Seanad Éireann debate -
Wednesday, 9 Nov 1983

Vol. 102 No. 4

Dentists (Amendment) Bill, 1983: Second Stage.

Question proposed: "That the Bill be now read a Second Time."

Minister of State at the Department of Social Welfare (Mr. F. O'Brien)

The Dental Board was set up under the provisions of the Dentists Act, 1928. Its principal functions are to maintain and publish the dental register every year and to investigate allegations of professional misconduct by members of the profession. The board has nine members: one nominated by the Government, three nominated by the Medical Council and five, who must be registered dentists resident in the State, elected by the registered dentists so resident. Elections of registered dentists to the board are held by the board itself.

The Government recently approved the preparation of new legislation for the regulation of the dental profession by way of a Bill to replace the Dentists Act, 1928. This legislation will provide for the abolition of the Dental Board and its replacement by a body to be known as the Dental Council. Until such time as the Dental Council is established it will be necessary for the Dental Board to continue in existence.

In the normal way a new membership of the Dental Board would be appointed for a period of five years from 14 November 1983 and this would involve holding an election of registered dentists. In view of the proposed new legislation which will abolish the board, the new membership would have a very limited life. The setting up of a Dental Council under the proposed new legislation would involve a further election of registered dentists. As the new legislation is expected to be introduced in the Dáil in the current session there would be no great interval between these two elections.

The Dental Board feel that an election of members to a new Dental Council, if it were to follow shortly on one for the board, might generate only a limited response from the profession. This would obviously be an undesirable beginning for the new council. The board have also drawn my attention to the financial implications of holding two elections of registered dentists within a short period. For their income the board rely on registration fees from dentists and their current financial situation is not entirely satisfactory. They must meet the costs of holding elections of registered dentists from their own funds. Since the new council would take over the assets and liabilities of the Dental Board these funds would have to bear the costs of the two elections, thus worsening an already unsatisfactory financial situation.

In view of the circumstances outlined, the board asked me to examine the possibility of extending the term of office of the current membership until such time as the new council has been established. The Dentists Act, 1928, provides no mechanism by which the current term of office can be extended beyond the specified five years. I am satisfied that it would not be appropriate to proceed with the appointment of a new membership to the Dental Board now, so I am proposing to provide, by way of this Bill, for a two-year extension of the term of office of the current membership. I would expect that the proposed new legislation to replace the Dentists Act, 1928, which will, inter alia, provide for the setting up of the Dental Council, will be enacted well before the expiry of this extended period of office so that the members will not necessarily serve out the full two-year period.

I hope I have made it clear why this legislation is necessary and I ask for the co-operation of Senators in its passage.

Mr. Fallon

It goes without saying that we agree with the purpose of this Bill. The Minister said he is seeking an extension of the period from five to seven years. He has given us the reasons why this is necessary. The Minister told us we will soon be having legislation to deal with this problem which will incorporate the existing Dental Board into a new Dental Council. This presumably will be enacted within six or nine months. Why the two year extension? While the Minister has given reasons for that, the fear would be that after two years the other Bill which the Minister proposes to introduce might drag on for a further two years. I would have preferred a ministerial order, if that were possible, extending the life of the present board to June, or even for 12 months. That would be giltedged in that the legislation the Minister refers to would be compieted by then. I have that little fear and perhaps the Minister will comment on it and guarantee that the legislation will be introduced as quickly as possible.

The Bill is quite simple but nonetheless there are aspects of it that should be referred to. Before I move on to those aspects which I hope will be incorporated in any new Bill it is only right to say that the Dental Board are a respected and well-regarded group of people. The dental profession see them as a very worthwhile watchdog and fly-by-nights and people coming in from other countries are watched carefully. I think the board are to be congratulated for their efforts. It is important not just from the dentist's point of view but from the ordinary patient's point of view that this should be the case. That is the case and, as I said, congratulations should be given to the board. It is important to say that when we talk about this problem and the problems of dentistry, we must stress the importance of educating young children about the prevention of dental decay. This is vital and I hope full emphasis will be placed on it when the new Bill is being drafted.

There are certain criticisms one can make of the existing scheme. For example, 50 per cent of the children of Ireland who are eligible for treatment are denied that treatment. To me that is scandalous. I am not attacking any particular Government for that, but all Governments over the years. The fact that 12 year old to 16 year old children are not catered for in some way is also wrong. The other thing that we all know is totally wrong, and hopefully will be rectified in the new Bill, is the fact that the wives of social welfare contributors are not eligible for treatment.

An Cathaoirleach

I am afraid that it is not relevant.

Mr. Fallon

This Bill is not controversial. One point is relevant to this Bill and to any future legislation and I would be very anxious to hear the Minister's comments on it. If I were a dentist I would be annoyed about the fact that dentistry in Ireland is under the umbrella of the Department of Social Welfare. To me it is clearly a matter for the Department of Health and it should be seen as such. Particularly in the field of dental surgery there are medical matters that must be dealt with. The ordinary dentists in the various towns must have a knowledge of all aspects of medicine. Their very training is medical.

The British Association of Oral Surgeons stated recently that to be members of that organisation people must have a clear medical qualification. The training embraces very many medical aspects and these people have to deal with medical problems in dental surgery. The ordinary dentist in any town in Ireland might have to know all about the drugs a heart patient is taking, or a kidney patient, or a person who has had a heart operation. The dentist must know these things. It is totally acceptable that this area should be under the umbrella of the Department of Health.

To conclude, this is a non-controversial Bill. We are all waiting with interest for the Dental Council Bill that will be with us in the near future, we hope. We have no objection to this and we look forward to a worthwhile debate on the next important piece of legislation in this area.

Mr. Kennedy

Is mian liomsa ar dtús fáilte a chur roimh an mBille seo chun leasú a dhéanamh ar Bille na bhFiaclóirí, 1983.

I should like to join with Senator Fallon in welcoming the proposal by the Minister of State to extend the term of office of the existing Dental Board until such time as the new Dental Council comes into existence. It does not mean that the lifetime of the existing Dental Board will last for two years, but it will last until the new Dental Council comes into existence. I hope the Minister of State will indicate to the House when he will be in a position to introduce the new Dental Bill to replace the Dentists Act, 1928. Those of us who are members of health boards will agree that the existing dental service provided by the boards is unsatisfactory and inadequate at the moment. As has rightly been said in the Dáil and by Senator Fallon, 50 per cent of the children who are entitled to the services at the moment do not receive them. That is a matter of serious concern. The ratio of dentists is a matter that deserves special consideration. There is a 25 per cent dentist vacancy rate in a number of health boards. Also the important role of the orthodontic service deserves recognition in the new Bill.

In the Dáil the Minister indicated that he was concerned to look after the housewife who has to remain at home. He pointed out that the introduction of a new scheme would cost in the region of £5½ million. I have no doubt that the Minister of State is the type of man who will see that justice is done to the housewife who remains at home and who currently is not entitled to dental care arising from her husband's contributions.

I agree also that the question of extending dental service to the 12 to 16 age group should be examined. It is very important that there should be positive consumer representation on the new Dental Council because that is the best way to protect the patient. In all matters of medical and dental care the patient must be of paramount concern. I appeal to the Minister to give earnest consideration to having the consumer represented on the new Dental Council.

I wish the Minister every good luck in his work. As Senator Fallon has said, it is a non-controversial Bill and I am sure it will have the full support of the House.

Mrs. Honan

I do not agree with Senator Fallon and Senator Kennedy. I am deeply disappointed that the Minister sees fit to give this board another two years to serve. In the crazy situation out there the new Dental Council should be appointed now. Quite a number of dentists are upset at the fact that we are passing a Bill which will leave us with a chaotic situation for another two years. Under the Dentists Act, 1928, we have a dentist working for a health board for £15,000, and his colleague down the street is making £40,000 and paying less tax.

I am interested to note the change in attitude of the Coalition Government here this evening. They are leaving one board intact. To date they have removed any board that was there when they took office ten months ago. The Dental Board must be all the right colour. The Minister is leaving them there for another two years. I have not actually looked at their credentials but they must be right because that board is being left while other boards were shoved aside because they were Fianna Fáil-orientated.

Leaving the dreadful situation of the care of children's and adult's teeth as it is, the Minister of State says he does not want somebody to be involved in a second election in a short period. It was a pity the Government did not adopt that attitude before. If they had we would not have had three elections in 18 months, but we are not worried because we know we will be back. The World Health Organisation said that every dentist should look after 1,500 children only. The situation is so bad here that we have 3,500 to 4,000 children being looked after by one dentist.

I am asking that the Dental Council be set up straight away because of the dreadful conditions that exist and the long waiting lists. Senator Kennedy is a member of the Mid-Western Health Board and he is well aware of the situation. Yet he stands up here this evening and says the right thing to do is to allow this service to go on for another two years. At the next meeting of the Mid-Western Health Board he should look at the figures on the two to three years waiting list in Clare, not to mention the other services that are required.

I hope the Minister will note kindly my remarks. What I am concerned about is the service being provided for children. It is no use telling them in two years time that we will have a new council and they will cure all their dental problems. The system is crazy. I am amazed at my colleague's warm welcome to leaving this board for another two years instead of bringing in this council and getting this whole mess cleaned up.

Mr. Ferris

Maybe I am very naive, but I look on this legislation in a totally different light from Senator Honan. This is just an enabling piece of legislation to ensure that the Dental Board are legally functioning so that dentists will be registered until the new Bill is introduced. There is nothing sinister in it. If there was an ulterior motive we would not be putting the council in for two years. We would be putting them in for five years if we were worried about their affiliations.

Mrs. Honan

You are leaving them in.

Mr. Ferris

It is rather unfair to pass a remark like that. Senator Honan is so intelligent and so involved in the health care world that she knows the legality of what we are trying to do. She certainly is concerned about the service being given. As a member of a health board, I am ashamed at times of the service given by boards in the area of dental treatment. People legally entitled to free treatment on a medical card cannot get dental treatment simply because the health boards cannot recruit sufficient dentists to do the job properly. That is a pity. We are confining our service to schoolchildren and children in that age group. All the adults are being left without care or attention, except if they have social welfare contributions, which only entitles men and not their dependants to the dental service. That has nothing to do with this Bill. I share the concern about the lack of service given to medical card holders by health boards in the dental area.

This is an enabling piece of legislation and if we do not pass it, the Dental Board would be illegal and would not be able to register more dentists. Then the situation would be twice as bad.

I commend the Bill to the House for the reasons the Minister stated.

Mrs. McGuinness

While I appreciate what Senator Ferris says about the necessity for measures to make the Dental Board legal in the interim period, I would on the other hand have a great deal of sympathy with what Senator Honan has said because if we give a period of two years, human nature is such that nothing will be done during that period. If, for instance, the Minister would agree to cut the period to six months, it would concentrate the minds of those who have to produce the new Dental Council and the legislation to cover it, and they would produce it within six months. I am a great believer in the use of the severe deadline. I know perfectly well from my own experience, and from experiences of all sorts of organisations, that if you say a thing has to be done within two years they will not actually start being serious about it for about 18 months, whereas if you say it has to be done in six months they have to concentrate from the very beginning. I support Senator Honan in that.

I agree with other Senators — while it does not arise directly from the Bill — in their criticisms of the present service. This matter is very urgent. I would draw particular attention to the question of orthodontic treatment which was mentioned by Senator Kennedy. As I understand it, at present when national schoolchildren who are entitled to free dental treatment get it, the dentists do not even mention the fact that their teeth need straightening or that they need orthodontic treatment, because the same dentist knows perfectly well they do not have a hope of getting that treatment before they leave the national school. This means their teeth are neglected until they get into the secondary school and their parents have to pay a private dentist maybe £500, £700 or £800 to have this orthodontic treatment carried out.

I would also agree with Senator Kennedy about consumer representation. We all have teeth and some of us as consumers might like to bite with them. I would like to see consumer representation, and consumer representation with teeth, on the new Dental Council. All professions need some regulating from the outside and from the consumers' point of view, I admit that straight away, and this would be an ideal opportunity to introduce this.

There is one other old chestnut of a question which I would ask the Minister, but old as it is it is still an urgent one: what has happened to all the plans for a new dental hospital in St. James', because as far as I know the Dental Hospital is still practising in Lincoln Place?

An Cathaoirleach

You are getting far from the Bill.

Mrs. McGuinness

This is very important to the dental profession. They are still struggling away in that indescribable building in Lincoln Place. Perhaps out of courtesy the Minister would give us some reassurance that some progress is being made because anyone who has been in that place with children knows what it is like and how urgent it is to replace it. Many years have passed since the new dental hospital was promised.

Mr. Robb

I noticed when reading through the Dáil debate that the Minister at a meeting with the Irish Dental Association in Galway stated that the new Bill would be introduced in the Dáil in the current session. As a person who is extremely suspicious of institutional power, the covert power of institutions — to reinforce what Senator Honan and Senator McGuinness have already asked — I want to know, why two years? Being a member of a profession, I have some justification for being suspicious. When I took up my present post in a non-prestigious hospital and I was left with only one supportive staff, I wrote to the appropriate institutional body and I was told that the only answer to my problems was to arrange to have two of the three hospitals to which I was attached blown up to force the people to accept centralisation of the services. You can see I have some feeling about the way in which central institutional management works. I am reminded — and I am sure this applies to the dental profession as well as to the medical profession — what Ivan Illich who wrote the book The Appropriation of Health by the Professions from the People said in the first line of that book “the medical establishment has become a major threat to health.” I cannot speak for the dental establishment but I suspect from some of the things I have heard, that there are vested interests which at a time of an increasing number of graduates, increasing third level education, prevent Ireland from having enough dental graduates to meet its needs. There is no reason why our universities cannot produce enough dentists. Senator Honan mentioned the World Health Organisation recomendations, one dentist to 1,500 children and one dentist to approximately 3,000 adults and the fact that Ireland has only one dentist to 6,000-odd, but the question arises: why are there not enough dentists? I think the Minister must address himself to that point in the preparation of this Bill. How are the people who cannot afford private treatment going to get the treatment they need? Somewhere in the legislation there must be an obligation on the professions to provide the service to meet the needs of the ordinary people and only then should they be allowed to indulge in private practice.

With regard to consumer representation with teeth, as somebody said, it is easy to have representation which is a sop to consumer frustration. It is easy to put a few tame consumers on boards and have them making decisions remote from where the action takes place. In his contribution in the Dáil debate, Deputy Mac Giolla brought up the whole area of the operative in dental surgery, the payment to the operative, the conditions of the operative, the knowledge of the operative and the insights of the operative into the dangers of what he is doing. I suggest here, as I have suggested elsewhere with regard to my own profession, that, when we spoke about representation it was time we brought the three legs together — the professional, the operative and the consumer. I would like to see in the statute an obligation to bring together once a year the people who use that particular practice — the people who work in that practice and the professionals who have their unique contribution to make. They would discuss the problems of dental health so that they would become aware of the needs at local level, and then they could pressure on the institutions as well as on the Government to respond to that need.

Mr. Lanigan

One small point on the Bill which will be before us very shortly. When will we have the new legislation? Obviously it is overdue. So far we have not had a replacement of the 1928 Act although there have been many changes in all areas of medicine. I think it is disgraceful. I would like to ask the Minister a straight question: when will we have that legislation before the House?

Minister of State at the Department of Social Welfare (Mr. F. O'Brien)

Firstly, I want to thank Senators for their contributions. They were all very helpful and any points that dealt with dentistry will be taken into account. Concern has been voiced by many Senators, particularly Senator Fallon, with regard to the two years. I want to emphasise that I was talking about one year but legal advice said it would be better to make it two years. The board remains only until the new legislation is passed. Once it is passed the new Dental Council will be constituted. I do not think people should read the two year situation as being procastination. There is no intention of doing that. I am very anxious that this Bill would be enacted as soon as possible. It is long overdue, as Members said, and it is important that we do something about it.

Senator Honan mentioned the necessity for having the Dental Council because of the lack of services. I would like to point out that the Dental Board have no say whatsoever with regard to the functions of the services provided. Their function is basically to deal with the regulation of the profession, and not to services provided by the dental profession. A number of people asked when the Bill will be introduced. All I can say is that it will be introduced in the current session; it is still with the parliamentary draftsman.

Senators raised the point about consumer representation. It would be my desire that we cater for that in the new Dental Council. People should have a contribution in any consumer service that affects them. I want to assure the House that that will happen.

Senator Fallon raised the question about transferring dental services from the Department of Social Welfare to the Department of Health. That is my ambition as well. There are reviews going on with the dental profession at present and when they are completed we will be in a better position to make moves in that direction. I agree with the Senator that this should be in the health area because it is about health. Senator McGuinness said we should have a six months time limit because that is the only way to get things done. We are in the business of legislation and once one starts introducing embargos and time schedules on any kind of legislation it is a recipe for bad legislation because everyone is under pressure. If we allowed that to happen it would not be in our best interests. I would not want to see that happen.

Senator Honan raised the question about the World Health Organisation making a statement and giving numbers on the dentist-patient ratio. I do not know where she got that information. The World Health Organisation have made no such statement on dentist-patient ratio. I accept the point that there should be ratios——

Mrs. Honan

Is the Minister saying that they are not there?

Mr. F. O'Brien

I am saying the World Health Organisation did not have any such criteria——

Mrs. Honan

We will send it to the Minister in writing.

Mr. F. O'Brien

Good. Senator Robb said there were not enough dentists being trained. One of the problems is that a number of dentists emigrate, but we are not far short of what might be required to give a very good standard of dentistry.

Mr. Robb

Am I allowed to ask a question?

An Cathaoirleach

We will take it on Committee Stage.

Mr. F. O'Brien

I want to reassure the House about the two years. As soon as the legislation is passed the board will go. It is not a question that this board is appointed for two years and that it must stay for that period. This is not so. As soon as the Bill is passed, the council will be appointed and the board will fall. I want to make that quite clear. In other words, if we can get the legislation through by Christmas and appoint a council, the board goes.

I would like to thank Senators for their co-operation and, hopefully, I will be back as soon as possible with the Dental Bill. At that time, I will be delighted to hear Senators' views on the dental services and on the Dental Bill.

Mrs. McGuinness

Will the Minister say something about the Dental Hospital?

Mr. F. O'Brien

Of course. The only thing I can say is that I would not disagree with the Senator's sentiments about the building and what is inside, but that is a matter for the Department of Education. It does not come under the ambit of health. I am sorry.

Question put and agreed to.

Agreed to take remaining Stages today.