Prof Leo Stassen: Gaps in dental plan will cause damage.

Prof Leo Stassen: Gaps in dental plan will cause damage.

(10 Dec 2019)

The children who are most in need of support (those with additional needs or in families with reduced socio-economic circumstances) are those who will not seek care and will have difficulty navigating the proposed system.

The National Oral Health Policy will shift responsibility for children’s care from a gutted public service to private dentists, says Prof Leo Stassen

The Government’s decision to implement a National Oral Health Policy is unprecedented, yet welcome.

We need an extensive, ambitious public policy to ensure that people are receiving the best oral healthcare possible.

However, the policy, as proposed, is concerning, and the Irish Dental Association (IDA) believes that if implemented in its current form, it will have a negative effect on our most vulnerable citizens.

The policy suggests a reduction in treatment for adults who hold medical cards and nothing for all other adults, even though the State offers hardly any support for families towards the costs of dental treatment.

However, the policy’s shortcomings are most obvious in its proposals on children’s oral health. Our risk-based, targeted public dental service model has been in place for decades: public service dentists reach out via primary schools to children who need treatment, offering an integrated safety net and continuity of care.

The National Oral Health Policy proposes to change this satisfactory, if underfunded, system to one whereby children are seen only if they attend private dental practices.

They will not be targeted further if they do not present.

Children rely on parents to bring them to the dentist and not every parent can prioritise those visits, which is why a targeted approach is so important.

What safety net will be put in place for those children who are not routinely taken to their family dentist?

The children who are most in need of support (those with additional needs or in families with reduced socio-economic circumstances) are those who will not seek care and will have difficulty navigating the proposed system.

The proposal to shift the treatment of children from the public dental service to private general dental practitioners (who would have a contract with the State to treat children) is also problematic for GDPs.

Under the proposals, GDPs would be contracted by the State to deliver allocated oral healthcare packages covering prevention, primary care, and emergency care. Eight oral healthcare packages would be available for children up to the age of 16. Last month’s budget also seeks to compel GDPs to offer free treatment to all under-sixes.

This is well-meaning, but poorly conceived. The IDA supports a fully funded and resourced state dental scheme, but GDPs should not be compelled by the State to provide work while the public system itself is being gutted.

GDPs provide an excellent service to private patients, and now the Government wants to use this resource to suit its own ends and to shift responsibility and accountability away from the State.

GDPs are understandably wary of taking on care for children, or of taking on more State-funded work. Provision of this care will require additional resources for areas where there are insufficient general dentists available, and additional access to advanced care services, which have not yet been defined or resourced.

The IDA has consistently called for an adequately funded public dental service.

However, we are concerned that the erosion of the HSE public dental service is being accelerated, following the publication of the new policy. This will leave children with the worst of both worlds, in terms of access to dental care.

The number of dentists employed by the HSE for school screening has decreased by 30% in the last 10 years, the number of children eligible for care has risen by 20%, and there are waiting lists of 24 to 30 months for specialist treatments.

Furthermore, increasing numbers of children are only being offered examination and dental care for the first time at sixth class (the oldest age group), instead of in first/second, fourth, and sixth classes (three age groups).

HSE documentation has confirmed this as policy in Cork, for example. This increases patients’ reliance on access to emergency dental care, which also has serious implications for dentists currently working within the services.

We need to invest in our salaried public dental health service simply to stand still, to replace departing staff, and to deal with the increasing number of closed dental clinics.

The IDA’s primary objective is to achieve better oral health for Irish people and we wish to engage in constructive dialogue with the Government, but trust has been considerably eroded, given that the IDA was not consulted when the Government drafted this proposed policy.

Moreover, after agreeing to discussing with the IDA alternative approaches to the policy, Health Minister Simon Harris’s office subsequently informed the IDA, just weeks later, that the policy would not be re-opened, and only wished to discuss its implementation. This is wholly unsatisfactory.

The provision of public dental care is of huge importance to the continued well-being of children and adults in Ireland.

We have the opportunity to develop a truly national policy that caters for all. We must not waste that opportunity.

Prof Leo Stassen is the president of the Irish Dental Association and an oral maxillofacial consultant at St. James’s Hospital, Dublin