Ireland’s Dental Bill: where are we now?

Irish Dentistry’s Managing Editor Carlotta Eden looks at progress made on the new Dental Bill this year – and how far we have left to go.

Since the beginning of the year, Irish Dentistry has been investigating progress behind the new Dental Bill, undertaking our own independent research as to when and how the new bill will come into action.

Over the last 12 months, we’ve spoken to the Dental Council, the Irish Dental Association and the Department of Health in an attempt to unravel current proposals. In the process, we’ve encouraged dental professionals to have their say in our Regulation Debate – on our website, on social media, and in the magazine. We wanted to find out where you stood on dental regulation, and why a new Dental Bill is important – and long overdue.

Here, we’ve decided to take a look back through the year to see what you’ve made of it all – whether or not you want to see a new Dental Bill, if all dental professionals should be regulated, and how this will affect patients, and ultimately, the profession.

Independent practice

At the end of 2015, we sat down with the Irish Dental Hygienists Association (IDHA) to understand how proposals in the Dental Bill draft would affect hygienists’ standing in Ireland. The proposals addressed independent practice and, consequently, to subject only those dental professionals who practice independently to mandatory registration.

Grainne Costello, former secretary of the IDHA, pointed out in our January issue: ‘… there are more than 400 registered dental hygienists working in Ireland, none of whom, to my knowledge, are trained to work independently.’

She adds that if hygienists are deregulated, ‘it will take time and cooperation from dental schools and the Dental Council for more than 400 hygienists to be retrained to work independently in order to be allowed to work at all.’

What happens to patients, and dental teams, in the meantime?

A few months later, on 18 January 2016, the IDHA met with the then Minister for Health, Leo Varadkar, to urge the Department of Health to revise these proposals. In response, the Department acknowledged the society’s worries.

‘We were assured that we would get independent practice and that all dental hygienists would be registered regardless of working status,’ said Louise Fleming, past president of the IDHA.

The Department confirmed that all classes of allied dental health professionals who practise independently – as determined by the Dental Council – will have mandatory registration and be made subject to fitness to practise.

Until this is in written in primary legislation, the struggle for regulation for allied dental professionals continues.

Standard of care

In our March issue, Philip McGrath, chairman of the Clinical Dental Technicians Association Ireland (CDTAI), spoke about his concerns for the profession and the public if these proposals were made official.

‘It’s going to increase risk to patients and decrease standards in the profession,’ he says. ‘Hygienists will have to be deregulated in order to be given independent practice. Technicians and dental nurses will never have independent practice, so they will not be entitled to registration or CPD.

‘If there is no registration for hygienists, anybody could call themselves a dental hygienist; because there will be no regulator in check. If that doesn’t scream “patient safety” to anybody, then there is something wrong.

‘The Dentists Act 1985 is more than 30 years old. This should be a time to improve and change things, not take 10 steps backwards.’

Mary O’Donnell, president of the Irish Dental Nurses Association (IDNA), advocated for statutory registration, telling Irish Dentistry back in February: ‘Without mandatory registration for dental nurses there is little incentive for dental nurses to participate in, and to maintain, their ongoing professional development.’

In which case, maintenance of standards could slip, and with continued advances in all aspects of healthcare, health and safety legislation, infection prevention and control practices, it means that dental nurses would need to keep on top of a wide range of expertise, competencies and skills that nobody would be overseeing – apart from themselves.

Ruth Moore, the IDNA newsletter editor, believes that ‘not recognising the professionalism and competence of dental nurses through mandatory registration would be a retrograde step for the dental profession as a whole’.

As a newly qualified orthodontic therapist, Alma McNally also saw the positive impact of registration. She believes in patient safety first and foremost, and added that registration with the Dental Council ‘allows us to be held accountable for the treatment we provide’. Equally, there will be no benchmark for the level of care provided, and no guidelines for CPD or continued training.

In June, Stephen Murray wrote an article on why this all matters, concluding that possession of a qualification is ‘not the same’ as an entitlement to practise.

‘The benefit of a register for dental professionals practising independently is obvious,’ he wrote. ‘So much so, it should be publicly available online 24 hours a day and regularly updated.

‘Certainly, you don’t have to be registered to be regulated (which is essentially what the Department of Health wants) but that makes smooth regulation much more complicated. Why would we want a system that is more complicated?’

Waiting game

It comes as no surprise that everyone we spoke to was in favour of dental regulation for allied dental professionals, calling for a new Dental Bill sooner rather than later.

As it stands, progress on the new bill is ongoing. In a recent statement to Irish Dentistry, the Department of Health says that it is ‘continuing… legislation to replace the Dentists Act 1985’ and adds ‘it is not possible to provide a publication date at this early stage in the legislative process’.

While we wrap up the year, we remain steadfast in our commitment to support the regulation of all dental health professionals in Ireland, regardless of their working status.

In the meantime, Donna Paton, the new president of the IDHA, says that she hopes to approach the Dental Council and Department of Health to request a meeting to update members on the progress made in the next few months.

We will keep our ears to the ground; the Regulation Debate remains open for those who wish to have their voice heard. But for now, we wait.

Tweet us @IrishDentistry with the hashtag #regulationdebate to share your thoughts about a new Dental Bill. Is it long overdue?

Carlotta Eden is a journalist and editor of Irish Dentistry and the clinical journal Endodontic Practice. To get in contact, email carlotta@irishdentist.ie.