31 August 2005

Labour revamping dental services for young NZers

Prime Minister Helen Clark and Health Minister Annette King announced today
that the Labour-led government in its third term will revamp New Zealand’s oral health services for young people based around a new mix of school dental clinics, mobile units, and community-led services.

Helen Clark and Annette King said this initiative extends the provision of dental services for children and adolescents beyond the current largely school based service.

“Labour’s plan involves facilities which will be open over the whole year, and will be complemented by mobile units reaching areas where access is more difficult. The services will continue to be delivered from schools in many instances, but some school clinics will be consolidated and replaced with modern community facilities which are either permanent or mobile.

“When implemented, our plan will see a significant increase in the numbers of dental therapists and assistants employed by the District Health Boards, of 20 per cent and 70 per cent respectively, enabling more children and young people to receive a greater level of care.”

Annette King said that rebuilding oral health services for young New Zealanders is a matter of personal faith for her as well as an essential health priority.

“As a former school dental nurse, I was appalled at what happened in the 1990s. All the courses training dental therapists were closed down, so that we were training no new staff to replace an ageing workforce, and school dental clinics and equipment were run down with little or no thought given to what would happen in the future.

“To achieve our goals for child and adolescent oral health, we need a skilled workforce. That is why Trevor Mallard is today also announcing that funding for dental therapy studies is to be increased by more than 20 per cent so that it better reflects the costs of clinical training.

“It is important that our dental workforce is used in the most effective ways possible. One such example is using dental assistants to carry some of the workload of dental therapists, so that therapists can concentrate their time on actually providing services. Some DHBs are already doing this most effectively.

“The revitalised oral health services will also focus on improving oral health through prevention and early intervention, and reducing current disparities. The reality is that, on average, children living in areas without fluoridated water supplies have greater levels of tooth decay, and children from low socio-economic groups have more missing or filled teeth than do other children.”

"A seamless oral health service for young people up to the age of 18 will ensure continuity of care from early childhood on. Currently, while school age children have an enrolment rate of around 95 per cent in the school dental service, the rate for younger children is relatively poor, and many children do not access dental care when they move from primary to secondary school."

"This policy will require additional capital expenditure of approximately $100 million over the next five years and some increase in operating funding.

The detail of the operational funding, split between what is already in baselines and new money, will be finalized during next year's budget round," Annette King said.

Labour’s Dental Health Policy
Questions and answers

What is Labour’s full policy on oral healthcare?

Labour will ensure that all children and adolescents up to the age of 18 have access to free dental care by:
- Rebuilding and re-equipping the School Dental Service
- Working with dental professionals to provide a comprehensive adolescent oral health service
- Ensuring that there are adequate mobile and community dental services available
- Requiring DHBs to provide Dental Assistants to work along side Dental Therapists, so that Therapists are able to maximize the time they spend treating patients
- Increasing the number of Dental Therapists in training

Labour will also improve access to dental care for low income adults, as resources allow, by utilising spare capacity in mobile and community dental services.

What are the challenges facing children's dental services?

Only 45 percent of primary and intermediate schools have a fixed on-site clinic; of these, many are not designed for modern dentistry, do not comply with health and safety standards, and are not in a location that allows easy access to the eligible population.

Challenges also include:

- A diminishing dental therapist workforce, with many therapists working part-time.
- A decline in the oral health status of specific groups of children, which began with the rise of child poverty in the early 1990s.
- Ageing dental equipment that is in need of replacement and facilities that require significant refurbishment to meet the needs of modern dentistry.
- The need to ensure that service delivery models keep pace with new technology, health and safety requirements, population changes and workforce changes.
- Variation in the prevalence and severity of tooth decay. Both are more serious amongst those from lower socioeconomic groups, those living in rural areas, and Maori and Pacific peoples.
- A split in responsibilities for school dental services between the health and education sectors, with the result that neither has the flexibility nor the incentive to maximise the effectiveness of these services.

How will Labour’s policy address these issues?

Labour is committed to ensuring oral health services for children of preschool, primary and intermediate school age are:

- delivered in a seamless manner from pre-school through to adolescence.
- delivered from facilities that comply with all relevant regulations and guidelines relating to health and safety, including infection control.
- accessible for all children of preschool, primary and intermediate school age, including Mäori, Pacific peoples, those from families of low socioeconomic status and those living in rural areas.
- delivered cost-effectively, flexibly and efficiently.

As a result of these changes to oral health services, child oral health outcomes will be improved and inequalities in health status will be addressed.

What were the findings of the two dental health reviews?

The Review of School Dental Service, and Review of Maori Child Oral Health Services (both commissioned by the Ministry of Health in 2004) have shown that despite considerable improvements in child oral health into the mid-1980s, the last decade has seen a plateau, and in some cases a decline, in the oral health services of this group.

The reviews highlighted ongoing disparities in oral health between groups of children, with Maori and Pacific children, and children living in low socio-economic, rural, or non-fluoridated areas, showing relatively poor oral health compared with other children. The reviews also highlighted several challenges facing the School Dental Service, including recruitment and retention issues in the dental therapist workforce and inadequate clinical facilities.

How many pre-school, primary and intermediate-aged children are looked after by the school dental service (SDS)?

In 2004 the SDS provided care for more than 500,000 children: preschoolers (from the age of 2½), primary and intermediate school children, and adolescents older than 13 years who are not yet attending secondary school.

What does Labour’s policy mean in terms of dental clinics?

There will be no lessening of access in dental health care provision, but Labour’s policy will see an increase in the use of mobile dental services, and facilities positioned in the community. This will raise the visibility and accessibility of oral health care services for children and adolescents. Increased use of dental assistants in many areas will also free up dental therapists for more clinical time.

What will Labour do to address issues in the dental therapist workforce?

Labour re-established dental therapy training. Courses are now available at Auckland University of Technology (AUT) and the University of Otago. The School Dental Service Review included a number of recommendations for raising the profile of dental therapy, increasing recruitment, and improving retention of therapists.

Trevor Mallard has today also announced that funding for dental therapy studies is to be increased by more than 20 per cent to better reflect the costs of clinical training.

ENDS

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