Dr. Eamon Croke:

Before I answer individual questions, there is a common theme which is close to the heart of the Dental Council of Ireland. The committee members have all talked about the protection of the public, which is absolutely what we are about.

To address Deputy Ó Caoláin’s points about those entitled to advertise or perform the treatment they offer, in the policy issue statements from the professional regulation unit, which the Deputy has a summary of, there is a break down in thought - on the one hand, it has accepted that regulation, licensing and inspection of practices have to take place and, on the other, it will quite severely limit the number of people registered. That brings us back to the problem we have at present and back further than that. We will go back 30 years because people such as dental hygienists - whom the members highlighted - may or may not be on the register now but they would not have been on it then. The problem will get bigger unless registration is combined with the licensing process for premises and the inspection of premises. It requires that joined-up thinking. In our view, there is no other way of doing it.

We are aware of the cases to which the Deputy alluded. As the Deputy will appreciate, prima facie evidence must be established before a case can be taken against anybody. Where the Dental Council of Ireland has uncovered evidence, however, it has informed the Garda which has the power to go into places where we believe illegal practices are being carried out. The Garda brought a successful case against an individual who was practising illegally in the midlands some years ago. Around last April there was a case of someone practising illegally. Initially, this person was in charge of the practice. We believe it is possible to have a non-dentist in charge, provided the practice is regulated and someone can inspect it to ensure that proper procedures are being carried out. The person to whom I refer suddenly started to practice. By the time that became obvious, the Garda was informed but the individual was gone.

We share the Deputy’s concern and frustration. For a lay person, the Deputy does himself down to an extent. He is very well informed and I thank him because he has presented a very good reason for bringing the new legislation forward quickly. The existing Act is 30 years old, is grossly out of date and does not protect the public. In our written and oral submissions, and in the submissions to the Department, we have consistently looked for those powers. We believe we are well positioned. When an inspector goes into these places, he or she will find problems not only with regard to the regulation of premises but also in respect of the behaviour to which Deputy Catherine Byrne alluded. It is important that those who carry out inspections possess the skillset to examine all aspects.

On advertising, the registrar has done work with The Golden Pagesto try to ensure that it is very obvious that clinical dental technicians, CDTs, are qualified and registered to carry out their work. One of the difficulties that has arisen is that we do not know how many there are. I commend the work of the Dental Technicians Association of Ireland, DTAI, which has spent a great deal of its own money in preparation for going onto the voluntary register and in trying to identify both those who are operating in this area and the individuals who are in possession of qualifications in any form. The association has been surprised by what it has discovered, even though its members are involved in the profession. The Dental Council of Ireland would be very concerned if legislation gave carte blancheto everybody who had acted illegally to join the voluntary register without any assessment of their ability or skills to qualify for inclusion on it.

This relates to the points raised by Deputies Kelleher and Catherine Byrne that people need to be confident that when they walk into a premises, the person there is ethical, skilled and professional in approach. In the voluntary understanding with the DTAI, the Dental Council of Ireland has agreed that a step would have to be taken to prove the practitioner had a level of skill and expertise and that an assessment would be carried out if the person did not have the required documentation from a dental hospital, City and Guilds or from FÁS or AnCO, the training council, which in years past ran courses. We would look for that. It is very important that committee members, as public representatives, are mindful that "grandfathering" individuals who have no training will not encourage the necessary confidence that Deputies Kelleher, Catherine Byrne and Ó Caoláin have sought.

In response to Deputy Kelleher, the Dental Council of Ireland has developed a scope of practice to identify those who should be in the register. We know the roles people can carry out. That is very clearly laid out, for example, a dental technician can do the fabrication and the supply of dental appliances but not the fitting, whereas a CDT can do the fitting, provided there is no interference with living tissue. The scope is relatively easy to work out if we know who are the individuals. That goes back to a general concern that the Deputies share about identifying who can do this and whether the person is qualified to do it.

Deputy Kelleher made several references to cosmetic procedures. The Dental Council of Ireland produced a code on non-surgical cosmetic procedures very early on and in the face of some opposition because wherever large interests are involved, as they are in the cosmetic industry, one faces considerable pressures. We have defined where a practitioner can use certain materials, such as Botox, off-licence because they have a function in health care. We have distinguished between the cosmetic and non-cosmetic sides. That also went through the National Adult Literacy Agency, NALA. We invite the public to look this up. For example, Deputy Byrne can look up the Dental Council of Ireland website and see in plain language what she can expect from her dental health care professional when she comes for treatment. We tried to bring in the public. We did that with our ethics and display of fees documents to let the customer see what to expect. We encourage the committee to do that.

In respect of to whom the committee and Department should listen, all voices carry some weight but on the basis that we are transparently in the business of protecting the public, a statement the lay members of the council would support - as they did to the Minister whom we met recently - perhaps, with respect, our voice should carry more weight. We have the experience and we stand up to scrutiny. We are, and are willing to be, accountable for the actions we take. I hope our submissions to the Department and to the committee today will be given some extra weight in that regard. We will only sort out where the grey areas are when we marry registration with inspection and licensing. That is the only way around it.

I agree with Deputy Catherine Byrne. Whenever I put trust in somebody else, I want to know that person has a standard and I want to be treated fairly and with respect.

The various codes of practice and ethics the Irish Dental Council has produced is very important to that.

The Irish Dental Council is a founder member of the International Society of Dental Regulators. Our registrar is chairman of the society, which suggests we are held in high standing abroad. It is very important to us that we show leadership in order that the public can have confidence in our remit under the current Dentists Act but also that they will understand we are trying to make matters better, and we hope to achieve that. We have shown leadership also in terms of the profession. It is to the credit of those in the profession that they have come with us without kicking and screaming because the proposals we have made in our codes are seen to be proportionate and effective, and they are welcome. The display of fees, which is an early item we brought in, has been very well received not only by the public but also by the Office of Fair Trading in the United Kingdom, which has held it up as an example of how professionals should interact with the public. I agree with the Deputy that it is about standards as well as skills. It is about being treated as a human being.

Dental tourism is a fact of life. Even with the National Health Service, which has an accessible, relatively cheap form of dentistry, dental tourism is still rife in the UK. The previous Irish Dental Council produced a document called Choosing a Dentist at Home or Abroad which sets out for the public what they should look out for, not just when going abroad for treatment but also in terms of dentists and all dental health care professionals registered here in terms of standards and that they will work with them to ensure they get the service they want and that they are treated as they would want to be treated. Those are the areas we will continue to develop with, I hope, the support of legislation, and I believe the skillset lies with the dental council. The goodwill of the dental council is very much to continue the work we are doing, but to do it better. We need a new dental Act to do that, and we need it quickly.