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 The way this Bill has been brought to us, whereby the whole of the 1928 Act has been repealed, even though many of the sections have been substantially reproduced here, is the way it should be done and is welcome.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)?
