Department of Health Written Submission in response to the Committee’s written questions
This submission was augmented on 22 April with further oral submission and response to questions.
Is it the intention of the Eastern Health Board to get a new office complex as a condition of transferring the site for the new dental hospital?
1.The site which has been selected for the new dental hospital is part of the site of St James’s Hospital.
At present, Eastern Health Board Offices and a building housing the Health board’s computer are on this site, close to where it is intended to build the dental hospital. The Eastern Health Board forsee serious problems to the work of their administrative staff and to the operation of the computer if building work starts on the new dental hospital before alternative office accommodation is provided. They are therefore withholding agreement to transfer of the dental hospital site until new office accommodation is available or can be seen to be becoming available.
The Health Board is at present investigating the possibility of getting an existing building for use as offices.
Are there any plans for introducing legislation or posts in the Health Service to provide for the dental auxiliaries to work in Ireland?
2.The legislation to permit the introduction of dental auxiliaries already exists in the Dentists Act, 1985. The Dental Council has a special committee on auxiliary dental workers which is at present examining the need for different types of dental auxiliaries. If the Council decides that there is a need for a particular class of auxiliary dental workers then, subject to the consent of the Minister, it can make a scheme for the establishment of that class of dental auxiliary. The question of posts for dental auxiliaries in the health board service could be looked at in the light of the Dental Council’s recommendations.
What are the requirements of the Department of Health or the Eastern Health Board in relation to a dental hospital as distinct from the training requirements?
3.A dental hospital is primarily an educational institution but of necessity it must provide a certain amount of treatment. The expertise that exists within the dental hospital is availed of by patients but in no case does this expertise exist purely for the purpose of providing treatment. The Eastern Health board has an oral surgery and general anaesthetic unit in James’s Street which will be integrated into the new dental hospital. However, when this occurs the unit will also serve in a teaching role within the hospital. In addition there will be certain dental staff of the Eastern Health Board working within the hospital, particularly in specialist areas such as orthodontics. Such an arrangement already exists with the present dental hospital. Generally speaking the new dental hospital is designed for the purpose of providing training but it will provide an element of treatment incidental to its teaching function and no particular facility will be provided specifically to meet the requirements of the Department of Health or the Eastern Health Board.
To what extent has the Department of Health been involved in the discussions and decisions to date about the provision of a new Dental Hospital?
4.The Department of Health was not involved in the decision on the volume of student intake in the new hospital which would have had a crucial influence on the design and on the extent of the facilities to be provided in the new building. The Department’s Chief Dental Officer acted as professional adviser to the Dept. of Education and the Higher Education Authority and made comments on the detailed plans of the hospital which were referred to him for his observations. The Department was concerned with the issue of the location of the new dental hospital and agreed to the proposal to site it at St. James’s.
What downstream additional costs would arise for the Department or the Eastern Health Board in the event of the project going ahread? Is it true that the Cork Dental Hospitals grants was cut by 14% in 1986?
5.While it is difficult to accurately predict all the costs associated with the operation of the new dental hospital it is anticipated that current funding levels would be adequate. It is not expected that there will be any increase in costs to the Eastern Health Board either.
The 1986 original allocation to Cork Dental Hospital represents a reduction of a little under 14% on the 1985 provisional out-turn figure. This reduction was part of a range of restrictions in funding levels which it was necessary to apply in the Voluntary Hospital sector. It is misleading to compare the 1986 original allocation figures with the 1985 out-turn because the 1986 figure would be subject to adjustment during the course of the year to take account of factors such as pay awards which might occur. Further discussions are to be held with the authorities of the Cork Dental Hospital on the 1986 financial provision.
The arrangement has been that one third of the agreed funding requirements of the Dental Hospitals were met by the Department of Health. However a special provision of 100,000 for Cork by the Department of Education in 1985 was not matched by the Department of Health and cutbacks were incurred by the Department of Health in Cork in 1986.
Are there any plans to increase recruitment or the number of posts for dentists or the Health Service?
6.There are no plans to increase the number of posts in the public dental service. There are currently 270 posts (264 dental officers and 6 consultant orthodontist posts), of which 233 are filled by permanent officers. Most of the remainder are filled by temporary appointments. It has been found possible in the recent past to fill most posts on a permanent basis when they have been advertised. It is anticipated that two orthodontist appointments will be made in the near future, in addition to the consultant already in post.
Are there any plans to apply an equivalent to the GMS scheme to the Public Dental scheme, using private dentists on a fee per item basis? Has the Department of Health any evidence to support a reduced need for dentists in Ireland in the future?
Has the Department of Health any basis for estimating the future requirement for dentists between public and private care to maintain the density now in the private sector?
7. (a) An Ad Hoc Dental Scheme, involving private dental and 8. practitioners in the treatment of adult medical card patients was initiated in 1980. Under this scheme, private dentists may treat patients who are authorised to receive private treatment by a health board, and they are paid in accordance with an agreed scale of fees. The number of patients treated is dependent on the amount of money allocated to the scheme by each health board. A number of boards have decided not to operate this scheme, giving a higher priority to other services.
(b)A review of arrangements for the delivery of dental services was initiated in 1981 in conjunction with the Irish Dental Association. The review, which is continuing, has been examining priorities in the delivery of publicly funded dental care, the scope for participation by private practitioners and the financial and organisational arrangements which might apply to such involvement. No decision has been taken about future arrangements and any such decision will have to take account of the resource implications, as well as the implications for the public health priorities of the existing health board service.
(c)The need for dental care in Ireland has been the subject of extensive analysis initiated or supported by the Department of Health. A number of epidemiological studies have been carried out into the pattern of dental disease in the Irish population. In particular, a national survey of children’s dental health has shown that there has been a very significant fall in levels of dental caries (decay) since the advent of fluoridation. Nevertheless, there is a significant level of unmet need in children and scope for more intensive preventive care in non-fluoridated areas.
As a result of the lower caries experience in children, more adults will retain their teeth for longer periods, with a likely increase in need for treatment of periodental (gum) disease. Need for dentures should decrease.
In addition to the level of unmet need, dental manpower requirements are heavily influenced by demographic factors and patterns of demand, rather than need for dental care.
Population projections imply a sharp reduction in the number of children and an increase in adults of middle age over the next 20-30 years. This will accentuate the profile of dental need outlined above. Of potentially greater significance is the pattern of demand for dental care. At present, about 25% of insured persons eligible for the Social Welfare dental benefit scheme seek treatment every year. This level of demand is significantly lower than in other European countries and a greater willingness to seek treatment for dental disease in future could produce greater demands on dentist’s services.
(d)The implications of projected future demand for dental treatment for the level of intake to dental schools is subject to the influence of a variety of factors. Foremost among these is dental migration patterns, from Ireland to Britain and subsequent patterns of return by Irish dentists who have worked abroad. Another factor is the likely future participation rate of female dentists in full-time dental practice. In general, net emigration of dentists has declined and may continue to decline. Equally a higher proportion of female dental graduates tends to result in a reduction in the quantum of available dental manpower. The impact of the employment of dental auxiliaries would also tend towards a reduction in the required level of dental graduates.
(e)All of the foregoing factors are subject to considerable uncertainty. In these circumstances the Department seeks to keep the various factors under continuing review. At present, the Department considers that the planned level of output from dental schools (73 per annum) should not be exceeded. A radical reduction in the planned number would not be warranted at this stage, but a sustained level of output at the planned level would produce significant increases in competition in the private dental sector, given the constraints which are likely to continue to apply to the provision of dental services by health boards.