Exclusive face-to-face with Mary Harney

Upon meeting with the minister in her office at Leinster House, any notion that I could effect a breakthrough in the current predicament of State-funded dentistry was stopped in its tracks by her statement that there were ‘many cuts across all of this’.

We began by discussing the position of chief dental officer. I explained that this is a crucial advisory role to help the Government implement appropriate policies when it comes to the provision of dentistry. Mary was receptive to what I was saying, but stated that in the current economic climate and with the moratorium on public service recruitment, this situation will not change any time soon. Instead, she is currently being advised by Dr Kavanagh, who is the chief dental adviser to the Health Service Executive (HSE).

I pointed out the necessity of input from general dental practitioners, to which she responded positively, asking:‘How do we integrate the public and private mix?’

She is keen to form an advisory panel that will include a GDP and an orthodontist, rather than relying on one person, and I believe this is an area that has merit and we should explore further.

We also talked about the minster’s much publicised visit to Arizona, where she had been so impressed by the provision of public dentistry. She promised that ideas from that trip would form part of the oral health policy that is due to be published later this year.

Again, however, she reiterated: ‘We don’t have the luxury of money at the moment.’

She also spoke on the theme of general health insurance and is keen to include dentistry. Although aware that the scheme only covers hospital-based treatment at present, Mary feels it could provide dental cover for up to 40% of the population. I think that this is an area we need get involved with, to avoid the risk of losing clinical control.

I went on to mention how, as a profession, and as contractors of the State-funded schemes in particular, we feel victimised by their effective removal and pointed out that no such limitations have been placed on our general medical colleagues.

I also explained that we receive no subsidies in any form and that while two-thirds of dental practices relied on State income, we were constantly paying out while GPs get €55 million per year in subsidies.

Her response to this was that 70% of medical card holders attend a GP while only 30% attend a dentist. However, she also told me she wasn’t aware that two-thirds of practice incomes had been reliant on State schemes (the IDA needs to get the information together to prove this to be the case, if possible).

When asked if there was any hope of reversing the decision on both State schemes in the upcoming Budget, ‘unfortunately I can’t hold out much hope’ was her reply.

Mary spoke of her belief that to avoid bureaucracy we should, in fact, have only one State-funded scheme. She went on to agree, however, that we should be offered the same negotiating rights as the Irish Medical Organisation (IMO), per the Croke Park agreement, and I stressed that this would benefit her department, my profession and, more importantly, patient interests.

She then went on to ask me why dentistry is cheaper in Northern Ireland. I explained the subsidies dentists receive there, compared to none here.

I went on to tell her that this issue was to be covered in the IDA’s forthcoming Budget submission. I was surprised to learn that she wasn’t aware that dentists in the North are subsidised.

I told her that most dentists are in agreement that we earn a good living but that we work hard to deserve that, to which she replied: ‘I don’t begrudge that’.

Minster Harney mentioned that McCarthy had recommended tendering for dental and medical care, and this is an area of which the IDA needs to be mindful.

She also asked how we dentists feel about a capitation scheme. Explaining our frustration in regard to how dentists are currently operating under the GMS with no advice as to what constitutes an emergency, she seemed to think that we just had to apply for approval. I explained this was usually responded to with ‘we have no funding for that’.

Seeming surprised by this information, the Minister asked: ‘Are our incentives, in the way we pay, perverse in that they incentivise extraction?’ I replied, ‘yes’.

We concurred on the necessity for dentists and the Department of Health and Children to ‘knock heads together’ and agreed to keep in touch, hopefully meeting up again next year.

Upon leaving Leinster House, I was naturally disappointed not to have gained any concrete promises. Also, having sent my questions to her office a week prior to the meeting, as requested, I was rather disheartened that Mary was not better informed on some of the subjects I raised with her. I do feel that it is necessary for all dentists, especially those in general practice, to engage more fully with politicians so that they are aware of the issues, as well as our sense of frustration and victimisation.