Dentistry’s future in question
Irish Parliament debates crisis in care as HSE dental surgeons gather for the first time, post-pandemic
The HSE Dental Surgeons Seminar took place this autumn, in-person for the first time in three years. Those attending said it was important to meet colleagues, share experiences and benefit from guidance at a time of great stress within the service. They pointed out that the scale of the decline in staff numbers within the Health Service Executive (HSE) dental service can only be appreciated when looked at over a longer timescale.
Understaffing and a lack of resources in the public dental service is being blamed for the delays in providing much-needed treatment, with the numbers of practising public-only dentists having dropped by almost a quarter (23 per cent) in the past 15 years; decreasing from 330 in 2006 to 254 in 2022. It means the HSE would need to hire 76 dentists, immediately, to the bring the service back to the levels it was at 15 years ago.
A discussion in the Irish Parliament, the week before the seminar, featured an acknowledgement by Stephen Donnolly, the Minister for Health, that the Irish Dental Association (IDA) was correct to identify the need for a significant increase in staff.
The issue of the public dental system, particularly in relation to primary school age children, was raised by Labour’s Duncan Smith, who said: “The system has collapsed. The waiting times, in areas where they even exist, are too long. They are longer than the time children spend in primary school. What is the Minister’s plan to address this?”
Deputy Donnelly responded: “The HSE public dental service provides care for children up to 16 years of age. It includes emergency care, a fissure sealant programme and care for orthodontics. There have, as the Deputy Smith correctly said, been significant delays in the provision of these services. These were significant before COVID-19 arrived and, as with many other patient services, COVID has made them worse. It is not acceptable that children and their families are facing these long waiting periods for access to oral healthcare.
“It is a top priority for me and the Government to address it. Critically, we are backing that sentiment up with money, which is what matters. I have allocated an unprecedented ¤15 million in the budget for next year to enhance the provision of oral health services.
“A dedicated amount of nearly €5 million has been provided to develop a comprehensive oral healthcare package for children. This will make a huge difference. This is an intervention package for children from birth up to seven years of age and is aligned with the national oral health policy.
“We will see the benefits of these packages in the years to come. On top of that, I have allocated €9 million specifically to address the waiting lists in orthodontics, which the Deputy has quite rightly called out, and to allow the public dental service to provide care to all eligible children.
“In addition to the €15 million allocation, resources will also be available to recruit more orthodontists. There has been a specific request for orthodontists to provide clinical leadership within the HSE to drive this oral health strategy, Smile agus Sláinte. These staff will allow for the very substantial reform that is required right across the system.”
Deputy Smith acknowledged the financial commitment but questioned from where the much-needed dentists would be sourced: “The Irish Dental Association has said we need 400 whole-time equivalent staff in our dental service to bring us to where we need to be.
“There is a role for the [Education] Minister, Deputy [Simon] Harris, in resourcing third level and further education in UCD [University College Dublin] and Trinity College. What negotiations are taking place to ensure that we are able to develop dentists and orthodontists here, but also to attract them from overseas?”
“The IDA is correct in saying we need significant additional numbers in public service provision”Stephen Donnolly, Minister for Health
Deputy Donnelly responded: “While we need to keep going, what has been done this year? A number of community healthcare organisations have already run recruitment initiatives to fill the vacancies that exist. Vacancies equivalent to approximately 72 whole-time equivalent staff have been filled so far this year. That is very welcome progress.
“The HSE dental service recently held a recruitment event. It invited dentists who are registered or entitled to be registered with the Dental Council of Ireland. I am delighted to say that the event was well attended by dentists who were expressing an interest in these public service jobs, which is where we need them.
“So far this year, there has been a net increase of 72. We are going to continue to push on that. We have sanctioned more roles because, as the Deputy quite rightly says, we need to build up the workforce. The Irish Dental Association is correct in saying that we need significant additional numbers in the public service provision.”
Deputy Smith also raised the lack of oral or dental hygienists and the need to get dentists back into schools “examining children at a young age and getting them into streams to ensure they have good oral care and that they get any structural dental issues sorted out in their early teens”.
Deputy Donnelly agreed with the opposition member, adding: “There are several layers to what we are doing. One is prevention. The programme we are now bringing in for children from birth up to seven years of age is really exciting.
“The second layer is building additional capacity in our public health service, which we have discussed, and the third is modernisation and reform. This is why we are introducing clinical leaders to the system, which we have had not had before, to help with regard to models of care for children and adults.
“One area in which we need to be open to quite radical action is that of college places and training places. The reality is that we do not educate remotely enough healthcare professionals in our country. We need to see at least a doubling of college places. That would cover both groups of workers the Deputy has described, dentists and dental hygienists. We need to be radical and ambitious in scaling up the number of college places and training places in the coming years.”
Back at the HSE seminar, delegates were urged to support the IDA’s campaigning efforts by contacting their local politicians and speaking to local media.
The impact of the collapse in the Dental Treatment Service Scheme on the HSE dental service was evident in the discussions among dentists who attended. One example cited was that the number of private dentists with DTSS contracts in the Laois-Offaly constituency has fallen from 36 in January 2015 to 11 last August.
This makes access to dental care for adults challenging and, in turn, puts extra pressure on the HSE dental services which are supposed to focus on children, special care patients, refugees and other vulnerable groups.
At the seminar, a presentation by Dr Dympna Kavanagh, Ireland’s Chief Dental Officer, signalled that significant changes in the model of dental care are envisaged by the Department of Health. However, many dentists were sceptical, and the IDA said that it was critical that discussions began with the association “sooner rather than later”.
Meanwhile, a spokesperson for the IDA said the difficulty many dentists experienced in securing time off, and any form of funding, to attend the seminar underscored the need to have a collective agreement with the HSE which explicitly covers protected time and appropriate continual professional development funding. Talks are under way with the HSE, and the IDA said this was a priority for the association in the coming year.
This was the final IDA Seminar for HSE dental surgeons in the first century of the association’s history; it will be one hundred years old in January and members were urged to use the anniversary as an opportunity for suggestions about evolving future events, including the seminar.