Dr. Anne Barry-Reidy:

We are happy to be here to discuss oral healthcare services among the other range of services. It is important to state that we are very aware there are issues currently and long-standing ones for people with additional needs and disabilities in terms of their access to oral healthcare services. We have a national oral health policy, namely, Smile agus Sláintecare. In developing policy and gathering the evidence base and in consulting, it was abundantly clear that people with additional needs are experiencing poor oral health outcomes. We are very clear about that.

I am very aware of international best practice and evidence in designing the future model of service. First and foremost, we are embedding a mainstreaming approach for people with disabilities. What that means is people need to be supported in the first instance to attend a local general dental practice that they can choose. That requires that we have updated contractual arrangements in place for adult medical card holders and also, for the first time, for children. We are aware there are access and capacity issues in the system, both publicly and privately, that are having a bearing on access to care for adults and children. In the fullness of the policy, we have a suite of reforms under way looking at capacity, strategic workforce planning and education and training. That is all to support modernised packages of care where general dental practices can take on a contract and deliver to people in the community, including those with additional needs. This means people with additional needs can be supported to attend more frequently than the general population. That can be needed to address their health conditions. They can also access additional treatment items that may not be needed in the same frequency by members of the general population. For families trying to co-ordinate care, there may be parents, children, elderly parents and people with additional needs. In accessing and co-ordinating access to dental care for families, it is important that the model needs to be made much simpler. They need to be facilitated to choose a dental practice in their community that is accessible to them. Whether they are an adult, child or older person, or whether they have additional needs, they need to be supported to attend in their general dental practice setting. That is the concept of mainstreaming as it applies to oral healthcare services.

We are aware as well that there is a small proportion of the population who, with the best of service reforms, will not be able to attend a general dental care practice for, possibly, the entirety of their care. Of course, we have our salaried HSE oral healthcare services. We have our directly employed dentists and broader dental teams. That will remain in place and is a crucial element of our future model of service. That will re-orient and those people will be skilled and their teams developed to focus on providing care for those with additional needs. What that might look like for patients is that they are ideally attending in a general dental practice setting for as much as their care as is feasible. They may be referred by a general dentist into the HSE for an episode of care. The HSE then has the additional time available. They are employed by the State. They have access to additional technologies, be that physical infrastructure, such as hoists and wheelchair tilts, access to physically accessible modern primary care centres or access to sedation services of various types. For people who are unable to access the entirety of their care in their local general dental practice, the HSE is available as a safety net service to provide care, more so to those with moderate to profound additional needs who cannot access that care in a general dental practice setting.

We are aware that access to services under anaesthesia can be required. That is a prominent feature of the model of service at present. We intend to have a much greater preventative element of care. When people can access care from birth, which is the intention, although that is not happening at the moment, they are supported to maintain their oral health to reduce the likelihood of ending up in a situation where something has gone wrong with their oral health and they need to be referred for care and, for people with additional needs, that can look like they need to attend for a general anaesthetic.

To summarise it, the ethos of the policy is about accessing care from birth, which is not where we are at present with our public schemes, emphasising preventative care, supporting everybody with affordability and access, but recognising that people with additional needs need additional support to access care.

I will touch briefly on people in residential settings or people who are supported to live at home who in either instance may be, for a variety of reasons, at greater risk of not attending a dentist or being unable to do so. That may be due to a lack of understanding of the service available. It is quite a disjointed service at present. The HSE will be tasked with providing that safety net service. We have a clinical governance piece whereby our senior dentists in the HSE are putting in place approaches to ensure they understand the range of population need in the dental area for which they are responsible. That may look like going into a residential facilities, doing an assessment of the oral health needs and understanding what needs to happen to put those people in touch with a dentist. It will ideally be in a general dental practice setting but some people will need to come in to the HSE.

I will touch on some of the investment that has been in place. We are finalising an implementation plan at present between the Department and the HSE. It was inherent in the policy approved by the Government in 2019 that one of the first things we needed to do was to address the access issues at present for those with additional needs. That is a phase one priority in the implementation plan being finalised. In budget 2023, the Minister awarded an additional €2 million to the HSE for 2025, which will increase to €4 million in 2026. Although the specific details need to be finalised, one of the things we have agreed with the HSE that we will do with that money is to start to develop that approach for the HSE to be in touch with residential settings. We will assess and understand what services those people actually need in order that we can start to design in a very informed and systematic way what that service, which we do not have in place at present, will look like to take people who are in residential facilities and get them the care they need. As was described at the start of the session, the majority of people can attend a dental practice setting in one way or another. Particularly for older people, there will be a proportion who are too frail at that point in their lives to physically attend and we will need to develop some sort of approach whereby the HSE can attend proactively. Again, prevention is the real cornerstone there and, in some cases, with some changes we have envisaged, dental hygienists and other members of the dental team will be very well placed to deliver those simple aspects of preventative care.