Investment needed not austerity: the viability of dentistry in Northern Ireland being put at risk

While Stormont continues to be 'on hold', the range of issues that need to be addressed within dentistry continue to stack up.

We recently submitted written evidence to the Northern Ireland Affairs Select Committee Inquiry - Funding priorities for the 2018-19 Budget: Health.

This Inquiry presents us with an important opportunity to highlight many of those issues via a Westminster platform.

Throughout our submission, we made the case for additional investment being essential to secure a sustainable future for Health Service dentistry, and those dental professionals who underpin it.

An end to pay cuts

Nine years of austerity budgets have resulted in unprecedented erosion in the take-home pay of dentists.

We have witnessed cuts to the GDS budget in the form of removal of commitment payments; the imposition of maximum one-per-cent pay caps for salaried dentists and general dental practitioners at a time of soaring expenses, and additional regulation means practice owners in Northern Ireland have seen an average reduction in income of 38% in real terms since 2008, and average associates' income has fallen by 28 per cent in the same period.

We've called for the pay review body's (DDRB) recommendation of a minimum two per cent pay uplift to be implemented without further delay, to be signed off if necessary by the UK Government while we still have no Executive in place.

Community dental services contract must be implemented

Community dentists have been waiting for their 'new' contract to be implemented since 2016. These dentists are working under terms and conditions dating back to 1989.

We've called on the UK government to implement the new contract now, in lieu of a Northern Ireland Executive.

Morale at rock-bottom

We highlighted that morale in the GDS workforce in Northern Ireland is now so low that we have grave concerns about the future sustainability of health service dentistry. Last year, 63 per cent of practice owners reported their morale as being 'low' or 'very low'; latest figures show morale has worsened even further to 70 per cent, saying it is 'low' or 'very low'.

Moreover, the more time dentists spend on Health Service work, the lower their levels of morale, and the less they earn. The strain of inadequate health service remuneration is evident as figures clearly show dentists whose Health Service earnings account for at least 75 per cent of their gross earnings had the lowest taxable income.

Clearly, morale has reached an historic low, and urgent action must be taken to address the underlying factors. 

In our submission, we've called on the UK Government to guarantee the long-term sustainability of Health Service dentistry by investing adequately in the dental professionals who deliver these services.   

Real commitment to prevention needed

The Northern Ireland Oral Health Strategy dates back to 2007 and has never been formally reviewed. The current lack of vision and foresight for advancing dental services and improving the oral health of the population reinforces the need for an updated Oral Health Strategy.

We've highlighted the continuing situation of children's oral health outcomes in Northern Ireland as being among the worst in the UK.

We've asked for a significant portion of the £12.3 million extra coming to Northern Ireland from the Sugar levy to be used to improve child public health, including oral health, and not to be lost into the 'black hole' of public finances.  

Other key issues we've raised in our submission include:

• Successive wholly inadequate Health Budgets during the austerity era have resulted in placing professionals who deliver care under intolerable pressure;
• The need to realise 'win-win' budgetary savings and enhanced oral health outcomes e.g. introducing a universal nursery toothbrushing programme could deliver significant cost savings, as well as better oral health
• The importance of Health Budget 2018-19 targeting unmet need, including addressing growing pressures on community dental service staff to provide care for an increasing elderly population with complex oral care needs

The current trajectory of relentless pressure on the Health Budget, with little headroom to plan ahead for the future, is no longer sustainable.

The impact within dentistry - both financially, and in terms of morale among dental professionals - is putting the viability of Health Service dentistry at risk.

Dentistry must be prioritised more highly within the Health Budget in 2018-19. Additional meaningful investment is needed to address existing gaps in oral care provision - particularly among our growing elderly population - as well as investing in improved child oral health outcomes.

Tristen Kelso, National Director

BDA Northern Ireland

BDA Northern Ireland