When Anne O’Neill was nominated for the presidency of the IDA back in September 2019, there appeared to be clear goals and problems that she would have to deal with: “I thought OK, we’re going to be implementing this oral health policy, I can contribute a lot to the debate of how that system might be built, and what the IDA might advocate for independent practitioners and salaried services. Since March, so much has changed and the timeframes we consider for advocacy are so different. We now have changes happening every four weeks. My aims for the rest of the year as President are firstly, to maintain as many of the members being with us on the journey. It’s a very difficult environment for dentists as a profession, and we need to support each other through these changing times. The second aim is to continue to reflect the aims of our strategy document. I believe that the IDA is one of the leading providers of continued professional development in dentistry in Ireland and we want to continue building on that. Unfortunately, we’re going to have to rely heavily on digital platforms to do it. But I think we’re certainly off to a good start with the team we have in IDA House, who are working hard to roll out new content to the membership”.
While education programmes lend themselves to continuing online, Anne is eager to find a way to replace the social element of IDA events, which she says many are missing: “We want to see how we can replace the branch meetings, which were part scientific, part social. We’re missing the face-to-face interactions that are part of the social fabric of our professional network. If we could find a way of reconnecting the social interactions into local networks, that would be a great achievement in the current environment”.
Anne qualified from UCC in 1989, where she was awarded the IDA Costello Medal. Shortly after graduating, she was unsure where she wanted to practise, and decided to join the HSE dental service for a year but forgot to leave. She now exclusively provides clinical care to special care patients.
After working in the health service for two years in Dún Laoghaire, her principal at the time, Dr Gerry Fitzgerald, told her she should join the Irish Dental Association: “I started, like most people do, just going to the various education pieces, in particular the Health Board Dental Surgeons Conference, as it was at the time. It was a great way to network with people from around the country. Then I joined the Health Board Dental Surgeons’ committee, spent time representing it at Council and was president of the group twice. I’ve also worked on different IDA committees, depending on topics of interest at the time. I have also had the great honour of being one of the judges of the Colgate Caring Dentist Awards”.
Covid-19 and other issues
Like everywhere else in society, Covid-19 has muscled its way to the top of the agenda for the IDA. Anne says one of the biggest challenges is staying sane against a backdrop of constant change: “As a profession we are fixers of problems, creative, patient focused, and very organised. If you look at how dentists organise their day, something that’s common among all of us, we organise things against what was up until recently a fairly fixed background. With Covid, all of that has changed, and that’s been one of the biggest challenges”.
It is going to be hard for dental care to get the attention it needs while Covid is around, says Anne, but the issues that were there before its emergence remain: “We waited a long time for the publication of the National Oral Health Policy document. The policy proposes substantial changes in a system that has seen little or no development within the past 10 years. It comes at a time when the profession has very little confidence in the Department to implement change. The gap between where we are and the proposed finished system is vast”.
She warns against too much commodification of dentistry, as is reflected in parts of Smile agus Sláinte: “When health is treated as a commodity, it mitigates against continuity and you don’t get patients buying into their own health. They’ll chop and change depending on the price, depending on what they want. They’ll take the easy pieces they want, ignore the others and expect to be able to purchase a solution when things go badly. Good dental health doesn’t work like that. Good dental services don’t work like that. And that is one of the biggest challenges. While you do have to interact with your patients as consumers, too much consumerism reduces the quality of engagement with people and their health, so trying to get that rebalanced is a much bigger issue”.
Although she doesn’t agree with everything in the policy, Anne says there are some good aspects to it: “If I were given the pen and paper to write it, would you have gotten the same document from me? The answer’s no. I think if you review the policy as a series of ambitions, then it is easier to agree with some of the content. The ambition to add prevention to the programme is key to oral health improvement. The ambition to have more frequent services available: the policy talks about attendance every two years, where ideally it should recommend attendance every year. Even to get funding for attendance every two years on a structured basis for everybody would be a fantastic improvement on our current system. More structured digital information so that we can develop our dental public health, part of my day job I know, is essential to support continued development of our dental system”.
However, she believes it will come down to the money available for implementation, which will be difficult to secure: “We can’t ignore the competition in the system for existing health resources – dental has to complete with cardiac, orthopaedics and others. I think that the system that they’re proposing is far more complex than the one we operate now; it will be far more expensive relative to current investment in dental public health and I think that will be the greatest obstacle for implementation”.
Financial decisions have decimated dentistry in the past, and against this backdrop it is understandable that there is little trust among dentists for any Government-backed scheme. The approach of the Government towards dentistry needs to change: “If the Department promises something, the Department needs to deliver. It is that simple. The most recent example has been PPE, where the Minister promised but there’s no delivery. This undermines the trust between the profession and the Department. It will take considerable effort to rebuild that relationship”.
There is a temptation to look elsewhere when developing models of care but Anne says we’ve devised good systems before in Ireland, such as the school screening service, which has been in operation since the 1970s: “I chaired a group that was researching evidence on which to base guidelines for what was known at the time as school screening. We quickly came to realise that the service wasn’t screening according to accepted definitions. It was assessing children in schools and bringing them in to surgeries for treatment. Part of the work the group undertook was looking at models in other countries. We identified that where the salaried service targets children at specific age ranges and provides them with care, where examination is linked to the provision of care, is a very positive model. Actively targeting the children ensured that the service was able to identify those who hadn’t responded and we were able to follow up to make sure that they participated in attending for care. As not everyone prioritises the dental health of their child in the same way, the current model has an inbuilt dental public health safety net, which is not obvious in the proposed new model”.
Smile agus Sláinte mentions the dental home, but Anne explains: “The dental home comes from the American dental system, which is a predominantly insurance-based system. People who can afford dental insurance can access the relationship and care that the American Association of Pediatric Dentists defined as the dental home. There are very poor public dental services for people who don’t have that level of insurance. The dental home is not part of their public health model, which has significant care provided by charitable organisations. I think it’s important we look at other countries’ models of care to see what works and what doesn’t, but that we can’t necessarily import another country’s model of care or dental culture. Ireland is unique in that we still have the examination and the assessment being done by the salaried service, which has prevention inbuilt, albeit under-resourced for many years. We shouldn’t throw out the current model until we are sure we’re replacing it with something better”.
With new Covid practice advisory notices coming from different organisations and countries every day, Anne says we are on the verge of advisory overload: “There’s an awful lot of Covid dental advice out there. You turn around and there’s another advisory from another jurisdiction that suggests something slightly different for the implementation of safe dental care in the current environment. It leads to great stress and difficulty for dentists as we strive to provide safe care to our patients.
“The one social event I attended on behalf of the IDA before events were cancelled was the inauguration of the president of the Northern Ireland Branch of the BDA [British Dental Association]. That was before Christmas last year when I had the great pleasure to sit beside Roz McMullan, President of the BDA at the time, when we discussed her great interest in the mental health of the members. Considering that was before Christmas, before Covid made its little presence felt, you can imagine how much more concerned we are now.
“I suggest two positive things for dentists: the first is to check in with themselves on a regular basis as to how they’re actually feeling about life, the universe and everything. We get so busy minding patients, providing care for patients, and providing care for staff. We are trained to mind everybody else, but we don’t necessarily include ourselves in the list. The second relates to how we look after the staff we work with: check in with them, see how they’re getting on. Much of our stress can come from family. When we stop and ask how someone is, it can make a huge difference to them as an individual. It doesn’t improve the quality or carving of a restoration nor change the cost of the electricity bill, but it makes a huge difference to their mental health and well-being”.
If needed, the Practitioner Health Matters Programme is available, as well as the Dental Benevolent Society to support dentists navigating the many stresses that Covid has imposed. Anne reminds members to engage more with the IDA, be that through the website, branches, committees, and the Council in particular. Each member has a voice and if they communicate with the IDA, the Association can then build their individual concerns into action: “We’ve been using surveys recently because with Covid it’s very hard to do face-to-face contact. We’re getting some response to those, but we could do with more. It takes five minutes to answer a set of questions, and that’s an easy way for members to give us direction that we will then incorporate into our advocacy on their behalf. We’re advocating hard on behalf of the patient and the profession the whole time. It’s very hard to advocate against a system that has selective deafness, but we will keep advocating”.