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Assembly Speech- Dental Care 30/09/2008

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Mr Speaker / Deputy Speaker

The motion put before the House today is of the utmost importance.  Oral health in Northern Ireland is at its worst standard ever, it is currently ranked as being the poorest in the United Kingdom. This shows a worrying trend in our oral care, every other nation is improving their oral health and Northern Ireland is not showing any improvement.

However, the main point of this motion is to address the fact that many people throughout Northern Ireland do not have access to a dentist.  This is either due to financial means or due to a lack of dental practices in their area, even though according to Central Services Agency sources Northern Ireland has a ratio of more dentists per person than other parts of the United Kingdom.  This is a worrying trend as it is most often the people who require dental care the most who are unable to access it.

One of the problems identified is that a dental surgery is run more like a small business than a medical facility.  If it is not economically viable for a dental surgery to survive in an area then it will not be opened or stay open.  This has led to a situation in which a dental surgery will only open in an affluent area which will lead to those who need the care the most being forced to travel long distances or face not going to a dentist.  It is also noticeable that more and more dental practices are turning to private practice, which once again means the socially disadvantaged cannot afford the oral heath care they require.  This has meant that the oral health of many Northern Ireland citizens has gone unchecked for many years.

At the current time, the peak age groups for dental registration in 8 to 18 year olds, when people receive universal free health care.  However, there is a marked decrease in the number of people registered with a dental practice when they begin paying for treatment.  This affects the socially disadvantaged, such as the unemployed, disabled, those with a lack of education, addiction or ethnicity.  This is very worrying as the dentist is often the first person to catch diseases such as oral cancer and the general decaying of teeth can have a detrimental effect on people not only in a health sense but can also affect their overall well-being.
 
I am aware that the current system for providing dental care in Northern Ireland is currently being reviewed; however, there is a need to ensure that those who cannot receive dental care due to their social situation are going to be able to access treatment after this review. 

I accept the arrangements for the provision of Health Service dentistry in Northern Ireland are currently the subject of reform and that constructive dialogue with the profession about the nature of that reform is currently ongoing.  It is hoped that the new arrangements might be piloted in 2009.  These pilots would need to be properly evaluated before wider implementation, which has bee scheduled for 2010 at the earliest.

Let me make these general comments about the reform:

1. Many existing dentists are already struggling to provide an NHS service.  Any cuts in administrative or practice allowances will result in NHS dentists moving to private work.
2. The opening of any additional practice(s) should not be detrimental to current NHS dentists.  The location strategy should be based on quantified need.  The terms of the review should not see existing NHS dentists disadvantaged and they should be encouraged to supply an additional NHS service. 

Access to Health Service dentistry in Northern Ireland has declined over the last two years.  Figures from the Central Services Agency show that almost 53,000 fewer patients were registered for Health Service dental care in September 2008 compared to September 2006.  the majority of this decline can be attributed to fewer adult patients being registered; 49,757 fewer adults are now registered for Health Service dental care.

 Adults Children Under 18
Sept 06 – Sept 08 -49,757 -3222
Sept 06 – Sept 07 -26,300 -5015
Sept 07 – Sept 08 -23,457 +1733

The Government’s most recent estimate of the shortfall of Health Service provision in Northern Ireland comes following the Minister’s statement in the Assembly on 29 April 2008.  It is now estimated that 36 dentists are necessary to address the current lack of provision and care for the additional 54,000 patients who do not have access.

At the same time as patient access is declining, there are also changes in the number of dentists in the workforce and the number of dental practices in Northern Ireland available to provide Health Service dental care.

No of dental practices No of dentists
April 06 375 751
April 08 362 796
Change -13 +45

That the number of patients able to access Health Service care has declined in the same period that there has been an increase in the number of dental practitioners working in Northern Ireland highlights the fact that increasing the size of the workforce is just one of the measures required to address the problem.  A clearer understanding of why this is the case is required.

The British Dental Association has made recommendations for action to be taken in three key areas- 

• They have identified that there is a need to create a system in which a dentist can provide the modern, high quality care their patients expect.  This means that a properly funded system which is affordable to patients is required.

• There is a need for increased investment for the future of dental healthcare.  This involves investing in educational programmes in order to ensure that the Northern Ireland dental service has the highest quality of skilled graduates within its ranks.

• They also recommend the need to invest in the existing infrastructure, expand practice facilities, and to create initiatives that will help dental practices to be opened in areas where there is a defined need.  This may require incentives to newly qualified dentists to establish a new practice but as I have already said care also needs to be taken not to impact negatively on already established practices.

I do need to highlight the desperate need in my own constituency:

• In East Belfast, which is included in the Eastern Board Area of East and South Belfast, the past 2 years have seen just over 9,000 fewer adult patients registered for health service dental care.  At Sept 06 there were 88,198 adults and at Sept 08 there are now 79,110.

• Nearly half of 3 – 5 year old children in the Sydenham area are not registered with a dentist.

I urge the House to support this motion.

 

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