Regulation Debate: hope for registration changes

Whether you are a dentist, hygienist, nurse or technician, registration matters. It’s the lifeline to which you hang your professional standing on, and a way for patients to recognise your qualifications and dedication to care.

Recently, the issue of registration in the Irish dental profession has been opened up for debate, as proposals for the upcoming Dental Bill were made evident at last year’s Irish Dental Hygienists Association (IDHA) Annual Winter Conference in November.

The issue concerned the Department of Health’s proposal to only subject those dental professionals who practise independently to mandatory registration.

So, in Irish Dentistry‘s January issue, we opened this up for discussion: does every dental professional have a right to regulation? And, if so, how can this be made certain? Currently, only clinical dental technicians practise independently in Ireland – so what happens to dental hygienists, who are currently not trained to practise independently, and other auxilary dental workers not practising independently?

Since opening up the floor for debate, Irish Dentistry has spoken to even more members of the profession to gain their views and, hopefully, encourage the Department of Health to reevaluate this proposed policy, one way or another.

Key updates

We caught up with Louise Fleming, president of the IHDA, after her meeting with Minister Varadkar on 18 January, to discuss the deregulation proposals in the new Dental Bill – and it seems as if it went well.

We want commitment from the Department of Health before we can begin celebrating – Louise Fleming, IDHA president

‘We were assured that we would get independent practice and that all dental hygienists would be registered regardless of working status,’ says Louise. ‘We came out of the meeting feeling positive and we are happy that things seem to be going in a good direction, but we are still wary.

‘We want commitment from the Department of Health before we can begin celebrating. We want to actually see this come into effect; we need action.’

Of this action, Louise makes it clear that there will be little movement for the foreseeable future, while the bill is still in its initial stages of drafting.

‘We are happy that we have managed to highlight this issue, but for now, all we can do is keep reminding everyone what is important,’ Louise continues. ‘We will be keeping in close contact with the department and the Minister to ensure they know that we are still here and we are not going anywhere.’

Speaking to Irish Dentistry, the Dental Council states: ‘The proposals being considered are the same as those made last autumn and our concerns remain.’

The Department of Health offered the following comment: ‘At the IDHA meeting with the Minister on 18 January, it was confirmed that the current proposal for the new dental legislation is that classes of allied dental health professions, which have been determined by the Dental Council as being suitable for independent practice, will have mandatory registration and be made subject to fitness to practise. The Dental Council will make this determination based on suitability to independent practice.’

Safety net

In the UK, the General Dental Council introduced direct access in 2013, but this ‘still remains an optional way of working,’ according to Elaine Tilling, dental hygienist and education and project manager for Tepe Oral Hygiene Products Ltd.

She adds: ‘Effectively forcing a group of healthcare professionals to change their working practice before the relevant training and support networks are in place is really not logical. Moreover, it is not in the interests of the patients nor the profession to implement this before these safeguards are in place.’

Forcing a group of healthcare professionals to change their working practice before the relevant training and support networks are in place is not logical – Elaine Tilling

Commenting on the proposal to introduce independent practice for dental hygienists in Ireland, Elaine says: ‘There will be a need for additional training for qualified dental hygienists to ensure competency and patient safety. Deregistration of those already qualified pending their update training seems to be a bit shortsighted and could arguably put patients at risk. Without the regulatory safety net of the Dental Council one assumes that some sort of interim arrangement will be made to protect both parties.’

After the introduction of direct access in the UK, the British Society of Dental Hygiene and Therapy (BSDHT) moved to provide a roadshow delivering the required training around the UK, and the schools of hygiene and therapy now also offer update training to meet the needs of direct access.

Mary O’Donnell, president of the Irish Dental Nurses Association

‘Voluntary registration of dental nurses with the Dental Council was approved in 2002. While this was a step forward, we as a profession have always advocated mandatory registration for dental nurses. Voluntary registration by its very nature means that only some dental nurses are actually registered.

‘When the consultation document for the proposed new Dental Bill was released in June 2013, the Irish Dental Nurses Association (IDNA) put a lot of effort into developing a comprehensive submission detailing why dental nurses should have mandatory registration. I was very disappointed to see that the issue of proportionality of legislation seems to have become the overriding factor in reaching this decision.

I strongly believe that dental nurses should have statutory registration, as they are skilled professionals in their own right – Mary O’Donnell, IDNA president

‘Without mandatory registration for dental nurses there is little incentive for dental nurses to participate in, and to maintain, their ongoing professional development. Maintenance of standards in the profession is also an issue in this regard. Since I qualified in 1985 there have been enormous changes and advances in all aspects of healthcare, health and safety legislation, infection prevention and control practices and in instrument decontamination. These changes mean that dental nurses today require a wide range of expertise, competencies and skills in disparate areas necessary for the provision of safe care to every patient.

‘I strongly believe that dental nurses should have statutory registration, as they are skilled professionals in their own right and have a significant and vital role to play in the treatment of every single dental patient.’

Your turn

Don’t miss Irish Dentistry’s February issue to check out what other members of the IDNA had to say in the Regulation Debate. To share your view, tweet @IrishDentistry using the hashtag #RegulationDebate or email carlotta@irishdentist.ie.