Róisín Shortall (Dublin North West, Labour)

I thank Deputy Kitt for raising the issue, which he has been concerned about for some time. I am pleased to address dental services for homeless people in Galway. The dental treatment services scheme, DTSS, provides access to dental treatment for adult medical card holders. The service is provided by dentists contracted by the HSE. The DTSS budget for 2012 is €63 million. A free oral examination every calendar year and free emergency dental treatment are available to all eligible patients. Patients with special needs, those who have greater clinical needs and high-risk patients, including people who are homeless, receive priority for treatment. High-risk patients are those for whom untreated dental disease or the treatment of dental disease poses significant health problems.

The National Oral Health Office of the HSE issued standard operating procedures to dental contractors in November 2011 to support equitable and priority funding and provide clearer guidance to dentists on the application of DTSS prior approval requests. The procedures confirm that high risk patients are to be prioritised for approval. They receive all DTSS services that were available prior to April 2010, when services were reduced because of budgetary constraints. This includes an examination, all fillings as required and approval for complex care including root canal treatment, gum treatment and dentures. Homeless people, because of their lifestyles, tend to have a range of attendant needs including education, training, employment and housing, as well as a range of medical issues including addiction, mental health and general health issues. Addressing this range of requirements requires interaction between the HSE, Departments and statutory and non-statutory agencies. The needs of homeless people are complex and the response must be multi-faceted and complex.

The HSE has established a number of ways to bring health services to homeless people through, for example, the establishment of outreach multi-disciplinary teams that provide sessions in a range of homeless hostels and day services. The HSE gives priority to processing of medical card applications for homeless people in order to assist them in accessing available services. Of course, access to services can be arranged locally where necessary, pending a medical card being issued. Key workers for the homeless in Galway routinely link with dental services and the use of mainstream services is directed and encouraged.

The HSE is currently funding a diploma in special care for six dentists as part of an upskilling programme. Part of their training and remit includes the provision of services for homeless people and other vulnerable groups. The expertise of the graduates will be used to advise and support decision making on dental services for homeless people. I am pleased that, once qualified later this year, one of the graduates will be assigned to the HSE west area.

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