2015 AGM Address by Mr Fintan Hourihan, Chief Executive, Irish Dental Association

2015 AGM Address by Mr Fintan Hourihan, Chief Executive, Irish Dental Association

(16 Apr 2015)

I am honoured to present a brief report on the activities of the Irish Dental Association and our newly licensed trade union the Irish Dental Union.


You will be aware that copies of our 2014 Annual Reports offer information on the activities, finances and plans of both the Irish Dental Union and the Irish Dental Association.  I would be pleased to take any queries on any aspects of either report at the conclusion of this address.


I propose to speak briefly on a number of significant developments and also to signpost some important challenges facing us in the year ahead.


Strong Organisation

I am pleased to announce once more a record level of membership.  We have exceeded total membership of over 1,700 dentists at this stage.  In fact since 2008 membership has increased by 28% overall.  This reflects a very significant increase in membership amongst our general practitioner members and the current membership stands at over 48% ahead of the numbers of general practitioners in 2008.


Regrettably we have also seen a haemorrhaging of membership amongst members employed in the public dental service.


Clearly the overall rise in membership reflects the significant increase in benefits and services afforded to members but it also reflects the strong leadership shown by successive Boards and Officers over the last decade.  The adoption of an ambitious strategic plan in 2013 is predicated on further expansion of the membership and I believe that it is now appropriate to set a clear membership target of 2,000 dentists and I feel that there is no reason why we cannot aspire to such a level of membership within the next three years. 


You will have noted the significant decline in membership of our colleagues employed by the HSE and this must be a first priority for us in the coming months.  I am pleased to say that significant work is already being done and I am confident that there are very real and tangible benefits which we can roll out with a view to retaining our existing members and expanding our numbers employed in the HSE.



You may be aware that the Board and Executive Committee commissioned a Governance Review in the last number of months. The initial analysis prepared by our external consultant shows that in overall terms there is a strong sense of commitment and good governance practice within both the Association and the Union.  Yet, reflecting the fact that it is over a decade since the last such review was undertaken there will be significant changes recommended when the next stage in the process is completed and we will of course notify members in due course.


One of the very striking themes to emerge has been the need to build up our representative structures particularly at branch level within the Union.  At a time when we can finally see some real prospect of negotiations commencing on a replacement of the schemes in place for medical card and PRSI eligible patients it now is a particularly opportune time to assess the extent to which we can campaign from a position of strength, ensure the members voices are heard and that there are appropriate channels of communication between elected leaders for general practice and the wider membership. 


Representing Members

I’d like to draw your attention to two important new initiatives, namely the Dental Complaints Resolution Service and our new pilot mentoring scheme.  The Dental Complaints Resolution Service had another busy year and has proven of great assistance to both dentists and patients alike.  


After completing two full years of operation, it has been the subject of a review in the past few months and I expect that we will see a number of small but significant changes in the way it operates in order to enhance the capability of the service and to ensure a timely and professional response for users of the service. You can expect to see more information about this in the coming months.


A highlight of the last number of months has been the launch of the new pilot mentoring scheme. I am delighted to say that we have so far helped almost 10 dentists who have sought assistance on a confidential basis from peers who have generously given their time to help predominantly younger dentists in mapping their way through the many issues arising for members in what can still be a very lonely profession.


I would encourage everyone here to promote awareness of this initiative amongst members and I would call on branches in particular to assist in this regard.


Collective Bargaining

Turning to collective negotiations it is important to remind everyone that there have been significant developments in the area of collective bargaining for professional representative bodies such as ourselves and the Irish Medical Organisation.  You will have read that a frame work agreement has now been concluded and negotiations involving the IMO, Department of Health and the HSE have progressed significantly already as regards medical care for under-sixes. We expect that there should be no difficulty outstanding for the resumption of discussions which were stalled as soon as they started in 2006 on a new contract for dentists participating in the DTSS. 


It is also worth noting that we have now sought the assistance of the Labour Relations Commission to help with stalled negotiations on behalf of our members in the public dental service and again it’s important to say that we are determined that all outstanding elements of the 2011 agreement are implemented in full before any further changes can be introduced for our members in that service.


Primary CPD Provider

For the Association, the commitment is to maintain and enhance our position as the primary CPD provider.  With the imminent introduction of mandatory CPD for all dentists there will undoubtedly be an increase in the numbers of other providers of CPD.  The role of the Association has always been to cater for the CPD needs of all its members and particularly to foster a strong sense of collegiality amongst members in all branches of the profession be it in general practice, specialist or limited practice and we are anxious to build on the strong foundations as we seek to build an even stronger position as the primary CPD provider.


Recently we were invited to nominate a number of representatives to attend a stake-holders day to take place next month in Limerick as part of the preparation for a new oral health policy.  We will of course be sending a strong team to represent the interests of the profession to that conference and we will continue to make strong representations in relation to all aspects of oral health including health promotion and prevention as well as areas which have previously not received much, if any, priority and this would include areas such as care for the elderly, nursing homes and also new models of provision of care for specialist services. 


The Association will shortly be involved with the Deans of the Dental Schools in a further round of discussions following publication of the first ever report of the National Oral Health Forum.  I am pleased to advise you that we will be attending a meeting with the Minister for Health and the Secretary General in the coming weeks and we also expect to attend the Oireachtas Health Committee in support of the plans we have developed and which have been published in the Oral Health Forum Report. 


General Election Ahead

Of course we are all well aware that a general election is pending and will take place within the coming months. 


We have already begun to review our plans to campaign to ensure that dental health features in the manifestos of the main political parties and also to ensure that we have ready access to the key decision makers in all the main political parties. 


We all remember the promises that were made prior to the last general election and the extent to which they have been shamelessly ignored by the current Government.


Severe Dental Infections

New research, to be published shortly, shows that there has been a notable rise in severe dental infections requiring hospital admissions since the state made savage cuts to the medical card and PRSI dental schemes.


This research shows that there has been a 38% increase in the number of patients admitted to hospital in the two years following the introduction of these savage cuts. The authors state that “it is likely that many more dental patients are suffering from dental abscesses.” They have also identified a “worrying trend of increasing numbers of patients accessing the emergency department and ultimately requiring secondary and tertiary level care for the management of dental infections.”


The authors also state that “most patients in this study required surgical intervention” and noted a “worrying increase in the number of patients being operated on for dental caries, a condition that should be dealt with long before it gets to the operating theatre.” Reflecting the more serious nature of the admissions in such cases, the authors found in 2011 that 70% of patients were brought to theatre on the first day of admission compared with just 27% in 2008. It should also be noted that the average length of stay for patients admitted with dental infections as in-patients stands at 5.5 days.


A further prospective study is taking place and the figure of over 100 in-patients admitted with dental infections within a twelve month period represents a four-fold increase in the numbers being admitted compared with typical annual numbers of admissions in the recent past. This shows that the rise in admissions apparent in the initial study is now being accelerated at a remarkable rate.


There is no reason why we should have other than a small handful of such admissions in a first-world health service but regrettably we are now seeing evidence of the long held view of dentists that significant damage is now being done to the oral health of the nation which is clearly linked to cuts in state supports for patients.


This is simply disgraceful and this research shows that the oral health of many Irish people and their families is suffering severely in spite of promises made by the Government parties prior to the last election to restore dental treatments.


It is no exaggeration to say that there is significant morbidity associated with severe dental infections and regrettably there have also been across the world a number of mortalities from deep abscesses and dental infections which threaten systemic harm to the body. Causing patients to be confined for five days in a hospital within a bed starved health service is a serious resource issue.


Just what will it take before this Government begins to address the crisis in our dental services? As a first step this Government needs to honour its promise to restore vital dental care and treatments in the next Budget.


It is incomprehensible that the Government is making huge cuts to dental care for patients when all the evidence shows that prevention is so much better in health and economic terms for patients and when we see the huge toll on the health of our community when patients are left with severe abscesses and life-threatening infections as a result of state neglect.


In a radio interview earlier this week the Minister for Health Dr Leo Varadkar linked the PRSI dental benefits to the Government’s universal health care plans and  indicated the Government ‘might’ restore the benefits.


While we welcome the Minister’s comments, I must point out that both Government parties had in fact promised to restore these dental benefits prior to the last election.


The ball is now firmly in Tanaiste Joan Burton’s court. As the Minister responsible for the PRSI dental scheme, the Tánaiste should indicate whether or not she shares this view and tell us when we can expect to see action on this issue.


As the evidence of the impact on oral health of cuts in state supports emerges, we repeat our call on the Tanaiste to restore essential treatments available previously under the DTBS. We have no doubt this would be appreciated enormously by hard-pressed citizens who have continued to pay their PRSI contributions / USC charges while their benefits have been curtailed severely.


Meanwhile, the best advice we can offer patients is to see their local family dentist and ensure that they not only protect their oral health but also avoid costly remedial treatments in future. Your local dentist is best placed to advise you how to maintain a health smile.


Promoting Patient Safety

We have still to see publication of the heads of the new Dental Bill and I will be repeating our calls to the Minister for Health to ensure its urgent publication.  In the last number of months, the Association was alarmed to learn of claims that patients are being seen here in Ireland by a dentist whom it is alleged has been struck off in another jurisdiction and whom also, it is alleged, is not registered to practice here at all.  


Separately, the Association has received claims that patients are seen in clinics here in Ireland by dentists commuting from abroad every couple of weeks to see patients.  And we are all aware of instances where patients commence treatment in this country and have that treatment completed outside the jurisdiction beyond the reach of the Dental Council. 


We have to be concerned about the redress available to patients where registered dentists visit this country occasionally or where patients complete treatment outside the jurisdiction. Where it is alleged that patients are being seen here by dentists who don’t hold registration and may have been debarred in other countries, the Dental Council does not appear to have the powers to regulate and if necessary sanction dentists where standards of care far below those practiced by the majority of the profession.


Patients need to check that they are being seen by a dentist registered to practice here in Ireland and most especially if their treatment is concluded outside the country. Ireland has the highest standard of regulation, we have transparency as regards fees, we have a highly successful complaints resolution service and of course there are other avenues of redress where complaints cannot be resolved. By contrast, too many patients are paying a very high a price for overtreatment or mistreatment when they are seen by dentists who are not accountable to the authorities here in Ireland or subject to the levels of scrutiny our members subject themselves to every day.


It is important to remember that while new legislation may impose additional burdens on the profession it will also be important in ensuring that the highest standards of care and professional practice are maintained while also affording the Dental Council the powers to take on those who seek to undercut or undermine the high standards of Irish dental care you provide to your patients.


Therefore, it is incumbent on the Minister to ensure that new legislation is afforded the highest priority and we must all continue to press the Minister for urgent action in this area.



I wish at this point to conclude with thanks to a number of colleagues who have provided unstinting service over the past number of years.  In the first instance I want to thank all of the Officers, the Board and Council as well as representatives on all of the committees which you will see enumerated in the Annual reports.


I would particularly like to thank the outgoing President, Dr Peter Gannon. Peter has a long history of advocating for general practice and in the past year has been singularly successful in promoting the interests of all branches of the dental profession and in driving on progress and development at a national level within the Association.


Likewise I would like to thank all those who are stepping down from the Board, Council and all other committees for the work they have undertaken selflessly on your behalf and look forward to working with their replacements.


I wish to thank in particular Dr Nuala Carney who has provided outstanding services as Honorary Treasurer over the last number of years and who step down from the Board today along with our former President Dr Sean Malone.  Both have offered strong leadership for the profession through their participation at the highest level in recent years. 


I want to join with you in congratulating Dr Anne Twomey on her appointment as President.  I know she will be an energetic and committed leader for the profession in the coming year and will ensure that the interests of members in all branches of the profession are promoted with the greatest vigour.  I would also like to congratulate all the newly elected officers appointed here today.


As always I wish to put on record my sincere thanks to all the hard working staff in IDA House.  They have been a terrific support to myself and to the leadership in the past year and have always provided the greatest standard of service to an ever expanding level of membership.


In the past year we have been joined by Ms Marie Walsh who has taken over from our esteemed colleague Mary Graham and I wish to thank Marie for the way she has participated and become an integral part of the team in IDA House in such a short period of time. 


Finally as we look forward to yet another successful Annual Conference I wish to particularly thank Elaine Hughes for the great work she has undertaken to ensure another successful conference in addition to driving on the CPD Programme and indeed has been integral to developing the learning management system which she will present to the meeting later.