A 10-year derogation has been secured specifically for Northern Ireland, rather than a direct ban on amalgam under EU Regulation 2024/1849.
Met with a palpable sense of relief by the profession, this derogation was secured against all the odds. It was a culmination of massive efforts over many months, of lobbying, media work and collaboration, ultimately securing political agreement between the UK Government and the European Commission for the protection of dental services in Northern Ireland.
Understandably, the profession can be forgiven for questioning the level of political commitment shown to dentistry over recent years; but on the dental amalgam issue, we have witnessed the warnings issued by the dental profession being taken up in an unprecedented way by party leaders, and successive Health Ministers in engagements with the Secretary of State and the UK Government who advocated on our behalf.
Our issues prompted an Inquiry by the Stormont Windsor Framework Democratic Scrutiny Committee, and have been raised on a number of occasions at Stormont’s Health Committee; and, we recognise the considerable effort expended by Department of Health (DoH) officials, including by the Chief Dental Officer (CDO) in providing the evidence base ahead of this derogation being granted.
Who would have imagined that an issue centred on Northern Ireland dentistry would become a test case for the new post-Brexit constitutional arrangements, just as Stormont was restored and at a time when the new UK Labour Government wishes to reset relations with the EU.
As a profession, dentistry must take heart that its voice has been heard at the highest levels of government and considered a priority in the context of relations between Stormont, United Kingdom and European Union levels.
This positive outcome was secured by the collaborative efforts already mentioned, and crucially with the political will in place. Our representatives were relentless, but we were always bracing ourselves for the impact of yet more unmitigated costs being imposed upon practices from an amalgam ban at a time of such pressure within the service.
In January, we sounded the alarm when the European Parliament voted in favour of a total phase-out of dental amalgam from 1 January 2025, the default position being that a ban would also apply directly in Northern Ireland under the NI Protocol.
In March, we followed up in our oral evidence to Stormont’s newly formed Windsor Framework Democratic Scrutiny Committee, warning of the irreparable and long-lasting damage to the provision of dental services by moving from phase-down to the phase out of dental amalgam, at a time when Health Service (HS) dentistry is on its knees. Our evidence was informed by crucial feedback received from the profession which captured the significant issues already evident within HS dentistry. And, we continued to brief MLAs on these issues and provide briefing papers over this time.
We recognise the significant stance the CDO took, advising the Windsor Framework Democratic Scrutiny Committee in her oral evidence that Northern Ireland wasn’t ready to implement an amalgam ban from 1 January 2025.
BDA and the Department of Health agreed on this important issue, and we got successive Health Ministers onside.
The derogation provides breathing space; however, this issue has reinforced the need for urgent reform and adequate investment into dental services. It has illustrated the range of actors who each have a responsibility to make dental reform happen - an approach which we want to see carried forward, and not lose momentum.
We require that same level of political leadership to get on with putting HS dentistry onto a sustainable footing for the future.
The amalgam issue is a microcosm of the change we need to see in dentistry. And, all through these discussions, we have repeated that we need governments to act to enable the continued phase-down of dental amalgam use in a managed and supported way.
We welcome conditions attached by the European Commission to this derogation aimed at ensuring UK authorities, ‘take the necessary measures to ensure regular and consistent progress’, including an update of the Northern Ireland Plan to phase down the use of dental amalgam.
While the direction of travel is clear, the lack of government action previously to create the conditions to enable amalgam phase-out which led to this crisis should serve as a wake-up call.
While we have bought time, we urge Stormont and the UK Government to follow through on dental reform:
- By funding and implementing Northern Ireland’s Oral Health Improvement Plans (OHIPs) to improve population oral health
- By reforming and adequately investing in our dental services to stabilise General Dental Services by taking forward dental payment and contract reform
- By growing our Community Dental Service and Hospital Dental Service workforce, informed by the Dental Workforce Review work carried out last September
- By placing a renewed focus on new treatment materials and techniques.
Securing a bespoke arrangement for Northern Ireland on dental amalgam involved a massive effort on the part of the profession and its representatives, working to inform and influence decision-makers, who in turn must be credited with finding a workable way forward.
Now, we urge authorities to commit to following-through on prevention initiatives, reforming dental services, and giving a greater focus to new treatment materials and techniques.
After years of delay and neglect, let’s grasp the nettle on reforming our dental services and improving oral health outcomes. Support the profession to take dentistry forward.