The Dentists Act, 1928, is the legislation that governs the registration and control of persons practising dentistry and the maintenance of standards of dental education and training in this country. There has been only one minor amendment to the legislation since its enactment. That was in November last when it was found necessary to extend the term of office of the Dental Board, established under the 1928 Act, so as to keep it in office until this new legislation was passed.
The 1928 Act has, therefore, remained virtually unaltered over the years. Legislation, no matter how well thought out and drafted, cannot be expected to provide for every eventuality, especially in times of rapid change, and so with the passage of time and in particular in the past few years, it became evident that alterations were required to the provisions of the 1928 Act. Some of these alterations could be termed necessary while others were of a desirable rather than of an essential nature.
A series of amendments to the 1928 Act perhaps could have effected the necessary changes but it was thought preferable to bring in an entirely new Dentists Act and to incorporate in it the best of modern thinking in relation to the practice of dentistry.
This Bill, therefore, is designed to bring the laws governing dentistry up to date and, in so far as possible, to provide for future developments in the profession. It is being put forward as a comprehensive measure, repealing the existing legislation, but at the same time re-enacting where necessary the provisions of the old Act. In many ways the proposed legislation is parallel to the legislation governing the medical profession contained in the Medical Practitioners Act, 1978 but it contains also certain provisions which are peculiar to dentistry.
The Bill provides for the dissolution of the Dental Board set up under the 1928 Act and its replacement by a new body to be known as the Dental Council. Over the years the Dental Board has served the general public and the dental profession well. The esteem in which Irish dentistry is held today throughout the world is due in no small measure to the dedication and efficiency of the many individuals who have served as members of the Dental Board over the years.
I would like to take this opportunity to extend my sincere thanks to all of them. Special thanks are due to the current membership of the Dental Board who were willing when called upon to serve for an extended period beyond the normal term of office of board members in order to facilitate the smooth transition from Dental Board to Dental Council arising from the provisions of the new legislation.
In drafting any legislation it is necessary to consult with all those who will be affected in one way or another by its provisions and with those who might have an input into the legislation. I can assure the House that this has been done in the case of the Dentists Bill and that every shade of opinion has been sought and listened to. We are indeed fortunate in this country in that in almost every sphere individuals exist who are dedicated to the promotion of excellence.
The dental profession is no exception and in the course of consultations on this new Bill discussions were held with those who are committed to promoting the profession and the practice of dentistry and who are anxious to maintain and improve standards of education and training, and indeed the code of behaviour which governs the members of the profession. In formulating the proposals contained in this Bill, due regard was had to all opinions put forward by those consulted.
The purpose of the new Dentists Bill is to update and improve the legislation governing dentistry in this country. One of the fundamentals of the regulation of any profession is the recognition and registration of those who by virtue of their education and training are regarded as competent to practise it. The benefit which the general public derives from statutory registration is that it enables them to recognise the qualified practitioner, thus protecting them from those who are unqualified.
The registered practitioner on the other hand, through statutory registration, enjoys the benefit of public recognition of his status and the consequent practical advantages which this bestows. Statutory registration is, therefore, to the mutual benefit and advantage of the general public and the practitioner.
There are eight main parts in the Bill and I propose to deal with the principal provisions of each part in sequence.
Part 1 of the Bill provides for interpretation, by defining certain words and phrases which occur throughout the Bill. It also provides for the fixing of commencement days for the bringing into operation of certain provisions of the Bill. It provides, too, for the repeal of the existing legislation governing the dental profession; that is to say, the Dentists Act, 1928 and the Dentists (Amendment) Act, 1983 — the latter being the Act through which the term of office of the present Dental Board was extended to facilitate the introduction of this new legislation.
The first major change in the existing provisions is contained in Part II. This provides for the dissolution of the Dental Board and its replacement by the new Dental Council. This is not merely a changing of the name of the statutory body for the regulation and registration of the dental profession.
First of all, the new council will have 19 members whereas the Dental Board has only nine. However, it is the make-up of the membership of the new council and its powers, rather than the number of its members that is significant. The role of the Dental Council in the education and training of dentists is reflected in the representation given to educational interests. The council will have four members appointed by the undergraduate educational institutions and one member by postgraduate interests and it will also have a nominee of the Minister for Education. The number of representatives of the practising profession, elected by their colleagues, will be increased from five to seven and while this will not give them a majority on the council as they have on the present board, it will nevertheless ensure that the practising profession will form the biggest single group on the council. Two members of the new council will be nominated by the Medical Council which has three representatives on the Dental Board at present. The reduced Medical Council representation reflects the increased independence and responsibility of the Dental Council in the matter of the education and training of dentists. The remaining four places on the council will be filled by my nominees and at least two of these must be non-dentists who will represent the general public as consumers of dental services. This is in line with the provisions of the Medical Practitioners Act, 1978 which gives similar representation on the Medical Council to consumers of medical services.
The Dental Council will have the authority to set up various committees to carry out specific functions of the council, and the Bill provides in particular that three such committees shall be set up to act for the council in matters relating to its education and training functions, its functions in relation to the fitness of members of the profession to practise dentistry and its functions in relation to auxiliary dental workers.
The remainder of Part II of the Bill deals with the mechanics for the setting up and the staffing of the Dental Council, the make-up of membership of the three specific committees of the council and the various powers of the council, including the charging of registration fees.
Part III of the Bill deals with the registration of dentists. In addition to the establishment and maintenance of the basic register of dental practitioners there is provision for the future establishment of a register of dental specialists, should the council consider it desirable. The provisions relating to the establishment of the basic register follow the pattern of the existing legislation except that specific provision is made for the registration of nationals of member states of the European Economic Community who possess the necessary qualifications. Under directives of the EEC which came into effect here in January 1980 we here in Ireland are obliged to recognise certain qualifications in dentistry issued by other member states of the EEC and vice versa. There is also an obligation under these directives to permit the holders of the recognised qualifications to practise dentistry anywhere in the EEC. One of the directives relates to the setting and maintaining of minimum standards of education and training in dentistry within the EEC.
An agreement concluded in 1927 between this country and the United Kingdom and incorporated in the 1928 Dentists Act provides for the mutual recognition of dental qualifications awarded in these islands and could be said to have foreshadowed the provisions of the relatively recent EEC directives.
Registers of dental specialists, such as orthodontists and oral surgeons, exist in France and Germany and such registration is about to be introduced in the Netherlands. It exists also in many countries outside the EEC, for instance in the USA and in Canada. The registration of specialists is of benefit to the public in enabling them to identify those who are qualified and who specialise in particular aspects of dentistry. It also enables the public to clarify whether a practitioner possesses the qualifications he purports to possess. 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 it should consider it desirable to do so.
Part IV deals with the education and training of dentists. It spells out the duties of the council in relation to undergraduate and postgraduate education. The council will have to satisfy itself as to the suitability of the education provided by the two dental schools in the State, that is to say Trinity College, Dublin and University College, Cork, and as to the standards of education and clinical experience required for basic qualifications in dentistry.
The council will also be required to satisfy itself as to the standards of postgraduate education and training in the State. Part IV also outlines the duties of the council in relation to compliance with EEC directives regarding minimum requirements for qualifications in dentistry in member states. It also outlines the Council's responsibilities in relation to qualifications in specialised dentistry. Our standards in dental education and training are highly regarded abroad and I feel sure that the objectives of the Dental Council will be to establish and maintain standards that are higher than those stipulated by the EEC as minimum requirements. The educational role of the council is far more responsible than that exercised by the Dental Board at present and in general the new Bill makes provisions which will assign to the council powers in relation to undergraduate dental education that are vested in the Medical Council at present.
This move to make the dental profession self-governing is long awaited and will, I know, be welcomed, not only by the dentists, but also by the undergraduate educational interests and indeed by the medical profession. The education and training functions of the Dental Council will be performed by the Education and Training Committee which I referred to earlier.
Part V of the Bill extends greatly the powers of the council in relation to the discipline of members of the profession for professional misconduct or general unfitness to practise. While, fortunately, it is only very rarely that it is necessary to have recourse to disciplinary action in regard to any member of the dental profession, it is essential in the interests of the public and of the profession itself to have adequate and suitable machinery available whenever it is necessary to have recourse to such action. The statutory powers of the Dental Board at present provide only for the erasure of a dentist's name from the register. Recognising the fact that circumstances may arise where some disciplinary action may be called for but that the penalty of erasure would not be always warranted, provision is also made in the Bill for lesser penalties.
Section 39 empowers the council to suspend a dentist's registration; section 40 gives the council power to attach conditions to a dentist's continuing registration and section 41 contains provisions enabling the council to admonish, to advise or to censure a dentist in relation to his or her professional conduct.
In relation to Part V as a whole, it was necessary to ensure that its provisions would not be in conflict with the Constitution. Difficulties have arisen over the years in relation to the constitutionality of the powers of registration councils and other bodies dealing with the regulation of certain professions and there have been some instances where these powers have been found to be in conflict with the Constitution. The provisions of Part V of the Bill, therefore, have been very carefully drafted to ensure that there can be no such conflict in so far as the discipline of the dental profession is concerned. What is proposed is that every disciplinary decision of the council will be subject to the approval of the High Court either on appeal by the dentist concerned or by way of application to the court by the council in the event of no appeal being made.
There is also a provision which enables the council to take action against a dentist because of his unfitness to practise by reason of physical or mental disability. Again, the judicial safeguards have been built into this section.
Part VI defines the practice of dentistry and describes those who are entitled to practise dentistry in the State. The 1928 legislation could be regarded as somewhat defective in that it made no specific provision for the practice of dentistry by students of medical and dental schools. The new Bill contains provision for the practice of dentistry by these students, under the supervision of a registered dentist. The Bill also provides that the general prohibition on the practice of dentistry by non-dentists does not apply in the case of auxiliary dental workers, subject to certain provisions outlined in Part VII. The penalties for offences under this part of the Bill have been updated, as indeed have all others throughout the Bill, and these could serve as deterrents to those who at present might be prepared to run the risk of prosecution in the knowledge that the maximum penalties that can be imposed for the illegal practice of dentistry are relatively trivial in this day and age.
Under Part VII there is provision for the recognition and registration of classes of auxiliary dental workers. It gives the Dental Council the power, subject to my approval, to determine the nature of the dental work that a dental auxiliary may be allowed to undertake and to stipulate the circumstances and conditions under which such work might be undertaken. We already have dental mechanics and dental surgery assistants working in this country though neither class of dental auxiliary can be registered under existing provisions. There are certain classes of auxiliary dental workers in other countries who perform various dental procedures which under the existing 1928 legislation are illegal here. For instance, dental hygienists are a class of dental auxiliary that exist in some countries and which I would like to see introduced here under the new provisions. Hygienists, as well as carrying out clinical tasks such as cleaning and polishing teeth, perform a very useful service in instructing patients in preventive care measures such as oral hygiene and in dental health education in general. The dental profession would have no objection to and in fact would welcome the introduction of dental hygienists here. In the public sector they could make a significant contribution to the dental care of school children since, apart from the valuable service they would provide themselves, their use would permit health board dentists to concentrate on the delivery of clinical work rather than have them spend valuable time on oral hygiene instruction, etc.
I intend also to establish under the new legislation a class of auxiliary dental workers whose education and training would make them competent to supply dentures direct to persons of 18 years of age or over. They would not, of course, be permitted to perform any work on living tissue. The idea of such a class of dental auxiliary workers is not new and they already exist in many countries abroad. For instance, such a class has existed in Denmark for many years. The introduction of such a class of dental auxiliary here was one of the alternatives suggested by the Restrictive Practices Commission following the public inquiry which they carried out in 1982 into the legal restriction to registered dentists of the supply of dentures to the public. The commission made it clear in their report that they were not at all in favour of dentures being supplied to the public by unqualified persons but they were against the retention of the existing legislative provisions which they regarded as restrictive.
The establishment of a qualified class of auxiliary dental workers who are competent to supply dentures to the public direct will to some extent remove the monopoly enjoyed by dentists in providing this service at present. However, it is well known that for many years certain dental mechanics have been dealing with the public direct, which, in the case of the supply of dentures, constitutes the illegal practice of dentistry within the meaning of the 1928 Act. As indicated earlier, the penalties for offences under the existing legislation did not prove to be an effective deterrent and this will now be rectified. The provisions of the new legislation, therefore, far from constituting a relaxing of the restrictions on the practice of dentistry, should in fact result in greater safeguards for the public from the activities of illegal operators. Only qualified persons will be permitted to practice dentistry and those who are in breach of these provisions will be liable to incur stiff penalties. I would hope that preliminary moves towards the establishment of this new class of dental auxiliary would be initiated as soon as this legislation is passed. This would involve discussions with all concerned leading to agreement on standards and on education and training programmes for the new class of auxiliary.
Although there is no specific provision in the membership of the Dental Council for auxiliary dental workers, any class of auxiliary established by the council would have a representative on the committee of the council dealing with auxiliary dental workers. This is provided for also in section 13 of Part II of the Bill.
As well as providing for the establishment by the council of certain classes of auxiliary dental workers, Part VII also gives the Minister the authority, if he thinks fit, to direct the council to establish a particular class of dental auxiliary either on a permanent basis or for an experimental period, in order that the value to the public of the particular class of auxiliary may be assessed.
Part VIII contains various miscellaneous provisions including authority for the making of regulations by the Minister for Health to give effect to any of the provisions of the Bill. It also provides, under section 65, for the continuing in force for the time being of the agreement I referred to earlier between this country and the United Kingdom for the mutual recognition of dental qualifications awarded in these islands. This agreement has served its purpose well over the years but it is no longer relevant in the light of the mutual recognition of dental qualifications and rights of nationals of member states of the EEC to practice dentistry in the other member states. This agreement will, therefore, be terminated as soon as practicable following the enactment of this legislation and discussions are already in progress with the United Kingdom authorities towards this end.
There are two Schedules attached to the Bill, one of which lists the primary qualifications in dentistry issued in the State at present. The other Schedule contains details of the rules regarding membership and meetings of the new Dental Council. It covers such items as tenure of office of members, resignations and termination of membership, casual vacancies, quorum, proceedings at meetings, etc., all of which are on the lines of the normal rules governing bodies of this type.
Before concluding I would like to place on the records of the House my appreciation of the role played by the dental profession in our society. They have given long and dedicated service to the community and I know that this will continue to be the case in the future. I would like in particular to thank all those members of the profession who have given and continue to give their services voluntarily in serving on various committees, boards and working parties. Their contributions help to maintain the high standards in dentistry which we in this country are so lucky to possess.
The general description which I have given of this Bill will, I hope, demonstrate that it is non-controversial and that its only aims are the advancement of standards of the practice of dentistry and the safeguarding of the general public. The introduction of the Bill is long awaited by the dental profession itself and I am sure that the profession will be in agreement with its general provisions and would wish for its enactment at the earliest possible date. In that regard I welcome the statement issued on 8 March by Mr. Donal Atkins, General Secretary of the Irish Dental Association, commenting on the Bill and generally welcoming its introduction. I welcome his agreement and the agreement of the association that the general direction of the Bill will provide for the protection of dental patients and the community as a whole from harmful practice by unqualified personnel. Further, I welcome the indication from the association that the composition of the proposed Dental Council appears to reflect the public interest as well as that of the profession and that they will be given sufficient powers to safeguard that public interest.
I noted that the association were reassured and pleased by the fact that the Bill makes provision for the establishment of schemes whereby properly qualified, registered and supervised dental auxiliary workers, such as dental hygienists who will be concerned with the prevention of dental disease, may be permitted to practise under the supervision of dentists.
Therefore, I hope that this Bill will have a speedy passage, and I look forward to the co-operation of the House in making this possible. I want to thank Senator Jim Dooge for initiating the Bill in the first instance in Seanad Éireann, and its passage through this House is the first step.