I move "That the Bill be now read a Second Time".
This Bill is being brought in to replace the existing legislation governing the registration and control of persons practising dentistry and the maintenance of standards of dental education and training in this country. The existing legislation is the Dentists Act of 1928 which has served its purpose well over the years but is now outdated.
The changing trends in dentistry, particularly over the past few years, necessitated changes in the legislation governing the profession if we here in Ireland were to keep pace with these changes and maintain the high standing internationally to which Irish dentistry has become accustomed.
This legislation is designed to meet present needs and, in so far as possible, to facilitate anticipated changes in the future. I am, of course, aware that no legislation, no matter how well thought out, can provide for every eventuality, but every effort has been made to ensure that the Bill incorporates the best in modern thinking in relation to dentistry. It does not seek to bring about change for change's sake as will be evident from the fact that many of the excellent provisions of the 1928 Act are retained and are being re-enacted in this legislation. The new Bill is in many ways parallel legislation to the Medical Practitioners Act of 1978 which updated and improved the laws governing the medical profession, but it has, of course, certain provisions which are peculiar to the dental profession alone.
Under the provisions of the Bill the Dental Board, who have served the interests of the general public as well as those of the profession itself over the years, will be abolished and replaced by a new body to be known as the Dental Council. It is appropriate at this point that I should extend my sincerest thanks to all those who served as members of the Dental Board down through the years. They have done an excellent job and are largely responsible for the high standing which Irish dentistry has attained and the esteem in which it is held throughout the world today. The dedication and enthusiasm of successive Dental Boards is quite remarkable, particularly when it is considered that active membership must inevitably result in a certain amount of inconvenience and disruption of routine for the individual member.
The present membership of the Dental Board had an extra burden placed on them when they were asked to serve for an extended period beyond the normal term of office of board members. This was necessary in order to facilitate the smooth transition from Dental Board to Dental Council arising from this legislation. To a man the membership of the board agreed to serve for an extra two years and I would like to extend a special thanks to them for their generous response.
In updating the legislation governing dentistry and providing for future developments it was necessary to consult on a very wide basis, not only with representatives of the profession and others directly concerned, but with all those who might be affected one way or another by the Bill's provisions as well as those who might have an input into the legislation. Naturally enough not every suggestion and view put forward was incorporated in the Bill — that would have been impossible given that differences of opinion exist even among those who profess the same ideals and share the same goals.
However, consideration was given to every shade of opinion put forward by those consulted. The Bill before the House is essentially that which was introduced in Seanad Éireann last March. The Bill generated great interest and was the subject of lengthy debate in the Seanad and there were quite a few amendments to it on Committee and Report Stages in that House.
Nevertheless, its basic provisions remain the same. Not every amendment tabled in the Seanad was accepted by me but I think it is fair to say that I adopted a very flexible approach in the matter and was quite amenable to changes which were considered to be for the betterment of the Bill, regardless of their origin. The amendments to the Bill which I accepted in the Seanad have served to strengthen the legislation, while not detracting from or diluting its underlying principles. Indeed I commended the Members of Seanad Éireann for their interest in the Bill and for the remarkably constructive and lively debate which the Bill generated. I will now give the House a brief run-down on the main provisions of the Bill.
Part I contains the normal provisions for interpretation by defining certain words and phrases which occur throughout the Bill and provides for the fixing of commencement dates for bringing into operation certain provisions in the Bill. It provides also for the repeal of the existing legislation on dentistry, namely, the Dentists Act, 1928 and the Dentists (Amendment) Act, 1983. This latter Act was enacted last year in order to extend the term of office of the Dental Board. The board's five year term of office was due to expire in November 1983.
In order to appoint a new membership of the board it would have been necessary to hold an election of registered dentists to fill their five places on the board. Considering that the new Dentists Bill, which would abolish the Dental Board and involve another election of registered dentists to the new Dental Council, was about to be introduced it was thought preferable to extend the term of office of the existing Dental Board for a period of two years. Under the 1928 Act there was no provision for extending the term of office of board members beyond the stipulated five years period — hence the need for the Dentists (Amendment) Act, 1983. The extension of the period of office of the Dental Board served to avoid two elections of registered dentists being held within a relatively short period — the second election would possibly have generated little response from the profession and this would have got the Dental Council off to a bad start. As well as this, the Dental Board were saved the expense of holding an election of registered dentists. Given the cost of these elections and having regard to their financial position at the time, the board were happy not to have to undergo the expense of an election.
The dissolution of the Dental Board and their replacement by the new Dental Council are among matters provided for under Part II of the Bill. In numbers and in composition the new Dental Council will differ greatly from the Dental Board. The council will have a total of 19 members whereas the existing board have only nine. Of more significance is the make-up of the new council compared with the board. The increased role of the council in the education and training of dentists is reflected in the representation given to educational interests. Four members will represent the undergraduate teaching interests—two appointed by Trinity College, Dublin and two by University College, Cork. The Royal College of Surgeons in Ireland will appoint one member to the council to represent the post-graduate teaching interests. There will also be a nominee of the Minister for Education bringing the total educational representation to six on the 19 member council. The present board have three of their nine members nominated by the Medical Council but there will be only two nominees of the Medical Council on the new Dental Council. The reduced Medical Council representation and increased representation of educational interests reflects the increased independence and responsibility of the new council in relation to the education and training of dentists. The practising profession will have seven representatives on the Dental Council elected by their fellow dentists as against five on the Dental Board.
Although they have increased representation on the new council the elected dentists will not form a majority of members on the council as they do on the Dental Board at present. Nevertheless the practising profession will form the biggest single group represented on the council.
It was suggested in Seanad Éireann that health board dentists should have specific representation on the council. However, since they form approximately 25 per cent of the dentists registered in the State they are almost certainly going to have representatives on the council in any event — as they do at present on the Dental Board. In fact their representation on the council seems assured considering that the elections of registered dentists by their fellow dentists will be by means of the single transferable vote, that is, by proportional representation. This provision was written into the Bill following an amendment tabled in Seanad Éireann and convincing arguments in its favour which I accepted. The remaining four places on the Dental Council will be filled by my own nominees. However, the Bill lays down that at least two of these must be non-dentists who will represent the interests of the general public as consumers of dental services. This consumer representation is something that will be welcomed generally.
Part II also deals with committees of the council and provides that there shall be three particular committees dealing with the functions of the council in relation to education and training, fitness to practise and auxiliary dental workers.
In regard to the make-up of the council there were representations made and, indeed, amendments were tabled in Seanad Éireann to change and extend the membership and to give representation on the council to various groups. These included teachers organisations, students and auxiliary dental workers. Considering that the primary function of the Dental Council is to regulate the dental profession — the actual delivery of dental services is not their function — the proposed make-up of the council is generally regarded as giving a reasonable balance of representation between the various interests involved. These are broadly the educational, working profession and consumer interests as well as my own nominees.
I accept that members of the teaching profession can play a valuable role in promoting dental health care among their pupils, but to have a representative of the profession on the Dental Council would be inappropriate in the light of the council's functions. There would be nothing to prevent me from including a representative of students of auxiliary dental workers among my own nominees to the council but I would not agree with the idea of specific statutory representation for them under the provisions of the Bill. If such groups were to be given places on the council there would be a problem — certainly in relation to auxiliary dental workers — in deciding which particular group of auxiliary workers should be represented and of deciding which organisations should be regarded as representing them. I am satisfied that the composition of the council as detailed in the Bill is just about right in the present circumstances. If at some future time due to changed circumstances it is found necessary to alter the make-up of the council there is provision for this in the Bill also.
Part II also covers the make-up of the three specific committees of the council. There is provision for each class of auxiliary dental workers established under the Bill being allocated places on the committee of the council that will deal with auxiliary dental workers.
The remainder of Part II deals with the setting up and staffing of the Dental Council and the various powers of the council including their power to charge fees for registration.
Part III deals with the registration of dentists. The provisions in relation to those entitled to registration in the basic register of dentists established under the 1928 Act are being changed to meet present day requirements. For instance, the 1928 Act gave access to registration here to persons whose names appeared in the Commonwealth and foreign lists of the British Dental Register. Since this provision is no longer relevant it has been omitted from the new legislation. On the other hand, provision has had to be made for the registration here of nationals, of member states of the European Community who possess the necessary qualifications. We are obliged to recognise certain qualifications in dentistry issued by other member states under directives issued by the EC which came into effect here in 1980. It is also obligatory under these directives to permit those who hold the recognised qualifications to practice dentistry anywhere in the EC.
An agreement concluded in 1927 between this country and the United Kingdom and incorporated into the 1928 Dentists Act already provides for the mutual recognition of qualifications in dentistry issued in these islands. In the light of our membership of the EC and our obligations under the EC directives on dentistry this agreement is no longer relevant and provision is made later in the Bill for its termination.
There is provision also under Part III for the establishment of a register of dental specialists in addition to the basic register, should the Dental Council consider it desirable to set up such a register at some future date. Registers of dental specialists already exist in many countries, for example in France, West Germany, Holland, the USA and Canada. Orthodontists and oral surgeons are among the classes of specialists whose names would appear on such a register. The registration of specialists enables the general public to recognise those who are qualified and who specialise in particular branches of dentistry. It also serves to permit the public to clarify whether or not any particular practitioner possesses the qualifications which he purports to possess. There are persons who argue against specialist registration on various ground but I would like to make it clear that what I am introducing here is not the establishment of a specialist register. What I am doing is providing the enabling legislation which will facilitate its establishment at some future date if the Dental Council see fit to do so. There is also a possibility that specialist registration could become mandatory here due to a directive of the EC and, if it did not already exist, new legislation would be required to put the directive into effect. On balance, it would be remiss of me not to make the enabling provision for specialist registration in this new legislation. There is a similar provision in the Medical Practitioners Act, 1978 but to date no register of medical specialists has in fact been established.
Part IV of the Bill, which covers education and training, sets out the duties of the council in relation to the education of dentists at both undergraduate and postgraduate levels. The council are obliged to satisfy themselves as to the suitability of the education provided and as to the standards of education and clinical experience required for basic qualifications in dentistry in the dental schools in Dublin and Cork — that is to say at Trinity College, Dublin, and University College, Cork. At present the Medical Council have certain powers in relation to undergraduate dental education which the new Bill assigns to the Dental Council so that the educational role of the council will be far more responsible than that exercised by the present Dental Board.
The transfer of responsibility for dental education from the Medical Council to the Dental Council is something which is long awaited and will be welcomed by both professions. The Dental Council are also required under this part of the Bill to satisfy themselves as to the standards of postgraduate education and training in dentistry in the State. It has duties also in relation to compliance with EC directives regarding minimum requirements for qualifications in dentistry in member states. The council's responsibilities in relation to EC requirements regarding specialised dentistry are also set out in this part of the Bill. As I said earlier, the standard of dentistry here in Ireland is second to none and this could hardly have been brought about if the standards of education and training here were not of the highest order also. Attaining the minimum standards laid down by the EC will pose no problems for the council. I know that the target of the council will be standards that are considerably higher than the minimum required by the EC.
Part V of the Bill deals with the discipline of members of the profession. It is indeed a rare occurrence to have disciplinary measures taken against a member of the dental profession. Nevertheless, such provisions must be made in the interests of the general public and indeed in the interests of the profession. The powers in relation to discipline which the new council will have will be far more wide-ranging than those enjoyed by the Dental Board at present. The problem with the existing legislation is that the only disciplinary measure open to the Dental Board is the removal of a dentist's name from the register. Obviously cases will arise where some disciplinary measure is warranted but where the rather drastic measure of removal from the register is not merited. Under the new legislation there is provision for suspension of a dentist's name from the register for a period and the council can also advise, admonish or censure a dentist in relation to his professional conduct or attach conditions to his continued registration. Over the years difficulties have arisen about the constitutionality of the disciplinary powers of registration councils and other such bodies. Part V of the Bill has, therefore, been very carefully drafted to ensure that the powers of the Dental Council cannot be successfully challenged on constitutional grounds. The Bill provides for each disciplinary decision of the council being subject to the approval of the High Court either by means of an appeal by the dentist or by way of application to the court by the council in cases where no appeal is made. As well as disciplinary action arising out of professional misconduct the Bill also gives the council the authority to take disciplinary action against a dentist because of his unfitness to practise due to his physical or mental disability. There is no such provision under the existing legislation.
Part VI of the Bill describes those persons who are entitled to practise dentistry in the State. It excludes auxiliary dental workers from the general prohibition on the practice of dentistry by non-dentists subject to certain provisions which are set out in Part VII of the Bill. The penalties for the illegal practice of dentistry, and for all other offences throughout the Bill, have been updated.
Part VII of the Bill is where provision is made for the recognition and registration of classes of auxiliary dental workers. The Dental Council will have the power, subject to my approval, to determine the nature of the dental work an auxiliary worker may undertake and the circumstances under which it may be undertaken. As Deputies know, we already have dental mechanics and dental surgery assistants working here but neither category can be registered under the existing legislation. There are other classes of auxiliary dental workers in countries abroad who are trained to carry out procedures which it would be illegal for them to perform here under the existing legislation. Dental hygienists, for instance, can perform a very useful service and I would be anxious to see them introduced here. The hygienists carry out certain clinical work such as the scaling and polishing of teeth but they are particularly useful in instructing patients in preventive measures such as oral hygiene and dental health education generally. The dental profession would welcome the introduction of hygienists here. They could provide valuable assistance in private practice and could make a very significant contribution to the health board service by permitting the dentists to get on with the clinical work and not have their time taken up with oral hygiene instruction.
The Bill will permit the establishment of a class of auxiliary dental workers fully trained and competent to supply dentures direct to persons of 18 years of age and over — they will not of course be permitted to perform any work on living tissue. It is important for me to stress that these auxiliary workers will have to be fully qualified in this particular area of dentistry. The Restrictives Practices Commission, following their inquiry in 1982 into the legal restriction of the supply of dentures to the public, came up with alternative recommendations, one of which was that there should be no restriction whatsoever on the supply of dentures direct to persons of 18 years of age and over provided it did not involve work on living tissue. The second alternative of the commission was that the 1928 Dentists Act should be amended so as to provide that the general prohibition on the carrying on of dentistry by a non-dentist should not apply to the provision of dentures by a denturist to a person of 18 years of age or over provided it did not involve work done on living tissue. It suggested that a denturist for this purpose would be the holder of qualifications recognised by regulations which the Minister for Health might make from time to time. The commission opted for the first alternative.
However, the Government felt that the complete de-restriction of the supply of dentures would not be in the best interests of the public and that the second alternative was preferable. Consequently, the Bill has been drafted in such a way as to permit the implementation of the principle of the second alternative of the Restrictive Practices Commission. There has of course been considerable opposition to this on various grounds. The introduction of a class of qualified denturist dealing directly with the public will not, however, result in a lowering of standards. The fact that only qualified and competent persons will be allowed to deal with the public direct will in fact represent an improvement over the existing situation in which it is well known that certain persons are already operating in breach of the law. The increased penalties for the illegal practice of dentistry, combined with the introduction of the new class of qualified denturists, should provide greater protection for the public from the activities of illegal operators. Preliminary moves towards the introduction of the new denturist class of auxiliary dental workers will be made as soon as possible after the Bill is enacted.
There is provision also under this part of the Bill for the Minister, if he sees fit, to make an order directing the council to exercise their powers in relation to the establishment of a particular class of auxiliary dental workers, either on a permanent basis or for a trial period. Any order made by the Minister under these provisions must be laid before each House of the Oireachtas and can be annulled by a resolution of either House.
Part VIII of the Bill contains miscellaneous provisions including, in section 65, provision for the keeping in force for the time being of the agreement between this country and the United Kingdom, which I referred to earlier that is the agreement under which there is mutual recognition of qualifications in dentistry awarded in these islands. The agreement is now obsolete in the light of our membership of the EC and it will be formally terminated as soon as the Bill is enacted. In fact correspondence with the UK authorities towards this end has already been initiated.
There are two Schedules attached to the Bill one of which sets out the rules regarding membership and meetings of the Dental Council and covers such matters as tenure of office of members, resignations and termination of membership, casual vacancies, quorum, proceedings at meetings, etc. The provisions are on the lines of the normal rules governing this type of body.
The other Schedule lists the primary qualifications in dentistry which are awarded in the State at present.
The new Dentists Bill is primarily for the purpose of updating and improving the laws regulating the dental profession so before I conclude I think it appropriate that I should record my appreciation of the enormous contribution which the dental profession has made to our society. Their dedication is not only to the clinical element in the delivery of dental treatment but also to the maintaining of the highest standards of dental education and training. This was brought home to me when I saw the interest which all aspects of this new legislation generated among the profession generally. There were submissions made to me by many individual dentists as well as those which one might expect from such bodies as the Irish Dental Association and the Dental Board. Many of the submissions from dentists in private practice were in relation to matters of an academic nature and this is the best illustration of the genuine interest of the profession in the new legislation.
This legislation is long awaited and its provisions are of a non-controversial nature. I would remind the House that the Bill is not about the delivery of dental services so that criticisms of the dental services, whether valid or not, are not really appropriate in the context of debate on this legislation. The Bill as it now appears is the product of co-operation and compromise following widespread consultations and lengthy and informed debate in Seanad Éireann. In the circumstances I would appreciate Deputies' co-operation in its speedy passage through this House.