I am, as always, very pleased to see so many members in attendance and honoured to present a brief report on the activities of the Irish Dental Union over the past year and to offer an insight into the year ahead.
To expedite matters I would also propose, with your agreement, to speak to the annual report of the Irish Dental Association at this point.
For organised dentistry as a whole, it obviously remains an extremely difficult environment in which to practice given the stagnant economy and the continued indifference and lack of support from the State for patients and dentists.
Rather than solely bemoan the difficult environment in which members are practising both the Union and the Association have endeavoured to examine and introduce new ways in which we can support our members and by extension, the patients you serve.
Record Membership Levels
It is gratifying that the exhaustive efforts of so many members involved as representatives within both organisations have been recognised by the profession and we are now in a position where we have record numbers of dentists in membership of the Association and Union.
However, it is critically important that we continue to evaluate the services and assistance we offer dentists and also to ensure that the subscriptions charged provide value for money. And we need to show that we have a well ordered organisation where those entrusted to represent the members’ interests discharge those heavy responsibilities in a professional manner.
It is gratifying that in addition to the extensive range of new benefits and services we have seen continued progress in attracting new members to serve as representatives of both the Association and the Union and I would take this opportunity to thank everyone at branch, national and honorary officer level for the continued commitment and support they have shown to colleagues within the profession and to the secretariat in what has been another busy and challenging year.
As the Treasurer will explain later the finances of the Association and the Union are particularly healthy reflecting the record levels of membership but also reflecting tight control of expenditure.
The continued important work of the Audit and Finance Committee and the introduction of guidance for members of Council, Board, Branches and Committees has enhanced our existing governance arrangements and these have proven invaluable at a time when all representative bodies are subject to appropriate scrutiny.
The three year strategic plan which was adopted in 2010 has been successfully realised in large measure and I am pleased that we will shortly commence a strategic review exercise with a view to publishing a further strategic plan for the coming years later in 2013.
New Services and Benefits
A feature of the past year has been the introduction of some significant new services and benefits to members which I wish to touch on briefly.
We have seen the introduction of the Dental Complaints Resolution Service which has been very positively received by members of the profession and by the general public. I wish to put on record my appreciation of the continued efforts of the mediator Mr Michael Kilcoyne who has been courteous and professional in his dealings with both dentists and complainants and also to those dentists who have offered to assist him and myself in coming to terms with some of the issues arising in the complaints as well as the invaluable support offered by Dental Protection and indeed the support provided by Dental Council for the scheme.
We have also seen the introduction of helpline services this year for members which offer support to dentists in dealing with legal difficulties, health problems and also provides counselling services to family members as well as dentists. In addition, the introduction of a new service to assist dentists who are the subject of a Revenue Audit has received a very positive welcome.
I am delighted to advise the meeting that from September 1st coming we will be introducing a pilot mentoring scheme for dentists and I wish to thank sincerely all those who have been involved with me in preparing for the introduction of this scheme which we hope will be of great benefit to dentists at all stages of their career.
In a similar vein I am pleased to advise you that I have been invited to help the creation of a service for doctors initially (and soon after to include dentists) which will provide a specialist health service for health professionals relating to mental health or substance misuse disorders. It will provide advice, assessment, limited treatment, case management services and, where necessary, onward referral to specialist services.
It is largely modelled on a similar scheme in place in the UK for doctors and dentists and our hope is that it will fill a badly needed gap in helping colleagues in distress in a sympathetic and confidential manner and with appropriate support for such assistance from the regulatory bodies (who will be interested but entirely uninvolved parties in the running of this service)
There has never been a greater need for independent and professional advice and support services for the dental profession and I am pleased that these three separate initiatives will go some way towards helping many colleagues who find themselves suffering great stress and in need of support at this moment in time.
Generating Greater Dental Attendance
On a positive note, I am pleased to advise that we have been involved in discussions with a view to commissioning market research with a view to generating greater dental attendance and promoting better awareness of the links between oral and general health.
The Association has also committed to supporting an advertising campaign in this regard but for obvious reasons we are prioritising the commissioning of market research so that this can better inform an advertising campaign.
New Dental Bill
The fact that the Department of Health has indicated it will shortly commence a consultation exercise prior to the publication of a new Dental Bill is to be welcomed. Undoubtedly, many of the changes will replicate those which have been introduced in recent times for the medical profession, nursing, pharmacy and other health care professions and we should expect many of the headline changes to reflect those already introduced for those professions.
There will of course be many issues which are very specific to the dental profession and I can assure the members that we will be fully prepared and will offer all members an appropriate opportunity to give us their views in preparing a formal submission to this exercise.
The superior and unique knowledge held by a dentist obviously is intended to be shared for the greater good but equally for the public at large who don’t have access to the insight and knowledge of dentists, they wish to be assured that there will be procedures in place to protect them in a situation where they are at a significant disadvantage in terms of information available to them regarding their best interest and ensuring their optimal care.
One of the changes we can anticipate in the new Dental Bill will be the introduction of mandatory CPD. I am confident that the Association is particularly well placed to help dentists meet their statutory obligations in this regard.
Over the past year we have seen the roll-out of the highly successful CPD road-shows and these have attracted huge numbers of dentists to receive the benefit of leading edge presentations by very eminent speakers whom I wish to thank along with our own CPD Committee and in particular my valued colleague Elaine Hughes.
It is important to recognise also the huge work undertaken at Branch level in organising scientific presentations for colleagues in addition to the organisation of the annual conference and also the Croke Park seminar.
In the year ahead I look forward to a new phase in the assistance we offer members by rolling out online CPD linked to our Journal which has itself had a tremendously successful year in 2012.
In many ways the health or standing of the profession might best be assessed by the level of trust afforded dentists by society and the patients you serve. I am pleased therefore to inform you that the evidence suggests that dentistry is held in very high regard.
I would draw your attention to the findings of a survey of the general public carried out by Behaviours and Attitudes on behalf of the Irish Dental Association in 2010 which show large levels of satisfaction with the care provided by Irish dentists. Seventy four per cent of respondents stated they are very or extremely satisfied with the service provided by their dentist.
Among female respondents 76% were very or extremely satisfied with their dentist’s care while a remarkable 80% of 25-34 year olds and 76% of under 24s were also extremely or very satisfied. I suggest these are remarkably positive findings and infer a high level of trust in Irish dentists.[i]
The success of the Mouth Cancer Awareness Day has only served to underscore the importance of the dental profession and the crucial role a visit to the dentist can play in tackling some of the most significant threats to general health.
Last September a survey published by the Platform for Better Oral Health in Europe reported that the most trusted sources of information on dental health were dental professionals at 81% followed at 30% by pharmacists. The media, government and corporate groups made up the smallest group of trusted sources.
Of course this also puts an onus on us all to have evidence-based policies at hand to support the credibility of our guidance and we know this is expensive and time consuming.
Oral Health at the crossroads
The oral health of the nation is inextricably linked to Government policy and price supports (or the lack of them) for patients. The current Government has to take responsibility (with its predecessor) for arguably the most alarming and rapid deterioration in oral health over recent decades as it refuses to pay for dental treatments previously available to patients and valued at over €100m per annum. To look at that another way those cuts alone are equivalent to one third of the entire cut in the public service pay bill suggested in the rejected Croke Park 2 proposals.
The decision to reduce spending on the PRSI dental scheme by 90% in little over two years (now restricted to a free annual examination even though well over one million adults still pay their PRSI contributions) and to severely restrict dental care for the record numbers of medical card patients means the state is removing €100m from the pockets of over three million adults and their dependents each year. The continued denial of dental treatments paid for by the state means that Ireland now has the highest numbers citing cost as a factor preventing attendance at the dentist and the lowest number of adults visiting for routine examinations.
What has compounded the problems caused by these decisions has been the cynical failure on the part of the HSE and the Department of Social Protection to publicise the availability of free dental examinations to over three million adults. The most recent figures available to us show that eight out of ten PRSI eligible persons failed to avail of their free dental exam while six out of ten medical card holders did not avail of their free annual check-up. They offer pathetic explanations and announce the availability of free dental examinations yet in the past year the Department of Social Protection has rejected our appeal to arrange a publicity campaign and three years after the despicable stealth cuts applied to the DTSS, the HSE continues to refuse to explain to the public what remains available to vulnerable patients including the annual examination.
If the Government wants to at least show its bona fides, then it must support our call for a voucher system whereby all those eligible to medical card and PRSI dental care would receive a voucher reminding them of their entitlement to a free dental exam. It doesn’t bestow anything beyond the minimal entitlements currently available but at the very least might encourage greater numbers to at least visit their dentist.
We received strong support for this idea at our recent appearance at the Oireachtas Joint Committee and I intend to repeat this call to the Minister for Primary Care, Alex White, who is due to speak to the conference tomorrow.
We need to remind our politicians that problems which may be caused or made worse by poor dental health include heart disease, strokes, diabetes, premature and low-birth-weight babies and respiratory disease. Obviously oral diseases have a damaging effect on quality of life and impaired function as well as the pain and suffering caused.
This is having an inevitable effect as numbers attending their dentist fall while dental decay and gum disease rise and the oral health of the nation suffers dramatically. To compound these disastrous decisions the state has halved tax reliefs for expensive dental treatments such as orthodontic care and it has reduced the numbers of dentists, nurses and others in the public service by 20% in barely two years causing longer and longer waiting lists. And as dental visits have dropped alarmingly, the dental and allied professions have suffered around 1,500 lay-offs and huge numbers emigrating to provide dental care elsewhere.
The answer to arresting this shocking decline also rests with choices available to our Government. Gradual restoration of price supports, restoration of marginal rate tax relief, ending the embargo on recruitment of dentists by the HSE and the appointment of a chef dental officer after twenty years without any dedicated oral health adviser – all these choices rest with the Government and I look forward with interest to what the Minister of state for primary care, Mr Alex White has to say to our conference tomorrow (Friday).
Where the state has decided to actively address serious oral health problems, such as in Denmark and the UK, it has been shown that remarkable improvements can be achieved. While the state has perpetrated huge damage as a result of its recent decisions, it should also be aware that it now has a great opportunity to make long lasting improvements in the oral and general health of the nation and the profession stands ready to play its part in reversing the terrible damage which has been wrought in recent times. The alternative is that this current administration leaves a lasting legacy of poor oral health which will scar in particular our young people for decades to come.
In terms of representing members, the last year has seen extensive resources and support provided to dentists in dealing with the Revenue Commissioners and it is gratifying that a number of dentists have confirmed that they have successfully retained self employment status for associates and, in a small number of incidences, hygienists.
Obviously, this has been a matter of great concern to members and continues to be so I look forward to hearing from dentists across the country over the next few days and I wish to assure all that the expert and professional advice we have made available will continue to be updated and we will remain available to assist members.
The critical importance of good HR and employment advice available without charge from the Association continues to be valued very highly by our members and I wish to thank Clare Dowling in particular for providing dedicated, courteous and professional support to members. We have ambitious plans to enhance the services and assistance we offer to principals, partners and associates in the coming year and I know this will only enhance the value of membership.
The many changes introduced in the HSE public dental service have also been a priority over the past year and I am pleased that some limited progress has been made. However, the fact that there has been a 20% reduction in the number of dentists employed by the HSE and those on maternity leave are routinely not replaced means many children are not having their first school screening until sixth class.
The HSE has now effectively abandoned the laudable aims set out twenty years ago to screen children regularly, to promote oral health and to provide invaluable care and treatment not only to children but also to special care patients. A strong public health care system is the hallmark of a civilised society and that is why we will continue to agitate and advocate for a public dental service we can be proud of and which reflects the commitment and skills of our members employed to provide top class dental care.
A New Oral Health Coalition
It is important to recognise that we can achieve much within the profession but equally we need to extend and to build a coalition of like-minded interests to advance our case. I am pleased therefore to advise you that we have begun discussions with other dental stakeholders with a view to preparing a strong coalition for oral health in presenting our case to Government and to key decision makers and opinion formers.
The success of our recent attendance the Oireachtas Joint Committee on Health & Children goes to underline the fact that there is a strong interest in dental care and the particular difficulties we face at present but also shows that we must be prepared to step forward and present our case to the public in well-argued and persuasive terms.
A positive future
I want to finish on a positive note by looking forward and by suggesting that there is a very healthy future for the dental profession and that there is ample scope for dentists to seize the many opportunities available to secure and build on the trust in the profession.
At a most basic level there is a growing need and demand for great dental care; in fact there is a huge unmet need for such care. Consider also that the younger generations have a much more positive attitude to dental care and place a greater value on good dental health (even if it is skewed to the aesthetics of good dental care, there is a growing and positive base on which to build and educate the public) than their preceding generations. At its simplest I think one of the most profound and overlooked shifts in everyday Irish life has been the change in attitudes among the very young to visiting the dentist and the growing number who look forward to such visits along with the diminishing numbers who fear such visits.
I believe the profession has much to gain from greater regulation and that informed and appropriate oversight, reflecting legitimate concerns raised beforehand by a credible dental profession and its representatives, will only serve to enhance the highest quality of dental care we all wish to see provided.
To illustrate this point, I refer to the new legislation to regulate the provision of tooth whitening in line with the European directive on this topic (in passing I wish to record our thanks in particular to our CED representatives who have been instrumental in achieving progress on this issue within CED and ultimately in dialogue with the European Commission).
As I am sure you will be aware, since last October tooth whitening has clearly become the practice of dentistry exclusively. Tooth whitening products can only be sold by dentists and the provision of such products and treatments requires the oversight of dentists. The Irish Medicines Board has been charged with enforcement of these new rules and the indications are that some high-profile visits to beauty parlours, hair salons and other clinics have already taken place.
This regulation can only be positive for the public and for the profession it offers the possibility that many who don’t otherwise attend regularly are at least exposed to visiting the dental office and the possibility they can be persuaded to attend for other elements of dental care and treatment. Removing such treatments from untrained and unprofessional third parties and bringing these under the supervision of a dentist serves to underscore the professional nature of dentistry and of course this is important also.
Furthermore, I believe there is a very significant vacuum to be filled in providing honest, patient-centred and credible information on dental health to the communities we serve and which is ripe for the profession and its representatives. In some ways the rise in social media has only expanded the opportunities available as the current multitude of self-serving, exclusively commercial, evidence absent or bogus advice only enhances the value and credibility of impartial and professional information and advice.
I am aware that representative bodies have huge responsibilities to the profession and to the community also and I am confident we won’t shirk from our responsibilities. We thrive on and need actively engaged members so for anyone out there with an opinion don’t hold back. Get involved, make your voice heard, roll up your sleeves. There’s so much we can achieve together and sometimes we even have fun in the process.
This year marks the 90th anniversary of the first AGM of the Irish Dental Association. We should all feel proud of the strong organisation we are pleased to serve and support today. The positive progress we have made in recent difficult times is testimony to the strong commitment and support of the profession for the Association so we should look forward to our centenary anniversary with confidence.
I wish to conclude by reiterating my thanks to our honorary officers, Branch and Committee representatives as well as to my hard-working colleagues in IDA House. Finally, I wish to congratulate the outgoing President, Dr Andrew Bolas, on a very successful year and also to thank on your behalf Drs Conor McAlister and Ray McCarthy for their sterling service over the past three years.
The new President, Dr Sean Malone, will receive our full support in the year ahead and let us hope we can look back on another fruitful year when we meet in Kilkenny in 2014!
[i] A survey in Ireland carried out by IPSOS / MRBI in 2010 asked members of the public in regard to various professions “for each (of these professions) would you generally trust them to tell the truth or not”. While the survey listed doctors and not dentists, it is reassuring that in spite of the unrelenting criticisms of the medical and indeed dental professions, an overwhelming 97% of respondents said they trusted medical doctors to tell them the truth. You’ll be interested to see where the other professions are placed in the trust hierarchy so next time you see a gathering of politicians, business leaders, journalists and trade union leaders, prepare to suspend your disbelief.