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NEWS FROM GREAT BRITAIN N ATIONAL H E A L TH SERVICE ACT
the commencement of the Service the attitude of dentists to it was generally one of hostility. At meetings and in letters to the professional journals, the profession voiced a refusal to take part in the scheme. Allowing for the fact that those who intended to join the scheme did not attend the meetings or write to the journals, it was generally agreed that at the beginning of May 1948, about two-thirds of the profession would not enter the service. At the beginning of June the figures had altered but little. Then the scale of fees became known and on the appointed day, July 5, at least 50 per cent were enrolled in the service. The scale of fees that the Government offered was astonishing and, I believe, far superior to anything that the representatives of the profession had hoped to achieve. Here is one practitioner’s view at that time: “What ever may be our opinion on the N.H.S. dental scheme at least let us pause before condemning the startling scale of fees; for the first time in dental history authoritative recognition is given to the true value of our calling.” This was not, I think, the common vielv, which tended rather towards the opinion that it was the carrot dangling before the donkey. It was a hastily prepared scale, but I think it was an honest interpretation of the Spens recommendation and I do not hold with the more sinister view. The shape of things to come was clearly seen by C. H. Housden, who wrote in the British D ental Journal in July 1948: “The scale of fees appears on the surface to be a very generous inducement by the Minister for mem bers of the dental profession to apply whole heartedly for enlistment in the ranks of the N.H.S. . . . I, like many others of my col leagues, feel that we are being bribed into joining a service which has no security for our future and also no security for the patient. . . . I believe I am correct in stating that £7,000,000 has been set aside for dental benefit but I understand that £60,000,000 will be needed for an efficient dental service. If this is so, this generous scale will be considerably reduced in a very short time because the Minister will not be able to afford the cost of the Dental Service.” This was prophetic indeed! However, it was the financial aspect of the scheme which in duced 50 per cent of the practitioners to join
1952
The National Health Service Act of 1952 came into force on June 1, and it is expected to have a marked effect on general dental practice. Under the terms of this Act, patients accepted for dental treatment after June 1 have to pay for the treatment if the cost is £1 or less; if it is more than this amount, the patient pays £1 and the state the rest. Should dentures be required, the rate for dentures is still as formerly, but the patient will not be called upon to pay more than £4.5.0d. ($11.90). Certain patients are exempt from the new charges; these are all patients under 21 years of age, expectant mothers and patients who have borne a child within the previous twelve months. Certain items of treatment remain free of cost to the patient: (1) examination and report, (2) arrest of hemorrhage, (3) house calls, and (4) repairs to dentures and appliances. With the exception of dentures, treatment at dental hospitals is free. In a statement issued to the press on the dental provisions of the new Act, the British Dental Association said, “One result of the Act is that there is no longer a free emergency service for the general public since the fees for the most common types of emergency treatment are under £1 and, therefore, pay able in full by the patient. “Patients who are in pain and need urgent emergency treatment must in the future be prepared to pay the dentist for that treatment at the time they receive it. Patients applying to the National Assistance Board for a grant will only be able to obtain emergency treatment through the good will of their dentist pending consideration of their case by the Board. The British Dental Association must, therefore, make it quite clear to the public that the den tal profession is in no way responsible for the new position whereby patients must pay in order to get relief from pain. ” REVIEW OF STATE DENTISTRY
This is perhaps a convenient opportunity to look back over the four years of state dentistry in Britain from the viewpoint of fees and finance. Let me recall that two months before 96
IN T E R N A T IO N A L CORRESPO NDENCE . . . V O L U M E 45, JU LY 1952 • 97
the scheme by July 5, 1948, and about 90 per cent to join by D ecem ber o f the same year. It was also the financial aspect— nothing to pay — that made m any patients apply for dental treatment. T here should be no mistake about the p o p ularity o f the Health Service as far as the patients are concerned, and the new A ct is politically unpopular fo r the Conservative Government in 1952. REDUCTIONS IN DENTAL INCOME
In D ecem ber 1948 the success o f “ free den tistry” was causing alarm in treasury circles. In that m onth M r. Bevan, Minister o f Health, was announcing to Parliament measures w hich were introduced in February 1949. He altered the regulations so that dentists cou ld earn £ 4 ,8 0 0 at the scale o f fees but anything over that figure was cut b y 50 per cent. This tem porary measure was soon super seded b y another one. In June 1949 an interim scale o f fees was substituted for that w hich in duced so many to join the service 1 2 months before. This reduced the fees by about 20 per cent. This certainly reduced the incomes of dentists, but patients still flocked to practi tioners fo r dental treatment. Eleven months after the interim scale, in M a y 1950, a further 10 per cent was deducted from the dentists’ cheques but patients were unaffected until in M ay 1951 a charge was im posed u pon them. T h ey were required to pay 50 per cent o f the fees for dentures and now a further restriction is being placed upon them by the new legislation. Some figures are available to show the effect o f charges. For the three-month period of September, O ctober and N ovem ber 1950 (before denture charges^, the payments made to dentists amounted to £ 1 6 8 ,7 0 6 — an average o f £ 9 8 3 per dentist for the quarter. C om par able figures fo r 1951 were £ 1 1 0,7 3 3 (includ ing £ 9 ,4 2 8 paid by patients), an average o f £ 6 5 8 per dentist fo r the quarter.
Another analysis o f th e same figures shows that 12.5 per cent o f practitioners received less than £ 1 0 0 per m on th in 1950; 28.7 per cent received less than £ 1 0 0 per m onth and 13.4 per cent received less than £ 5 0 per month in 1951. T he alarm with w h ich the members o f the dental profession view the new charges easily can be understood. In addition to charges for dental treatment the new A ct introduces charges for the first tim e for spectacles, some surgical appliances a n d prescriptions. ORAL SURGERY CLU B AT GLASGOW
T h e O ral Surgery C lu b m et under the presi dency o f A dam C u b ie at Glasgow on April 25-26. T h e club was w elcom ed to the Dental Hospital, where the m eetings were conducted, by Professor A itcheson. T he hospital is on e o f the most up-to-date in the country, as the present building was opened shortly b efore the com mencement of W orld W ar II. Special facilities are available for postgraduate training in orthodontics, as the Royal Faculty o f Physicians and Surgeons o f Glasgow awards the only postgraduate diplom a in orthodontics in Britain. Highlights of the meeting were surgical operations viewed at n earby general hospitals, demonstrations w ith patients suffering from m axillofacial injuries and the showing o f a series o f interesting roentgenograms. A dem onstration of oral surgery was given by the president and two lecture demonstrations were presented. T h e first, o n nonsurgical closure of cleft palates, is in deed most fascinating; visi tors to the International Dental Congress in L ondon should n ot miss seeing this work. T h e second was a discussion o f neuralgia with par ticular reference to its tem porom andibular relation and its treatment by dental appliances. T he annual dinner was held at a hotel on the shores o f L och A rd in the Trossachs, a noted Scottish beauty spot. John Boyes
NEWS FROM GREAT BRITAIN N ATIONAL H E A L TH SERVICE ACT
the commencement of the Service the attitude of dentists to it was generally one of hostility. At meetings and in letters to the professional journals, the profession voiced a refusal to take part in the scheme. Allowing for the fact that those who intended to join the scheme did not attend the meetings or write to the journals, it was generally agreed that at the beginning of May 1948, about two-thirds of the profession would not enter the service. At the beginning of June the figures had altered but little. Then the scale of fees became known and on the appointed day, July 5, at least 50 per cent were enrolled in the service. The scale of fees that the Government offered was astonishing and, I believe, far superior to anything that the representatives of the profession had hoped to achieve. Here is one practitioner’s view at that time: “What ever may be our opinion on the N.H.S. dental scheme at least let us pause before condemning the startling scale of fees; for the first time in dental history authoritative recognition is given to the true value of our calling.” This was not, I think, the common vielv, which tended rather towards the opinion that it was the carrot dangling before the donkey. It was a hastily prepared scale, but I think it was an honest interpretation of the Spens recommendation and I do not hold with the more sinister view. The shape of things to come was clearly seen by C. H. Housden, who wrote in the British D ental Journal in July 1948: “The scale of fees appears on the surface to be a very generous inducement by the Minister for mem bers of the dental profession to apply whole heartedly for enlistment in the ranks of the N.H.S. . . . I, like many others of my col leagues, feel that we are being bribed into joining a service which has no security for our future and also no security for the patient. . . . I believe I am correct in stating that £7,000,000 has been set aside for dental benefit but I understand that £60,000,000 will be needed for an efficient dental service. If this is so, this generous scale will be considerably reduced in a very short time because the Minister will not be able to afford the cost of the Dental Service.” This was prophetic indeed! However, it was the financial aspect of the scheme which in duced 50 per cent of the practitioners to join
1952
The National Health Service Act of 1952 came into force on June 1, and it is expected to have a marked effect on general dental practice. Under the terms of this Act, patients accepted for dental treatment after June 1 have to pay for the treatment if the cost is £1 or less; if it is more than this amount, the patient pays £1 and the state the rest. Should dentures be required, the rate for dentures is still as formerly, but the patient will not be called upon to pay more than £4.5.0d. ($11.90). Certain patients are exempt from the new charges; these are all patients under 21 years of age, expectant mothers and patients who have borne a child within the previous twelve months. Certain items of treatment remain free of cost to the patient: (1) examination and report, (2) arrest of hemorrhage, (3) house calls, and (4) repairs to dentures and appliances. With the exception of dentures, treatment at dental hospitals is free. In a statement issued to the press on the dental provisions of the new Act, the British Dental Association said, “One result of the Act is that there is no longer a free emergency service for the general public since the fees for the most common types of emergency treatment are under £1 and, therefore, pay able in full by the patient. “Patients who are in pain and need urgent emergency treatment must in the future be prepared to pay the dentist for that treatment at the time they receive it. Patients applying to the National Assistance Board for a grant will only be able to obtain emergency treatment through the good will of their dentist pending consideration of their case by the Board. The British Dental Association must, therefore, make it quite clear to the public that the den tal profession is in no way responsible for the new position whereby patients must pay in order to get relief from pain. ” REVIEW OF STATE DENTISTRY
This is perhaps a convenient opportunity to look back over the four years of state dentistry in Britain from the viewpoint of fees and finance. Let me recall that two months before 96
IN T E R N A T IO N A L CORRESPO NDENCE . . . V O L U M E 45, JU LY 1952 • 97
the scheme by July 5, 1948, and about 90 per cent to join by D ecem ber o f the same year. It was also the financial aspect— nothing to pay — that made m any patients apply for dental treatment. T here should be no mistake about the p o p ularity o f the Health Service as far as the patients are concerned, and the new A ct is politically unpopular fo r the Conservative Government in 1952. REDUCTIONS IN DENTAL INCOME
In D ecem ber 1948 the success o f “ free den tistry” was causing alarm in treasury circles. In that m onth M r. Bevan, Minister o f Health, was announcing to Parliament measures w hich were introduced in February 1949. He altered the regulations so that dentists cou ld earn £ 4 ,8 0 0 at the scale o f fees but anything over that figure was cut b y 50 per cent. This tem porary measure was soon super seded b y another one. In June 1949 an interim scale o f fees was substituted for that w hich in duced so many to join the service 1 2 months before. This reduced the fees by about 20 per cent. This certainly reduced the incomes of dentists, but patients still flocked to practi tioners fo r dental treatment. Eleven months after the interim scale, in M a y 1950, a further 10 per cent was deducted from the dentists’ cheques but patients were unaffected until in M ay 1951 a charge was im posed u pon them. T h ey were required to pay 50 per cent o f the fees for dentures and now a further restriction is being placed upon them by the new legislation. Some figures are available to show the effect o f charges. For the three-month period of September, O ctober and N ovem ber 1950 (before denture charges^, the payments made to dentists amounted to £ 1 6 8 ,7 0 6 — an average o f £ 9 8 3 per dentist for the quarter. C om par able figures fo r 1951 were £ 1 1 0,7 3 3 (includ ing £ 9 ,4 2 8 paid by patients), an average o f £ 6 5 8 per dentist fo r the quarter.
Another analysis o f th e same figures shows that 12.5 per cent o f practitioners received less than £ 1 0 0 per m on th in 1950; 28.7 per cent received less than £ 1 0 0 per m onth and 13.4 per cent received less than £ 5 0 per month in 1951. T he alarm with w h ich the members o f the dental profession view the new charges easily can be understood. In addition to charges for dental treatment the new A ct introduces charges for the first tim e for spectacles, some surgical appliances a n d prescriptions. ORAL SURGERY CLU B AT GLASGOW
T h e O ral Surgery C lu b m et under the presi dency o f A dam C u b ie at Glasgow on April 25-26. T h e club was w elcom ed to the Dental Hospital, where the m eetings were conducted, by Professor A itcheson. T he hospital is on e o f the most up-to-date in the country, as the present building was opened shortly b efore the com mencement of W orld W ar II. Special facilities are available for postgraduate training in orthodontics, as the Royal Faculty o f Physicians and Surgeons o f Glasgow awards the only postgraduate diplom a in orthodontics in Britain. Highlights of the meeting were surgical operations viewed at n earby general hospitals, demonstrations w ith patients suffering from m axillofacial injuries and the showing o f a series o f interesting roentgenograms. A dem onstration of oral surgery was given by the president and two lecture demonstrations were presented. T h e first, o n nonsurgical closure of cleft palates, is in deed most fascinating; visi tors to the International Dental Congress in L ondon should n ot miss seeing this work. T h e second was a discussion o f neuralgia with par ticular reference to its tem porom andibular relation and its treatment by dental appliances. T he annual dinner was held at a hotel on the shores o f L och A rd in the Trossachs, a noted Scottish beauty spot. John Boyes