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Wednesday, 24 November 1965

Mr BEAZLEY (Fremantle) .- This Bill arranges for Commonwealth grants for capital works at medical teaching hospitals amounting to £1,555,850 and for further grants amounting to £184,900 for the recurrent costs of those hospitals directly attributable to the instruction of undergraduates. This makes a total of £1,740,750. 1 move -

That all words after "That" be omitted with a view to inserting the following words in place thereof: - "whilst not opposing the passage of the Bill the House is of opinion that the Government should adopt the recommendations concerning University dental schools by the Committee on Teaching Costs of Medical Hospitals."

The Prime Minister (Sir Robert Menzies) mentioned in the course of his second reading speech that the Government had accepted some of the items in the report of the Committee on the Teaching Costs of Medical Hospitals but had not accepted others. A number of the recommendations in the second report of the Committee on Teaching Costs of Medical Hospitals to the Australian Universities Commission have been rejected in this Bill. The Opposition has an open mind on some of these questions - for instance, the recommendation for the payment of honorary medical staff in teaching hospitals who give their services to teaching. This would cost over the triennium 1964 to 1966 about £1,500,000. No doubt it is this cost of about £500,000 a year that has discouraged the Government's acceptance of this recommendation. Honoraries have an ancient tradition of attending patients free, but teaching university students free, whilst a noble public service, must make heavy inroads on their time and earnings. We have no. settled view on the rejection of this recommendation although it does appear that non payment is not just and perhaps non payment is not likely to continue.

What we cannot understand are the rejection of the whole section of the report on dental schools and hospitals and the continuing neglect by the Government of the question of dental health not only in this measure but in the national health scheme. The report, in paragraph 4,24, indicates that all is not well in the dental profession. It states -

Because in most Australian schools the teachers have been, for one reason or another, unable to carry out research, or have not been interested in it, the undergraduate has not made this vital contact. The overall result is seen today in the general apathy of the profession towards the necessity for research and training in research methods.

I think the dental profession rejects this view, but at any rate the recommendation that has been made to the Government does establish that there is an unsatisfactory situation in the dental profession. I will quote figures shortly to show that there is certainly an unsatisfactory ratio of dentists to the Australian population.

The report also points out that teaching of dentistry requires a very high staff-student ratio, and in the quaintest terms the Committee explains why this is so. Its logic seems inescapable. In paragraph 4.25 of the report the Committee states -

Teaching in dental schools and hospitals requires a high' staff-student ratio for its consists of demonstrating operative procedures on patients. Because of the small size of the oral cavity, only the operator can see what he is doing at any one time, and, when teaching, he has to change position frequently to demonstrate each step of the treatment. This procedure requires concentration and is tiring to both patient and operator for obvious reasons it cannot be prolonged.

It is not very easy, in other words, for a great number of students to crowd around a mouth, and one therefore needs a high staffstudent ratio. I think the logic of that is inescapable. We have also learned that the costs of a five year course in dentistry are about equal to the costs of a six year course in medicine and that the number of people entering the profession is not adequate for the needs of the Australian community. We therefore cannot understand why the section, of the report which recommends an expenditure of £897,000 has not been adopted by the Government.

The report covers each State and in paragraph 4.58 the Committee refers to unsatisfactory conditions in New South Wales and states -

Because of overcrowding, inadequacy of accommodation, and lack of essential equipment and lighting, the University was invited to submit a revised proposal for assistance designed to improve the clinical instruction of dental students in the present biennium. The- Committee subsequently received a new submission requesting assistance for extending the sixth floor over the existing fifth floor operative dentistry clinic in order to provide urgently needed office and laboratory accommodation for teaching staff. In the revised submission the University also requested assistance for the provision of up to date lighting of 200 dental units used by students, air-turbine cutting equipment for 100 chairs used by students, closed circuit television, and air-conditioning of the existing lecture theatre. The Committee regarded the provision of these facilities, except for the closed circuit television, as essential, and accordingly recommended an appropriate grant.

J.   should have thought that closed circuit television was one means of overcoming the disability that many students cannot see at the same time into the small oral cavity. Therefore the Committee cannot be accused of recommending the ultimate luxury in dental teaching, since it does not recommend that facility. However, its recommendation, which is also covered in the table of costs at the end of its report, likewise has been rejected. I refer now to another important recommendation which has been rejected. After saying how satisfactory the situation was in Melbourne, in paragraph 4.63 the Committee states -

The Committee decided, however, that there was a case for providing a small grant to improve facilities in the Children's section of the Department of Conservative Dentistry and to provide some equipment for the Department of Dental Prosthetics.

This, again, seems reasonable. About Queensland, in paragraph 4.70, the Committee states -

After careful consideration of all the aspects of this problem and after further discussions, the Committee recommended a substantial grant to enable adequate dental teaching facilities to be included in a new dental building to be constructed alongside the existing Dental Hospital on Turbot Street.

The State of South Australia had an important programme, and in paragraph 4.74 the Committee said -

The total cost of the proposed- building was estimated at £1,144,000 of which £835,120 was claimed as being directly attributable to providing accommodation and facilities for teaching dentistry, and the remainder to hospital services. The problem of differentiating between the cost of providing teaching facilities and hospital services in a jointly occupied building is not new to the Committee who decided to recommend a substantial grant towards the provision of dental teaching facilities in the proposed new area of the existing building.

Finally, in a table that itemises the grants, the Committee recommended for the University of Sydney, £56,000; for the Uni versity of Melbourne, £41,000; for the University of Queensland, £400,000; and for the University of Adelaide, £400,000 - a total of £897,000.

For some reason or other a prestige appears to be accorded to the doctor which is not given to the dentist. If I examine my own heart in this matter I can certainly say that I develop a tremendous warmth for the doctor who comes into my home when there are emergencies affecting my children, but I do not like the dentist, whom I have to visit deliberately - he does not come to my home in an emergency - in unpleasant circumstances. In television programmes we have Dr. Kildare and Dr. Casey. It is possible for the producers to put them through a great variety of adventures and maintain public interest, but if ever a dentist is depicted on the screen it is always in some farce, either connected with laughing gas or with some humourously horrifying vision of a person towering over a mouth with forceps. It seems to me that it may be that the constant ignoring of dentists and dentistry in our national health scheme, and now in this measure, may have some such psychological foundation.

Every provision that we make for health leads to an increased demand for more legislation for health. It is a snowballing demand. The more medical science prolongs life, the more people have, need of the dentist, pharmacist and the doctor. In 1901 when the expectation of life was 52 years there would be less need of a doctor than there is today when the expectation of life is about 70 years. The more the patient's life is prolonged the more he will have need of health facilities so we must face up to the fact that there will be a constantly rising demand for those facilities. But we do not face up to the rise in demand for dental facilities and a serious situation is developing in this field. The report to which I have referred, while showing that in Australia the ratio of dentists to population was unsatisfactory in comparison to the position in Scandinavian countries, the United Kingdom, the United States and New Zealand in 1956, does not give the recent position. Let me show honorable members how the ratio in Australia has deteriorated over the last three years. In 1 963 the ratio of dentists to population was 1 to 2,531. In 1964 it was 1 to 2,551. In 1965 it 1 to 2,585. It is constantly deteriorating. The situation in certain States is more serious than the Australian average. For instance, Tasmania which in 1963 had 1 dentist to 4,002 people now has 1 dentist to 4,113 people. South Australia which in 1963 had 1 dentist to 3,315 people now has 1 to 3,390. In Victoria the ratio has gone from 1 to 2,998 in 1963 to 1 to 3,136. The Australian armed Services, in dealing with young soldiers - not a section of the population characterised by the worst dental health - considers that 1 dentist to 1,000 persons is the proper ratio. Yet we have States such as Tasmania where the ratio is 1 to 4,113. Bear in mind also that in the States you are not dealing only with young men but also with children and other people in the greatest need of protective dentistry.

We therefore regret deeply that the Government has not seen fit in this legislation to provide for the same kind of dental education in meeting the costs of dental hospitals as it is providing for medical education. We note that the Government has accepted a good many of the recommendations of the Committee. For instance, it accepted the recommendation about library books. I think a case can be made for the Government's action some time ago in rejecting the recommendation that a grant of £625 per head of medical students be made and, instead, adopting the policy of meeting actual itemised administrative costs associated with teaching hospitals. A case can be made for all those kinds of modifications of the recommendations of the Committee on Teaching Costs of Medical Hospitals, but we cannot understand why so constantly nothing is done in the Government's decisions about dentistry. Entries into the dental profession recently numbered 276 and there were 127 graduations.

Mr Reynolds - That is the average over 10 years.

Mr BEAZLEY - I thank the honorable member. The figures show a serious leakage. At present the movement of dentists out of the country has been stabilised. There are about 500 Australian dentists practising in the United Kingdom. This trend of Australian dentists going to the United Kingdom is not continuing at its early post-war rate, but still not sufficient men are being attracted to the profession. The Government recently justified its action in introducing fluoride into the water supply in Canberra on the ground of the serious state of dental health of children in this Territory. Children in the Territory would belong to a group which in nutrition and parental care stands above the norm of the Australian community. Notwithstanding that, the Government was concerned about the dental health of children here - not to the extent of assisting the dental profession in the ways that we propose by our amendment but at least to the extent of introducing fluoride into the water supply. The Government's case in regard to dental health when fluoride was introduced in Canberra should remind it that it needs to revise the national health scheme in the direction of dental health. If the Government is to revise the scheme to strengthen the dental health of the Australian community, it must pay the same attention to dental education as it is now paying to -medical education.

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