Dr. Dympna Kavanagh:

Thank you, Chair, for inviting me here today to outline the key aspects of the national oral health policy, Smile agus Sláinte, which was launched in April this year by the Minister for Health and the Minister for Employment Affairs and Social Protection. As Mr. Fergal Goodman said, it is a comprehensive and evidence-based policy informed by extensive research and consultation. Its aim is to better facilitate oral health for everyone and to support continued professional development. The programme is transformative, introducing and managing a series of changes over eight years. The policy is aligned with other Government policies, including Sláintecare, Healthy Ireland and First 5, which is a whole-of-Government strategy for babies, young children and families, as well as the national strategies on disability and mental health. It conforms to the international policies of the WHO and the European Union. The policy embraces the "no child is left behind" principle of First 5 and the education policies.

This is the first major oral health policy statement in 25 years and much has changed in Ireland in that period, including the standard of general and oral health, the materials and technology used in dentistry, and the types of services we aim to provide. In developing the policy, we have ensured that it is supported by up-to-date information about the oral health of the population, as well as by appropriate international evidence. A broad range of stakeholders was consulted, including those who use the services and those providing the care.

Our current oral health system is out of step with other Irish and international health services. There are gaps remaining in routine dental care for the very young and the vulnerable, including people in residential care, people with disabilities and older people. Smile agus Sláinte reorients how care is provided in line with Sláintecare so that most dental care is provided in people's own communities, as close as possible to where they live. This is beneficial for service users and allows acute services to focus on more complex care. What is described in Smile agus Sláinte is not a demand-led service. Instead, it enables the Irish public to access services and forge a relationship with their chosen dental practice; we call this their "dental home".

To support this universal primary care approach, a safety net system will identify those who do not or cannot attend their local dentist. This safety net system is part of the surveillance system outlined in the policy and ensures that the most vulnerable children and adults, including those on lower incomes, will be supported and receive the same quality of service as the rest of the population. The existing public dental service will be stronger. A key service will be to identify, support and deliver care for vulnerable children and adults when it cannot be provided in the local dental practice.

The measures set out in the policy will provide professional opportunities for staff in areas such as health promotion, special care services and public health.

I will pick out some of the key policy strategies and proposals, which members have in front of them. Water fluoridation is one key reason we have such good oral health in Ireland and will remain a cornerstone of oral health policy. Health promotion programmes will be put in place for the whole population and to target the most vulnerable. Most children and eligible adults will be treated in local dental practices and a package for children from birth until the age of 16 will, in a phased way, replace the existing schools programme. It is the first time that those under the age of 6, teenagers and adults will have lifetime access to preventive treatment such as fissure sealants and fluoride varnishes, as well as access to dietary advice in dental practices. The expansion of primary care is proposed from birth until old age, across the whole life course. We have focused on improving access for vulnerable groups such as those on low incomes, rural dwellers and people with disabilities. Enabling them to get to local dental practices is key. As I mentioned, the safety net service is essential to ensure that their needs are addressed and they get comprehensive care. We must not forget that we need advanced care and specialist care services, and that includes the concerns around general dental anaesthesia. Monitoring systems will have to be put in place to identify people who are not taking up the services, overall dental needs and the policy's impact. There must be a full review of dental undergraduate education, in tandem with career-long professional mentoring for dentists.

I will talk briefly about the development of the policy. As mentioned, it was informed by oral healthcare professionals through a series of working groups and consultations. We are indebted to the Oral Health Policy Academic Reference Group, and we drew expertise from Irish universities in this regard. These experts assess current needs and how best to meet them. In addition, we had an external international independent panel made up of leaders in different aspects of policy development. From this, recommendations and research from the reference group were quality assured in line with international standards. All research undertaken, including the additional facts study analysis, was robust, representative, ethically compliant and externally quality assured.

At the start of policy development in 2014, and again in 2016, more than 5,000 letters were sent from the Department of Health to the whole profession inviting all dental registrants to comment and engage in policy. A stakeholder day was held, with more than 70 attendees from 16 representative organisations. There was one-to-one engagement with dental practitioners in independent practice and with those in the public dental service. Their views overall highlighted an appetite for change in oral healthcare services but emphasised the challenges of such a change. The Dental Council of Ireland training bodies, including the RCSI and the Expert Body on Fluorides and Health, were also consulted and given a draft document. These engagements informed the direction of policy in key aspects of service provision and training for professionals.

I have outlined the key findings from both the public and from dentists. I will mention a few points arising from the public point of view. The public indicated that the current system is complex and very difficult to navigate and they were worried about cost, particularly in relation to children's care. Young children rarely attend the dentist before six years of age. Of concern to us is that over the age of 55, there is a decline in quality of life, which sharply declines beyond 70 and into a person's later years. Overall, all age groups and social classes perceived that their main access to care is via their general dental practice.

Stakeholders and practitioners insisted that very early childhood care is needed and also want special care services for the vulnerable. They expressed frustration with bureaucracy, barriers to accessing care for patients and an outdated State payment system. There is a need for a greater emphasis on primary care in the profession to bring it forward. Those in the public dental service emphasised the need for prevention and for opportunities to expand their skills. The information from the consultations fundamentally changed the direction of a lot of our policies. Leadership roles in primary care to refocus the profession and facilitate leadership from within it is a key action being called for by dentists. The policy also includes very early intervention for children, to give them the best start, and the need for comprehensive support for the most vulnerable through specific support services within the reoriented PDS.

Along with the policy action, a career-long mentoring framework will be put in place, as exists for other professions such as social work and psychology. Undergraduate and graduate education is the first priority within the policy, with an emphasis on training and primary care.

The policy includes a review of dental technology and clinical dental technology training. This was a key issue that arose from the public, regarding the needs of those in residential services, and from dentists, regarding the need to maintain a workforce in this direction in relation to dentures and prosthetics for those with total tooth loss.

The committee will be particularly interested in implementation, which is where all the action is. We have shared with members an overview document showing 41 actions and the priority for each of those over the next eight years. The implementation period is needed to commit actively to engagement on significant and complex issues. First, we need to build a framework to support long-term sustainability, the education review, a mentoring framework and a focus on legislative issues.

The Department has already begun to discuss the priorities with key agencies and we are agreeing targets and timescales. As an example, action 29 in the policy, which is a priority, is the national plan for amalgam phase-down on which we worked closely with our colleagues in the Department of Communication, Climate Action and the Environment and key stakeholders. It is being finalised in line with Ireland’s EU legislative obligations to publish on 1 July and submit to the EU in August.

I mentioned the full review of undergraduate training which, along with graduate mentoring programmes and upskilling for graduate dentists, are key immediate actions. The Dental Council, through the Irish committee for specialist training in dentistry, will lead in developing the advanced centres of care framework for specialists. We are convening in July to commence this work.

For the First 5 strategy, the Department of Children is working with the Department of Health to support the framework for the under sixes policy in programmes of health promotion and services. We have already met the Clinical Dental Technicians Association and we have its support to assess dental technology training.

Water fluoridation remains and we continue to review it and we will link with the expert body on fluorides and health.

The HSE has two main service focuses. Epidemiology data indicate that those in residential settings require urgent attention and support. The reorientated public dental service and community oral health care services will identify their needs and put in place a treatment programme for those who cannot use primary care. The second priority is that the very young, up to six years of age, receive packages of preventative and primary care. This is in line with Healthy Ireland and the First 5 strategy. It will also give the public dental service an opportunity to release capacity.

Implementation of a transformative policy such as Smile agus Sláinte will present challenges. All change is challenging. However, those challenges will present opportunities for the staff in private practice and the public dental service. It is important that implementation is owned by the profession while listening to the voice of the public. To achieve these priorities, we need key leadership roles operationally and in dental schools. Primary care, special care, advanced or specialist care delivery and public health leaders must be in place so that implementation is sustainable and placed where it belongs in the services.

I thank the Chairman for this opportunity to outline the national policy. We look forward to working with our colleagues in the HSE services, professionals and key stakeholders to implement this change.