After the election

Opinion with Tommy O’Malley

“There is a clear social failure involved in persistent famines or in widespread exclusion from medical access, which calls urgently for remedying (thereby yielding an advancement of justice), even after taking note of the costs involved” – Amartya Sen

Now that the election is over and we have a new government at last, it is time to reflect on what the previous government did for dentistry and look to the future for what might happen as regards funding of dentistry for the next five years, if the hamstrung government lasts that long.

Under the Fine Gael/Labour coalition, of course, the funding of the PRSI scheme and Medical Card dental support scheme had already been, and continued to be, decimated. The PRSI (DTBS) scheme was virtually abandoned with funding left in place only for once yearly examinations. The Medical Card (DTSS) scheme removed most cover and left extractions as the principal treatment option for many.

At no stage was funding put in place to encourage dentists to upgrade their practices or take on new staff. The Irish Dental Association failed to deliver a workable system for its members in negotiations, mainly because successive governments backed by the Civil Service considered dentists a soft touch and without any real negotiating power. The result was the creation of two totally inadequate schemes that provided fragmented benefits for patients and caused nothing but resentment for most dentists operating the scheme. There were a few who used the system and felt aggrieved when the press flagged the figures to sensationalise the story. But, the figures did not help the public’s perception which was of a greedy profession milking the system. It seemed at the time that the government spotted the opening and went for it with an easy target that would not cause public uproar.

Of course what is needed is a properly funded scheme that will give patients a basic cover that would be needed to render them dentally fit. What is obvious is that if the government were to introduce a free dental scheme for say the under sixes, as was done with the doctors, you can bet your negative equity house that the dental remuneration will be miserly and way below what would be needed to maintain a properly functioning dental practice, especially now that new cross–infection control measures are coming under inspection, wage pressure mounting and increasing rates and so on. A move to free dental care no matter the age of cover will probably finally spell the end of the single–handed practitioner in Ireland, certainly the single–handed practitioner operating even on 50 per cent state–funded schemes.

And what has the Irish Dental Association got to say? Well, at the recent IDA annual practice management seminar in Croke Park, Dr Tom Feeney who is currently European President of the International College of Dentists concluded that the “aim in Ireland to restore pre–crash funding model” would bring a reasonable level of support for dentistry in Ireland. I don’t think so.

The pre–crash funding model was neither good for patients nor good for dentists. It was under–funded, an administrative nightmare and failed to deliver quality dental care for patients.

The only party that even mentioned dentistry in their Election 2016 manifesto was Fine Gael, the other parties made vague wishy–washy promises about reform and even the introduction of healthy snacks in vending machines. The vending machine carrot is laudable but this is a health SYSTEM in crisis and some intellectual debate about how to fix a third world health system masquerading as a first world one would be appreciated.

Don’t get me started on how I think the next government will fund a “decent” dental scheme.