Har­ris must lis­ten to den­tists on new pol­icy

Fail­ure to con­sult IDA on oral health strat­egy is in­ex­pli­ca­ble and ob­jec­tion­able

The Irish Times - - Opinion & Analysis - Fin­tan Houri­han

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.

Med­i­cal card

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.

Pri­vate out-of-pocket pay­ments ac­count for 83 per cent of all money 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.

Long over­due

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

“Pri­vate out-of-pocket pay­ments ac­count for 83 per cent of all money spent on den­tal care, with State ser­vices ac­count­ing for just 14 per cent

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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