Committee Reports > List of Committees > Dáil > 1986 > Committee on Public Expenditure > Report No. 19 - Proposed Dublin Dental Hospital

APPENDIX 6

UNIVERSITY OF DUBLIN

RESPONSE TO THE CRITICISMS ON THE BUILDING OF THE DUBLIN DENTAL TEACHING HOSPITAL

A document (Appendix A) was circulated to Dail Deputies in the Cork area criticising the decision of the Government to proceed with the building of a Clinical Sciences Complex in Dublin which includes a Dental Teaching Hospital. The plans for Dublin are an integral part of Trinity College’s development programme of training in health care within the Faculty of Health Sciences (Dentistry, Medicine, Speech Therapy, Physiotherapy, Dietetics, Occupational Therapy, Medical Laboratory Technology and other ancillary health care specialties). The “Cork” document is misleading and misinformed in that it suggests that the Clinical Sciences Complex only provides for dentistry and that its dental facilities are more costly than those provided in Cork.

No Dispute in Relation to the Need to Provide a New Dental Teaching Hospital in Dublin

The need for a new Dental Teaching Hospital in Dublin is not in dispute, even our Cork colleagues seem to agree. A new Dental Teaching Hospital has been planned for Dublin since 1963 because of the unsuitability of the existing 19th century buildings and their facilities for present day patient treatment and dental training and research.

Inadequacies of Existing 19th Century Buildings

The Dublin Dental Hospital currently occupies approximately 2,800 square metres of space spread over four locations - Lincoln Place, Fenian Street, Westland Row and part of the Genetics Building in Trinity College Dublin. The accommodation consists of a number of old buildings which have been acquired over a considerable period of time and adapted for use by the Dental Hospital as and when funds permitted. This piecemeal development resulted in a complex of buildings that cannot be fully utilised because the various elements of the Hospital are widely dispersed, overcrowded and seperated by one of Dublin’s busiest thoroughfares. These problems result in the following:

(a)Inadequate facilities in which to carry out modern dental procedures and a modern dental training programme;

(b)Reduced operating efficiency;

(c)Marginal safety standards;

(d)Uncomfortable treatment and waiting facilities for patients;

(e)Inadequate facilities for disabled patients, some of whom have to be carried up six flights of stairs;

(f)Inadequate facilities for special category patients who have to be treated in outlying general hospitals;

(g)No facilities for general anaesthetic and sedation procedures;

(h)Inadequate laboratory conditions;

(i)Inadequate research facilities;

(j)The lack of immediate access to a general hospital.

These conditions have been tolerated by the staff and students only because of the imminent move to the new hospital at St. James’s.

World Health Organisation Recognition of Dublin Hospital

Despite these recognised deficiencies, the School of Dental Sciences in Trinity College Dublin is unique in that it has been designated a Collaborating Centre by the World Health Organisation in recognition of and as a result of the implementation of an innovative curriculum directed towards the Primary Health Care Approach in line with policies which have been adopted by the Government.

Demographic Situation makes Dublin the Most Justifiable Centre for a Dental Teaching Hospital on this Island

No one could question Dublin as being the most appropriate site, if not the only justifiable one, for a Dental Teaching Hospital on this island, in that it caters for a hinterland of over 2.5 million people in the provision of primary and secondary dental care for patients. The Hospital provides treatment to 70,000 patients per year, undertakes dental treatment services for seven hospitals in Dublin, provides service to Eastern Health Board clinics and provides refresher courses for public and private dental practitioners from all over the country.

Ireland has Lowest Dentist/Patient Ratio in E.E.C.

The dentist/population ratio in Ireland is the poorest in the ten E.E.C. countries (pre Spain and Portugal) (see Appendix B). The position in Denmark is approximately four times more favourable than in Ireland (and Denmark, like most of these countries with which comparisions are being made, employs, additionally, operating clinical auxiliaries who currently are not permitted in Ireland). Despite this poor dentist/population ratio the intake of dental students/1,000,000 population is the lowest of these ten countries. This will effectively widen the gap in dentist/population ratios unless there is a net immigration of dentists into the country.

Ireland has the Highest Level of Untreated Dental Disease

We had the highest level of untreated dental disease in the recent International Collaborative Study. This is particularly acute in the lower socio-economic groups. It is understandable that the dental profession might be concerned that more dentists in the country could result in a lowering of their income levels. This should not prevent the country having a level of dentist/patient ratio approaching the European average.

There is a particular need to provide dental care to the lower socio-economic communities. It will also be necessary in the future, for cost effective reasons, to train dental operating auxiliaries and provide more continuing education for practicing dentists. The new facilities in the Clinical Sciences Complex are designed to accommodate both these needs in a way that will be highly cost effective. The balance between dentists in training and auxiliaries can be tuned according to need.

Comparison of Costs between Dublin and Cork

The unit cost of teaching dental students and treating dental patients in the Clinical Sciences Complex will be significantly less than that in Cork. The precise comparative figures are as follows:

Capital (Building) Costs at July 1985 Rates

These figures have been independently verified by the Building Unit in the Department of Education.

Inter-School Collaboration

One of the most surprising elements in the “Cork” document is the suggestion of collaboration between Cork and Belfast in providing the training needs of the country. This would certainly be suitable for the city of Cork and its outlying area and also for Belfast, but it is rather insular in its attitude to the 2.5 million people served in the hinterland of the Dublin area. It is understandable that Belfast would be satisfied with such an arrangement since their school leavers have access to the Dental School in Belfast and to every other dental school in the United Kingdom and in the Republic. At present there are twice as many dental students from Northern Ireland training in Great Britain than there are in Northern Ireland, so there are probably three times as many Northern Irish school leavers gaining access to dental training than there are in the Republic of Ireland. It will not protect the professions’s position to close either Dublin or Cork since even if we did not provide such careers for school leavers in this part of the country there would be an abundant supply of dentists from Northern Ireland. This parochial conflict does not take account of the number of graduates from other E.E.C. countries, all of whom are entitled to practise in Ireland.

The Health Sciences Concept

Unlike Cork, Dublin was planned after the acceptance by Government of the Primary Health Care approach which emphasises an appropriate training programme for personnel in health education and primary care at more realistic costs and availability of services to the entire community. The Dublin approach which received World Health Organisation support must be promoted if we are to develop a more effective means of combating dental disease than the ineffective one of repair.

The concept of a Clinical Sciences Complex which integrates the Health Sciences provides an exciting opportunity for an innovative faculty. Others should not see that as a threat, particularly those in Third Level education and the profession must also recognise that school leavers should be given opportunities that dentists have already had themselves. Income levels may decline with increasing emphasis on prevention and cost effective care and with the introduction of auxiliary personnel. However, dentists must not maintain high standards of living by denying access to treatment or career opportunities to an ever expanding number of people seeking third level education with guaranteed employment at the end of it.

Dr. A. Clarke

Vice Provost

21 March 1986