Seanad debates
Thursday, 16 May 2024
Nithe i dtosach suíonna - Commencement Matters
Dental Services
9:30 am
Micheál Carrigy (Fine Gael)
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My Commencement matter this morning relates to a crucial issue that affects many parents throughout the country who have kids with additional needs. The simple act of a routine dental appointment is an overwhelming challenge and experience for these children, particularly those on the autism spectrum. The sensory overload from the lights and sounds etc. can induce stress in those children and is a daunting task for both the parents and the child. I recently met with a parent of a nine-year-old child who required a dental visit and for whom the only option was through the school's dental system. Within that system there are no special needs dentists, they are currently in the public system. The family had very limited options and had to go privately to have treatment carried out, extractions and crowns, at a cost of over €3,000. The reality as we well know and as we have highlighted in various reports, and in the joint committee report on autism, is that there are already significant costs there for the families of children with various disabilities, particularly those with autism, who are paying for services not available on the public system. This is on top of the necessity of taking leave. There is now another cost for families because we do not have specialised trained dentists within the HSE system. I am asking that this be rectified and we actively recruit dentists within the HSE who have this specialised training so that families of kids with autism spectrum disorder can get treatment within the public system.
I would ask that until such a time as this will be put in place, the National Treatment Purchase Fund be utilised. I tabled a Commencement matter on this previously. It is recommended in the joint committee report that this fund be put in place and used to be able to adequately compensate parents who have to pay for services privately because we do not have the people needed within the various CDNT systems throughout the country. Until such a time as we have the required number of professionals with the qualifications necessary to be able to do this, we must allow the National Treatment Purchase Fund to compensate parents who have to organise this specialist dental care privately. I do not think that is a big ask; we are not providing the services for these children that we provide for every other child through the public system. It is a fair ask that we at least compensate the families affected until such time as we have the professionals in place and, as I have said, it is a recommendation in the joint committee report and something we dealt with extensively in our committee meetings. I would like to see that put in place.
Mark Daly (Fianna Fail)
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Thank you Senator, I know a lot of people will agree with the sentiments you have expressed and I recognise that you have done a lot of work on behalf of people with autism. I call Deputy Burke.
Colm Burke (Cork North Central, Fine Gael)
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Thank you a Leas-Chathaoirligh. I am here on behalf of the Minister, Deputy Donnelly to reply to this Commencement matter. I thank Senator Carrigy for the opportunity to address the issue of specialised dentistry within the public service. The salaried HSE public dental service providers offer care to several groups of patients including those with complex and additional needs. In addition, public dental service provides a programme which includes screening and necessary treatment for children at ages corresponding to second class, sixth class and subject to capacity, fourth class. Emergency care is also provided to children up to 16 years of age and for those with complex and additional needs.
This service provides care to many children and adults who would otherwise not have access to oral health care services. Officials in the Department of Health engage with the HSE on an ongoing basis to understand and address any challenges arising in the provision of public dental services. The Minister has been assured by the HSE that it is continuing to restore dental screening and treatment to children up to 16 years of age, through recruitment initiatives to fill vacancies that have arisen or may arise, prioritising clinical treatment and patient groups and reallocating clinical resources according to greatest need. The HSE has advised that many general dental surgeons would see patients with special needs routinely.
Regarding capacity and recruitment, it is extremely heartening to note that we currently have more registered dentists in Ireland than ever before. We have 3,652 at present which is an additional 189 registered dentists since March 2023. This reflects positive trends with comparative figures being 3,217 in 2018. The HSE has confirmed that in February 2024 there were 821 whole-time equivalents working in the public dental service across all grades, including 302 dentists, wholetime equivalent. Of the 302 these include consultant and specialist orthodontists. It should be noted that there are only two specialists recognised across EU orthodontics and oral surgery. In Ireland oral surgery and orthodontics have specialist registers in place.Ireland aligns with the EU dental postgraduate education models, which lean on QQI levels to determine the standard of education in dentistry. More than one third of the dental workforce in Ireland comprises dentists who have qualified outside of Ireland but within the EU. These dentists will continue to contribute to our workforce due to the oversupply of dentists in other EU countries but, in the main, few have specialist training outside of orthodontics or oral surgery.
The national policy prioritises the development of robust primary care, which caters for 90% of oral healthcare. This is aligned with both the EU model of care and the World Health Organization workforce model. The policy outlines, however, that the care pathways for the advanced centres of care and complex care will inform us of the need for additional training, specialisation or both in specific areas of dentistry.
Concerted efforts are ongoing within the HSE to address any current vacancies and any resourcing challenges that may be experienced by the dental and oral health professions. These are important measures to ensure the adequate staffing of our services for patients today. In tandem, we are also investing in fundamental reform of our healthcare services through implementation of the national oral health policy. The policy provides a framework and a set of action areas, including strategic workforce planning, to comprehensively reform oral healthcare service design and delivery.
Micheál Carrigy (Fine Gael)
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I thank the Minister of State. He stated few dentists who have specialist training outside of orthodontics or oral surgery are employed within the public health system, but there are dentists working in the private system who have that additional training to work with kids with special needs to make sure they are able to get treatment. I want to ensure that within the public system, there will be availability of dentists with that training in order that more families will not have to go private to get treatment for their child, who would be able to get it under the public system, and pay a figure of, as in this case, more than €3,000. I am asking the Minister of State to ensure that will be looked at, but until such time as we can employ people with that training, we should compensate families through the National Treatment Purchase Fund. That fund exists and it should be expanded for other treatments, whether assessments of need, occupational therapy or speech and language therapy, that we are not providing for kids with additional needs. We need to expand it and use it. It has been used successfully for other operations. We need to put the funding in place, expand the scheme and make it available in these cases.
Colm Burke (Cork North Central, Fine Gael)
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I take on board what the Senator is saying and I will certainly follow it up with the Minister. I assure him access to dental care through the public system is a priority for the Minister and the Government. The Minister has made substantial additional investment in oral healthcare services in recent years. In addition to the more than €200 million the Government invests in public oral healthcare services annually, an additional €17 million in one-off funding has been invested since 2019 and 2020 to address service backlogs. More than €200 million annually, therefore, is going into the dental services.
Fundamental reforms are also being progressed through the implementation of the national oral health policy, for which funding has been made available. The policy sets out the vision for the future of oral healthcare services. While it will take a number of years to be brought to complete fruition, there will be an early and continued emphasis on addressing the current issues. The policy fundamentally aspires that all Irish people will have their own dental home where they can build a lifelong relationship with a local dental practice or practices of their choosing for continuity of care from birth to old age. The policy has two goals, namely, to provide the supports to enable every individual to achieve their personal best oral health and to improve access to dental care in an equitable and sustainable manner, thereby enabling vulnerable groups to improve their oral health. I am confident that, working together with the dental profession and other stakeholders in line with respective roles and responsibilities, the goals of the policy will be met. A review is ongoing into dental training and the numbers of places in our colleges, which will, we hope, be completed reasonably soon. I take on board the other matter the Senator raised and will follow it up.
Eugene Murphy (Fianna Fail)
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I thank the Minister of State for being with us. I hope he will have a good day. I am sure it will be busy for him as usual.