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Dentists say government's new oral health policy will result in more teeth being extracted in both children and adults

The Irish Dental Association says policy will be ‘catastrophic’ for adults and children in lower income areas.

LAST UPDATE | 15 May 2019

DENTISTS HAVE SLAMMED the government’s new oral health policy stating that key aspects of the public dental service are now to be privatised.

Last month, Health Minister Simon Harris announced the new scheme of dental care for Irish children under the age of six, as well as packages of care for children from birth to 16 years of age.

Professor Leo Stassen of the Irish Dental Association criticised the policy stating that prevention takes time to work. 

“The package is going to detract from the capability to look after children,” he said.

He added that it will result in an “increased need in extraction not just for children but for adults”. 

Fintan Hourihan, chief executive of the Irish Dental Association told the Oireachtas Health Committee today, that not only will the new policy fail, but it will be “catastrophic for patients in lower socio-economic areas with high treatment needs”.

The association, which represents 2,000 dentists nationwide, said it was not consulted on the new oral health policy, despite being the practitioners that will have to roll it out.

The new policy for the care and treatment of children and adults is “seriously flawed, economically unviable and operationally unworkable”, said the chief executive.

Under the changes, contracted local dental practices will replace the existing Public Dental Service (PDS) school programme.

Currently, the PDS provides emergency treatment to all children under 16 years of age and routine dental examinations for school children at certain periods. 

Children are examined and given a grade depending on how quickly the child needs treatment. The child is then referred to a local HSE dental clinic to receive treatment.

Sinn Féin’s Louise O’Reilly said she was very concerned to hear that the professionals who will be tasked with rolling out the new scheme were not consulted when drafting the policy document. 

She said it was very rare for the committee to receive a submission from a group that used such “stark language” against a new government policy.

Dentists not consulted on new plan

Hourihan told the committee today that it is “incomprehensible to our members in both the HSE public dental service and private practice that key aspects of the public dental service are now to be privatised”.

He said in his opening statement to the committee that the association’s members are concerned moving from a targeted, risk based model to a demand led model will pose risks in relation to the continuity of care and the provision of emergency care for children. 

dentist Fintan Hourihan, chief executive of the Irish Dental Association.

He added that dentists “fear that the public dental service will ultimately prove to be a dumping ground when the unworkable model proposed, which our members believe is based on a failed and discredited NHS experiment, inevitably collapses”.

Public service dentists employed by the HSE play a critical, complementary role in providing expert care primarily for children and special care children
and adults, he said.

“Regrettably, based on our members’ analysis of the plan, it seems certain that oral health inequalities will increase rather than reduce with the plan’s proposals in regard to the provision of dental care and treatment,” added Hourihan.

He said that this is “the inevitable consequence of moving from a targeted approach where HSE public dental surgeons directly target children at key age ranges of their development for dental services including, but not limited to, prevention, restorative care and referral to secondary services where eligible”.

This approach enables those who do not attend to be identified and followed up.
The policy’s proposal is to redirect this service into general practice where identifying risk will be dependent on attendance by the very groups who are both least likely to attend but also have the worst oral health and the greatest treatment need.However, the policy’s focus on prevention needs to be counter-balanced by the fact that prevention going forward cannot fix the significant amount of untreated oral diseases that are already present today.

Hourihan said dentists have long been calling for the replacement of the “unfit for purpose” medical card scheme, but the declaration from the Department of Health over
the years is that this couldn’t happen until the publication of a new oral
health policy.

“This has been used as an excuse also for the delayed publication of new legislation to update and amend the Dentists Act of 1985.

“The publication of the oral health policy now clears the pitch and allows all parties to engage without delay in long overdue discussions on the state contracts and also the need for new legislation,” he said.

While the association said they welcomed that the department has decided to move on rolling out an oral health policy, he questioned why dentists were not consulted. 

Hourihan said the association has a “track record in speaking out” adding that “if that is why we are being punished, that is the only reason I can offer”. 

Moving towards privatisation

Highlighting the “most glaring weakness” in the policy is the proposal to extend limited “free dental care” to under 6s and eventually to under-16s.

“However, the plan offers no evidence to justify taking care and treatment of children from the HSE public dental service,” he said, adding:

It may seem easy to suggest taking work from the HSE public dental service when it has been hollowed out and left to crumble over the past decade.

The association also notes there is no mention made to the current crisis in arranging dental care for children who require to be treated under general anaesthetic. Hourihan states up to 10,000 children a year are undergoing painful operations because routine screenings are no longer taking place and issues are not being identified in time.

In addition, the new government policy offers nothing to the 60% of adults who do not have access to free or subsidised dental care other than very limited PRSI dental benefits, he adds, and questions why there no support or funding towards the cost of dental treatment provided to those adults.

No change in tax relief 

Hourihan also questions why there is no change in the tax relief for those adults, adding that the provisions for adults represents “little more than repackaging of the existing suite of treatments which were savagely cut in 2009, a decision which everyone described as shameful at the time”.

Currently, there is 20% tax relief only for a limited number of dental procedures.

Hourihan added that dentists first reaction to news of the new scheme was “disbelief and anger” at how few dentists in practice – within general practice, specialist practice or within the HSE – were consulted in the preparation of this new policy even though they are the ones it is hoped will deliver 95% of dental care in future.

“Therefore, we respectfully submit that this is not the last word on oral health in Ireland.

The association regards this as a starting point for a badly needed discussion on oral health,” he stated.

Responding to the criticism, the Department of Health said in a statement to that “this is a transformative oral health policy which requires a programme of change over eight years. The policy will be implemented in phases to give time for people and the profession to adjust and become familiar with the new system of care”. 

“In the first years the focus will be on engaging with the relevant stakeholders, including dentists, to agree on how the new arrangements will be rolled out. The introduction of packages of care for children under six years of age will be prioritised.

“In addition, there will be a focus on enabling vulnerable adults to access their local dentist as a first point of contact and ensuring that they are referred to the HSE community oral healthcare service or other appropriate service, if required,” added the department.

In correspondence to the minister and the department since its launch, the Irish Dental Association welcomed the new policy, said the statement, adding that it invited a written submission from the Irish Dental Union/Association in December 2017.

“In response the IDA declined to submit a written submission. Subsequently in 2018 and more recently in February 2019, they were provided with an outline presentation on the draft policy. On the latter occasion the Association responded positively to the policy and looked forward to engagement during implementation,” said the department.

Health Minister Simon Harris said he very much welcomed the “written support” he received from the association, but stated frankly:
I would make the point that it is government that makes policy and then government negotiates with the contractors that provide that policy. This is what we do in relation to GPs and lots of other people who provide services in the health services. We set the policy, that is why we are elected by the people and the policy direction is clear we want to see a situation in this country where children have access to free dental care.
Free dental care for children will begin to be rolled out from next year, said the minister. He added that dentists will be given investment and resources to roll out the new policy.

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