National Oral Health Policy

In 2014 the Department of Health began a three year project to develop a new national oral health policy under the leadership of Dr Dympna Kavanagh, Chief Dental Officer. This policy will be aligned with government commitments on primary care as well as broader health policy as outlined in Healthy Ireland.

The Department of Health is being assisted in its work by an Independent Panel with expertise in the areas of oral health services development, and epidemiological, social and economic research. This Panel acts both in an advisory capacity, and provides independent oversight to ensure the quality of the outcomes produced.

In order to support the policy and ensure that it is informed by evidence, an Oral Health Policy Academic Reference Group was established in 2014. This reference group builds on the core strengths of academics across several oral health and other relevant disciplines. Findings and recommendations have been submitted and will assist the department in its approach to development of the policy and how it will fit within the department’s wider policy agenda.

The policy development project has three key aspects:

• a needs assessment to inform how new services should be provided
• a review of oral health care resources
• consultation with stakeholders, including the public, on new ways of delivering oral health services

Since 1994, there have been significant social, economic and demographic changes, as well as a reduction in the level of fluoride in public water supplies in 2007. These are among the factors which indicated that a review of the oral health needs of the population was necessary.

With the prevention of oral disease noted as central to any prospective policy development, the assessment of population oral health need is focusing upon a review of pertinent national and international literature, a review of existing reliable oral health survey information, and a consideration of available dental services data.

Current and recent relevant research projects include the Health Research Board’s review, Health Effects of Water Fluoridation, Fluoride And Caring for Childrens Teeth (FACCT) study and The Irish Longitudinal Study on Ageing (TILDA).

As part of the Economic and Social Research Institute (ESRI) Research Programme in Healthcare Reform, options for providing Primary Care Oral Health Services are being examined.

This workstream encompasses consideration of the volume, profile, and geographical distribution of oral health care personnel.

Workforce related aspects are being informed by a Health Research Board and EU 20/20 funded project currently being undertaken in University College Cork, with support from a Social and Economic Consultant.

The development of the policy will identify future education and training needs. It is important that oral health professionals have a skillset appropriate to meet the present and future oral health needs of the population.

Consultation with both the public and oral health care professions and stakeholders is a key aspect of the development of a new National Oral Health Policy.

The department commissioned research to gain an understanding of the views of the population on their use of oral health services and to provide an insight of the experiences of the population in relation to their own oral health.

The vast majority of dental services are provided in primary care settings, often by independent practitioners. A key focus of the policy development will be to elicit the views of the profession to inform the policy. This commenced with the Stakeholders Day, which took place on 6th May 2015.

A Practitioners’ Reference Group was established to focus on dental service delivery in primary care and consider the implementation of different types of oral health service delivery models appropriate for the Irish population. This group was chaired by Mr Pat O’Dowd, Assistant National Director, National Contracts Office, Health Service Executive.

The final phase of this consultation process focuses on gaining a comprehensive insight of the profession’s views. In June 2015 the department invited Expressions of Interest from departments/Schools of Sociology/Social Science with expertise in the area of the social research. The University of Limerick has been engaged and is tasked with consulting with the dental profession. The method of research will involve consultation with dental students, dental educators, primary care dentistry providers and other dental health professionals. Letters have initially issued to dentists seeking their participation in the consultation. Themes emerging from the Academic and Practitioner’s Reference Groups and the Stakeholders Day will provide a framework to elicit the views and concerns across the profession. Themes emerging from the Academic and Practitioner’s Reference Groups and the Stakeholders Day will provide a framework to elicit the views and concerns across the profession.

The methodology which guides this consultation is qualitative in nature, including interviews and focus groups with key stakeholders and future stakeholders. Qualitative methods are widely used to capture in-depth accounts of experiences, histories and knowledge of practice, which would be difficult to obtain through methods such as surveys. The subjects covered in the interviews / focus groups will look into the following areas:

• thoughts on the development of the dental profession in general
• key elements which you consider should inform policy
• key challenges that the dental profession currently faces
• thoughts on preventative dentistry and primary care
• specific concerns about Irish dentistry in particular
• funding models, economic incentives and methods of delivering care
• patient experience and concerns about how the policy may effect patients

Due to the qualitative methodology which guides the study, the sample size is much smaller in comparison to quantitative methods. While the information obtained will be contextually deeper, it is unlikely to be as broad. Participants in the consultation will be selected to ensure national coverage (all cities and rural areas), that both established and new entrants to the profession are included, and that European Economic Area dentists practising in Ireland are adequately represented in the sample.

Practitioners employed directly by the HSE and other oral health professionals will be consulted in a separate process in 2017.

Dentists who are interested in participating in the study but who are not selected as part of the interview process may write to dentalhealthproject@gmail.com with any concerns or opinions.

These will feed into the study.