Dr. Eamon Croke:

I wish the Chairman and members of the committee a good morning. I thank the committee for the invitation to appear before it to discuss dental regulation. The Dental Council of Ireland has been in correspondence with the joint committee following a letter of 16 October 2014 from Mr. Paul Kelly, principal clerk. This letter resulted from the meeting of this committee with representatives of the Clinical Dental Technicians Association Ireland, CDTAI, on 1 October 2014 and I will return to the matter of that letter in the course of our submission.

First, I will outline the role of the Dental Council of Ireland. The council was established by the Dentists Act 1985. The primary function of the Dental Council of Ireland is to protect the public. It does so by promoting high standards of education, as well as professional, ethical behaviour for all its registrants. The council is composed of 19 members. There are three main committees of the council, namely, education and training, fitness to practice and auxiliary dental workers.

The council's term of office is five years. There is mandatory registration for dentists and specialists, of which there are two recognised specialties - orthodontics and oral surgery. Mandatory registration is in place also for dental hygienists, clinical dental technicians and orthodontic therapists. The council has a voluntary register for dental nurses and is working very closely with dental technicians to establish a voluntary register.

The Dental Council of Ireland awaits a new dental Act. The council has been consistent in seeking new legislation that would permit effective, flexible regulation which is evidence-based, equitable and proportionate. The council acknowledges the progress made by the Department of Health in the lifetime of this Dáil but regrets the continuing delay in the enactment of new legislation. The council met with the representatives of the professional regulation unit of the Department of Health recently to discuss its summary of policy issues for inclusion in the new dental Bill, of which members have a copy.

I will introduce the major topics which arise from the summary of policy issues. Key policy issue No. 1 is fitness to practise. The council urges in the strongest terms that the wording in Part V of the Dentists Act 1985 on fitness to practise be retained and amended rather than introducing the very prescriptive provisions of both the Medical Practitioners Act 2007 and Nurses and Midwives Bill 2010. The council's experience of operating the provisions of Part V of the current Dentists Act is that the procedures work well for managing fitness to practise matters. The Dental Council of Ireland broadly supports the main provisions of both the Medical Practitioners Act 2007 and the Nurses and Midwives Bill 2010 in providing for a preliminary proceedings committee which is separate from the fitness to practise committee, the establishment of a health committee and for a wider range of sanctions. In the Dental Council of Ireland’s view, the same range of sanctions that apply to practitioners should apply to all registrants and to the entity registering dental premises including, in the case of the latter, the power to temporarily or permanently close dental premises and to attach conditions to the ongoing registration of dental premises.

Key policy issue No. 5 is the regulation of the allied dental health professions. The Dental Council of Ireland strongly disagrees with the provision in the summary of policy issues that only those allied dental health professions who work independently will be registered. The Dental Council of Ireland believes this proposal to be regressive and potentially harmful to patient safety and the development of the dental team. To ensure it has the capacity to fulfil valid regulatory function, to enhance patient-centred safer, better health care, the Dental Council of Ireland requires the new dental Act to provide mandatory registration for all members of the dental team, including dental technicians.

The issue of registration and regulation is at the core of illegal practice, which the Clinical Dental Technicians Association Ireland, CDTAI, brought to this committee's attention. In that meeting the representatives alleged "that there are significant numbers of people illegally practising as dental technicians in Ireland" and further alleged "there has been a complete failure on the part of the Dental Council of Ireland to regulate the profession". The registrar of the Dental Council of Ireland repudiated the false allegations made against the council in his letter to Mr. Kelly of 23 October 2014. The Dental Council of Ireland, under the Dentists Act 1985, has no power to inspect or close illegal practice. The limitations imposed on the Dental Council of Ireland by the present Act to deal with alleged illegal practice are widely recognised and were noted in the Competition Authority's report on dentistry in 2007. The inability of the Dental Council of Ireland to directly intervene in illegal practice is known to the CDTAI, as clinical dental technicians have representation on the council's auxiliary dental workers committee. Many hours have been given to the CDTAI representatives, within Dental Council of Ireland and in informal meetings, to explore their concerns. They are fully aware of the limitations of the Dental Council of Ireland's power and the CDTAI has misrepresented the council's powers to the committee.

The issue of illegal denturist practice highlights a quintessential issue to any discussion on dental regulation. Without registration, can regulation be effective, transparent or consistent? How is accountability enforced? It is the stated desire of all organisations representing those who work legally within dentistry that mandatory registration should be provided by the new dental Act for all dental health care professionals.

Key policy issue No. 7 is the board. The proposal that a new dental Act would limit the council size to a maximum of 12 members will irrefutably change the successful operational traits of the Dental Council of Ireland. While the council appreciates that one of the main aims of having a non-dental majority is to minimise the perception of professionals protecting professionals when considering fitness to practise cases, it is important to understand that most of the work the council undertakes relates to dental education and general practice. To operate effectively, it is vitally important that the voice of dental educators and specialists, as well as members of the general practice dental team, are represented at council. The Dental Council of Ireland advises that regulatory impact analysis specifically assesses the necessity and effectiveness of the proposed changes in light of the council's day-to-day workload and international best practice.

Key policy issue No. 9 is the regulation and inspection of dental practices. The Dental Council of Ireland welcomes the provision made in the summary of policy issues that new legislation will provide for the regulation and inspection of dental practices and premises and that it will also provide that regulation and inspection powers will be held by the Dental Council of Ireland. The Dental Council of Ireland believes it is best positioned to oversee the registration and inspection process because of the expertise it has developed over years of regulating dental practitioners. Legally and administratively, it makes sense for one body to regulate both dental practitioners and dental practices and for that body to have an inspectorate. Most important, it is probable that serious breaches of regulations concerning dental premises will also uncover matters which may form the grounds of a complaint against one or more dental health care professionals. In order to deal with such matters expeditiously it is necessary to have both regulatory functions under the direction of one organisation.

The Dental Council of Ireland would wish to see the new dental Act contain provisions giving it the power to enter and inspect a place where it is reasonably suspected that dentistry is being practised. That power is essential to the ability of an inspectorate to investigate reports of illegal practice and would address the issues highlighted to this committee of illegal work undertaken by some dental technicians. The Dental Council of Ireland is of the view that registered dental premises need not be owned or controlled by dentists but must be regulated. The council proposes that the entity registering a dental premises must be accountable to the Dental Council of Ireland for ensuring compliance with the new Dental Act. The framework set out in the Pharmacy Act 2007 allows the Pharmaceutical Society of Ireland to register and inspect pharmacies as well as to regulate retail pharmacy businesses and could be adopted for inclusion in the new dental Act.

Key policy issue No. 10 relates to the principal dentist and registered owner representatives in dental practices. The Dental Council of Ireland welcomes the provision made in the summary of policy issues that new legislation will provide for the appointment of principal dentists and registered owner representatives in dental practices and that this provision will also apply to any independent allied dental health practice established. The council recommends that the proposed new dental Act allow the council to take criminal prosecutions in a manner similar to the provisions under the Pharmacy Act 2007 and the Food Safety Authority of Ireland Act 1998.

Key policy issue No. 12 relates to staggered term of office board appointments. It is the strong view of the Dental Council of Ireland that corporate memory primarily rests with the staff of the Dental Council of Ireland who have acquired an understanding of the day-to-day functions of any council and the relevant legislation. The Dental Council of Ireland is unaware of any evidence to indicate that staggering the terms of council members will improve the effectiveness or consistency of the council's functions.

Key policy issues Nos. 18 and 19 relate to continued professional development for dentists and allied dental health professionals. The Dental Council of Ireland welcomes the provision in the summary of policy issues that will require dentists and allied dental health professionals to maintain their own professional competence and that the Dental Council of Ireland can require them to demonstrate competence to its satisfaction in accordance with a professional competence scheme. However, it questions how it is possible to do this when the proposals will effectively deregulate most allied dental health professionals. If one has no register, how can one enforce a mandatory code of continuing professional development?

It is the council's intention that all registered allied dental health professionals will be accountable to the council with regard to continuing competence. The Act should allow the council to refer issues concerning non-compliance to the preliminary proceedings committee under the fitness to practise provisions of the new Act.

The council has made previous submissions to the Department at its request.

There are two outstanding matters related to standards in patients safety which the summary of policy issues has not addressed.

The Dental Council of Ireland is very disappointed that foundation training is absent from the summary of policy issues. The council aspires to the introduction of a mandatory foundation training scheme as it considers it not only an elemental part of continuing professional development but also an essential part of the development of any young dental professional. Foundation training is a period of training following initial qualification and registration that builds on the achievements in the undergraduate curriculum and aims to produce a competent, caring, reflective practitioner. This is generally achieved through treating patients under supervision and in taking part in structured and unstructured clinical review and learning. The Dental Council of Ireland acknowledges that the current economic climate might make the introduction of a scheme challenging in the short term. The council seeks a provision in the proposed dental Bill that would allow for the introduction of such a scheme by way of statutory rule.

Finally, the Dental Council of Ireland is concerned that professional indemnity is not addressed in the summary of policy issues. Professional indemnity is an indispensable element of patient protection. The Dental Council of Ireland is of the view that any registered member of the allied dental health professionals team who can perform intra-oral procedures for his or her patients must have appropriate professional indemnity cover. The proposed Bill should allow the council make regulations in relation to indemnity.

I thank the committee for taking the time to consider this oral submission. My colleagues and I would welcome the discussion of these and any other matters that the committee may wish us to address under dental regulation.