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Seanad Éireann debate -
Wednesday, 21 Mar 1984

Vol. 103 No. 6

Dentists Bill, 1984: Second Stage (Resumed).

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

Speaking at the adjournment of this debate following the Minister's introduction of the Bill setting up the Dental Council, I had made some references to sections to which I wanted the Minister to refer in his reply and I hope he will be here when this Stage of the debate is concluded. I made particular references to sections 51, 54 and 56 and it will be necessary for us to have an explanation from the Minister in regard to how these sections will affect the workings of the new Dental Council.

In making those points last week I was dealing specifically with the delivery of dental care by health boards. As a member of a board I am very disappointed at the ability to deliver a service which is due to people who are entitled to the service under the Health Act. The Health Act provides for full eligibility for dental services to all medical card holders and their dependants and that dental service would normally be expected to be free of charge. Unfortunately, and for some reason with which I hope this Dental Council can come to grips, the boards seem to be unable to deliver that service in their own clinics due to under-staffing. The health boards are unable to attract dentists into the public service and that must raise the question of the remuneration of dentists by the Department of Health. If there was an incentive for dentists to join the health service I have no doubt that they would be available and would give of their valuable professional service to the boards.

As a member of my area health board I have found that the dental service we can give is confined totally to children of schoolgoing age and even then it is a minimal service. It is so minimal that when there are specialised requirements of a very important nature like the fitting of braces and other special treatment a waiting period of up to three years can apply through no fault of the dentists employed by the board. They are not able to get around to dealing with this problem. The Department of Health have a responsibility to examine this anomoly in the delivery of the dental service by health boads.

Last week I complimented the number of dentists who have made themselves available for the delivery of the service to medical card holders. I wish that all dentists would make themselves available for this particular care but I know there are problems because there is a limit to the working day of any dentist. I know that it is not physically possible for them to look after their private practice and their social welfare patients, to go through all the documentation and to deal with medical card holders. If there is an anomaly there which leads to the lack of attention to people who are constitutionally entitled to the service, then certainly we as legislators have a responsibility to look at this and to see why people are neglected at the social level where they are likely to be most in need of the service and definitely unable to provide the service themselves. If the Dental Council when set up can address themselves to this problem and deploy auxilliary technicians and people who will specialise in the practice of non-dental surgery perhaps we may be able to increase the detection rate at school level among our younger population so that qualified dentists can then apply themselves to the real work which they are qualified to do, that is, to deliver the very high level of care which we have come to expect of that profession.

Because of their limited numbers and the availability to the board of professional people, we are unable to match the demand. It concerns me that many people who are in need of this treatment and care do not get it. I sincerely hope that this council when set up will address themselves to this problem. I am glad to see that so many dentists will be on the board because they are aware of the problems firsthand. The consumer on the board will also be aware of this.

One of the major complaints from parents is that their children have been told by the dentists examining them that they are in need of specialised treatment but that it will be a considerable time before the board can give them what they require. I hope the new council will look at it as a matter of urgency and take whatever steps they consider necessary. This Bill empowers them to do quite a lot. For that reason the dental profession have, in principle, accepted the Bill for what it is trying to do and are participating fully in it. I hope this deficiency that I see in the service will be overcome by trying to ensure that other people could have a reasonable input into initial examination of these problems, particularly among school children. The adult population who are normally entitled to treatment on the medical card complain also that they find it quite difficult to get the kind of attention that they need. I hope that that area will also be looked at.

If we have a good dental service the overall health service will benefit immeasurably. The number of people who become ill will be cut drastically if we have a good dental service. One of the key elements in anybody's health is having a healthy mouth and we all owe a debt of gratitude to the dental profession for their action in this regard up to now. If we can make a major breakthrough there, we will have made a major contribution towards dealing with the demands that are now being made on our health services, mostly because of diseases that are self-inflicted. Many self-inflicted diseases create demands on the public purse, such as alcoholism or smoking or neglect of one's mouth.

I listened with interest to my colleagues on the other side of the House last week when they suggested that possibly the Minister for Education would consider putting a teacher on the council. That would be a major contribution to make in the field of education. The educating of children to look after their mouths properly must be one of the basics in any educational curriculum. Education for one's health is as important as education for one's brain. I know that the Minister's nominee will have an input from the training and education of dentists and auxiliary operatives in this field. That is possibly why the Minister for Health is giving to the Minister for Education the specific responsibility to nominate somebody in that field. I would like to think that that person would match the two responsibilities, the responsibility in the area of education and the responsibility in the area of advice and education to children to be conscious of their responsibility to their own health.

I will have quite a lot to say on several sections when we come to Committee Stage but I have itemised for the Minister the sections on which I would like clarification in his reply to the Second Stage debate.

I welcome this long overdue legislation and, indeed, I suppose credit must be given to the right person. It was the idea of a former Minister for Health, Deputy C. J. Haughey, to set up the joint working party of the Irish Dental Association——

May I continue without interruption? There was an excellent report on our dental service by the joint working party and it was described as the future blueprint for our dentistry programme. Senator Ferris and I have not a lot in common but serving in the west and seeing the service at local level I agree that there are a lot of loopholes and much planning needs to be done. The service in the health board area is disgraceful. I would use as severe a word as that. I understand it is because we are short of dentists. We are told by one person that we have a shortage of dentists in the nation and we are told by somebody else that they are there but that the health boards cannot pay them the salaries that these persons would like to be working for.

This joint working party highlighted the absolute need for a prevention-based dental policy and the need to make the public dental service much more attractive as a career. As a serving member of a health committee, I have said that maybe we should channel some money — and there is not too much of it around these days — and give these dentists the proper salaries to get them in to serve. Everybody seem to be going around the country at the moment trying to create the impression that they are creating jobs but no jobs are being created. It might be a good idea if we got dentists that we need badly into the health boards and let them give the service to the people that we are only pretending to be giving.

Obviously there is a shortage of dentists but we may have a better service when this legislation is passed. Concurrently, we must introduce dental hygienists who will act primarily as educators. Senator Ferris referred at the end of his speech to the importance of education. He said the proposal came from this side of the House last week that a teacher or some such person should be on the council. I presume like all the bodies this Coalition appoint, the Minister will be very careful as to who is put on the council. If there is someone who even if in the Minister's opinion votes the wrong way but who has the ability to serve on the council, the Minister might be big enough to appoint him and thereby help to provide the people with the service they expect from us.

The Senator belongs to the most selective party this side of Moscow.

A very positive and responsible statement was made recently by the General Secretary of the Irish Dental Association, Mr. Donal Atkins, in welcoming the establishment of properly qualified, registered and supervised persons working under the direction of qualified dentists. The Association seem to be happy enough with this proposal and they are the experts.

The Minister for Health appears to have a priority to introduce certain people on to the council. If he decides to put certain people on it he will need to be clear in his mind that they have adequate training but anything we may do must not divert us from the real priority which is the protection of our children's teeth. If our children have proper dental services available to them it follows that in the years ahead the nation will need fewer dentists.

I must make reference to dental mechanics. These people have played an important role as members of a team but the ever-increasing sophistication of dental treatment is leading to an equally increasing demand for highly qualified mechanical skills. It is in this area that the dental mechanics must continue to progress and develop. It is not my first time to be confused by a Coalition Minister but I am confused in regard to section 54 which states that, "the council may with the consent of the Minister..." because at the Minister's press conference on March 8 he said: "When the Bill has been enacted and the new council has been set up I intend at that stage to bring forward training schemes". The Bill says "the council may" and the Minister all unto himself on March 8 said he will bring forward training schemes. Perhaps he would clarify that for me in his reply.

I have already asked him to do so.

Sometime earlier, speaking on another dental Bill, I made reference to different side services, as Senator Ferris has just done now, like this awful waiting list for the orthodontic service. I know two people in Clare who have been waiting for this service for four years. We should be united in our efforts to correct that situation.

With this Bill before the House today we must always remember that the welfare of the patient must take priority so I for one would not be prepared to interfere with any safeguards which are designed to protect the general public. This is a very important piece of legislation. We seem sometimes to be in the habit of rushing legislation through this House when quite a number of Senators are very committed to the field of health. I am glad we are steadying ourselves this week and only taking Second Stage. This will give us a chance to take a look at amendments. Indeed we may even have amendments from the Government side to a Government Bill and we may have amendments from this side to a Government Bill. I could speak for longer on the Bill. Apart from affiliations to any political party the persons who serve down in the west of Ireland or outside this "Ireland Dublin" on health boards are dealing with this problem and realise how serious it is. I sincerely welcome this legislation and I will be speaking again on certain sections of it.

I, too, join other Senators in welcoming this Bill. In fact, I give the Bill a triple welcome. I welcome it for its content in so far as it is an important contribution to an important area of community health. Secondly, I welcome the Bill because it has been introduced in this House. That was a particularly suitable move because certainly as Senators in the Cultural and Educational Panel will know, there are among the nominating bodies to this House the Dental Board and the Irish Dental Association, so when we are talking about the operations of the Council that is to succeed the Dental Board, when we are talking about the organisation of the profession to which the members of the Irish Dental Association belong, we are talking about the business of two or our own nominating bodies. Thirdly, I welcome this legislation because of the format of the Bill. Senators who have been Members of this House previously will recall the many times I have argued in this House for an end to legislation by reference. I have argued many times, as other Senators have done, notably Senator Eoin Ryan, who has continually raised this point, that if we are to have an informed public, if we are to make the legislation that comes from the Houses of the Oireachtas intelligible to the public who send us here, we must abandon legislation by reference. We must get out of the situation where every time we have an amending Bill we have to look up three, four or sometimes more old Statutes in order to find out what exactly a section means. The way this Bill has been brought to us, whereby the whole of the 1928 Act has been repealed, even though many of the sections have been substantially reproduced here, is the way it should be done and is welcome. There is an attempt to get a clean sheet so that we have just the one piece of legislation.

I will be returning on Committee Stage to the fact that there has been one slip up. There is one stain on the sheet that is supposed to be perfectly clean, that is, that we have a reference back in section 27 of the Bill to section 30 of the 1928 Act. It is not possible to find out the meaning of subsection (2) (e) of section 27 of this Bill without having access to a copy of the 1928 Act. Perhaps that is something that can be remedied on Committee Stage.

This Bill, as has been mentioned earlier, has been a long time coming. I, too, would like to pay tribute to those who have been responsible for the Bill being brought forward now. I join you, a Leas-Chathaoirligh, in giving credit to Deputy Haughey for the establishment of the joint working party in June 1978 which, I think, we can take as being the start of the final phase of this reforming legislation. We have seen since then, by the appointment of a Minister of State with special responsibility for dentistry, the value of such an action. I should like to pay tribute to the Minister of State, Deputy Fergus O'Brien, for the work he did in what were essentially the formative stages of this Bill. I should like to pay tribute to him — it is safe to do so since he has moved on to another job — for the many other initiatives he took during the period in which he occupied the post of Minister of State at the Department of Health and Social Welfare. Perhaps I will mention them now so that the present Minister of State could try to match the record of his predecessor.

We saw during that time the appointment of senior surgeons for the mentally handicapped, an initiative that many people had looked for; the appointment of consultant orthodontists; the resurrection of the review of State-sponsored dental care; the initiation of a survey on oral health in schools and the appointment of a professor in TCD and a senior lecturer in UCC on community dental health. These administrative actions have brought us into a new phase in regard to the question of dealing with dental health as a community dental problem. As part of that whole process, we have the Bill which is before us today.

Many Senators have mentioned the fact that it is a long time since we had a Dental Bill. It is 56 years. It is rather interesting, looking back at that Dentists Act — and I was curious enough to go to the Library of the House to look it up — to see how the Dentists Bill of 1928 was handled by the Seanad of the day. I was surprised at some of the debate which was handled in the Seanad by the then Minister for Industry and Commerce. There was a Second Stage which was like a rather disorderly Committee Stage, so often did people talk. The Cathaoirleach continually intervened to make points of substance. I do not want to encourage anybody in this House to follow the example of the Seanad in the Second Stage debate at that time.

The Dentists Bill had an even stranger history in Dáil Éireann where the Bill had to be introduced three times. We are inclined to think that it is only in modern times that we have had these successive elections but the Dentists Bill was originally the Dentists Bill of 1927 which fell with the dissolution of the Dáil at the end of May 1927. The second Bill was introduced in June of that year and fell with the dissolution in the following August. It is tragic to think that one of these Bills was moved by the then Minister for Justice, the late Mr. Kevin O'Higgins, whose assassination caused the Dáil dissolution of 25 August 1927. When the Bill was revived for the third time there had been a critical change in Irish political history. At the time the Bill was substantially discussed, Fianna Fáil were in Dáil Éireann for the first time. The 1928 Act belongs to history not only because it is old but because it belongs to the political history of this State, because it wound its way rather slowly and jerkily through the Houses of the Oireachtas at that most important time.

Reading the debate one can see that the Seanad of 1928 did a thoroughly good job on the Bill. Towards the end of its passage the Cathaoirleach mentioned that rarely had a Bill been discussed so thoroughly. Even if we seek to avoid following this more leisurely manner of discussion, we could imitate the Seanad of 1928 in giving a thorough discussion to this Bill in the Seanad of 1984. There were many amendments moved on that other occasion. People often say to me, "Do you not find it frustrating as a Member of the Seanad if you move amendments in the Seanad and the Minister who has put a Bill through the Dáil just cannot be bothered taking your amendments and they are then withdrawn or voted down?" I have always told such people that it is not quite that bad, that even when Ministers do not take one's amendments, one very often finds that his amendment becomes a section in the next Bill on the topic in question when the Minister has had plenty of time to consider it. It is the Minister's own idea by that time and it then goes through. So you can affect legislation with a slight delay. It is rather unfortunate if the delay amounts to 56 years and I have great sympathy for Sir Edward Coey Bigger, a Member of this House in 1928, who argued most cogently for his particular amendment that the control of dental education should not be left in the hands of the Medical Council but should be put into the hands of the new Dental Board so that they could exercise their functions not only in regard to registration but in regard to the training of those who were being registered.

We have this amendment which was voted down by 21 votes to 14 in the Seanad in 1928 incorporated in the present Bill. I hope that when we come to Committee Stage amendments which receive support from both sides of the House will secure acceptance by the Minister. Even on those points on which he is not ready to move, I hope we do not have to wait as long as has been the case of Sir Edward Bigger's amendment. It was a very interesting case he made on that occasion. It was to give the power from the Medical Council to the Dental Board. He was a member of the Medical Council so there he was looking at it from the inside and pointing to this particular measure of excluding the Dental Board from education and training as an undesirable restriction on them.

We have to look at this Bill which is a Bill dealing essentially with the operation and the power of the Dental Council over the control and the practice of dentistry in the general context of dental care. If we were to look at it too narrowly we could make the wrong decision in regard to how this problem should be tackled.

The problem of dental care in Ireland is immense and complex. We need a dental service for 900,000 children. We have an inadequate service catering for about 600,000 children who are eligible. We need a community dental service for almost 600,000 fully eligible adults. We need an adequate service for the handicapped, for the infirm, for the aged. Of course in facing this problem we face the same difficulties as we face in every one of our problems. We have problems of limited financial resources, limited manpower resources and the problem of a distribution of manpower resources that is far from ideal. We have to face the fact that to tackle this problem it is necessary for us not only to seek to improve financial and manpower resources but to seek to make the best possible uses of those resources we have. The World Health Organisation has indicated that in general one could operate a dental service which could be considered adequate on the basis of one dentist to 2,000 of the population. While some countries, such as France and Germany, achieve that figure and while some of the Scandinavian countries have over-achieved it to the extent of having a dentist per 1,000 people, we have about one dentist to 3,500. I am not sure of the exact figure but it is an improvement on the position ten years ago but it still means that in regard to numbers we are decidedly short.

This is not the only problem in regard to manpower. A worse problem in that regard is the distribution of our manpower throughout the country. While this is a problem in all countries it may well be a more severe problem in Ireland than elsewhere. We have the tremendous concentration of our population in the east, worse than the concentration in the south-east of mainland Britain, and it is inevitable under those circumstances that whatever may be the overall figure of dentists in relation to the population that figure will vary very widely between the general area of the east coast and the remoter areas of the west coast, if the Minister of State will allow me to appropriate his constituency as an example.

Not only have we a problem of trying to develop manpower but we also have the problem of trying, even with the manpower we have, to do everything possible to improve distribution. We are producing considerable numbers of dental graduates. One of the problems that the working party discussed was the way in which we could attract those graduates into working in Ireland, in particular into the health service.

I should like to ask the Minister if he would, in his Second Stage reply, indicate the extent to which progress has been made in regard to the recommendations of the working party on the attraction of graduates. For example, they recommended sponsorship by health authorities of dental students. This has happened in the North-Western Health Board. I would be glad if the Minister would indicate the extent to which there has been sponsorship in recent years and how it is working out in practice.

The recommendations of the working party in regard to entry grades and grade structure generally have been met since the publication of the report but there were other recommendations and I would be glad to know from the Minister what progress has been made, for example, in regard to re-training and in particular in regard to the question of part-time permanent posts, particularly in the areas remote from Dublin and the east coast where there is a very distinct shortage of dentists. In the Dental College at the moment 40 per cent of the students are women. It may well be that if we had these part-time permanent posts women at a certain time of their married lives would find these posts very suitable. They would not have to face a choice between a full-time appointment and full-time home duties.

While we face a considerable problem in regard to the dental profession, I do not think we should ignore the fact that we have made substantial progress. It is very heartening when reading something like the WHO Collaborative Study to find that the level of decay revealed in our school children was below the average of other countries and that in regard to adults who did not have the benefit of such progress as we have made, in the age group from 35 to 44 it was about average.

We should take note of the very substantial improvement in regard to the level of decay in the years from 1961 to 1980 when the figure in regard to teeth decayed, missing and filled, approximately halved. A very, very substantial improvement. A good deal of this must be attributed to the fluoridation of the majority of our water supplies through, of course, improved dental hygiene must also have played a great part. Here again we have the problem of distribution. It is in the remoter areas not fed by a large water supply system that we will find non-fluoridated water or, even if there is a scheme for fluoridation, we may well find that the standard of operation of the fluoridation is not the same as it would be in a larger undertaking. I recommened to the Minister that there is a case for an examination of the efficiency with which the fluoridation of public water supplies is carried out in the country. Once again we will probably find that those in the remoter areas are at a disadvantage from this point of view also.

The indications are that we have made progress in the past two decades, that our problem is not too bad, but when we come to look not just at the level of decay but at the level of children with decay of various amounts who have not been treated and who are still awaiting treatment, we come up against the problem which has already been mentioned of delays which are well beyond being tolerable. Again I return to the point that, if we were to examine the distribution of those delays geographically, once again we would find that those in the remoter areas are discriminated against. This picture, then, is the context within which we should consider this Bill before us. I have already indicated — and nearly every Senator has indicated — that we would like to tease out certain sections at quite some length on Committee Stage. I join in that view and look forward to a thorough discussion of the Bill on Committee Stage.

On Second Stage I would like to mention a number of points in order to elicit a response from the Minister in his reply to Second Stage that would help all of us in the House who are interested in this topic to consider our attitudes towards these various sections and to consider whether or not we wish to frame amendments for Committee Stage. I would like to comment on the various sections of the Bill and to touch on a few points.

Part II is concerned with the Dental Council which is to replace the Dental Board. This will be recognised by all as an important step in the evolution of the dental profession in Ireland. If we look at the make-up of the old Dental Board and the make-up of the new Dental Council we see a number of changes. On the old board of nine there were five representatives of practising dentists, three representatives of the Medical Council and one Government representative. In contrast in the new council of 19 there are seven practising dentists, five representatives of educational bodies, two representatives of the Medical Council and five representatives of the Government.

It may be that some practising dentists will feel they are to some extent being submerged in this new council. I do not think they have any reason to fear this. They were a majority of five out of nine on the old Dental Board. They are only seven out of 19 on the new board. We certainly would expect that the five representatives of the educational authorities would also be registered dentists. Indeed, we could say that there is more consent, more community of feeling, between dentists in educational institutions now than there was at the time of the 1928 Act. So I do not think there is any fear that matters on which a professional opinion is important will be influenced or decided by non-practitioners.

The inclusion of a number of Government representatives, five out of 19, is a welcome movement. I am sure the dental profession would agree with me that if their objectives in regard to the improvement of dental health in Ireland are to be achieved, they can only be achieved through the co-operation of the public at large. It is not a mere question for a profession apart. The problem of community dental health is not just of interest to both the profession and the public. It can only be improved, and its major problems can only be overcome, by the closest possible co-operation between the profession and the public.

The new members of the Dental Council will have a very important function to perform. They will need to extend their influence in two directions. Within the Dental Council they will be representing the public at large, but equally I would hope, they will exercise the function of representing the Dental Council to the larger public. I hope the Minister will appoint people not just with ability but with real energy to these positions, so that they can carry out that double task to as great an extent as possible. It is always a difficulty that where a committee are dealing largely with professional concerns, non-professional people who come on to the committee can sometimes find themselves at sea. If 12 or 18 months after their establishment a person listening from the doorway to a meeting of the Dental Council were able to tell beyond any doubt which of those members was a dentist, and which was a non dentist, then I think the new council will be on the road to failure. The job and the responsibility of whoever is the first president of the new Dental Council will be to fuse these various members together in order to establish right from the beginning this departure — that there is a break from the old Dental Board, dealing with matters of registration and matters of professional practice, to a new Dental Council who are being charged by the Government and by the Houses of the Oireachtas with a public function in regard to this important area of community health.

In this Part of the Bill we have, in section 13, the power to set up committees and the duty to set up committees with regard to education and matters of professional conduct. I would like to ask the Minister in regard to section 13 (1): what is the force of the phrase "as in the opinion of the council, may be better or more conveniently performed by a committee..."? Now this appears to establish that, apart from the mandatory committees in subsection (2), it is a matter of absolute discretion for the new council as to what other committees shall be formed. Could the Minister say whether there is an absolute discretion in section 13 (1), or whether that absolute discretion is governed by section 15 (1)?

An Leas-Chathaoirleach

The Senator is the Leader of the House and I do not like to interrupt him but on Second Stage we do not take the Bill section by section. He may continue with my permission but he is giving me the impression that we are on Committee Stage as he takes the Bill section by section.

A Leas-Chathaoirligh, I submit that you have not heard me on Committee Stage yet. You do not know the detail I will go into on Committee Stage.

An Leas-Chathaoirleach

I look forward to that.

I will try to relate my remarks more directly to the questions of principle. Perhaps in trying to make it easier for the Minister to reply I was talking unduly of individual sections. I assure you that what I am talking about here is the question of how autonomous are the new Dental Council. They appear to be autonomous under section 13 (1). When we look in section 15 at the power of the Minister to direct the council they appear to lose their autonomy, only two sections later. This, I can assure you, is no detailed point. This is a substantial point of principle on the extent to which the Minister may direct.

I agree it is reasonable that the Minister should have some power to ensure that the Dental Council are acting in the public interest but I think section 15 can create a difficulty if the council fail to perform any function assigned to them. They have the function under section 13 of appointing committees if they so wish, if they so think fit, but it appears from section 15 that the Minister can possibly direct them to set up a committee. At this stage, to avoid putting down any unnecessary amendments, can the Minister say whether he has the power under Part II of this Bill to direct the council to set up a committee? This point comes up later in the Bill and I will advert to it again. The principle at stake here is the power of the Minister to direct.

Talking also about the council and their powers and duties, I notice that in Part II of the Bill the council are required to furnish annual accounts. I suggest to the Minister that it might be desirable not only for the council to provide annual accounts but also to provide an annual report. In this very important area where we have had reports from time to time which have given us the information in regard to what progress we were making, it would be very suitable if at the same time they were presenting their accounts the new Dental Council produced an annual report. If this annual report also contained the reports of the mandatory sub-committees, such as the Education and Training Committee, this would indeed be of assistance not merely to the Minister, not merely to these Houses, but also to the general public.

In regard to Part III of the Bill which is concerned with registration, there are quite a number of points which will need to be discussed on Committee Stage. Section 27 gives less discretion to the High Court than section 33 of the 1928 Act and I would like to ask whether this is a deliberate limitation of the discretion of the High Court in that they appear under section 27 to have to say "register" or "do not register", but do not have the power to recommend other steps to be taken.

In section 30 we have a new proposal in regard to a register of specialists. As Senators know, this has created some anxiety among general practitioners. I would like to ask the Minister is there a directive or a draft directive which makes it a necessity for the Dental Council to set up such a register. I would like in this connection to recall what the Minister said in his Second Stage speech, and I am referring to the debate in Volume 103 of the Official Report of last Wednesday, 14 March at column 413. The Minister said in regard to this special register that although the provisions in the Bill do not compel the Dental Council to set up a register of dental specialists now, they give the council the facility for registering specialists at some future date if they should consider it desirable to do so.

Here we are back once again to the principle of the degree of autonomy, the degree of discretion which the Dental Council have. If the Dental Council with their representatives of the consumers, with their representatives of the profession, feel that it is not proper that a register of specialists be set up at any particular time, I would like to ask the Minister has he taken the power under section 15 to compel them to do so.

With regard to Part IV of the Bill which is concerned with education and training, there are points here which can be taken up on Committee Stage. I would like at this stage only to ask the Minister about the question of internships which was raised, I think, by the working party. Has the Minister any view in regard to the question of establishing internships for dental graduates before registration along the same lines as obtain in the medical profession?

In Part V of the Bill which is concerned with fitness to practise, we see some welcome developments. Compared with the 1928 Act there is an extension of power and I join with Senator Fallon in welcoming this. In particular I welcome the fact that it is now open to any person to initiate a complaint, whereas previously under the 1928 Act it appeared that only the Dental Board or an educational establishment were open to do so. It is in accordance with modern thinking that it should be open to any member of the public to initiate the various procedures. This may lead to certain trivial or frivolous complaints but that is a small price to pay for a public acceptability of the position that if they have a grievance they are entitled of their own right to set in motion the machinery which will adjudicate upon that grievance.

Also in regard to this — again it may help us to avoid a long discussion on Committee Stage — I would ask the Minister what is the significance of the change from the 1928 Act wording of felony or misdemeanour which I think is still maintained in British legislation to the language of section 42 "triable on indictment". I am not enough of a lawyer to know the difference. There are, of course, descriptions of the serious and the less serious, but I would like to know what difference the Minister is asking us to enact when he uses that alternative wording.

In Part VI of the Bill there is substantial updating in regard not merely to the penalties for illegal practice, but also in regard to the coverage. The students and auxiliary dental workers are now covered. I am very glad to see that it is no longer legal, as it was in the 1928 Act, for a pharmaceutical chemist to extract teeth without an anaesthetic. I am very glad we are not open to that hazard under the present legislation.

Part VII of the Bill has been mentioned by a number of Senators. There is a substantial new departure. Here once again we are seeing a substantial step in the evolution of the dental profession. This is a subject that was discussed in the working party report which talked of problems in relation to surgery assistants, technicians, hygienists, therapists, and so on. Almost all Senators who have spoken in this debate have sought elaboration of sections 54, 55 and 56 of the Bill. I would like to ask a few questions. The Minister might be able to answer them when concluding on Second Stage.

First, the working party mentioned that a ratio of one dental surgery assistant per practitioner was probably the minimum requirement. Are there any figures available as to what is the present position in regard to numbers? I would like also to ask the Minister whether any action has been taken on the working party report in regard to the method of recruitment and appointment of dental surgery assistants, and whether there are any plans in regard to the formal training and recognition of dental surgery assistants. There may well be openings here in these times of high youth unemployment for action which could help youth employment and at the same time give support to the registered dentists. I am thinking particularly of those areas which are relatively disadvantaged. I do not like to use the term density of dentists and I am using it only in a geographical sense.

I would also like to ask the Minister if he could give us some information in regard to the present position of dental technicians. I understand there may be about 100 of them in the country. I understand also that AnCO have been undertaking some training in this connection. It would help Members of this House if the Minister could indicate what the present position is and whether any action is contemplated in this regard.

A question that could give rise to a good deal of controversy is the establishment of a class of auxiliary dental workers whom the working party call denturists and who I understand are concerned with the direct supply of dentures to patients. The working party recommended against the establishment of any such class. The argument used was that the elimination of the waiting list by the use of dentists in general practice would reduce the problem, and that increased dental hygiene and the increased effects of fluoridation, and so on, would lead to a decline in the future in a number of those who were totally without teeth. It would appear from the Minister's Second Stage speech that he is accepting the question of a need for this particular class of auxiliary dental worker and proposes to establish it. I would be glad if the Minister would indicate whether in fact I am reading his Second Stage speech correctly here and that it does mean that he is taking a different view to that of the working party and, if so, for what reason?

This again brings me back to a recurring problem if this is so, of, whether the Minister would be able to use his powers under section 15 to direct the new Dental Council in regard to the recognition or the training of such a group since there would appear to be a danger that he and the professions, may find themselves in confrontation on this point. I am not suggesting here which viewpoint is correct. I am merely saying that there appears to be a difference here. I appreciate that there is a question of balance involved. It may be a very delicate balance but I would like to know exactly what the situation is and what the situation would be if the Bill were to be passed in its present form. Another group of auxiliary dental workers are dental hygienists. These are concerned with the preventive aspects of dentistry and would represent a very good use of scarce resources, scarce resources of money for training and scarce resources of personnel. Here we need to develop an Irish type of dental hygienists particularly suited to our problem.

With regard to the category of dental therapists I would like to ask the Minister what he envisages in regard to these operating auxiliaries working under a dentist. Does he, in fact, intend that they should be used largely in the public service or in private practice? Here again we have a question of balance and a question of deciding where the scarce resources should be used. I am not trying to suggest that the dental profession are in any way unscrupulous but I do not think that we would want to leave the temptation open to any dentist that he can establish a row of six chairs for social welfare patients and employ six dental therapists to work under his direction thereby making the social welfare recipients a type of second-class dental patients. I am not suggesting that this is liable to happen but certainly anything that would tend to leave ourselves open to such a situation should be avoided.

I have now come to Part VIII which deals with "miscellaneous" and the number of points I have to make here are few and miscellaneous. I did commend the Minister in the course of my opening remarks regarding the format in which he produced this Bill and the fact that we are now, with the exception of one section, able to hold everything in our hand and find out what the position is. There is another difficulty in this regard. In section 62 there are references to statutory instruments to be construed as referring to the new Dental Council. It would be of great use to the Houses of the Oireachtas in enacting this legislation, to the new Dental Council in carrying it out, and the general public who I have emphasised in this, as in many other matters, have a right to know, if we knew what statutory instruments were involved and if the Minister could make available to Members, perhaps by depositing in the Library of the House, a list of the statutory instruments made under the 1928 Act. They should be available in the Library but if we know where to find these statutory instruments it would help us to understand the manner of operation of the 1928 Act and, therefore, to judge more accurately what is likely to be the manner of the operation of the Bill before us.

Under section 63 there is the question of regulations made under this Bill and provision for them to be laid before the Houses of the Oireachtas and be subject to annulment. Again on section 15, to which I have returned several times during my remarks, in which the Minister has the power of direction, I would ask the Minister if he would be willing to make any direction issued under this section subject to annulment in the Houses of the Oireachtas so that if the Minister was directing, if the Minister was limiting the discretion of the Dental Council, if the Minister was in the position of making his view prevail over that of the Dental Council at least the Houses of the Oireachtas would have an opportunity to debate the matter. As matters stand, of course, annulment of a Minister's order is most unlikely under our political system.

In section 66 there is a provision whereby the Minister may request advice from the new Dental Council regarding any matter. In these new days of parliamentary procedures when we have a large number of standing Joint Committees of the Houses of the Oireachtas I would like to ask the Minister if it would not be appropriate for Committees of the Oireachtas to seek advice from the Dental Council and, indeed, from other bodies also, without having to go through the Minister. Prior to this the opinion of a body such as the Dental Council has been available to the Houses of the Oireachtas through the Minister to whom they are responsible but now as Parliament is developing the committee system this needs to be reviewed.

Regarding the First Schedule, there are points that can be discussed on Committee Stage. In Article 6 there could be some discussion about the question of a casual vacancy. There could be a cooption which could last for quite some time. I can understand that the Minister wishes to avoid an electoral procedure in this connection but it is a point that could be argued and, indeed, will be argued on Committee Stage. In regard to the question of a quorum I would suggest to the Minister that the quorum goes both for ordinary and disciplinary purposes seems somewhat small, a quorum of five out of 19. It is not small by too much, but it is a rather small quorum for such an important body which, in fact, contains representatives from so many different areas.

May I, in conclusion, say that the Bill is welcome as it has been welcomed by Members of the House? It is a Bill which needs thorough discussion, and there is much work to be done on Committee Stage. I talked earlier about the fate of Seanad amendments which, apparently, was much the same in 1928 as it has been in more recent years.

On the other hand we can, whether by way of sectional discussion or by amendment, do much to probe this Bill, to elaborate on it and to make its effect more clear by having a thorough Committee Stage debate. This is a good Bill, and there is no doubt about that, but that does not say it may not be capable of some further improvement.

After Senator Dooge's contribution I cannot see that there will be very much need for a Committee Stage debate. If there is we have an idea already as to the amendments the Government will be putting forward. I thank the Senator for that.

I am not the Government.

We will be well prepared to answer the Senator on his amendments when they are introduced. I do not intend to spend very long on my contribution but I wish to make some general remarks. The Bill must be welcomed by all sides of the House. In welcoming it we must also admit that the drafters of the 1928 Act did an excellent job when one considers the changes that have occurred in society since it was introduced. In general the 1928 Act has stood up to the changes that have occurred. I am not talking alone about the changes that have taken place regarding health practices and services. When one considers the massive hammering children and adults get in the advertising of sweets and other items which are detrimental to dental care it is heartening to know that in adult dental health, at least since 1963-64, many improvements have occurred in that the amount of dental care necessary for adults now is not as great as it was prior to 1963-64. There are a number of reasons for that. I am sure that the standard of dental education has improved over the years, just as the standard of general hygiene has. Indeed, I am sure that fluoridation has helped in this process.

It is good to have such a debate on this topic, because this concerns everybody. It is not a sectional Bill. There is no doubt that there is not one person who will not at some stage have to go to a dentist for some form of treatment, whether it be corrective or of another nature. The Bill deals with the necessity to regulate standards. Much of the debate that has taken place has been on the regulating of standards and the need to produce a dental care ethic and service for our people. Much has been made of the qualifications necessary before people are permitted to deal with oral hygiene or care.

There has been a lot of talk about the difference between a dentist, a denturist, an auxiliary dental worker and the various other people mentioned in terms of dental care. We have at present two excellent dental hospitals and the standard of those graduating from them is improving all the time. There are problems in those hospitals, and similar problems exist throughout the health board areas. There are excellent facilities for students and workers and magnificent equipment but a shortage of people to work those facilities. The resource management we have at present is not adequate in terms of medical care in general and of dental care in particular.

A large proportion of those who graduate from our dental schools emigrate for one reason, that they cannot be accommodated in the Irish dental care system. In particular they cannot get employment in health boards, an area which is crying out for them. Mention has been made by some that when a student leaves a dental college he or she should do at least one year in service here before going abroad. There may be some merit in that but I would not like to see somebody being compelled to do that type of service. When I mentioned that resource management was not good I was thinking of the South Eastern Health Board's report for last year. There is one principal dental surgeon for Carlow-Kilkenny and only six clinical dental surgeons. There is no orthodontic surgeon. There is one on the list but he has not been appointed. It is interesting to consider the number of sessions dentists in the Carlow-Kilkenny health board dental service area had last year, 2,560 sessions for children and 279 for adults with seven of a staff. The principal dental surgeon cannot be expected to work fulltime as a principal clinical dental surgeon if that person is supposed to be a superintendent in the area also.

With regard to the adult scheme, in

1981 it was found that the majority of children's cases were being dealt with by health boards while adults, in general, were treated by private practitioners. As a result of greater dental health care private practitioners are not getting more work while, on the other side, health boards, because of the number of children being treated, have to deal with an increasing work load. When one considers the increase in the birth rate here one can realise that the demand on the health boards will increase, particularly if they are to deal with children mainly. Due to bad resource management the position will get worse.

For severe orthodontic cases in the Carlow-Kilkenny area at present there is a three-year wait for children and there are 500 on that waiting list. Apart from that there are 800 others who are not considered to be severe and they will have to wait more than three years. It is horrific to think that in that area for fillings and general treatment, there is a two to three year wait. There is no waiting list for emergencies because emergencies are dealt with as they arise. Of course, the more emergencies that arise the longer the waiting list grows for general surgery. It would appear to me that the Bill will not become effective unless there is a greater allocation of resources to the dental service within the health service. I was glad to hear the Minister when introducing another Bill today mention that he has been fighting the Department of Finance for extra moneys. I sincerely hope that he will be fighting for extra resources for the dental service because it is a service which needs more and more resources.

On the question of registration, mention was made of the fact that we are going to have a general register of dentists and then a specialist register. Listening to the Minister's speech and reading through the Bill it appears that the basic reason for this is not one of essentials but rather to bring us into line with registers in EEC countries. Mention was made of countries outside the EEC. I do not feel we would need a registration of specialists. That is a personal opinion. If somebody has extra qualifications and specialises in a particular type of dentistry that will become known and the general dentist will refer people who need specialist treatment to that person. However, I am not in favour in general of specialist treatments within the health service at all because quite a lot of the illnesses we have are created by the fact that the referral system is used too often. A person who goes to a general practitioner is referred to somebody else and the psychosomatic problem the person has, if he has it, will be strengthened. If such people do not have a psychosomatic problem they will have one if they are referred often enough. The disease can become a bigger problem because of the referral system. I would prefer to see in our health service a patient having the full range of services in one place rather than the referral system we have now. That applies more to the general health services than it does to the dental health service.

I do not want to go into the make-up of the Dental Council in great detail but I agree with the comments already made as to the need to have somebody from the INTO involved because so much of dental care is tied up with schools and younger people. The Minister has left scope for that involvement in that he has the authority to appoint four members. I suggest to him that one of these four members should be from the INTO.

On the question of the preventive maintenance programmes that are needed we will have to make certain that the council give top priority to preventive maintenance services. If we are to have an improvement in our standard of dental care it can only come if we have proper preventive maintenance programmes. We must ensure that if we are to have auxiliary workers the vast majority of them should be used in the educational system to counteract the very vicious anti-dental care advertising programmes we have on RTE and other channels. Top priority must be given to education.

One of the reasons for the introduction of this Bill was to ensure that the consumer was protected and that the cost to the consumer would be kept down by allowing certain people outside the dentist profession to supply dentures direct. In the consumer report a price of between £15 and £17 was mentioned as the price of dentures to health boards. Last year's health board report for the Carlow-Kilkenny community care area states that 200 full sets of dentures to the health board cost £23,998 or £119 per set. The figures in the consumer report are not accurate and it is highly unlikely that there would be a major difference to the patient if the supply of dentures was to be given to non-dentists. We have to ensure that the dentist deals with living tissue and that anybody other than a dentist should not be allowed to deal with living tissue.

I was a little bit disturbed to see in a section of the Bill that extractions could be done by auxiliary dental workers but only of deciduous teeth. That would not be the way I would look at it because we are dealing specifically with the very young. It is essential for the proper development of a good dental care programme that a dentist, or a highly qualified person, deals with the child in the first place. There are a number of reasons for that. There is the question of confidence and, equally, it gives a dentist the opportunity to have a look at the general health of the patient. For that reason I would not agree at all with the suggestion that extractions of deciduous teeth could be carried out by non-dentists.

We must have a closer look at the orthodontic scene. There are two types of orthodontics. We have the actual orthodontic situation where there is a fault which for medical reasons must be changed. Equally, in the case of girls, there is a situation where if a girl does not get proper orthodontic treatment she may have a personality change. She might not be as outgoing as another girl who would have had orthodontic treatment. Unfortunately, at present people who can afford private orthodontic treatment can get it reasonably easy and those in the health services cannot. There is the cosmetic orthodontic treatment which while not totally necessary must be considered when one is dealing with this part of the dental service.

As far as fitness to practise is concerned, I can never understand what makes one fit to practise. Does it mean that one has strong wrists, or that one's morals are of a certain nature? We can discuss that on Committee Stage. There is mention in the Bill of unfitness due to physical or mental disability. There are people who might be mentally disabled in certain areas, but that would not mean that they would not be able to practise in any profession. The same goes for physically handicapped people. We must be very careful what we mean when writing into legislation that people are unfit because of either of these two inhibitions. I would not like to try to define physical or mental disability but I am sure we can get a definition on Committee Stage.

I am glad that the Bill has been introduced. It will have far-reaching effects, but if it does as good a job as the 1928 legislation, it will be for the good of all the people of this State for a long time to come.

I have a few observations to make on this Bill. In welcoming the Bill as a major contribution to the possibility of improving dental care throughout this part of Ireland, the key lies in how the council is composed and how it will conduct its work.

As one looks through the composition of that council, there is no doubt that there will be a number of very well-informed people on it. The question I ask is whether they will also be very aware people. Section 9 (f) says that of four persons appointed by the Minister, at least two of them shall not be registered dentists. This, in effect, means that we have only two consumers assured on that council. It is vital that the council should be apprised of the defects in the system, not just in the neighbourhood of the Dublin Pale but throughout the Twenty-six Counties and, dare I say it, beyond. Therefore, I would recommend that the Minister should very seriously consider increasing the input from the consumer and ensuring that that input comes from the different regions. I am quite certain that the availability and standard of dental care varies throughout Ireland from county to county, and locality to locality, as much as it does anywhere else in Europe. It is very important that the council should be aware of the defects as they exist.

There is another body who could have a very important input. Before I mention who I have in mind, I would remind this House that in my own profession only some 10 per cent to 15 per cent of hospitalised ill health requires the attention of the super-specialist attached to the super-technology. Yet virtually all the power to determine undergraduate attitudes to matters of health, to determine post-graduate training profiles, and also the patronage to determine who gets what job, is held in the hands of those 10 per cent or 15 per cent of practitioners in our profession who are primarily concerned with that very important element of medical care — super-specialisation. Therefore, it is important to have a balance when we are discussing matters dealing with training, the dispersal of dentists, the location of dentists, the availability of dental care in the different communities, the standard of dental care and so on. I would suggest that at least some endeavour should be made either through a seat on the council or in assuring that one of the committees has representation from the dental student body of Ireland. These young men will be training for approximately five years. They are all citizens of the country over the age of 18. Many of them go in with a certain degree of youthful idealism, and many will have ideas about the future as it will affect them and the society into which they are going to emerge. Then there is also the body of young dentists who will be temporarily registered. There is a great advantage to be obtained by ensuring that there is some representation from the student dental body and/or the junior dentists. I would define junior dentists as those who are not more than five years qualified.

The ideas expressed in this Bill and the hopes for it will be realised if we do what various Senators have suggested, that is, ensure that there is representation from those who are interested in education outside the dental profession — teachers — that there is adequate consumer representation and that junior dentists — and I would also advocate the student dental body — are represented if not on the council at least by statute on some subcommittee.

I take this opportunity to welcome the Bill because I believe it will be a decided help and advantage in this area of dental care and dental health. In particular, I want to refer to example and encouragement in this area. I am speaking from personal experience. At a very young age I was influenced by another poor boy like myself who took care of his teeth. At that time all we had to clean our teeth was soot on a piece of cloth. Nevertheless, providentially, I still have all my teeth and they are still pretty good. That may be one of the reasons why I am seldom seen around this House without a smile.

From an early age I attended a local dentist who looked after me for a very modest charge. He did not have a university degree but he looked after me and many other people very well. This man had served his time with another dentist. For this reason I feel that in this area of dental care there is a place for many people to help who have not gone through university. I believe there is still a place for people to help out in the dental services. I say that notwithstanding what Senator Dooge said about retraining. This is most important, for people in any profession because at present in any profession it is necessary to spend a half day every week to keep in touch with improvements and trends.

I want to refer to fluoridation. Senator Dooge said it would be necessary to examine the efficiency of fluoridation schemes carried out in country areas. I agree with him completely. I have five children and was always anxious to live inside the urban areas where the waters were fluoridated. I lived with four of my children outside the urban area for long periods, but my fifth child has lived in the urban area where the water was fluoridated yet he is the only child who has serious dental problems. At local level I questioned if fluoridation was taking place and if it was done in accordance with regulations and was told it was, and I believe it was, but as far as I am concerned, fluoridation has a big question mark after it.

I want to refer to the progress which Senator Dooge mentioned. He spoke of the old Act under which a pharmaceutical chemist could extract a tooth without an anaesthetic. I welcome this progress. Some years back an old man told me that in his youth it was usual to get a tooth extracted at a fair or a market by a man who was travelling around——

With the brass band playing to drown your screams.

Perhaps not a brass band, but a melodeon or accordion, and he could increase the volume as the cries and the shrieks rose. His business fell through when he changed to a gramophone because it did not have this flexibility. In my time, I have known of a carpenter to help out on occasions. Nevertheless I welcome the progress that has been made, and I welcome the Bill.

I welcome this Bill, which is long overdue and eagerly anticipated. Both the Minister, Deputy Desmond, and the Minister of State, Deputy O'Brien, must be complimented on their efforts to introduce the Bill after a relatively short period in Government. I welcome the suggested composition of the membership of the new board. Like Senator Robb, I am in agreement with consumer involvement: the suggestion that two non-dental persons should be on the board is good and should be extended. It has been suggested that a member of the INTO should be included on the board. I recommend that members of the other teachers' unions — both the TUI and the ASTI — should also be included, because if any dental preventive programme is to be successful in the schools, it will take the co-operation of both teachers and the people involved in dentistry. This relates not only to national schools but to secondary schools.

Recently I read of a very successful programme carried out in Zurich, Switzerland, under the guidance of a man who is renowned in the field of preventive medicine in dentistry. This programme achieved a very high success rating. It would be useful to have a programme like this introduced here. Up to now, the programmes we attempted to introduce were half-hearted, non-conclusive and very badly planned. There is a definite need to have an adequate health education programme on our curriculum. I hope the new curriculum board will have a serious look at health education when they are considering any suggestions for curriculum revision. Dental health should play an important part in any health education programme.

A dentist should be appointed to the Health Education Bureau. At the moment, there is no representative from this body in the Health Education Bureau, and there is a void in the bureau in this respect which should be taken into consideration.

The present VEC pilot schemes on health education should be expanded to include dental health education. We are all impressed with the success rate of the recent "Crest", "Colgate" and "Palmolive" projects that have been developed in the national schools, with the agreement of the Department of Health and the Society of Chief Dental Officers in Ireland but we need more initiatives like this if we are to make a favourable impression on the dental health of the nation.

On Committee Stage I will deal with sections 54, 55 and 56. Like most Senators, I have reservations about these sections and their operation. There is a great need for preventive medicine. I welcome the whole concept of dental auxiliaries, especially as it has definite employment potential. This must be considered in relation to this concept. There is no doubt that more specialists are needed in the area of preventive and treatment dentistry. Recent figures quoted in a newspaper indicated that there is a 60 per cent untreated need in the child population from eight to nine years of age and 89 per cent of the population are suffering from gum disease of one type or another. The fact that these alarming statistics prevail is due no doubt to the lack of sufficient personnel and their availability to administer any effective type of service. With all due respect to everybody concerned, I must say that the present service is not very successful, especially when one compares it with the services of other countries, particularly our EEC partners.

I should like to refer here to my own constituency of north Kerry, especially in relation to orthodontic care, which has been mentioned already, and which I am sure is a problem throughout the country. In Kerry we have a huge waiting list. There are children in urgent need of growth corrections and so on who are not being attended to. It is embarrassing when parents come and ask us to do something to get their child called for treatment after a period of four or five years. It is very difficult to defend such complaints. The parents have a right to feel that their children are being neglected. In some cases, by the time the children are called, the damage has been done and it is very difficult to make any proper corrections. I should like to express my regret that recently the Southern Health Board failed to appoint a whole time consultant orthodontist, although I am glad that the other five health boards have recognised the need and are in the process of appointing consultants. I should like to compliment the Minister on setting up the national children's survey and I am delighted that the first county visited was Kerry.

In relation to dental auxiliaries, I should like to point out that this concept will provide wonderful job creation possibilities during the next five years. It is estimated that there could be as many as 300 to 500 auxiliaries employed by the regional health boards, and another 300 could easily be employed in the private sector. This is an area of job creation which must not be overlooked. There is also the possibility of a new professional grade being opened as a result of this Bill. I also welcome the fact that dental surgery assistants will be registered and trained. This will give recognition and status to the job which at the moment is labelled under various headings, such as dental nurse. The training of dental technicians for clinical work is essential. Here is another wonderful job creation area to be explored. I should like to point out, and it is probably a well known fact, that we import large amounts of dental technology — estimated at about £5 million a year. This could be easily substituted by home produced goods. This is an area the Industrial Development Authority should definitely have a look at. The Ministers for Education, Labour and Industry, Trade, Commerce and Tourism should have a look at this area too because it has the potential to create jobs.

Universities currently training dental surgeons now have professors and lecturers in the area of community dental health on their staff. This is a major development. I am looking forward to closer links between the regional health boards and these universities. It is time to have more liaison between the universities and the health boards for research, scientific experiments and so on. I should like to mention the recent important development at Cork Regional College which carried out various dental projects which have been very successful. I am glad ties now exist between UCC and the Southern Health Board, and this must be welcomed.

Overall, this is a very welcome Bill. No doubt it will be a very important development not only for the dental profession but also for preventive dental health, an area in which we are lagging behind.

It is nice to have a Minister in the House and to be able to say something complimentary about him. The Bill is a great step forward in one specific area. I suppose I can slip in a disorderly compliment to him for yesterday's announcement about the combat poverty group.

The Bill raises the whole question of the relationship between any important profession and the community and the laity. It would be remiss of me to let the opportunity go without putting on the record that well known suggestion that all professions are a conspiracy against the laity to a greater or lesser extent. The whole idea of the regulation of professions is one that has a good, honourable historic basis, but it needs to be looked at again in the context of a more complex, a more consumerist, a more demanding and a better educated society. The basic concept that needs to be elaborated on and explored in much greater detail is the concept of the accountability of professions to the community at large and the underpinning of that accountability by the legislative structures that we develop. This Bill is a development in that direction because it now leaves one major profession regulated by a group on which that profession no longer has majority representation. I regard that as a major, significant and worth while innovation. What is even more impressive is the apparent acceptance, from what I have seen, by the dental profession of that principle.

Would it be out of order for me to look forward to the day when the Bar Council are similiary structured so that barristers will not represent the majority of those who regulate the bar, and solicitors will not represent the majority of those who regulate the legal profession, and indeed my own profession to the extent we are regulated, although more than most, by a competitive market place and therefore do not have the same capacity to protect our interests through self-regulation. It would be a worthwhile principle to extend to all the professions that the minority representation would be for the profession and the majority would be for the community through the consumer and various other interests. One could extend this idea of the professions and professional accountability beyond what are regarded normally as the profession, because medicine, dentistry, architecture, engineering and those in the law have always been regarded with a certain awe, but there are professions now which are so sophisticated and, without being too unruly, as powerful as those — banking, insurance and accountancy — that are as much in need of regulation by the community as the traditional professions which are, to a considerable extent, under the detailed scrutiny of the community.

It might be helpful if the Senator kept to the dental profession.

What the dental profession seem to have accepted willingly would be a welcome and useful innovation for other professions. The uniqueness of the whole area of health care and dental care, and particularly of dental care, is that it is an illness of degeneration in the way that the advancing ailments of western society are less a product of neglect, malnutrition and poor health and more a product of our deliberate abuse of ourselves through overindulgence. It is somewhat of an irony that we have to spend more and more time in our western affluent society looking after more illnesses that are not accidentally caused, not caused by factors outside our control, but are caused almost entirely by our own over-indulgence in things that do us no good. I wish the Minister would convey to the Government his reforming zeal in all the other areas of professional self-interest and powerful vested interest.

I welcome the Bill and, in particular, the extension of the principle of auxiliaries having rights. As one who participates in the non-university technological sector where there are many specialist technicians and technological people being produced in many areas, it is very important that the unique role of people outside the old limited concept of the professions be recognised and be extended into the areas of engineeing, the law and so on. The incorporation into the Bill of at least the possibility of specialist auxiliary dental work being done by people other than graduates of dental schools is welcome, and I am glad the Minister has introduced it. I hope no lobbying from one force to another will in any way water it down.

Cuirim fáilte roimh an Bhille. Cosúil le gach éinne eile anseo inniu, agus ós rud é nár deineadh athrú ar bith ar an mBille ó 1928 go dtí an bhliain seo, ní féidir liom a rá go bhfuil daoine ag dul ar aghaidh go ró-thapaidh.

As I have only two minutes, I feel I will not get my teeth into this Bill properly.

The debate on this Bill will be resumed another day.

There are many sections in this Bill on which people could speak, but the one that interests me in particular is section 7. Regardless of the standards of education of dentists, and their regulations, the one fault I have with this profession is that there are not enough dentists to do the work that needs to be done. Section 7 will provide extra people to teach oral hygiene. This is an important factor if it means that the dentists will be free to do the work they are trained to do. It is appalling that children lose their teeth because they did not get care in time. This is one medicine where prevention is better than cure, because there is not any cure when things go wrong. An extraction is not a cure; it causes other problems. Despite the best efforts of the dentists in the public health scheme, in my area they are run off their feet trying to catch up on the backlog but they will not succeed because we do not have enough dentists. I would like to see the Minister providing this extra help and giving more time to dentists, or if possible providing more dentists.

Debate adjourned.
Sitting suspended at 5.30 p.m. and resumed at 6.30 p.m.