What is going on out there this week? Has the Hon. Andrew Little said the word ‘health crisis’ yet? All the while frontline health workers drown attempting to meet the needs of their patient groups.
Influenza and Covid are also affecting bookings, staffing & general well-being and functioning of provision of dental (well, any health) care.
The Facebook parenting groups are making justifiable noises about inconsistent emergency dental care, waiting until things get bad to ask for help or advice… misunderstandings of service provision, service entitlements, different opportunities of dental care in different parts of Ao/NZ. One of my interests is advocating for accessible, quality dental care for the community (of course public health is my wheelhouse). So this Facebook rhetoric is professionally unsettling. There’s good reason for public confusion over when, where, and what dental services are available through public funding. I am sure the average oral health professional would struggle to make sense of funding streams, entitlements and eligibility.
As an aside, forgive me if I do not always have a private dental services understanding or focus. I am hoping this will grow as we learn and discover current dental service delivery in Aotearoa. I am always open to feedback, when it’s constructive, thoughtful and kind.
Public dental care delivery in Aotearoa is a convoluted business, not quite lined up to meet the needs of the patient groups, and with little (or no) value placed on preventive care. Public dental care provided in a private setting (if you are a dental or oral health therapist ) is another whole kettle of fish. The Ministry of Health contracts are held tightly by local health authorities, even when they know they can’t provide the routine care they are population-based funded to deliver. Private practices can provide emergency care for children up to 12 years of age, but, preventative services are not funded- I do wonder what funding model algorithm directs funding to the horse that has bolted…..
I digress, I have great faith that the Te whata ora (TWO) / Te Aka Whai Ora (TAWO) will bring some clarity to improving oral health service and delivery. Will the postcode lottery in health care delivery be replaced over time to a national directive for patient centered-community minded and fully staffed dental services- where you will receive more timely, appropriate care? I am all for standardisation, clear practice and procedural guidelines, for provision of quality, best practice, evidence based care. So for interest I had a look at a few TWO web pages.
So, even with the advent of TWO & TAWO, a quick google search shows each region’s Community Oral Health Service is doing their own thing…. this is not a critique of our peers and colleagues in COHS across Aotearoa, it is an observation of a space that could do with alignment, clarification and sharing of strategy, ideas and success.
https://www.cdhb.health.nz/health-services/service/dental-community/
https://www.nmdhb.govt.nz/health-services/community-and-outpatient-services/oral-health/
https://www.waikatodhb.health.nz/your-health/wellbeing-in-the-waikato/oral-health/
https://www.waitematadhb.govt.nz/home/ards/
https://www.southernhealth.nz/getting-help-you-need/dental-and-oral-health
What does your ideal model of dental care provision look like? How could you meet the dental needs for your community? What resources, mix of skill-set and environments would you need? Would we want universal funding, part-funding, or age/stage-based funding? Should funding be based on ethnicity or deprivation index? Read the Filling the gap report 2019, by the team at the Grattan Institute, with good evidence for universal funding. And increasingly Oral Health Therapists are finding autonomy and professional satisfaction being in a private dental practice – this link looks at the mix of dental skill and expertise The changing face of dental practice: emerging models of team care in Australia. Or do we keep the status quo, bar a few tweaks, clear delineations with age, service provider, funding streams?
Good oral health is essential to overall well-being. It’s just not so good when it becomes poor oral health- for future health care needs, employment opportunities, self esteem, future costs of maintaining those teeth, health care fears and phobias – you know all this!! So what are we going to do about it??
There is much evidence to support the team-approach to dental care, from my opinion, there needs to be a mix of dental providers equally across public and private. Hey, all oral health professionals – and that includes you too, dentists and dental specialists, do we have an opportunity to be trail blazers? Set up our services for success with oral health outcomes? There are more than enough patients, funding and opportunities for us all to be kept busy doing what we are professionally established to do.
If there are oral health decision makers, or oral health leaders, out there, come chat with us on the Whole tooth Ao/NZ podcast (https://the-whole-tooth-nz.castos.com/feed) and share this change process with us, the oral health professionals in Aotearoa. And we’d love to hear your great ideas about fixing the perfect storm of demand versus our capacity that we’re currently experiencing.
Nihil de nobis, sine nobis (For there shall be nothing about us, without us).
Becky ( & Diane)
