Simon Harris must listen to dentists or new oral health plan will fail

Why has new oral health strategy been developed without input from dentists?

‘Unlike medical care, dental care is primarily provided on a private basis by dentists’ Photograph: iStock

‘Unlike medical care, dental care is primarily provided on a private basis by dentists’ Photograph: iStock

 

Disinterested is unfortunately the most appropriate description of the Government’s view of oral health. It is a curious stance given the huge importance of oral health in its own right and its role as a gateway to promoting general health.

Good oral health enables us to speak, smile, kiss, breathe, whistle, smell, taste, drink, eat, bite, chew, swallow and express feelings. Oral health and general health have close links. On the one hand, oral health can be compromised by a number of chronic and infectious diseases, which show symptoms in the mouth. On the other hand, oral diseases can lead to infection, inflammation, and other serious impacts on overall health.

We are told that Minister for Health Simon Harris will finally publish an oral health strategy, developed without any semblance of consultation with representatives of the profession, in the coming weeks. This will be the first policy on oral health published since 1994, exactly a quarter of a century ago, and should serve to focus long-overdue attention on oral health.

It beggars belief that the department – which has been working on the policy for the past four years – has failed to consult with the Irish Dental Association (IDA) and other stakeholders. That failure is inexplicable, unwise and objectionable.

While the new policy will be awaited with keen interest by all who value their oral health (46 per cent of adults visited their dentist last year) and certainly will be examined closely by the dental profession, it will be doomed to failure unless the department develops a new relationship based on inclusivity and mutual respect with the country’s dentists.

Unlike medical care, dental care is primarily provided on a private basis by dentists who work independently of the State, but who can be contracted to provide care for large cohorts of eligible holders of medical card or PRSI benefits, albeit the treatments funded by the State are extremely limited.

While oral health in Ireland is improving, most of the gains are being recorded in higher income groups

Private out-of-pocket payments account for 83 per cent of all monies spent on dental care, with State provided or funded services accounting for just 14 per cent.

The latest CSO Survey on income and living conditions (2017) shows that more than 32 per cent of households with children, where at least one person had a dental examination and/or treatment in the previous year, reported that the associated costs were a “financial burden”.

This surely illustrates the consequences of the decision to take away an estimated €100 million in annual State supports for patients post-2009, with the cuts to the medical card and PRSI schemes.

While oral health in Ireland is improving, most of the gains are being recorded in higher income groups, and the chasm in oral health status according to income is widening as a direct result of the massive cuts in State support.

Despite not being consulted on the new policy, the IDA has produced its own document, Towards a Vision for Oral Health in Ireland, which we wish to see incorporated in a new oral health policy. We have also sent copies to Mr Harris and the main political parties.

Publication of the new policy should be followed by publication of a new dental Bill and negotiations on a new contract for medical card patients; both of which are long overdue (the Dentists Act dates from 1985 and the Dental Treatment Service Scheme dates from 1994).

The exclusion of the profession from talks on a new oral health policy and the petty bureaucracy of the medical card scheme – it is clearly unfit for purpose and only offers professional fees amounting to half of average private fees – has forced the IDA to shift its focus. Over the past year the association has concentrated on developing independent practice and to reducing the reliance of dentists and their patients on dental schemes funded by third parties such as the State. This policy will be pursued as a priority by the association in 2019.

So, will this preclude the association and its members from engaging with the Department of Health and its representatives following publication of the new oral health policy? Not necessarily, but what is clear is that any prospect of a successful realisation of the objectives contained within a new oral health policy will require a fundamental shift in the attitude of the State towards the profession in tandem with a new approach towards promoting oral health into the future.

The IDA has many positive proposals for enhancing oral health for all to share with the Department of Health. But is the department interested or capable of engaging with the profession? Time will tell.

Fintan Hourihan is chief executive of the Irish Dental Association.

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