HSE slammed over Public Dental Service
The Health Service Executive (HSE) has been severely criticised for its failure to manage its own public dental service that provides free dental care for children, people with disabilities and older people in care. The criticisms are contained in a new report on the service. The Public Dental Service (PDS) has a budget of €60 million for 2009 and services are provided by 200 dentists, working as HSE employees.
The Department of Health appointed Dr Paul Batchelor, a London-based oral care consultant to write an Analysis and Evaluation of the Public Dental Service of the Health Service Executive , a copy of which has been seen by me.
The evaluation report found “little evidence among senior levels of the HSE of a serious engagement to understand the operation of the PDS with a view to actively managing that part of the organisation, providing encouragement and knowledgeable direction. This lack of leadership at a national level is having a demoralising effect on the providers of the service.” It also found that “the most important factor inhibiting the introduction of improvement is the lack of clinical [dental] leadership in the PDS”.
The evaluation is positive about “frontline staff, both clinical and non-clinical, in the Public Dental Services, who demonstrate a high level of commitment and a desire to provide the best possible service to their patients. There was also clear evidence of ideas for improving the day-to-day operations being put into effect.”
Dr Batchelor specifically criticises the information made available to him while carrying out the evaluation, which he said “was characterised by a lack of consistency, comparability in definition and coverage. This was true of every aspect of the service”.
He outlines how one of the “main inhibitors to assessing effectiveness of the PDS and its value for money was the dearth of relevant management information”.
He also criticises the Department of Health, saying “it appears to us that there is also a lack of clarity in national objectives for the PDS as set out in the Department of Health and Children’s Annual Plan ”.
The evaluation found “unresolved differences between geographical areas” and “that these variations are an indication of an inefficient allocation and use of resources”.
It recommended providing care on the basis of need, not age or target group, to make the provision of care more equitable. This is particularly true in relation to services provided for children whereby screening of schoolchildren may not be occurring at the appropriate age or when it is too late, according to the report.
Previous reviews carried out by the department and cited in this report found the PDS failing particularly in its dental care for people with special needs and older people in residential institutions.
The evaluation highlights the inconsistency between different aspects of the public dental schemes, describing them as “disconnected” and “professionally focused”.
For example, the PDS is responsible for various aspects of dental care for children and young people up to 16, but there is no continuity of care after this cut-off age when young people have to transfer to a different dentist or scheme.
The report recommended that the Public Dental Service should be managed as a single unit and the HSE should appoint a chief dental surgeon with responsibility for all aspects of HSE dental care, including the budget and the Dental Treatment Services Scheme (DTSS). The DTSS provides free medical care for adults who are medical card holders.
Dr Batchelor’s report found the “main advantage of the current arrangements through which the PDS operates is the potential for high management”, which has been a missed opportunity to date.
The report says if the “management issues are addressed, the PDS has the potential to develop as a specialised service that plays an integral and complementary role in a modern efficient and effective care delivery system”.
Dr Batchelor, who was unavailable to comment on the reports, was paid €46,550 in 2008 and 2009 for two reports commissioned by the department on probity in the Dental Treatment Services Scheme and the Public Dental Scheme evaluation.
This article also appeared in The Irish Times, 27 October, 2009