Dr Dympna Kavanagh is both the Chief Dental Officer and the Oral Health Lead for the Health Service Executive. They are the most important posts in dentistry in Ireland. She spoke to PAUL O’GRADY for the Journal.
The man in charge of looking after welcoming guests to the Department of Health building, Hawkins House, is a counterpoint to his surroundings. Warm and efficient, he assures us (our photographer, Orla Murray, and I) that Dr Kavanagh will not keep us long – and shortly afterwards we are whisked up through the building to her office. Functional is a kind description. Our public servants may have many benefits of which we might be envious, but the office space of the Department of Health is not one of them. Pleasantries aside and a few photographs taken, we get down to business.
Is it unusual, I wonder, to have two jobs? “I do have two roles, but I am not sure that it is unusual. The HSE and the Department of Health are working very closely together and there is legislation coming in changing the HSE and we are working more as a continuum.” Dr Kavanagh tells me: “Looking at the roles, from the Department of Health point of view, it is about policy. It’s about putting priorities in place in relation to oral health. Then in relation to the HSE, it’s about implementing that policy, no matter what the HSE will be called in the future.”
What would success look like in these roles? “The [development of an] …oral health policy is a programme of three years. And it is a programme, not a document coming out, or a statement of intent. The theory behind policy has changed enormously in the last ten years. So it has to be a programme of change over three years to allow much more consultation, much more feedback, much more input; …[and] also to ensure that we have an opportunity to test what we are putting in place as we go along.”
How will that be achieved? Dr Kavanagh has identified three strands of work that are necessary in order to put a new oral health policy in place: needs assessment; skills (workforce) needs; and, consultation.
On needs assessment, she comments: “I would be very disappointed if we didn’t have clarity on our oral health needs … in that timeframe (three years). But more than that, we should put a framework in place so that someone else is not looking back down the line in 20 years time and we don’t have to start again. So I would consider that success: that we put clear policy scaffolding in place so that policy can develop all the time and is not dependent on one person or one role.”
The questions over the issue of skills needs are definitely long term: “Do we need more skills? Do we need less skills? Do we need more specialists? Do we need something entirely different? It’s not just about now; it’s about looking down the line 10 or 15 years … because that’s the length of time by which the workforce will really start biting into the needs.” Regarding consultation, she cites the need for discussion with the public as well as the profession: “The final work stream then is about consultation and that includes consultation with the profession which is an integral part of the whole policy. We have established the Academic Reference Group and that has come from the profession themselves. The same view would apply to primary dental care: to look at a reference group that would be drawn from the profession themselves. So part of the development of policy is automatically involving the profession, but the public consultation is a really big part. Not just about their views, but how they react if we test and pilot the policy.”
Reductions in PDS staff numbers
Given the 20% reduction in the number of dentists and dental nurses in the Public Dental Service, what is the future for that service? “Well again I reflect back into policy and the second work stream in relation to workplace development. While the clarity in the 1994 [policy]… is around child health and child provision, and for special needs care, the new policy is looking … at new and different ways of providing health [care]. It doesn’t mean that we will have less numbers, but we might incorporate different models of care. For example, … there might be an opportunity for some general dental practitioners to provide some aspects of care; there may be opportunities for the hospitals to be involved; and so not everything may continue the same as it is. We may turn around at the end of the policy and say that actually the way we do our workforce is perfect.”
There is a fierce sense amongst the profession of Irish oral healthcare having been damaged by the cuts. Does Dr Kavanagh see a chance for repairing that damage? “Well, again, the very first part of the work stream is about looking at needs assessment, and what is really important is that we get evidence … to see what our concerns are and what our priorities will be. I’m wary of saying that we take a blunderbuss approach because we know from the OECD figures that in the future the elderly are the single biggest group we have to be concerned about. They are now 30-40 year olds. While we have traditionally focused on children, we now realise with the way the population is going, that will not cover us in the future. It’s really important that I get my needs assessment priorities right so I know where I can put the system in place.”
Dealing with the DTSS
Perhaps the most interesting exchange with Dr Kavanagh came over the issues that arise from dentists trying to provide the best and most appropriate treatment for patients under the DTSS. The Journal conveyed to her the deep frustration about the operation of the Scheme and cited several cases supplied by dentists. However, Dr Kavanagh countered that the numbers of people that can receive additional treatment under the Scheme was expanded in 2012. This applies to vulnerable people and those with certain pre-existing conditions. The list of conditions under which this fuller treatment is available is sent to dentists every year, she stated, and is on the HSE website. She further stated that if a DTSS patient who cannot avail of treatment under one of the listed conditions, needed treatment above and beyond that which is currently available, their dentist may make the case for additional treatment to their local Principal Dental Surgeon. And, if that case is refused, then the dentist can appeal that decision to the HSE. Dr Kavanagh feels these safeguards ensure that patients are protected and that dentists need to work that system to the fullest extent. She also observed that many dentists are already availing of the opportunity to provide additional care to patients with listed pre-existing conditions. In relation to frustration with payments, while the payments system is not under her remit, she stressed that all detail on the paperwork is very important.
Dr Kavanagh was combative on the issues that frustrate dentists so greatly – the cuts to oral healthcare and the operation of the DTSS – but she is clearly very committed to the development of an oral health policy. The last new oral health policy was ready for publication in 2008, and never saw the light of day. It will be a significant achievement if Dr Kavanagh proves a successful mid-wife to the birth of a new policy.
The CDO/Oral Health Lead view on:
Universal health insurance
“There are currently no implications for oral health in that. As you know, UHI is just … starting off and as we move towards 2016 and UHI in general, all will unfold. But right now the current status quo is that UHI is up for discussion as to what is covered and is not covered.”
Fighting for more money
“Overall health figures in Ireland are coming in from OECD at around 11%, which [indicates]… in fact, we are spending very similar to other countries in Europe. We are very much up there. No Chief Dental Officer is going to say we have enough money; and no government is going to say that we don’t want more money but it is really important that any new policy that comes out says ‘Look we have our resources …and we are spending it in the right way and as effectively and as efficiently as possible’. We’ll never have enough money.”
Public Dental Health specialist
Dympna Kavanagh was appointed as Chief Dental Officer in 2013. A graduate of University College Cork Dental School, with a PhD in Preventive Dentistry, Dr Kavanagh has worked in the NHS and in the Irish Health Service. She completed her higher training in Dental Public Health in Guys Hospital, King’s College, London. Dr Kavanagh returned to Ireland in 2001 and is currently National Oral Health Lead in the HSE.