Oireachtas Joint and Select Committees
Thursday, 11 June 2015
Joint Oireachtas Committee on Health and Children
Dublin Dental University Hospital: Chairman Designate
I welcome Mr. Frank Nolan, chairman designate of Dublin Dental University Hospital. I thank him for coming and apologise to him for the delay in starting this session owing to the fact that our private business concluded later than normal.
By virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to the joint committee. If they are directed by it to cease giving evidence on a particular matter and continue to so do, they are entitled thereafter only to qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person or an entity by name or in such a way as to make him, her or it identifiable. Members are reminded of the parliamentary practice and ruling of the Chair to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official by name or in such a way as to make him or her identifiable.
Deputy Billy Kelleher has offered his apologies as he is taking Leaders' Questions in the Dáil. He would have been here if our previous session had not run late. I invite Mr. Nolan to make his opening remarks.
Mr. Frank Nolan:
I thank the Chairman and members for the invitation to appear before the joint committee. I am honoured to have been nominated by the Minister for Health, Deputy Leo Varadkar, to become chairperson of the Dublin Dental University Hospital board. I will introduce myself and outline the approach I intend to take as chairperson of the Dublin Dental University Hospital board.
I am 53 years of age. I have been married to Cathy for the past 29 years and have three children, Jennifer aged 22 years, Phillip, 24 and Stephen, 26. My hobbies include playing golf at Kilkeel Golf Club and sailing on Carlingford Lough. I am a past pupil of Terenure College and the College of Commerce, Rathmines, Dublin. I qualified as an accounting technician in 1982. I qualified as a member of the Chartered Institute of Management Accountants in 1990 and became a fellow in June 2013. I have been employed on senior management teams for over 24 years, covering areas such as performance, corporate governance, audit, regulatory systems, human resources, information technology, risks and strategy. I am a member of the Consultative Committee of Accountancy Bodies - Ireland. I hold the position of chairperson of the Chartered Institute of Management Accountants and have been an active participant on its boards since 2009. CIMA Ireland represents 5,000 members and 3,000 students on the island of Ireland. Later today, in my capacity as chairperson, I will be presenting the award to the winning Global Business Challenge Team in the Institute of Technology Tallaght. That is where I have to go next for a photoshoot and I am running a little late for it.
Mr. Frank Nolan:
I have worked in both the public and private sectors from 1983, spending about 50% of my time in each. I have also spent approximately 50% of my time working in the Republic of Ireland and 50% in Northern Ireland. I have managed budgets of £5 million to £3 billion and teams of five to 75 staff. I have been employed in financial control positions since 1983, working with the Northern Ireland Local Government Officers Superannuation Committee, the British Broadcasting Company in Northern Ireland, the Northern Ireland Tourist Board, Newry & Mourne District Council, Moor Steel Engineering, Aubrey Fogarty Advertising, Printec International and Diageo Ireland. I am employed in Navigator Financial Planning in Warrenpoint which provides financial strategies for a select group of clients. I am also employed by Aviareto, the manager of the International Registry of Mobile Assets.
My main ambition as chairperson of the Dublin Dental University Hospital board is to be an active participant with the CEO and board in publishing and implementing the 2015 to 2018 strategic plan. The Minister has asked me to pay particular attention to ensuring adherence to the eligibility provisions of the Health Act 1970, as amended, in the provision of dental services; taking account of the standards and procedures in place for the provision of dental services under the dental treatment services scheme and any equivalent scheme that may be put in place in the future as it is important to ensure there is equivalence of treatment for all those eligible for health service care provided in the State, regardless of setting; fostering collaboration between the two dental schools, the importance being their common remit in undergraduate training; supporting the Department of Health, as required, in the development of oral health policy; and educating and training a dental workforce in line with a new oral health policy to ensure the future oral health needs of the population are met. I intend to include these points in our strategic plan and hope to receive board approval by 29 June, with the plan being supplied to the Minister shortly thereafter.
I will review the accounts for the year ending December 2014 and expect to have them agreed and presented to the audit committee, passed and signed off on by the board and with the Comptroller and Auditor General by the next board meeting. In the next few days, following confirmation of my appointment, I expect to appoint a new vice chairperson, a new audit committee and a new performance committee.
I welcome Mr. Nolan. I also convey our apologies to him for the late start of our discussion.
Mr. Nolan's CV is very impressive. He has considerable experience in business and business management, all of which is well noted and appreciated. Was there an open competition to become chairperson of the Dublin Dental University Hospital board or did the Minister seek him out to take up this role? What was the genesis for the approach to him in the first place? Perhaps it was an open contested position and that quite naturally, supported by his CV, he rose to the top.
If it was not, however, I wonder what it would have been that struck the Minister from Mr. Nolan's CV to look at this particular position in the dental hospital. As we know, it is very close by to where we are meeting this afternoon. I am not asking the question to be vexatious in any way at all. It is just to get an understanding of it because the natural fit does not jump off the page. All of the experience is noted and I have no doubt that that is perhaps the explanation - that Mr. Nolan will be applying all those resources in his new position. As a lay person, I think of the dental hospital as something in another field from business. I wonder what the linkage is, what the expected role would be, and what Mr. Nolan can tell us about the brief or remit he has in taking up this position.
From the perspective of this committee, we want to see the dental hospital hopefully covering all areas of the preparation for, and provision of, required dental practitioners across all the different skill bases that the particular profession encompasses. We want to see that develop and thrive. Coming out of a period of contraction, we do not want to see stale or sterile accounting practices being applied that might in any way inhibit its future development and success.
If Mr. Nolan can elaborate on any of those points, I ask him to do so. I wish him every success and good luck in his new position and I hope that we will have occasion to engage with him in the future.
I welcome Mr. Nolan and thank him for his presentation. It is obviously an impressive CV. I have a couple of quick queries. As regards the post itself, is it full-time, part-time, paid or what? What is the situation in relation to that?
Mr. Nolan said that the Minister would particularly like him to examine the question of eligibility. Can Mr. Nolan explain what he thinks the Minister had, or has, in mind? Has he briefed Mr. Nolan on that? Where is that coming from?
Did I heard Mr. Nolan correctly to say that the strategic plan should be available by the end of June this year?
I thank Mr. Nolan for his presentation and congratulate him on his appointment. I wish him every success in it. Can I flag up two issues with him in view of his presentation? If I am out of order the Chairman may say so. In his submission, Mr. Nolan said it is important to ensure that there is equivalence of treatment for all those eligible for health service-provided dental care in the State regardless of the setting in which it is provided. It is an interesting quote. I have on file a letter concerning someone who was assessed for orthodontic treatment on 11 May 2011. The case is in the Cork area. I received a letter from the HSE stating that the average waiting time is three and a half years. If one adds three and a half years to May 2011 it would bring us to November 2014.
When I replied that the person had not been seen within that three and a half year period, I got another letter yesterday morning to say that three and a half years is an average. I was told that if someone has a real emergency, they should get a report from a psychologist and the HSE might then be able to give it priority. The case concerns a young person and I made the point that the delay was having a huge effect on the child. After receiving that letter, I went through another source yesterday evening to find that the file for that person has been in an archive since 2009. This is an appalling way for a service to be operating, although I know it is not in Mr. Nolan's area.
I have another document wherein someone made a submission to me about orthodontic treatment. While a person needs to have an initial assessment by an orthodontist, a lot of the work orthodontists are doing could be farmed out to qualified dental surgeons. An awful lot of work is staying under the control of orthodontists, which is unnecessary. I know this is a learning process from Mr. Nolan's point of view, but does he think he can deal with these areas? In view of his quotation that it is important to ensure that there is equivalence of treatment for all those eligible for health service-provided dental care, how does he see his own role in helping to alleviate the problem that currently exists, especially concerning orthodontic treatment and giving advice to the Minister on the matter?
Mr. Frank Nolan:
I will start with the first number of questions. The process for the role was an open competition, advertised through the public sector. I applied for the role because in the late 1970s and early 1980s I was a patient of the Dublin Dental University Hospital. It is also why I am the chair of CIMA Ireland, the Chartered Institute of Management Accountants. My son is studying for CIMA so I have decided to give something back. It is the same with the Dublin Dental University Hospital.
As regards my CV, I have been chair of CIMA Ireland and chair of CIMA Northern Ireland on two occasions in the last five years. I am used to dealing with boards and managing boards, but also getting boards to change. In the last five years for CIMA Ireland, we have joined the North and South together. In a contracting recession CIMA Ireland has not contracted, whereas all the other professional bodies have. That has been done through partnership and active participation. We look at the problem in a practical sense, asking what we can do as members to change.
As regards looking at the past and moving forward, we obviously have to address the example of having statistics for three and a half years and having average waiting times. We need to examine extreme cases and ensure that we come back to a reasonable standard for all of Ireland. It was the same when I started with CIMA five years ago, in Belfast, Cork and Dublin. We now have Derry, Newry, Galway and most of Ireland is covered for its members. One has to make that decision and go for it.
In deciding on resources, we have to move them back in and let us see if they have an effect. I will take the two examples the Senator mentioned and I will make it my business, over the next month or two, to see if we can address that matter.
The role itself is on a part-time basis and is similar to the two other roles. I have a role in Dublin on Monday and Tuesday and a role in Warrenpoint on Thursday and Friday. This role will be on a part-time basis, roughly on a Monday night involving tele-calls with the CEO. I do not expect it to take a huge amount of time but for the next couple of months it will, until I get up and running.
The strategic plan will have the seven points and the additional points I have been given today. In every organisation when one is doing four-year standards, there are always exceptions. From my experience in the 1970s when I came here first they told me to come back in two years time because it was growing. In the dental industry, they do not want to do severe dental work until a patient reaches the age of 18. At that stage, one's upper jaws will have stopped growing.
At times, that is an explanation that is used. People want a certain service, but the consultant says "No, can we wait until you're finished growing and then we will take that on?". I will check in this case.
Moving stuff from the orthodontist to qualified dental surgeons sounds great. I do not know much about the dental hospital apart from what I have read, but one must have a certain amount of throughput for consultants and one needs specialists. We have seen many examples in Northern Ireland and in the South where people have not had the numbers going through their hands as surgeons to be really qualified to do things. Dublin Dental University Hospital will have the volume going through for its consultants. When one goes and sees a consultant in the Dublin Dental University Hospital, one will be able to expect a service because they are seeing 15,000 patients a year. That service should be much higher because they have the right volume. We have seen that in a number of places up North and down South where units have been closed because there was not enough throughput going through the consultants. It is the same for dental hospitals as it is for normal hospitals.
I have one last comment. I take well Mr. Nolan's noting of the points that Senator Burke made. I say to him only that the committee has addressed a number of issues within the whole dental field in the past 12 months in particular. The whole area of regulation is very important to us. We have significant issues around non-registered practitioners, a number of whom have been exposed across the State, including in this city in the recent past. The Dental Council is apparently unable to effectively deal with this because it can only deal with those who are registered with it. Somebody who establishes a practice but who is not registered does not come under its remit. There seems to be a difficulty there in terms of the legislative provision. I understand that there is a review of legislation in relation to dental practice across the board.
Finally, I note that we are also anxious to see dental technicians upgrade to clinical dental technicians in order to allow them quite properly to deal with members of the public rather than only with those who are dental practitioners; that is dentists. It is also important that people who are not clinical dental technicians do not engage with members of the public as they are not entitled to do so. There are, regrettably, several instances known of this practice taking place, which is unacceptable. Regulation is critical and these are matters that will, perhaps, come before Mr. Nolan in this new position. I hope the joint committee can be of assistance in highlighting or reflecting on any of these points to him at any time. As I said earlier, I wish Mr. Nolan well in his new position.
Mr. Frank Nolan:
On regulation, I hope before my term is completed in four years that we have a dental Act. It has been promised and I hope it is implemented within the four years. It would bring the regulation part and clean matters up. On clinical dental technicians, I note that the Dublin Dental University Hospital has a programme of training in place already for that. The policing of unauthorised in-the-garage dentists is really a matter for An Garda Síochána, which needs to pick it up. As a very small organisation, we will not be able to find out in every garage in every town who is practising but not registered. If we hear of it, we will do what is required at that stage. However, the dental Act needs to be in place.
I thank Mr. Nolan for his time this morning and wish him well in his appointment. I hope he enjoys Carlingford Lough and Warrenpoint. It is certainly a very picturesque and beautiful part of the country. As a committee, we will send a transcript of the meeting to the Minister for Health, Deputy Leo Varadkar. I apologise for delaying Mr. Nolan. We suspend briefly and will resume in public session with the chairman designate of St. James's Hospital, Mr. Paul Donnelly.