Time for a new model
An ‘unprecedented’ funding commitment must go hand in hand with reform
As we detail in this issue, understaffing and the lack of resources in Ireland’s public dental service is being blamed for delays in providing much-needed treatment. The number of practising public-only dentists has dropped by almost a quarter (23 per cent) over the past 15 years – from 330 in 2006 to 254 in 2022.
This means that the Health Service Executive (HSE) would need to hire 76 dentists, immediately, to bring the service back to the level of 15 years ago.
The HSE public dental service provides care for children up to the age of 16, including emergency care, a fissure sealant programme and care for orthodontics.
Ireland’s Health Minister, Stephen Donnelly, has conceded that there have been delays in the provision of these services. These were significant before Covid arrived and, as with many other patient services, the pandemic has made them worse, he told Parliament recently.
It is, he added, not acceptable that children and their families are facing these long waiting periods for access to oral healthcare.
The impact of the collapse in the Dental Treatment Service Scheme on the HSE dental service was evident in discussions among dentists at the HSE Dental Surgeons Seminar held in the autumn. 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.
Deputy Donnelly has provided details of an “unprecedented” €15 million in the budget for next year to enhance the provision of oral health services, of which nearly €5 million has been provided to develop a comprehensive oral healthcare package for children.
This will make a huge difference. It is an intervention package for children from birth up to the age of seven and is aligned with the national oral health policy. In addition, €9 million has been allocated specifically to address the waiting lists in orthodontics. Resources will also be available to recruit more orthodontists.
“The profession has to be open to new ways of working that focus on prevention of disease.”
The Irish Dental Association (IDA) has said 400 more whole-time equivalent staff are needed in the dental service – a view on which the Health Minister concurred. The question is, from where will those dentists be sourced?
Deputy Donnelly said a number of community healthcare organisations have already held recruitment initiatives to fill vacancies, and the equivalent of 72 whole-time equivalent staff have been hired so far as a result.
A recent HSE dental service recruitment event was also well attended by dentists who were expressing an interest in public service jobs.
The lack of oral or dental hygienists, particularly in schools, is another issue. There is a need for radical action on college and training places – at least a doubling of the number currently available in order to meet the demand for dentists and dental hygienists.
Reform and modernisation of the model of care is also required. At the dental surgeons’ 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 are sceptical and the IDA said it was critical that discussions began with the association “sooner rather than later”. That is only right. But, equally, the profession has to be open to new ways of working that focus on the prevention of disease.