Peter Dunne: Address to Dental Health Association
Hon Peter Dunne
Associate Minister of Health
Embargoed until 7pm
Friday 15 May 2009
Address to Dental Health Association
Oral Health Professions Workforce Dinner
7pm, Friday 15 May 2009
Monaco Resort, Nelson
It is a real pleasure to be here this evening to join a group of professionals working in an important area of New Zealand’s health system.
The introduction of the Health Practitioners Competence Assurance Act in 2003-2004 created a single regulatory authority for the oral health professions, a situation that is not enjoyed across many of the other health professions.
The authority has managed, and continues to manage, a number of challenging issues across and between the professions that are the almost inevitable result of differing perspectives on the oral health needs and standards of practice from a range of professions.
However, you all have a shared aspiration for people to be able to enjoy good oral health.
Opportunities to improve the delivery of that care will come from open and constructive discussion between the professions centrally involved in the delivery of that care.
Your meeting today is the result of joint work between four oral health professional associations, each of whom has varying views on the issues you have come together to discuss.
This occasion is also encouraging evidence that interactive discussion between the professions can occur, and the groups can work together despite their differences.
Well done – too often we hear across the health sector of good initiatives foundering on the rocks of inter-disciplinary rivalry.
So I congratulate on having avoided this, and I encourage you to build on this co-operation and take advantage of your cohesive strength.
Make the most of this opportunity to discuss and bring together the main issues for the needs of the oral health professions in the next 10 to 15 years, and share ideas on how to meet those needs.
I am aware that there have been ongoing discussions over the last 3 to 4 years within the professions, with the universities that provide your new graduate oral health professionals, with the Ministry of Health and the Tertiary Education Commission about the future of the oral health workforce.
These discussions have underlined the concerns you have about your workforce, and the issues it faces.
There are concerns about whether there are sufficient oral health professionals right now, and whether there are enough being trained for the future.
I am aware that workforce reports have been produced, modelling undertaken and variety of conclusions drawn.
But the issues are more complex than simply looking at the statistics and future number projections.
The health workforce as a whole has been identified as being under pressure to deliver sufficient supply for the future health needs of the population.
In addressing these concerns, we need to open our minds to questions about whether the jobs that are being done today all need to be done by the same people in the future.
In your context, I am aware that dental therapists play a particularly important role in the oral health care of younger children, but there are concerns about the future supply.
Training has now moved to being jointly provided for dental therapy and dental hygiene – which has increased applications and intakes to the training programmes.
Your new graduates will have new skills and there is an opportunity to ask the question about options for greater access to care that this may offer for the future.
Occasions like this where you come together are important opportunities to advance your collective thinking, and to test ideas.
We need to consider the reasons that people choose to practice in certain geographic locations, or perhaps more importantly why they choose not to practice in some locations.
By more effectively spreading the skills of practitioners some of the current issues about access to care may well be better addressed.
There are important questions for the professions to help us all understand what influences oral health practitioners to work in different locations, or in different types of practices, and what could be done effectively for the oral health professions to assist better distribution.
Again, you are not alone in facing these issues.
Other professions are also confronting the same realities.
So it is, therefore, important that oral health does not become insular in its thinking.
Many of your issues are also the issues of the primary care and nursing workforces, and I encourage you to share your knowledge and your suggested solutions with those parts of the health sector.
There are concerns about whether the graduates being produced are appropriate for the needs of the populations requiring oral health care.
This is a very real issue.
Oral disease is no longer as evenly spread through the whole population as it once was.
New disease is concentrated in some population groups, particularly people of Maori and Pacific backgrounds, people with lower incomes, those with significant health and disability problems, and the elderly.
At the same time, a large group of the income-earning adult population have an ongoing burden of fillings from past treatments and a need for high quality maintenance and repair services.
New Zealand is also a country with significant migrant populations and I understand that, especially for dentists, the entry of many overseas trained dentists to your professional ranks has been important to the sustained growth and sufficient supply in the past few years.
However, all of these issues raise questions about whether we are attracting and training the right types of oral health professionals, in the right proportions and whether there are opportunities to make changes that will better meet the needs of the population.
There are concerns about whether the education programmes are keeping up with contemporary methods for teaching in oral health and meeting the needs of the professions.
We are very fortunate to have two universities offering a high standard of oral health education.
I thank the staff of the University of Otago and the Auckland University of Technology for the important roles they play.
But again the world is not standing still and we need to consider the merits of continuing to introduce new educational methods or new courses, and whether things we have done in the past are still relevant to our future.
The key to our development as a nation in any area is directly tied to the quality of the think that we do and the questions that we ask of ourselves.
I understand that in fact our universities have been quite proactive in this regard, but perhaps the question is whether your thoughts and aspirations are understood and matched by those of the professions you are educating for.
There will always be a degree of tension between whether it is the role of universities to lead changes to the workforce or to respond to community and professional need.
Of course, the answer is both, and this meeting offers a valuable opportunity to try to strengthen that dialogue and to share your ideas in a way that can build all of the oral health professions.
I note that this is a meeting primarily of the oral health professions and I congratulate you on taking ownership and leadership of these issues.
However, I encourage you to look at the issues under discussion from the viewpoint of the general public.
Consider how the public can be best served by
the options you put forward.
For many, the primary consideration will understandably be the financial cost of oral health services.
For example, the person who contacted me earlier this week complaining that a routine visit to the dentist for toothache resulted in a diagnosis of a number of root canal procedures being required at a minimum cost of nearly $3,400 that needed to be paid there and then will be focused on that issue alone when it comes to discussions about the future of oral health services.
No matter the justifications, issues such as this will shape the public’s future perception of oral health services, and will need to be factored into your future thinking and planning.
If cost is a significant barrier to access to the system, we need to be thinking of ways in which that can be addressed.
There are others who have a legitimate and strong interest in assessing whether the professions have it right.
Those groups include the public, and especially interest groups for sections of the population that do not currently enjoy good oral health or equal access to care.
Once your deliberations are complete, it is important we open the ideas up to debate and use the information to take positive steps to continue to improve oral health and access to oral health care.
ideas and solutions produced this weekend will be reviewed
and used not only by your own professions, but also by the
Ministry of Health, the Tertiary Education Commission, and
They will be used to inform discussion about how we can best work together to develop an oral health profession to meet the needs of the New Zealand population over the next 10 to 15 years.
The majority of public expenditure in oral health goes toward the care of children and adolescents, and many of you will be aware of the work that has commenced to reinvest in child and adolescent oral health services.
The Government has committed to continue the reinvestment programme commenced under the previous government.
Since taking office, this government has finalised and signed funding agreements for 10 district health boards and this means that at this time 17 district health boards have additional funding confirmed.
We anticipate that agreement with the four remaining district health boards will be resolved shortly.
Boards are commencing implementation of this work and over the next 3 to 4 years we will see significant activity that will create opportunities for further developments in the oral health workforce including additional dental assistants and more dentists working in community oral health services in team environments with dental therapists.
In addition, the Government has made a commitment to funding an increase in fees for the care of adolescents from 1 July 2009.
This agreement is subject to final confirmation from all district health boards, but it is reasonable to anticipate that this will proceed.
I am aware that the majority of this work is undertaken by dentists in their practices, but in some areas of the country access is poorer than is acceptable because families struggle to find a contracted dentist provider.
With this commitment comes a request for dentists who are not currently providing adolescent care to look again and consider joining the provision of this important care.
A Better Way
These are difficult economic times.
It is an unfortunate reality that the present discussions, and your aspirations, must be considered in the light of much more constrained economic circumstances than those which have prevailed for the past few years.
However, it is also important that the professions continue to openly debate, to innovate, and to consider the merits of doing things better.
It is possible that some of the ideas generated at this meeting may indicate the need for increased resources.
But it is also very likely that improvements can be made by other means - by doing things differently, by communicating and understanding each others issues, by coordinating approaches.
The very fact that this meeting is occurring is evidence that the value of this cooperation is recognised.
Improvements may also be possible by
matching the needs of the oral health professions more
closely to existing policies or programmes.
Avenues you might look into include the voluntary bonding scheme, and Maori Provider Development Scholarships.
In addition, the report you will produce this weekend will assist the government, the Ministry of Health, and the Tertiary Education Commission to better address the needs of the oral health professions when wider policy decisions are being made about the health workforce.
The Government appreciates that we need a strong and well educated workforce.
Your deliberations about the future oral health workforce are important to the future delivery of both publicly and privately provided dental care and I look forward to hearing of the outcomes of your meeting and the recommendations you have for improving access to dental care for all New Zealanders.