With just one party providing a detailed vision in its manifesto, the future of Ireland’s oral health policy depends on the outcome of talks to form a new government

[ Words: Will Peakin ]

When Sinn Féin experienced a late surge in popularity to secure the largest share of the vote in the Irish general election last month, the party’s success redrew Ireland’s political landscape, leaving the country’s two established parties of power, Fianna Fáil and Fine Gael, in a challenging position.

“Sinn Féin is poised to recast Ireland’s political dynamic and install itself as a third large party in what has historically been a two-party system,” said Professor John Ryan, of the London School of Economics and Political Science. “Whether in government or opposition, 2020 will be the election that sees Sinn Féin fundamentally break the historical tight grip of the two traditional parties on Irish politics.”

Sinn Féin won the popular vote, securing 24.5 per cent of first preferences in the country’s electoral system of single transferable votes. Opposition party Fianna Fáil came second with 22.2 per cent, and the ruling Fine Gael, third on 20.9 per cent. Fianna Fáil received 38 seats, down six seats on 2016. Sinn Féin won 37 seats, up 14 on 2016, and Fine Gael dropped 16 seats to finish with 35.

Because Sinn Féin only put forward 42 candidates to fill Ireland’s 160 parliamentary seats, and since its success came at the expense of other left-wing parties, the chances of it building a governing bloc in the wake of the result were thin. But if Fianna Fáil and Fine Gael are unable to form a government, then a new election will be called, in which Sinn Féin would almost certainly run more candidates and win more seats. On 23 February, the Irish Parliament adjourned until 5 March and talks seeking to agree a programme for government intensified, a process that could take weeks or even months, and end in another election.

For health policy generally, and dentistry in particular, a Sinn Féin government offers the prospect – at least on the basis of the parties’ stated policy positions – of a real shift in emphasis.

In the run-up to the election, the Irish Dental Association undertook a campaign to raise awareness among candidates and the public on issues around oral health and dentistry.

The association provided material for members to share on social media, using #youdeservebetter to highlight such issues as the 20 per cent rise in the number of under-16s requiring dental care, and the 30 per cent drop in numbers of public service dentists.

“The campaign highlighted the major flaws in the national oral health policy, which removes the safety net of the Public Dental Service for children, and offers nothing for adults or pensioners,” said an IDA spokesperson.

The association also produced a guide to help members engage with candidates. It also contacted the main political parties and asked:

• Will your party sit down with dentists to discuss an alternative plan for improving children’s dental health in place of the unworkable proposal contained in the 2019 oral health policy, Smile agus Sláinte?
• How would you deal with reducing emergency dental admissions as one of the leading causes of treatment for children under general anaesthesia in our hospitals?
• How would you make it easier for everyone to access dental care at their local dentist?
• Do you support proper and meaningful consultation by the State with the dental profession prior to introducing significant change in providing dental care?
• Will you commit to employing at least 100 extra dentists in the HSE and make a start towards reversing the cut in the numbers of dentists working in the public service, which have fallen by 30 per cent over the past decade as the numbers of eligible patients have risen by 20 per cent?

While Fianna Fáil did not respond directly to the IDA’s questions, the party’s election manifesto contained a commitment to enhance dental and oral health services. It said: “Oral health has long been regarded as the poor relation of general health and has generally been overlooked. While a new national oral health policy has been published, we believe it is flawed and inadequate. We will consult with the dental profession on how the new oral health policy can be improved and implemented, bring forward a reformed policy that will have an implementation plan, and replace and improve the 1985 Dentists Act.”

Of the other parties, Fine Gael committed to offering free dental care to under-16s, the Social Democrats committed to introducing “improvements in dental care”, the Greens committed to introducing a free post-natal check-up under the Maternity and Infant Care Scheme, and Labour to the introduction of a universal entitlement to a free dental examination, scale and polish twice per year.

Only Sinn Féin responded directly to the IDA’s questions. It said: “Dental care is an incredibly important strand of healthcare. The state of your teeth affects your overall health, with gum disease linked to numerous other health problems in other parts of the body. Throughout the austerity years, public-funded dental provision suffered a litany of cuts. Children have been particularly affected by these cuts.

“Such failure means that situations now exist whereby children are waiting as long as 12 years for their first dental screening. In order to ensure that the public has good dental health, the Public Dental Service needs to be properly funded and the number of dental surgeons, orthodontists, dentists, and dental nurses in the PDS needs to be increased. We will deliver free dental care for all children and young people under 18 over the course of government.

“Our spokesperson is committed to engaging with the dental profession in relation to the future of dental healthcare in Ireland and would be happy to meet with representatives of your profession to outline our proposals in greater detail and to discuss the outworkings and benefits of our proposals, once the Dáil is reconvened.”

Sinn Féin priorities include delivering free dental care for all children and young people under-18 and increasing funding for the Public Dental Service. In response to the questions, it said it would meet dentists to discuss an alternative to Smile agus Sláinte. To reduce emergency dental admissions, it would introduce free dental care as part of a national health service, reduce financial barriers to more regular check-ups, and improve education around dental care. Healthcare at the local dentist would be free as part of a national health service and it committed to employing at least 100 extra dentists in the HSE.

At the IDA’s Practice Management Seminar in January, its chief executive Fintan Hourihan said: “The model advocated in the [current] oral health policy seeks to compel private, independent dentists to take on care and treatment of cohorts of children they currently do not see, instead of investing in the service which has been designed to screen children. This approach has been prepared without any consultation with our members.

“[The previous Government’s] insistence on pushing through free treatment for under-6s is not properly thought through, proposing an onerous burden on independent dentists, who neither have the capacity nor appetite for taking on new cohorts of patients, requiring far greater time than is available in general practice to provide them with the care and treatment being proposed.

“Ultimately, this will have a negative effect on all patients being seen in general dental practices who deserve far better from the health system. We call on the next Government to reset relations with the dental profession and to commit to discussing badly-needed change with those who are expected to deliver such change.

“Politicians are trying to cut corners. Independent dentists provide an excellent service to private patients around the country without any State support, and they will not agree to changes which don’t serve the best interest of patients or which threaten the viability of dental practices.”