. Is that correct? Am I interpreting that correctly? If the Fitness to Practise Committee decide not to hold an inquiry the council can overrule them or, vice versa, if the Fitness to Practise Committee decide to hold an inquiry the council can overrule that decision also. The section says that where an application is made and the Fitness to Practise Committee, after consideration of the application, is of the opinion that there is not sufficient cause to hold an inquiry, it shall so inform the council and the council may decide that no further action shall be taken, or direct the committee to hold an inquiry. I wonder if the reverse is also true. If the Fitness to Practise Committee decided to hold an inquiry could the council overrule it? Is there any further recourse for a member of the public who is unhappy about the fact that the council will not allow an inquiry? Can that person go to the court?
Subsection (1) enables the council to hold an inquiry into the fitness of a registered dentist to practise by reason of his or her ill-health or alleged professional misconduct. Subsection (2) enables the Fitness to Practise Committee to decide whether there is sufficient cause for holding an inquiry and advise the council accordingly.
But the point is, can the council overrule in any case they wish, and does the person have any further recourse to demand an inquiry into somebody's professional competence? Does the person have to like it or lump it if the committee decide there are not sufficient grounds? Can he not take the matter to the court?
A person has the right under common law to pursue the matter whatever way he or she wishes.
Section 38 (9) states;
If the Fitness to Practise Committee requires the dental records of a patient of any registered dentist to be produced for the purpose of any inquiry conducted by that Committee, such records shall not be made available to the Fitness to Practise Committee without the consent of the patient concerned, unless that Committee specifically directs the registered dentist concerned to produce such records.
Does that latter phrase waive the right of the patient concerned? It appears to be a contradictory statement. Perhaps I am not interpreting it correctly. If the dental records are required, the permission of the patient must be given and if they direct that these be supplied they do not have to go near the patient. Is that what this section means?
This prevents the production of a patient's dental record without his consent except where the committee specifically direct the production of such record. This is to protect the dentist against any claim for breach of confidence in relation to information supplied about a patient by a dentist.
In the one instance, they require the dental records to be produced for the purpose of an inquiry but say that they should not be made available without consent. Do the committee take the direct responsibility if these records are directed to be produced?
Is the dentist exonerated from a claim of breach of confidentiality?
That is correct.
To get back to my initial point on section 38 (1), (a) and (b), there is a whale of a difference between one being declared unfit to practise by virtue of being involved in professional misconduct, for instance being a drug addict, and one who has been involved in a road traffic accident and has lost his right hand. As things stand, both these people will be declared unfit to practise. This is unjust. Some provision must be made to differentiate between the two cases.
I presume a drug addict would be an unsuitable person to practise dentistry.
I do not deny that at all.
I would be equally of the opinion that a person who has lost a hand would have his ability to practise dentistry inhibited.
I do not deny that either, but does the Minister not agree that it is unfair to lump the two cases together and say that they are both unfit to practise?
I do not think it is intended to lump them together. There is a great difference between the two.
That is my point.
Nobody is trying to associate the two.
I would agree with my colleague, Deputy Ormonde. Professional misconduct in one thing and certainly we would all agree that the Fitness to Practise Committee should operate with all the power and force available to them to ensure that anybody guilty of professional misconduct would be declared unfit to practise. We all agree that that should be well provided for in this legislation. The point Deputy Ormonde is making is that it appears a little harsh that somebody who through no fault of his or her own, through physical illness or mental disability should be put before the Fitness to Practise Committee in the same way as somebody guilty of professional misconduct. Would the Minister look into this matter? When we were discussing the Nurses Bill there was great concern about this. In the United Kingdom there is a different procedure altogether for dealing with nurses who are unfit to work because of a physical or mental disability. These cases are dealt with with a lot more privacy and sympathy than going before what, effectively is a court of law.
The person who suffers a physical disability during the course of his life would not be suitable to practise and the council would not approve them as suitable to practise dentistry. Anyone with such disability would not try to get into the profession. It is basically for the council to determine these cases.
I am asking why a person who through no fault of his or her own, working as a dentist, develops some illness that would preclude him or her from engaging in the practice of dentistry would be tried before what is a court of law, the Fitness to Practise Committee, in the same manner as somebody who has been guilty of professional misconduct.
They are being judged by their peers, by people in a similar profession.
That is not my question. I appreciate that they are being judged by their own peers. Why should it be necessary to bring a person who suffers from some illness which precludes him or her from practising dentistry before this elaborate committee which is effectively, a court of law?
That would only arise in the event of an individual wanting to continue to practise dentistry with one of the disabilities which have been referred to. If the individual stopped practising, the question would not arise. The natural thing to do would be not to continue to practise dentistry. The safeguard is there. It is up to the Fitness to Practise Committee to judge an individual who may want to continue to practise in his profession but perhaps in the Deputy's, or my view, or the view of the general public, is not fit to do so. That is the only reason for that.
I accept that. My next question is, what constitutes professional misconduct? Must it be something connected with the dentist's work, or could it be that he was convicted of, say, drunken driving? What, effectively, constitutes professional misconduct in the context of this legislation?
It is for the Fitness to Practise Committee to deal with that question.
I accept that it is for the committee to deal with any question that is sent to them, but what kind of offences will be sent to them? Will they be in connection with the dentist's work, or can other offences committed outside that work — for instance, drunken driving — be referred to the Fitness to Practise Committee?
Druken driving would be dealt with by any court.
It is up to the council or a person to make a complaint about a dentist before the dentist comes before the Fitness to Practise Committee. Do the committee have the discretion, like the Planning Appeals Board, to decide that the complaint is a spurious one, not properly brought before that committee? If somebody decided that he did not like the way the dentist carried on, not paying his taxes for instance, he might decide to get at the dentist by reporting him to the Fitness to Practise Committee. Would that be dealt with under subsection (2), where the committee would say there was not sufficient cause to warrant the holding of an inquiry?
Yes, it would.
Is that the safeguard against a spurious complaint?
That is correct. They could follow that course, if they wished, under common law and take an action against a dentist, just as against a doctor, or politician, or anybody else. I am informed it will not be a District Court.
The Minister has said that dentists, like everyone else, can be tried in the common law courts. I am asking if a dentist is convicted of an offence, either trivial or serious, will that be referred to the Dental Council?
That is not professional misconduct.
The Minister is satisfied that it will not be referred to the Dental Council?
Yes. We are talking about professional misconduct.
When we were discussing the Nurses Bill the Psychiatric Nurses Association had a specific worry in relation to being involved in industrial disputes and taking strike action. There is a danger that that could be regarded as professional misconduct and they could be deemed unfit to practise. Can we get an assurance from the Minister on that point?
It is not relevant in dentistry.
It is relevant in everything.
That is my opinion of it.
Is the Minister saying that there is no such thing as industrial action in dentistry?
I have not come across it.
What about dentists employed by a health board? As a result of some decision taken by a health board in relation to salary or some other matter, the dentists employed by the board might take industrial action.
I doubt if that would arise. The biggest problem is to get dentists to work with the health boards. They seem to prefer private practice.
The same thing applies with regard to any group of dentists. For instance, if dentists in the Dental Hospital take industrial action, can they be deemed unfit to practise because of professional misconduct?
That is not professional misconduct. I do not know what point the Deputy is making.
I support the point made by Deputy Ormonde. It is not sufficient for the Minister to say that the question will never arise, that dentists may never be involved in such instances. They could be involved in numerous cases in the future, even if they have not been involved in the past. The Minister should answer the question asked rather than say it is unlikely that dentists will be involved in industrial action. The question is, would that be regarded as professional misconduct?
It would not be regarded as professional misconduct.
With regard to failure to pay the retention fee, could a person be referred to the Fitness to Practise Committee in that connection?
No, they would just be removed from the register.
Is the Minister saying that the Fitness to Practise Committee have no powers in relation to failure to pay retention fees?
I have already dealt with that in section 37.
We are dealing now with the Fitness to Practise Committee. I am asking the Minister if a person can be referred to that committee for not paying retention fees.
That is not professional misconduct. If a person does not pay the fee, naturally he will no longer be on the register.
The Minister seems to be harping on the issue of professional misconduct. I go back to my original point, namely, that it seems a little unfair where a person may be declared unfit to practise because of some physical disability.
Is the Deputy advocating that a person with a severe physical disability should be allowed to practise dentistry?
I am advocating that he should be treated differently from the person who was charged with professional misconduct.
There is no point in my replying to that, because I have done so about four times.
Is there an obligation on the Fitness to Practise Committee to notify the dentist who is registered of a decision to erase his or her name from the register?
Section 39 (3) (b) states:
If at any time the Council satisfies the High Court that such person has delayed unduly in proceeding with the application,...
Will the Minister give some idea of what would be an undue delay?
Before making a decision the council must notify the person concerned, who has the right to appeal to the High Court against the council's decision within 21 days. If the person concerned does not appeal to the High Court or if he does appeal but delays unduly in proceeding with an appeal, the council may apply to the High Court for confirmation of the council's decision. In this way the council's decision is subject to review by the court before it is enforced, and this ensures it is in conformity with the provisions of the Constitution.
I really wanted to know if the Minister could give us an idea of what is meant by "unduly". Does he mean three months, six months or a year? If a dentist was found guilty of professional misconduct but was away from the country at the time and if he returned a year later and decided he wanted to clear his name, would that be considered an undue delay?
Basically that would be up to the council. If a decision is given by the council against an individual that person has the right to appeal to the court within 21 days. If the person does not do that, the council can proceed to the court to get their decision confirmed by the court. There is no timescale put on that, but I presume that within a matter of a few months the council would proceed to the courts to get their decision confirmed.
While the person concerned has 21 days to appeal, subsection (3) (b) seems to imply that the 21 days period is not binding. The wording seems somewhat loose.
An individual could appeal within 21 days and while waiting for the appeal could continue to practice.
Section 39 (1) (b) sets out that where a registered dentist has failed to pay his retention fee within two months his name will be erased from the register. Will the Minister not agree this is a very short period? Having regard to extended holidays and leave of absence, a two-month period away from one's home is not unusual. When that person comes back he may find his name has been erased from the register. Is a prepaid letter a registered letter? Surely it is just an ordinary stamped letter.
Would the Minister consider that, because if a registered letter is sent somebody has to sign it and nobody could claim that they had not received the notice. I thought prepaid meant registered but I have just been informed now that it does not. Perhaps the Minister might reconsider this.
Basically the Bill was drawn up to ensure that it was constitutional.
Would the Minister not agree that a two months period appears very unreasonable? Surely it would be better to extend it to a minimum of six months. I am thinking of a person who has done absolutely nothing, who has been unfortunate enough to be away from his residence for, say, ten weeks, coming back and finding himself having been knocked off the register.
The reason there is a particular time limit is because of consultation with the various bodies and people interested in this Bill. It was as a result of having spoken to them, along with the input of the Department and of the Minister himself; that the two months limit arose. I presume if it were extended to four months Deputy Ormonde would then be making the case that it should be extended to six months.
I would have said six months at the very beginning.
I presume he would. It was as a result of deliberations with many people that the two months' notice arose.
Could the Minister tell us which were the various bodies consulted and who agreed to the two months?
The Dental Board, the Irish Dental Association.
And did they agree to the two months?
In other similar legislation before the House was there agreement on two months?
What similar legislation?
The Nurses Bill, for example.
The Minister himself having dealt with Committee Stage of the Nurses Bill I cannot allude to that or be definitive about exactly what is in that.
That is the point I want to make. Deputy Ormonde has raised a very important and valid point because two months is too short a period. For example, if a dentist went to work in the Third World for a year he would not want his name fo be removed from the register in his absence. The point was raised on the Nurses Bill and debated with the Minister. The Minister recognised that probably the period was too short and said he would come back to it on Report Stage.
This was agreed with the profession itself. They agreed that two months was the correct time scale.
Would the Minister of State not be prepared to concede what the Minister conceded on the Nurses Bill, have another look at this and come back on Report Stage——
There is no need to have another look at it——
——and possibly extend the time to something more reasonable, like six months?
We are of the opinion that there is no need, having consulted with the people in question. It was agreed by the profession itself. Why should we extend it when they are satisfied with the two months?
I should like to ask the Minister if the profession themselves specified that the two months were satisfactory or did the profession not object to the inclusion of two months in the Bill?
They did not object to it.
They did not specify that two months was a suitable period?
They did not specify the two months.
I would ask the Minister of State to consider what the Minister himself has already agreed, that is, to look at this before Report Stage, because it is of fundamental importance. We are talking about the right of a dental surgeon to practise, to pursue his or her career. A dental surgeon might well go off to work, say, in the Third World or, as Deputy Ormonde said, might go on an extended holiday, returning after two months to find that his right to pursue his career had been taken from him. I believe the period is too short and I see no merit in having that short a period. Six months would be equally effective and would mean that within the year he was due to pay his retention fee he would lose his right to practise. We must be careful to ensure that we do not take away the right to practise from a dentist for failure to pay his fee, particularly if it is not through any fault of his that he happened to be out of the country for an extended period.
The whole section hinges on a person's right to appeal a decision. If in the first place he did not receive notice that his name is to be removed from the register then he cannot take the successive steps thereafter. By virtue of the fact that he has not received the letter notifying him that his name has been taken off the register, he cannot appeal within the 21 days. The whole matter hinges on the fact that the people to whom such letters are sent actually receive them. I am satisfied if the Minister can assure us that the council will be able to guarantee that the message gets to the dentist in question. I would not agree with the usage of the words "prepaid post". In a number of other Bills there is reference to registered post which means that somebody must sign for such a registered letter, when one would know that it was received by the person or a member of his or her family. If the Minister can tighten up on this provision of prepaid post that would ensure that at a later stage somebody who had been out of the country for a year would not have a claim that he was unaware his name had been removed from the register.
If a letter was registered it would be returned if somebody had not signed for it. But if it is prepaid, or any other type of post, all one can do is send it to last known address. Basically the council are not under an obligation to trace the whereabouts of dentists who have gone here, there, or elsewhere. What can they do but send the letter to the last known address and, if there is nobody at that address, then it is not the duty of the council. The onus should rest more on the dentist himself to let the council know of his whereabouts.
I would not disagree with what the Minister says. All I am concerned about is the time given to the dentist in order to fulfil his obligation to pay his retention fee. I believe two months is too short a period in certain cases where a dentist might be out of the country, when he might be working somewhere for a year or be on an extended holiday, or for some other reason might be unable to receive that letter. I do not think it is the duty of the Dental Council to find out where he is. It is up to him to notify them of his change of address. But if they do write to his home address, say, in this State and he happens to be working in, say, the Third World, he should be given sufficient time to receive that correspondence and deal with it. In those circumstances I believe two months is too short and it should be extended. I do not think the Dental Council or the Bill would lose anything by having that period amended to, say, six months.
Bearing in mind the population of dentists in this country, one is not talking about an enormous number of people.
That is all the more reason we should change it.
The number is quite small. They are well aware of the legislation that was in force. They are aware of the fact that this Bill is going through, has gone through Seanad Éireann and, by virtue of their presence here today and that of their representatives, they know that this Bill is going through this House. Having been in consultation with the profession we are of the opinion that the two months included in this section is sufficient.
In order to speed up proceedings would the Minister consult the Irish Dental Association and the Dental Board before Report Stage and establish whether they are satisfied that two months is a sufficient period of time? If they are satisfied we will be satisfied. The Minister has laid much emphasis on the fact that he believes that it is their wish that it should be two months. I would respect their wish, but I still believe two months is much too short. As the Minister himself says, it is a small number of persons only involved, which is all the more reason we should cater for that small number by extending it to six months. I do not think it will make any difference to the income of the Dental Council or lead to more people failing to pay their fee. I would ask the Minister to consult with them because he has laid much emphasis on his belief that this is what the Dental Board and the Irish Dental Association want. They seem to be generally satisfied. Because we have a relatively small number of dentists they would be well aware of what is in this legislation. Nobody will acquaint themselves with the contents of this Bill faster than the members of the dental profession.
At that stage it will be too late.
Too late for what?
The two months period will then be a fact of life.
The Deputy is trying to make a mountain out of a molehill.
This relates to the right to practise their profession and we cannot treat it frivolously. We are not making a mountain out of a molehill. We wish to ensure that persons on the dental register will have a reasonable time in which to pay their fee, for instance, if they were out of the country for some reason.
It is reasonable as it stands.
Do we take it that the Minister is not prepared to discuss with the dental professional bodies whether they are satisfied with the two month period? As Deputy O'Hanlon said we are talking about a person's livelihood. We are talking about erasing somebody from the register. One would think there is enough unemployment without adding to it.
There is no unemployment in the dental profession.
Does the Minister want to wipe them out?
Section 40(1) says:
40.—(1) The Council, following an inquiry and report by the Fitness to Practise Committee under section 38 of this Act, may decide to attach such conditions as it thinks fit to the retention in any register maintained under this Act of a person whose name is entered in such register. What sort of conditions could they attach to the retention of such a person on the register?
The council may apply any conditions on notifying the person concerned, who may appeal to the High Court. If the person does not appeal or delays unduly in processing the appeal the council may apply to the court to have this decision confirmed. We had this in another section in a similar situation. The council decisions are subject to review by the court before they are enforced.
Will the Minister say what conditions he had in mind when he wrote this into the legislation?
A person may be prevented from practising a certain procedure in dentistry because he may not be qualified.
Will the Minister qualify that? If one is a registered dental practitioner he must be qualified in all aspects of dentistry.
In the first place a dentist would be in breach of some rule of conduct before coming before the Fitness to Practise Committee.
We accept that but we want to know what conditions the Minister may lay down.
The individual could be allowed to lecture in dentistry but because of a physical disability he might not be allowed practise.
The section says quite clearly that following an inquiry and report by the Fitness to Practise Committee, the council may decide to attach conditions. I wish to know what conditions the Minister had in mind when he wrote that into the section. Surely it has nothing to do with the dentist's right to extract teeth, fill teeth or lecture on dentistry. Following a decision of inability to practise by virtue of physical infirmity, perhaps the council could decide in a certain way, but in relation to professional misconduct, when this section was written, what had the Minister in mind when he said that they could attach such conditions as they think fit?
It would be up to the council to decide. The case of physical disability would be an outstanding case where an individual would not be allowed to practise but would be allowed to lecture.
Would it need the authority of the Dental Council to lecture in dentistry?
Not necessarily but a person by virtue of his physical disability would be prevented by the council from practising dentistry.
That is not sufficient. It is part of the legislation and we should be absolutely clear as to the conditions the Minister had in mind when he gave this power to the Dental Council to attach conditions.
I have already answered the question. It is basically up to the council to attach conditions if they see fit. The council with a high proportion of dentists would not attach severe conditions to an individual's right to practise. If, for instance, a dentist was prone to beating up children, the council could attach conditions.
He could not practise on children?
I am not saying that there are individuals in the profession who are prone to that sort of thing but it could happen. It is up to the council to look at the individual in question. Unless there was some misconduct the person would not come before the council anyway.
To follow that logic to its conclusion a dentist could be confined to just practising on males.
If a dentist were given to beating up children or any other people he would be erased from the register. We would expect that from the dental profession. Am I correct in assuming from what the Minister is saying that the Dental Council can attach any condition they like because there are no guidelines laid down? The Dental Council can impose any condition that comes into their minds after a report has been made from the Fitness to Practise Committee.
From what Dr. O'Hanlon says, he certainly does not hold the dental profession in high esteem. We are dealing with a group of highly trained professional people and we would hope that they would act in a mature manner. There would be no great problem.
Is section 40 agreed?
No, I am not happy about it. It is very important to know what the Minister had in mind when he wrote into the legislation that the council would have the power to attach such conditions as they see fit to the retention on the register of any person.
As I have already said, there must be some irregularity if a dentist is brought before the Fitness to Practise Committee. The individual, therefore, is there for some reason. It is up to the council to decide on the issue. It must be remembered that we are talking about other members of the dental profession and it is up to them to attach the conditions they wish. The most outstanding example I can give the House is the case of an individual who, in the course of his work or following an accident suffered a physical disability which in the view of members of his own profession would prevent him practising dentistry in a manner they considered appropriate. Naturally enough, that individual may be considered suitable for lecturing or other purposes but would not be suitable for practising dentistry. Any decision in relation to conditions laid down in regard to a dentist may be appealed. If an individual is not satisfied with a decision of the council he or she may appeal to the court and, in the event of the individual failing to appeal to the court, the council goes to the court to have its decision confirmed.
We cannot agree to this amendment on the basis that we do not know what conditions the council may attach to the retention of a person's name on the register.
What is the difference between "admonish" and "censure" in relation to the professional conduct of a dentist?
The section empowers the council to advise, admonish or censure a person who has been the subject of report by the Fitness to Practise Committe. I presume the words mean that the council will talk to the individual concerned. The words used are a matter for the committee and the individual involved. Is the Deputy asking me if the individual will be asked to hold out his hand for the administering of some type of punishment?
I was interested in the words advise, admonish or censure and I wondered how much they meant. Do they simply mean a dressing down of the dentist, saying to him or her that having been found guilty of some professional misconduct he or she would be admonished? Will the Minister explain the reason for section 2, which seems to give the council power to do away with the recommendation of the Fitness to Practise Committee that a dentist should be censured by the removal of his or her name from the register? Does the section under discussion mean that the council can substitute such a strong censure by a dressing down, an admonishment or advice to the dentist? Obviously, it gives the council an overriding power even if it receives a strong report from the Fitness to Practise Committee. Is that a correct interpretation?
It is very hard to put into words what is meant by admonishing or censuring a person. We must remember that it will be a question of one crowd of dentists judging another member of the profession. The powers are additional to those that the dental board have under existing legislation. At present the dental board is only empowered to erase a dentist's name from the register. That has the effect of debarring a dentist from engaging in the practise of his profession. That rather drastic measure is in itself inadequate in dealing with minor transgressions, and hence the need to introduce a range of lesser penalties than removing from the register the name of the dentist.
On section 38 the Minister told us that the council was obliged to refer cases, where the Fitness to Practise Committee had found somebody guilty of an offence and imposed a penalty, to the High Court for confirmation. Section 42 deals with this problem. It appears under subsection (4) that the council has the power to apply if they so wish, if the dentist does not use his or her right of appeal within 21 days, for confirmation of the decision. There does not appear to be any obligation on them, as the Minister told us earlier in the debate on section 38.
The section basically provides that the council may decide to erase from the register the name of a dentist who has been convicted of an indictable offence. The person concerned must be notified of the decision and he or she may appeal within 21 days to the High Court. If the dentist does not appeal, or delays in proceeding with the appeal, the council may apply to the court to have its decision confirmed.
That is my point. Earlier the Minister told us that the council was obliged to have the decision confirmed by the High Court. We were referring specifically to the power of the Fitness to Practise Committee to try somebody and, on summary conviction, to fine that person £1,000. We were told that that decision would have to be confirmed by the High Court, but it appears from this section that the council has the discretion of whether to apply or not to the High Court to have the decision confirmed.
I have given the information at my disposal to the Deputy. If the person concerned does not appeal, or delays in proceeding with the appeal, the council may apply to the court to have its decision confirmed.
Does that mean that the information we were given earlier is incorrect and that, in effect, the Fitness to Practise Committee have the power to fine somebody guilty of an offence on summary conviction a sum not exceeding £1,000 and do not have to have this confirmed in the High Court?
The person concerned must be notified of the decision. That person may appeal within 21 days to the High Court if he or she is not satisfied with the decision. That seems to imply that there may not be any need for the council to apply to the court to have its decision confirmed.
May we take it that the Fitness to Practise Committee has the power to try a dentist, fine him or her £1,000 and does not have to have that confirmed by the High Court?
In the case of action in respect of conviction for a crime it is not considered necessary that a hearing by the Fitness to Practise Committee should be held to establish the facts of the case, since the person has already been convicted by the courts. The council has to satisfy itself that the seriousness of the crime is sufficient to warrant erasure or the imposition of a lesser penalty. The council's decision is also subject to review by the High Court.
Is that what is meant in section 42 (7)? If the High Court rules that the decision of the council that the person's name be erased stands, subsection (7) seems to give the council power, without having to go back to the court, to restore the name to the register. Is that a correct interpretation: that the name of the person which has been erased under this section may be restored to the register without any action back to the court?
Yes, it empowers the council to restore to the register the name of the person which has been erased under this section subject to such conditions as they see fit to impose including the payment of a further registration fee.
Unfortunately, we are back to the phrase "We attach to the restoration such conditions". Could the Minister give some indication what these conditions might be?
That arises under section 40. We have dealt with that. We are on section 42 now.
It is also in section 42 (7).
We have dealt with this already. We spent half an hour talking about it. We have already explained "such conditions as they see fit".
Could the Minister give some indication to what these conditions might be?
Does the Deputy want a repetition of what I said?
No, just name three or four.
The most outstanding one I can name, and I will repeat it, relates to an individual who has a physical disability, so to speak, and who may be very good at the lecturing end of it but would not in the view of his fellow dentists be able to practise dentistry.
Section 47 provides that:
—The Council shall notify the Minister on the occasion of—
(a) the erasure of the name of a person from a register maintained under this Act.
Does he also have to notify the employer? We referred earlier to the health boards and other such individuals. We came up against this also in the Nurses Bill and there was some confusion on it. I presume it is not sufficient to notify just the Minister. Would he notify the employer and other people concerned?
It obliges the council to notify the Minister of disciplinary action which they have taken. This is necessary to ensure that appropriate action is taken by employing authorities in the case of dentists working, say, in the public health service.
According to this the only person to be notified is the Minister.
It obliges the council to notify the Minister of the disciplinary action they are taking against people. Naturally, the council would have to notify the individual in question but it is obligatory on the council to notify the Minister.
We covered that in another section when we referred to prepaid postage and we are still not sure whether they are to be notified by registered post. We accept that the Minister must be notified by the council. We on this side of the House believe that the employer should also be notified of the council's decision.
The Minister would notify the health boards and they are the employers.
In relation to the health boards, but that does not apply in other areas.
What other areas is the Deputy talking about?
A dental hospital, for example.
A notification would also be sent in cases like that.
To the hospital in question.
This section does not say that.
It obliges the council to notify the Minister of the disciplinary action they have taken. When that is done then it is up to the Minister of the day to notify the people who would come within his normal jurisdiction. Naturally, the individual in question who is part of the procedure of the disciplinary action we are talking about would be notified also and I presume his employers would be notified too.
What about the private consumer of dental services? How is he or she to know that the dentist he or she has been attending perhaps for a few years has been struck off the register? Does this Bill provide anywhere a safeguard to ensure that a member of the public who is paying for private dental treatment will be appraised of the fact that somebody is no longer competent to practise as a dentist? Is there any obligation on the Minister to put a notice in the newspapers after being notified of this? Such a safeguard may be somewhere else in the Bill. It is not enough just to safeguard people in dental hospitals or the health board area. There are many private consumers also.
There is no question of putting into the newspapers a notice to the effect that a person has been knocked off the register, but his name would be erased from the register of the Dental Council. Also under this legislation it would be necessary for the dentist to show the relevant certificate and have it on display at his place of work. If a dentist was found guilty of misconduct and his name taken off the register, he would not be allowed to display his certificate of competence and so forth, but in the event of his displaying the certificate action can be taken against him by the Dental Council.
Is there an obligation on the council to delegate somebody to ensure that that dentist removes his certificate? Most members of the general public do not look for the certificate hanging on the wall of a solicitor or anybody else. Is there a gap here? People could continue to go to such a dentist. Have the council an obligation to direct one of their servants to pay a visit to the dentist who might be struck off the register to ensure that this certificate is removed?
We are talking about a very small number of people in a country where seemingly more than in any other country everybody knows what the other fellow is doing or at least makes an attempt to know. If a dentist's name was erased from the register that would become generally known. If he appealed to the High Court against the decision a great deal of publicity would emanate from that and as a result it would be common knowledge that this individual was found guilty of an offence and that he was no longer allowed to practice dentistry. There is no problem in relation to letting the public know that an individual in the opinion of the Dental Council is not entitled to practise. News travels fast in this country and people tend to talk about such things. I am sure there will be no problems.
Surely the Minister is not suggesting that people might be fortunate to hear about it from their next door neighbour. That is not what Bills in this House should be about. By virtue of the fact that the Minister has said that we are dealing with a very small number of people, why is he not prepared to notify those other than the Minister? Surely it is important that the employer concerned should be notified that their employee has been erased from the register.
I accept that the Minister is doing a good job in piloting this Bill through the House, but on a couple of issues he is being too rigid. He should be prepared to give in and this is one area in which he could give in. I do not see any problem in the Minister taking another look at this and saying that as well as the Minister, the CEO of the health board, the employing authority, the CEO of the dental hospital or the boss of a dental practice, should be notified. There are only a small group involved so it should not be difficult to tell more than the Minister what is going on.
As I said, it is necessary for the council to notify the Minister of any disciplinary action taken, the purpose being that appropriate action can be taken by health authorities on notification from the Minister of the result of the disciplinary action taken by the council against the particular individual.
Nowhere in this Bill does it say that the Minister must tell somebody else what he has been told. Commonsense suggests he will do that, but there is no onus on him to tell the CEO of the health board that a certain dentist has been struck off.
Irrespective of whether there is an onus on the Minister to do that, it would be the natural thing for him to do. The council are obliged to notify the Minister of any disciplinary action taken and the natural thing for the Minister to do would be to notify the employing authority, generally the health boards. Most dentists are in private practice, so when we are talking about the employing authority in general we are talking about the health boards.
We all accept that the present Minister and the Minister of State would notify the health boards but there is no obligation on them in this legislation to do so. This legislation will probably last well into the next century and we do not know what attitude a Minister might adopt. He might not be as practical as, or have the common sense of, the Minister of State to notify the health boards.
Or the Opposition spokesmen.
My view is that we should write into all legislation of this nature that the employer or the employing authority would be notified where a professional person is removed from the register and the right to practise is taken from him. That should be fundamental in legislation of this type. We had an amendment down on the Nurses Bill and I quote from the Official Report, 6 March 1985, column 1730, where the Minister for Health said:
I will prepare an amendment for Report Stage whereby the employing authority will be notified in the event of there being an employer in existence. We can get agreement on a drafting formula.
The Minister recognised the same problem which the Minister of State recognised this morning but the only difference was that the Minister was prepared to do something about it.
He is less rigid.
I recognise that there would not always be an employing authority in existence, but the Minister told us that where there was an employer in existence he would prepare an amendment for Report Stage to ensure that the employer would be notified. I believe this is in the public interest because we wish to protect the public in this legislation. Therefore, it would be very important that an employer be notified that a dentist's name had been removed from the register. It would be very serious if the Minister was notified of this but through an error did not notify the health board and they continued to allow the dentist to practise. It is in the interest of the public, the dental profession and the Minister that an amendment be prepared to ensure that an employer, where there is one, would be notified of the decision to remove the name of a dentist from the register.
I share the concern expressed by Deputy O'Hanlon and Deputy Ormonde but I do not think their suggested amendment would solve my problem. As a private individual I am an employer of a dentist. How do I know if I should continue to send my children to a certain dentist for treatment? Section 51 says it is an offence to continue to practise, but there is nothing in the Bill which will enable an individual to ensure that such a dentist will not continue to practise. I accept what the Minister said about the publicity attaching to a High Court case where a dentist has been struck off for professional misconduct because that would be big news, but if somebody is struck off because he has not paid his retention fee, that will not get into the papers. If I go to such a dentist for treatment and if I have a complaint to make the council will say there is nothing they can do because that dentist was not registered and I should not have gone to him for treatment. There is a gap here and there should be some way for the public to know when a dentist has been struck off the register. When I look into a dentist's eyes I will not know if he is registered, he may still have his registration form hanging in his surgery.
On the question of notification of the erasure of a dentist's name from the register to the dentist's employer as well as to the Minister, this is unnecessary and would not be practicable in many instances. The Dental Council would not have up-to-the-minute information on the employment of all dentists on the register, and dentists tend to move around a bit, particularly in the early part of their careers. 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.
Does Deputy Owen expect the Minister or the Dental Council to write to everybody on the register of electors? Most of these cases would get a certain amount of publicity because the case would be brought to court. Does the Deputy expect the Minister to write to everybody on the register saying that a certain dentist is not entitled to practise dentistry because of such and such?
Of course I do not expect the Minister to write to everybody on the register of electors but would it not be realistic to expect the council to implement some service whereby they would attend at the dental practice and perhaps post a notice to the effect that the dentist is no longer a registered dentist. It may be up to the council to make that kind of rule, and if it is I am satisfied that the council have the freedom to do that. I do not expect any Minister to write to 65,000 people on a register who might be attending a dentist in a particular area, but there should be an onus in this legislation to ensure that the information is transmitted to the people who will continue to attend a dentist who is struck off the register. The only valid way is perhaps by displaying a notice at the surgery.
There would be a lack of such a notice at the surgery because the dentist would not be allowed to have it. This would indicate that the individual was prevented from practising.
The most dangerous part of this Bill is Part VI. Most people assumed when this Bill was first mooted that its purpose was radically to alter the 1928 Act and to end the dentists' monopoly on the profession of dentistry, including denturists, dental technicians and auxiliary workers of all kinds. This was recommended by the Restrictive Practices Commission in 1982 when they held a sworn public inquiry into the dentist's monopoly and issued a report. Part VI of the Bill includes sections 49 to 52.
We are dealing now with section 49.
The beginning of Part VI relates to restrictions on the practice of dentistry. The only amendment I have put down is in relation to section 51. I understood that the Bill was to end most of these restrictions but Part VI reinforces everything and contravenes the recommendations of the Restrictive Practices Commission. Is it the intention of this Bill to reinforce and strengthen the 1928 Act to ensure that dentists have a total monopoly?
Most of the points raised by Deputy Mac Giolla relate to section 53 rather than section 49.
Section 51 as well.
Certainly not section 49. It would be better to deal with them at the appropriate time.
I wanted to ask a general question regarding the purpose of Part VI.
On Committee Stage we must deal with the Bill section by section. The question that the Deputy is now asking about Part VI and the general intent would have been more appropriate on Second Stage. I am bound to go through the Bill section by section but I have no objection to the Minister's giving a general answer if he wishes. We cannot labour the question of Part VI. That would be contrary to the procedure for dealing with a Bill in Committee.
Subsection (1) of section 49 provides that a registered dentist may use the titles "dentist", "dental surgeon" or "dental practitioner". While there is no legislative basis or special status for the title "dental surgeon" under the Dentists Act, 1928, it is in common use. Subsection (2) contains provisions which are found in the Dentists Act, 1928, which require a dentist to use the name by which he is registered and preventing the use of titles or descriptions which would suggest that he is more highly qualified than he is. It is particularly relevant with the proposed establishment of a register for dental specialists. Subsection (3) provides that a person who contravenes subsection (2) shall be guilty of an offence. Subsection (4) provides that the council may specify that those qualified in a particular dental speciality may use a particular title to indicate their higher qualifications. This would be of assistance to the public in seeking treatment.
Could the Minister give an example of a dental speciality which would become so distinctive that a dentist could use a title other than "dentist"?
Orthodontics and oral surgery would be two.
Section 50 (1) states:
A person who is not a registered dentist shall not take or use the title of dentist, dental surgeon or dental practitioner and a person, who is not a registered dentist, shall not take or use any title or description which implies that he is a registered dentist.
It is very vague. If a person uses a title such as "denturist" it could be taken as implying that the person is a registered dentist. In the UK and other European countries, as well as in the United States, "denturist" is an accepted term. Would the Minister say whether the use of that description would imply that a person was a registered dentist?
No. Section 50 makes it an offence to represent oneself as a registered dentist when this is not the case.
One must go by the wording in the section. What would constitute an implication that a person is a dentist? A person does not put "dental surgeon" on the door if he is not a dentist. He could put "denturist" or something other than the title of dentist which would imply that he is a registered dentist. They could describe themselves as dental prosthesists which would imply that they were registered dentists even though they are not claiming to be registered dentists.
A person can put any notice on the door. In this section we are dealing with the dental profession as we know it. We are talking about qualified dentists and it is an offence for qualified dentists to represent themselves as something which they are not. I presume it is illegal for individuals to represent themselves as having a qualification which they do not have. We are not dealing with auxiliaries in this section.
If a person with a plate on his door calls himself or herself a dental prosthesist, are they liable to a fine of £1,000 for misrepresenting themselves?
We are basically talking about registered dentists in this section——
We are not dealing with registered dentists; we are dealing with someone who is not a registered dentist and that is precisely what I am talking about.
It is an offence to represent oneself as a registered dentist if this is not the case. Under this section, we are dealing with that and nothing else.
I am sorry to persist in this matter but we are talking about a person who is not a registered dentist. He is entitled to call himself something but, under this Bill, he shall not take or use any title or description which implies that he is a registered dentist. The Minister should be very specific in this regard so that they will know what to call themselves without being regarded as criminals and liable to be jailed and fined a sum of £1,000. If they are liable to be put in jail or fined for putting a title on their door or on headed notepaper, they are entitled to know what title they can use and this is not specified in the Bill.
Suppose somebody represents himself or herself as a denturist. There is no such title at present but it is possible as a result of the passing of this Bill that there may be recognised people who have qualified in some branch of dentistry as a result of training laid down and specified by the Dental Council and they would be recognised as such. Section 50 makes it an offence to represent oneself as a registered dentist if one is not qualified.
The Minister is reading the explanatory memorandum and, if he concentrated on the wording in the Bill, we might get somewhere because it is all about words and the words are not satisfactory.
There is a substitute amendment No. 4 on the Order Paper with which we will be dealing.
I move amendment No. 4:
In page 28, subsection (2), between lines 12 and 13, to insert the following paragraph:
"(e) a recognised dental technician (who can satisfy the Department of Health that he has been providing dentures direct to the public for at least five years) from providing dentures to a person of 18 years or over, and which provision does not involve any treatment of work being done on living tissues, from the operative date of this Act."
Section 51 refers to the practice of dentistry. In an earlier section the practice of dentistry is defined as "the performance of any operation and the giving of any treatment, advice, opinion or attendance which is usually performed or given by a dentist and includes the performance of any operation or the giving of any treatment, advice or attendance on or to any person preparatory to, for the purpose of, or in connection with, the fitting, insertion or fixing of artificial teeth". That is the definition of the practice of dentistry and that is where the problems arise. Under this section, dentists have monopolised everything. It was said in earlier sections that members of the dental profession are people of high standing and that we expect and generally get good standards from them.
I know two or three dentists and I have the highest regard for them — I certainly have the highest regard for my own dentist — but that does not mean that dentists are better than any other profession, trade or group. However, that is not the point. The point is that they are the only profession who are given the total monopoly over everything to do with the mouth, whereas opticians are selling glasses all over town for a much more sensitive instrument — the eye. They are not qualified ophthalmic surgeons and they have not monopolised the sale of glasses and frames in the way that dentists monopolise the sale of artificial teeth. There are bonesetters in the medical profession who are entitled to practise without being liable to a fine of £1,000 and 12 months in jail. They are not regarded as criminals. People fit artificial limbs and doctors do not monopolise this trade to try to make a profit out of the sale, manufacture or fitting of artificial limbs. The mind can be affected by people who practise hypnotism but they are not liable to a fine of £1,000 or 12 months in jail for fiddling about with a person's mind.
This is one area where a monopoly is held despite the very specific recommendations after the sworn public inquiry by the Restrictive Practices Commission that non-dentists should be allowed to supply dentures to persons over 18 years of age so long as such provision did not involve work being done on living tissue. That is the only specific recommendation the commission made. Dental technicians are not just people who start to mess around with a person's mouth. A dental technician has a five year apprenticeship before qualifying. They are people of the highest skill and are very capable. They do the work of dentists in any case. They make teeth for the dentists. The dentists put them in a person's mouth and charge double the price. Dental technicians supply artificial teeth at half the price a dentist charges. In the sworn public inquiry the dental profession admitted that 51 per cent of artificial teeth were sold directly to the public.
We are here to defend the interests of the public but we are not protecting their interests in this section, rather we are protecting profit for the dentists. If the section is passed in its present form it will be in total opposition to the recommendation of the Restrictive Practices Commission.
There are portions of the Bill which could be considered unconstitutional. Dental prosthesists, denturists, call them what you will, are highly skilled and highly qualified people. They operate publicly and openly, some with their name plates over their door. Now they are being denied their livelihood after serving five years in an apprenticeship. Now they are being told they are criminals and can be fined £1,000 or be sentensed to 12 months in prison if they fit a denture. This is extraordinary, and this section illustrates just how extraordinary it is. It does not deal with the major problems that have arisen as a result of the 1928 Act not only for dental technicians but also for dental nurses, who are also tied in under the Dental Council. The Dental Council has total control of dental technicians, denturists, dental prosthesists, dental therapists, dental hygienists and everyone in the dental profession. It is as if the Medical Council had total control over all nurses. Paramedics are not regarded as paramedics at all but rather as clerks or receptionists and are paid accordingly.
I oppose this section. We wish to delete from our amendment the words "prior to the date of the passing of this Act" so that the amendment is now to insert in subsection (2) a paragraph (e) which reads:
a recognised dental technician (who can satisfy the Department of Health that he has been providing dentures direct to the public for at least five years) from providing dentures to a person of 18 years or over, and which provision does not involve any treatment or work being done on living tissues, from the operative date of this Act.
The intention is to insert the recommendation made by the Restrictive Practices Commission in 1982. If our amendment is accepted or if a similar amendment is put forward by the Minister it could get over the enormous difficulties which will arise after the passing of the Bill if it is passed in its present form. I do not understand how the Minister could accept a Bill drafted in this form knowing the very specific recommendation made by the Restrictive Practices Commission. I hope the Minister will accept the amendment in the light of the inquiry which has been held and in the light of the large number of people whose jobs will be at risk and who, instead of being allowed to practise their profession, will be regarded as illegal operators. Those are the words the Minister used when he spoke about them.
I agree with Deputy Mac Giolla. This is one of the sections which caused the greatest controversy from the point of view of people——
We are on amendment No. 4.
Can I not refer to the section?
No. When we dispose of the amendment we will deal with the section.
With regard to the amendment I know that Deputy Mac Giolla has received the same kind of representations as I have. The whole area of ancillary activity to the dental profession could be dealt with by this amendment, but perhaps the work these people do could be dealt with under a separate Bill. If the Minister does not accept this amendment I urge him to ensure that in the appointment to the Dental Council there is a voice to represent this element of the dental profession. I do not know whether the Minister will accept the amendment, but if he does not he should take the sentiment of it into consideration and ensure that there is someone to speak for these people on the Dental Council.
There is provision in the Bill for the establishment by the Dental Council of a class of auxiliary dental workers who will be fully trained and competent to supply dentures direct to persons of 18 years of age and over. It will be a matter for the Dental Council to decide on the training and qualifications for the grade of denturist, but any scheme put forward by the council must be approved by the Minister. The Minister has power to direct the council to establish a particular class of auxiliary dental workers, and he can refuse to approve of any scheme put forward by the council which he regards as containing unreasonable provisions. The provisions in the Bill are regarded as adequate to ensure that a grade of denturist will be established by the Dental Council.
The amendemnt put forward by Deputy Mac Giolla and Deputy De Rossa would give recognition as denturists to those dental technicians who have been illegally providing dentures direct to the public for more than five years without those technicians having to undergo any special courses of education or training. Dental technicians do not undergo any clinical training at present, and it is certain that some element of clinical training will be required for persons wishing to become denturists.
The Restrictive Practices Commission, in the report on their inquiry in 1982 into the restrictions on the supply of dentures to the public, said that having regard to the dangers to the public which could result from the supply of dentures to the public by people not fully trained for the purpose, they could not recommend that any short cut to recognition should be adopted or that this trade should be facilitated in any way. They also said that the supply of dentures to the public by unqualified persons must be vigorously discouraged.
In the course of the Restrictive Practices Commission's inquiry, the Irish Association for Dental Prosthesis, which represents those technicians who wish to supply dentures direct to the public, offered in evidence an estimate of 15 dental technicians throughout the country who were solely or mainly engaged in dealing direct with the public. The remainder of the 200 or so dental technicians work in dental laboratories and hospitals, or work independently for dentists in private practice. It is considered that it would be totally inappropriate that those technicians who have been acting illegally should be given preferential treatment in the Bill.
The decision to introduce fully trained denturists rather than to provide a free for all in relation to the supply of dentures, as would have been the case if the majority recommendation of the Restrictive Practices Commission was adopted, was taken by the Government following long and detailed consideration of the position. The Minister is not prepared to make any amendment to the Bill which would permit unqualified persons to supply dentures direct to the public. It is possible that the Dental Council may make some concessions to those who have already attained a degree of proficiency in the trade when drawing up the educational and training requirements for denturists.
I understand the reasoning behind Deputy Mac Giolla's amendment. As the Minister pointed out, there are 15 dental mechanics who are solely or mainly engaged in dealing with the public and providing dentures direct to them. That was in the Report of the Restrictive Practices Commission after their inquiry into the statutory restrictions on the provision of dental prosthesis in 1982 at page 21. The Irish Association for Dental Prosthesis offered that number themselves. Having spoken this morning about people's right to earn their livelihood, it is appropriate that we should be concerned about people who make their livelihood in this manner. They make their livelihood illegally as the law stands at present and naturally we cannot condone anybody working outside the law. These people have provided a service over the years and, in that context, I understand Deputy Mac Giolla's amendment.
We must ensure that we maintain a very high level of dental care. Section 53 gives power to the Dental Council to establish a scheme for denturists and dental craftsmen. That caters adequately for any situation which may arise. Dentists undergo very special training in the care of the mouth, the gums, and so on. It is important that we should maintain a very high standard of dental care. Section 53 which gives the council the power to set up a scheme also gives the Minister power to direct the council to set up such a scheme. That caters adequately for the problem. If such a scheme is set up it should be controlled and monitored by the Dental Council. They would be the appropriate people to do that.
The obvious weakness of the amendment which, I assume, is guided by the concern for people who had been practising in this business for some years is that it does not ensure that people engaged in this form of dental craftsmanship would be competent or trained. Minimum standards of ability, competence and training must apply in this area. As Deputy O'Hanlon said, there is provision in section 53 for the introduction of such a training scheme to which, I presume, access would be readily available for people who may feel themselves offended in some way by the section.
Deputy Mac Giolla's references to monopolies and so on exaggerate the true position. We are trying to bring a sense of order and modern training and discipline to what up to now unfortunately in some cases, has been an illegal practice although in many cases there was a very high standard of craftmanship. This cannot be allowed to continue as it happened in the past. We are talking about a very small number of people.
The omission of any reference to training in the amendment means that it is not acceptable to anybody because it would still allow an extremely bad dental technician to continue to practise. Nobody wants that. The principle underlying the concern in the amendment is to ensure that people have an opportunity to continue to earn their livelihood. The standards and the norms should be laid down in accordance with modern practice and the best standards of training available. The Dental Council have the capacity to introduce such a scheme and I have no doubt they will in due course. I do not think this amendment is acceptable. While I would describe it as being well motivated, in its presentation and its content it is inadequate.
I agree with the last speaker and with my colleague, Dr. O'Hanlon. This section of people will be adequately catered for under Part VII, section 53, with regard to the auxiliary dental workers' association. I totally accept Deputy Mac Giolla's feeling towards these people. They have been providing a service for many years. However, Deputy Keating put his finger on it in saying that no training period or qualifications were mentioned in Deputy Mac Giolla's amendment. There are only 15 people in the IADB about whom we are talking. I understand that the Minister suggested that the council look favourably at applications from these 15 people to be included as auxiliary dental workers when the time was right. Perhaps this is the solution Deputy Mac Giolla is looking for. A number of these people have provided very excellent service and I have no doubt that that excellent service will be recognised by the Dental Council when it comes to registering the auxiliary dental groups.
I do not think Deputy Keating was here when I was speaking.
I was and I listened carefully.
The whole question of training was dealt with earlier in the Bill and is a separate matter. This amendment is based merely on one section of the Bill. There is not sufficient argument on that basis. I am not talking about 15 people. There are 15 people who are publicly and openly operating illegally, as the Minister says, since 1928 because prior to that Act their work was quite legal. The 1928 Act made it illegal and gave the monopoly to the dentists that only they could stick dentures into patients' mouths. Some of these people existed before 1928 and gave a service to the public which the public want and demand.
The Restrictive Practices Commission refered to that matter. If there were free market conditions a very large number of people would choose to obtain their dentures from dental technicians. The commission recognise that, because people cannot afford to go to dentists for dentures. If there were not a monopoly established by legislation the people would go to these technicians. The commission also went into the whole area of health care and the dangers that the dentists said would arise and the Restrictive Practices Commission found there was no evidence to substantiate these allegations of mouth cancer and various other ills which the dentists said would occur. The Minister and the Deputies are missing the point of this. If it were not illegal, the remaining 250 or so would also be able to use their trade, or profession, or whatever you wish to call it, to better themselves and to their advantage to give a service to the public. They would put plates on their doors and give that service to the public. At present they can only operate under a dentist's control. They provide a service only to dentists, not to the public. That is the point that I am making. I did not know until the Minister mentioned that fact that 15 people were involved who are operating publicly illegally. Many of the others are operating illegally privately.
If you know the dental technician who lives down the road from you, you can go to him and he will fix you up, even though he does not belong to these 15. This is being done regularly all over the country. These people are skilled in their job and know it and if you ask them to provide dentures, they provide them. They provide them for your dentist anyway. They will provide them for you for half the price.
It is not sufficient to say that section 53 will make everything all right. It will not. That section states that the council may do this and may do that and the Minister may recommend this, that, or the other. The council may not do anything. As far as the dentists are concerned, once they have got their monopoly they will not do anything. It is not a question of being permitted to do something, they will retain their monopoly. If these dental technicians are given anything, it will be some benevolent gesture of giving special training perhaps, but they will still maintain these people under their control, saying that they only operate for the dentists and not for themselves. There is not a free market, and that is what it is all about.
Here we are talking to the free market society on both sides of the House and I have been fighting against them on various other issues. The free market society in this instance want to establish a monopoly for dentists only and do not want the free market forces to operate at all. The majority of people, certainly in my constituency, will go to the dental mechanic, as they call him, to get their false teeth, rather than to the dentist. Whether it is put into the Bill or not, these people will operate illegally.
Is it not dreadful that these highly skilled and very respectable people must operate illegally? They must now operate under a ten times worse penalty. The fine was only £100 under the 1928 Act. It is now £1,000 under this new Bill. This Bill does not improve anything. It is keeping us in the same position as 50 years ago, with dentists' monopoly. That does not exist in any other area, medical or otherwise. People are not given monopolies. The Restrictive Practices Commission also made the point that there was no longer need to protect the public by penal legislation. That is what we are talking of doing, protecting the public by penal legislation. In fact, this would not protect the public at all. It would protect the dentists. There is no need for this penal legislation and illegality.
If my amendment is accepted, it will be recognising the existence, status and rights of the dental technician to operate and provide dentures for people over 18 years of age, not dealing with living tissues. If that is accepted in this section, then the whole question of training and everything else can be dealt with. Their existence is not recognised until you come to Part VII, where it is said that the council may, if they wish, recognise their existence and may, if they wish, establish classes of dental workers. This is still not giving these people their rights to carry out their own job and give a service to the public which they wish to give. The acceptance of my amendment would save the Minister many problems in the future. There will be many battles over this and the Restrictive Practices Commission will again be operating as far as dentists are concerned. There is exactly the same procedure here as in the 1982 case, when they were operating under the 1928 Act. The Government have not changed matters one bit. In fact, they have defied the commission by putting this Bill, three years later, before the House. What the Government are saying is that they are not interested in the Restrictive Practices Commission and are insulting them by putting the same Bill in, despite their simple recommendation which is incorporated in this amendment. Would the Minister reconsider this amendment and accept it, thus avoiding many problems in the future?
It is very hard to understand Deputy Mac Giolla's reference to penal legislation.
A fine of £1,000 is penal.
I do not know who the Deputy is trying to impress by using words of that nature. There is provision in the Bill for the establishment, by the Dental Council, of a class of auxiliary dental workers who will be fully trained and competent to supply dentures direct to those of 18 years of age and over. In the Deputy's amendment he mentions "a recognised dental technician (who can satisfy the Department of Health that he has been providing dentures direct to the public for at least five years prior to the date of the passing of this Act)". No such person is recognised at the moment. Any of these persons supplying dentures to the public are acting illegally and until a few years ago a number of fines were imposed. Out of the 200 in the country at the moment, we calculate that approximately 12 are acting in this fashion.
The Government and the Opposition are fully in agreement with what we are trying to do here. The decision to introduce fully trained denturists rather than to provide for a free-for all situation in relation to the supply of dentures, as would have been the case if the majority recommendation of the Restrictive Practices Commission was adopted, was taken by the Government following a long and detailed consideration of the position. The Minister was not prepared to make any amendment to the Bill that would permit unqualified persons to operate.
The Deputy wants to allow unqualified persons to supply dentures direct to the general public, but we are saying that there can be auxiliary workers who will be trained and qualified. It is possible the Dental Council may make some concessions, as we hope they will, to those who have already attained a degree of proficiency in the trade when the council are drawing up the educational and training requirements for denturists. If the new council will not go ahead and establish this kind of auxiliary dental worker, they will be directed to do so by the Minister. These auxiliary dental workers will be trained and competent to supply dentures to persons of 18 years and over. We are trying to regulate the dental profession. There has not been any Bill to deal with these matters since 1928. This Bill will go a long way to meet the spirit of the amendment.
I would be quite happy if I could find substance for the Minister's opening remarks, which were to the effect that under this Bill denturists will be able to supply dentures to people aged 18 years and over.
That is in section 54 (3).
I should be obliged if the Minister would tell me in what part of the Bill is that provision. It does not exist in section 53. Deputy Keating has now referred me to section 54, but I am not satisfied that that section provides for what I am seeking. If the Minister can show me where in this Bill the necessary provision is inserted I will be quite happy on that matter. Perhaps he would confine himself to dealing with that point now. I realise that we may have to refer to some other section, but it is important that we see where is this provision in the Bill.
It is in section 54 (3).
Will the Minister please explain further?
We cannot discuss that at the moment. The House is now dealing with amendment No. 4 and we cannot go into detail on any other point.
In arguing against acceptance of this amendment the Minister specifically said that later sections of the Bill provide for what is in my amendment. He said they provide for dentures for people of 18 years and over.
The Deputy's amendment reads as follows:
a recognised dental technician (who can satisfy the Department of Health that he has been providing dentures direct to the public for at least five years prior to the date of the passing of this Act)...
As far as the Department of Health are concerned there is no such person qualified to do what people may be doing illegally.
I do not know what are the qualifications for a dental technician but there are dental technicians who supply dentures to dentists and the dentists must be satisfied regarding their training and qualifications. They have been there for years, ever since dentures were invented: probably they invented dentures before dentists ever thought of them. I do not know what are their educational qualifications, but a gentleman who approached me told me he did a five years apprenticeship before he was accepted as a dental technician in the trade with other dental technicians. These people have had some kind of training — and up to now it was regarded as satisfactory. The dentists who use the services of these technicians have been quite satisfied, but once the technicians start providing the dentures direct to the public they become unsatisfactory and untrained. They become illegal operators.
That is not what section 54 (3) is about.
This is what the Minister is saying. He is saying that because these people have operated illegally they have no qualifications or training. Deputy Keating also spoke about their lack of training. The training is there. Will someone please tell me what is unsatisfactory about the training of dental technicians who supply dentures to the Eastern Health Board, to the dentists, to me and to many other people? I am talking of people who are qualified and trained in the existing sense of the term. Some of them have been operating publicly providing their services to the public and others have been operating privately. However, now they are being attacked as illegal operators and untrained people. All I am asking the Minister is to show me where it will appear in the Bill that qualified trained denturists, dental prosthesists, dental technicians or whatever the Minister wishes to call them will be able to provide a service directly to people of 18 years. The Minister says that provision is in the Bill, but I do not see it.
Deputy Mac Giolla has stated that dental mechanics have a training that is acceptable to the dentists. I have no doubt it is correct that they have a training that is acceptable to the dentists to carry out a particular function, but I could not accept that dental mechanics have a training that is acceptable to dentists to fit dentures to persons under 18 years or over 18 years. I believe that in section 55 (1) the Bill makes it clear that the Minister has got the power to direct the Dental Council to set up a particular scheme providing for auxiliary dental workers.
That should be adequate. But we would become very confused if we took it that the dental profession and the dental mechanics work included fitting dentures to the public, because the dentists themselves would not accept that. They do accept them to carry out a particular function which I have no doubt the dental mechanics do extremely well. But that function does not include what Deputy Mac Giolla is asking us to do in this amendment.
There is provision in the Bill for the establishment by the Dental Council of a class of auxiliary dental worker who would be fully trained and competent to supply dentures direct to persons aged 18 years and over. Some of these people have some type of qualification at present and are supplying dentures to the public. No fines have been imposed since 1975. One was talking about a fine of £5 or something like that, and they had no regard to that whatsoever. We are here attempting to act in the interests of the public ar large in that we are preventing anybody from supplying dentures to persons over 18 years of age — provided they are not working on live tissue — if they are not qualified to do so. The qualification to do so would be enshrined in certain educational and training specifications laid down by the Dental Council. If the people to whom Deputies Mac Giolla and O'Hanlon are at present referring have a certain type of training and are in need of additional training, that can be given to them. I presume that the Dental Council will make concessions to people with a certain amount of training in a given direction at present. They could arrange a type of educational and training programme that would not take too long. Presumbly that would allow these people who are providing dentures to the public at present illegally to set up and provide them legally.
The nub of this amendment relates to some extent to the question of training. Perhaps the Minister would be kind enough to answer a specific question in this regard. He mentions that the Dental Council can establish classes of auxiliary dental workers from ancillary grades within the dental field whose work would not perhaps amount to the practice of dentistry as defined in the Bill. In this context would the Minister consider asking the council to examine, as a matter of priority, the question of training generally, particularly of training arrangements for dental craftsmen and technicians simply to ensure that the standard is raised to acceptable levels? My information is that there is an outflow of laboratory work — precisely on account of the lack of training — to the United Kingdom and to the United States, to the extent of some £2 million a year, indicating a clear vote of no confidence or lack of confidence in present standards of training in this area. Perhaps the council could be asked by the Minister to have this area of training examined as a matter of urgency in order to ensure that standards are acceptable and, on an auxiliary basis, to ensure that there are job opportunities for people in Ireland. It would benefit the whole field of health care, the economy and might do a great deal to bring into line training standards here with acceptable standards abroad. The Minister might ask the Dental Council to consider that request.
From the information we have it appears that what Deputy Keating says is quite true, that there is a great deal of work that dentists require to be done at present that our dental technicians cannot deliver to them because of their inability to supply what the dentists want. As a result there are technicians elsewhere who avail of this opportunity and seemingly it is lucrative for them. I have no doubt but that the Dental Council will set up these educational and training programmes so that technicians here will be able to undertake the type of work now going abroad. It should be of great benefit to the technicians who are operating here at present and who cannot supply what is needed by the profession.
Is Deputy Mac Giolla pressing amendment No. 4?
Subsection (1) reads:
(1) The Council may, with the consent of the Minister, make a scheme for establishing classes of auxiliary dental workers who may undertake such class or classes of dental work as shall be specified by the Council notwithstanding that the doing of such work would constitute the practice of dentistry within the meaning of this Act.
I do not want to go through it all again, but the word "may" is enough for me to wipe out the whole section and ask what is the point. The council may do all sorts of things and, if they do not, then the whole section is a waste of time. There is the phrase "The Council may, with the consent of the Minister, make a scheme for establishing classes——." but the council may decide to leave things as they have been for the last 50 years. It is more likely that that is what they will decide, particularly as it is totally monopolised by dentists.
On an earlier section, in regard to the election of people onto the council, I endeavoured to put down an amendment which sought a place on the council for dental workers. Subparagraph (f) of my amendment to section 9 read:
Four representatives of auxiliary dental workers nominated by the Irish Congress of Trade Unions, two of whom shall be dental technicians, and two dental nurses;
That amendment was not accepted, which means that they are not represented at all on the council. Therefore, it is reasonable to expect that the council will simply hold the position it has for the last 55 years. I am not satisfied that the provisions of this section will be in any way effective because the council will decide not to make use of them.
Deputy Mac Giolla is referring to the use of the words: "The council may". I should say that the Minister has the power to direct the council to establish and so on. We hope that if the Council do not take action themselves then the Minister will direct the council.
The Minister is talking about a later section. What is before us is section 53.
Under section 55.
What is before us is section 53. If the Minister will be directing the council to do something why can he not incorporate in the provisions of this Bill now words to the effect that "the council shall, with the consent of the Minister", etc. Why not do that here now rather than instructing them every now and again to do this or that? Why cannot this House give them the instruction, leaving it to the Minister to direct them? By changing the word "may" to the word "shall" we would know we were doing something effective or that meant something.
The difficulties Deputy Mac Giolla is anticipating are not anticipated by the Minister. Deputy Mac Giolla does not appear to have any confidence in the 19 member new Dental Council. We have confidence that the Dental Council will set up the necessary training and education programmes which in all probability will meet the spirit of the amendment being pressed. We do not anticipate that the Minister will frequently have to get in touch with the Dental Council to instruct them. The Dental Council will work as envisaged under this Bill. Section 55 says that the Minister can direct the council to do something but we do not anticipate a need for that direction from the Minister or from his predecessors.
Does this section include the various grades of auxiliary dental workers?
We hope so.
It is not a question of having confidence in the council. The council is not there. When one is drafting legislation one does not say we will have confidence in them, so we will leave the legislation sloppy. If something has to go before the courts it is decided on the words in the Act, not on whether one has confidence in a council or whatever else. That has nothing to do with the legislation before the House. I would ask the Minister not to come up with that sort of thing, saying that I have no confidence in them. If the Minister has every confidence in them, he would not have to put in a section saying that the Minister will direct them. The Government obviously have no confidence in them, so they are giving the Minister power over them. Why not insert the power in the Bill? Obviously it is the Minister's desire that all the things listed in the section be done, so he should accept our amendment. I recall that the Minister for Health made similar amendments in relation to the Nurses Council in altering "may" to "shall". There is no reason why the Minister of State should not have a look at this with a view to accepting my amendment.
On Deputy Mac Giolla's point, we must allow the council to have some discretion.
I welcome the later section to cover these auxiliary workers. In relation to subsection (2) (a), the council under this section shall determine the training and qualification necessary to become a member of such class. Is there an obligation on the council to ensure that that training will then be available? Section 61 refers to additional functions. If training is not available in our dental colleges there is not much point in determining the training qualifications. Is that covered somewhere else in the Bill?
In relation to Deputy Mac Giolla's point, as far as we can see section 53 is drafted in the best way possible and it is not our intention to amend it. In relation to Deputy Owen's point, it will be up to the Dental Council to set up these education and training programmes.
They will have power to do that?
It seems to me that Deputy Mac Giolla's argument is contradicting what he said a few minutes ago. I understood him, ten or 15 minutes ago, to be arguing against regulations or for minimal regulations. Here, in a section that affords the council the opportunity to order their affairs consistent with the public interest, he seems to believe that they should be bound hand and foot. The following section gives the Minister the opportunity to compel the council if he is not satisfied. It seems to me that we are getting the best of both worlds in the way the section is presented. This is a very standard type of drafting phrase in many Bills and it has not wrought havoc in any other analogous area of legislation.
The last Bill introduced in this respect was in 1928. It is very difficult to see the requirements of medical care, in the broader sense, over the next 30 or 40 years. It could be that if we changed the word "may" to "shall" we could compel a council to introduce a scheme for establishing classes of auxiliary dental workers and so on which might not be appropriate, depending on the revolution in medicine and in health care that could come about. As presented, when taken with section 54, section 53 gives us the best of both worlds in that it gives the council the respect and freedom to introduce a proper system of training, control and so on and yet gives the Minister a capacity to compel them to do something if he is not satisfied with what is happening in that area. The section is quite satisfactory.
Section 58 says:
(1) The Council shall print, publish and place on sale copies of any register maintained by it at intervals of not more than five years and, in each intervening year, the Council shall print, publish and place on sale a supplement to each such register.
and that these will be available from a health board. I wonder if this is sufficient. People using the health services might go to the health board, and presumably, the health boards will ensure that the dentists working with them are on the register, However, if the general public want access to the register is there any place where it will be available for inspection?
It will be on display in the offices of the headquarters of the council.