Regulation debate: the clinical dental technicians

As part of the Regulation Debate, Philip McGrath talks to Irish Dentistry about protecting patient safety and the profession

A new dental act should ring in new changes; an opportunity to update outdated legislation and secure the future of the profession. Patient safety should remain a primary focus. As readers of Irish Dentistry, it is not too much to assume that this is your primary focus, too. After all, where would your patients be without you? And without your patients, where would you be?

It is with patient safety and the protection of the Irish dental profession in mind that we launched the Regulation Debate: a platform for you to have your say in how your profession will be shaped, and how you can deliver the best dentistry to your patients.

There is still much confusion surrounding proposals in the initial draft of the Dental Bill. The proposals currently state that only those allied dental health professionals who practise independently will be subject to fitness to practise.

Chief dental officer Dymnpa Kavanagh made it clear at the Irish Dental Hygienists Association (IDHA) Winter Scientific Conference in November 2015 that the draft ‘is still going out for consultation’ and the ‘impact of regulation is still being assessed’.

Here, we speak to Philip McGrath, chairman of the Clinical Dental Technicians Association Ireland (CDTAI), about the outcome for the profession and the public if these proposals come into play.

What is the current situation for clinical dental technicians in Ireland?
Philip: Clinical dental technicians (CDTs) have mandatory registration and independent practice. It’s been this way from the outset.

Are you happy with the way things are for CDTs?
Philip: Absolutely. The issue that CDTs currently have is the amount of technicians illegally supplying dentures to the public. We have raised this numerous times with the Dental Council as the CDTAI, but as technicians are not registered they cannot be regulated – which happens to be the main issue with these proposals in the Dental Bill draft.

What do you see as the outcome if these proposals surrounding regulation and fitness to practise in the new Dental Bill go ahead?
Philip: It’s going to increase risk to patients and decrease standards in the profession. If these proposals go forward, dental hygienists will be deregistered. There is no question about that; 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.

The Dental Council already has a scope of practice in place ready to implement once mandatory registration comes in for technicians, which was the plan before these proposals were shown to the Dental Council without consultation. This is now on hold, and cannot be put in place if there is no registration because there will be no benchmark of standards.

If these proposals go through now, dental hygienists will be off the register – they’re not even off; there is no register!

The chief dental officer has already stated that ‘it is not the intention to have a two-tier approach’ (Irish Dentistry, January 2016), but if these proposals come forward, it could end up making a two-tier hygienist: those who do a course in order to practise independently, and those who do not.

If hygienists are de-registered then there has to be a course put into place and approved to bring them up to independent practice standards. How long will this take? Somebody also has to run the course, which will end up being the dental schools. But then you need funding and resources, on top of which hygienists will need to complete the course and, finally, register for independent practice, which will take years. In the meantime we have to hope that nothing happens that will put independent practice in jeopardy.

But why would someone put themselves through a course to qualify as a dental nurse if that in turn means nothing?

If there is no registration for hygienists, anybody could call themselves a dental hygienist; because there will be no regulator to keep things 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.

In a statement to Irish Dentistry in our February issue, the Department of Health confirmed that allied dental health professionals suitable for independent practice will have mandatory registration and be made subject to fitness to practise. Surely this is a step in the right direction?
Philip: In my opinion, there is no weight in this statement unless it has been put in primary legislation. On a legal basis, you cannot protect a scope of practice in a profession that you do not regulate. Again, hygienists will need to be deregulated in order to train to practise independently. How long will this take? What do you do with patients in the meantime? How can we protect them from somebody else walking in and calling themselves a dental hygienist? If these proposals go through now, dental hygienists will be off the register – they’re not even off; there is no register!

If CDTs won’t be affected, why does this matter to you?
Philip: Because it’s wrong. At the CDTAI, we believe these proposals are only going to work to the detriment of the profession and public safety. The primary focus of any dental act should be patient safety. If it’s not patient focused then it’s pointless, and if it doesn’t have enough power to properly regulate the profession then, again, it’s pointless.

When the people who will be passing legislation do not have a working knowledge of dentistry, and the regulators of the profession are saying that the legislation is wrong, surely it makes sense to listen?

Following on from the meeting the Dental Council had with the Oireachtas Joint Committee on Health and Children in October last year – after the council were made aware of the proposals – the CDTAI contacted the Professional Regulation Unit and asked if it would be willing to meet with a group of us allied dental health professionals. They agreed, so I contacted the nurse, hygienist and technician associations to set up a meeting in order to put forward our views on these proposals.

At the meeting we put a few safety scenarios forward concerning patient safety. The unit did not have an answer for any scenario. It was either ‘the dentist will look after that’ or ‘we need to look into that’.

When the people who will be passing legislation do not have a working knowledge of dentistry, and the regulators of the profession are saying that the legislation is wrong, surely it makes sense to listen?

We also put forward our need for CPD, which we need in order to improve standards within the profession. But, again, if members of the profession are not registered, how can they impose this? The subject of fitness to practise was also brought up at our meeting: in the proposals, only those professionals who have mandatory registration will be subject to fitness to practise. That means that no matter what you do as somebody who is not registered, the Dental Council has no power to regulate you. The only open alternative to them is a court case.

The Department said the basis for that decision came from a ruling in the Corbally v Medical Council case. But nowhere in that ruling does it say that certain individuals should or should not be subject to a fitness to practise proceeding; it actually says that because of the stigma involved in fitness to practise there should be a higher threshold before proceedings can be started.

What would you like to see happen?
Philip: The only thing we can hope for is that the Department of Health does a complete U-turn. Given the results of the election we are not yet sure what policies are going to be brought forwards. Once things have settled, the CDTAI will put in a request for the Oireachtas Health Committee to ask for pre-legislative scrutiny of the bill.

If anybody believes we are scaremongering I would invite them to watch the videos from the Oireachtas Health Committee meeting with the Dental Council in October 2015. The Dental Council couldn’t have any used any stronger terms to show its opposition to the proposals.

I would like to hear from the Irish Dental Association (IDA), and for the chief dental officer to offer her own opinion on what is happening, because I cannot find a single group or person from the profession, legislators or regulators that agrees with the proposals from the Department of Health.

Follow-up

In the wake of this inteview Irish Dentistry spoke to Fintan Hourihan, chief executive officer of the IDA, about the IDA’s position on the proposals. The IDA states: ‘In our submission to the Department of Health we stated our belief that mandatory registers should be introduced for all hygienists and indeed all auxiliary categories. In addition, all dental auxiliaries should be subject to fitness to practise provisions.

‘We also believe that the Dental Council should regulate auxiliary dental professionals.’

When asked whether the IDA will be following up with the Department of Health to ensure the changes in the proposal do not come into place, the IDA responded: ‘As we are awaiting the election of a new government at present, we will await the outcome of the general election and review matters once the next government is formed.’

Although Philip states that when the Dental Council was made aware of the proposals, the Department of Health had not undertaken a risk assessment, the Department of Health states that an assessment is now ongoing.

It said: ‘A Regulatory Impact Analysis (RIA) is currently underway in respect of the proposed new dental legislation. It will examine areas such as the regulation of dental practices, competence assurance, and the regulation of allied dental health professionals among other issues. When the proposed new dental legislation is published, it will be accompanied by the RIA.

‘The development of the RIA is an ongoing process, and will progress as the legislation develops.’

To view the meeting the Oireachtas Joint Committee on Health and Children had with the Dental Council last October, visit the Oireachtas website at www.oireachtas.ie/parliament/watchlisten. Alternatively, read the transcript at http://bit.ly/1Ms3Pr2.

Philip McGrath first qualified as a dental technician more than 20 years ago. Since then, he has undertaken courses to update his skillset, culminating in a postgraduate qualification in clinical dental technology (with distinction) from the KSS Deaney UK in 2012. He was also a DCP assessor for the FGDP UK. On completion of the clinical dental technology course he joined the Clinical Dental Technicians Association of Ireland (CDTAI) and became the chairman in 2013.