Dáil debates

Thursday, 19 January 2023

Public Dental Services: Motion [Private Members]

 

4:55 pm

Photo of Verona MurphyVerona Murphy (Wexford, Independent)

I move:

That Dáil Éireann:

acknowledges that:

— most oral health conditions are largely preventable and can be treated in their early stages;

— oral diseases share common risk factors with chronic disease, such as heart disease, obesity and diabetes;

— oral diseases are caused by a range of modifiable risk factors common to many noncommunicable diseases (NCDs), including sugar consumption, tobacco use, alcohol use, poor hygiene, and underlying social factors;

— oral diseases disproportionally affect the economically and socially disadvantaged members of our society;

— out-of-pocket costs for oral health care can be major barriers to accessing care;

— an integrated approach for the prevention and treatment of oral and general healthcare is required;

— children and adults with disabilities may have an increased need to have dental surgery carried out under general anaesthetic; and

— access to dental care for all is essential;

recognises that:

— all medical card holders are entitled to the following specific dental treatments, dental examination, two fillings in each calendar year and extractions as necessary;

— a significant number of contracted dentists across the country have withdrawn from the Dental Treatment Service Scheme (DTSS);

— most community healthcare dentists are at full capacity and unable to take on new patients;

— primary school children should have check-ups in second, fourth and sixth class, however some children are not receiving their first dental check until secondary school, therefore, missing check-ups at essential dental development milestones;

— the lack of primary school and early dental check-ups causes delays in referrals for orthodontic treatments and early interventions such as fissure sealant treatments;

— over 13,000 children are awaiting orthodontic treatment for Grade 4 and Grade 5 on the Health Service Executive eligibility criteria;

— children and adults with disabilities are facing delays in accessing dental surgery under general anaesthetic;

— medical card holders are finding it difficult to source a dentist;

— the number of people treated under the DTSS is decreasing year on year;

— there are staff shortages across the sector including dentists, associates, hygienists and nurses;

— staffing shortages are having an impact on patient access to dental care; and

— there is a requirement for specific workforce planning for oral health to the development of a dental workforce plan; and

calls on the Government to:

— improve access to dental care in an equitable and sustainable manner for all, across all income groups;

— reform the dental tax relief scheme (Med 2) to increase the tax relief to a minimum of 30 per cent, expanding access to treatments and reliefs available;

— provide supports towards the cost of private dental care for children;

— include dentures in the scheme to reduce the burden of costs on all patients;

— provide additional training to allow paediatric dental services to operate where a lack of paediatric nursing staff is currently preventing dental surgery under general aesthetic;

— provide additional undergraduate places for dental graduates in Irish universities;

— provide extra training places for auxiliary workers and a renewed vocational training scheme;

— improve career paths for auxiliary dental staff;

— reform the work permit scheme for dentists and dental nurses;

— immediately address the uncertainty over the public dental service; and

— review, reform and implement a renewed DTSS with the engagement of all stakeholders.

I am delighted to be able to present this motion today and I thank my colleagues in the Regional Group and Cáit Nic Amhlaoibh, in particular, for all her hard work.

It seems not a day goes by when our attention is not drawn to some area of the health service which is in crisis. Today it is the turn of the dental services. It is not just to highlight the problems but to try to encourage and persuade the Government to bring about action that will move to solve the problems. In June 2021, I brought forward and presented a Topical Issue matter related to the dental treatment services scheme, otherwise known as DTSS. This was brought about on foot of many constituent patients and dentists coming to me and highlighting the issues they were facing with the scheme. For the benefit of those who are not aware, the DTSS means that medical card holders are entitled to a free dental examination in each calendar year, as well as any extraction required along with a number of other limited services. In November 2020, it was reported that the number of private dentists participating in this scheme had dropped by 16%, from 16,054 to 13,093, in the ten months between January and October 2020. It was estimated at the time that approximately 200,000 medical card holders were facing delays for treatment as a result. To give an example of the practical implications of this, at the time I put forward that Topical Issue, the number of dentists in the scheme from Wexford and New Ross districts had reduced from 14 to four. I also questioned the Minister, Deputy Stephen Donnelly, on the dental treatment scheme on 12 July 2022, and highlighted a constituent named Sean Hayes who resorted to pulling his own teeth due to a failure to be seen by the dentist; he had tried seven. In response, the Minister stated:

I have allocated a very significant amount of extra money. The forecast spend for this year would have been about €40 million for this scheme. We have increased that from €40 million to €66 million.

Unfortunately, thanks to an email I received from the dentist, I later was to discover that in 2009 or 14 years ago, the spend on adult medical card dental services was €86.8 million. That is some €20 million more than the increased budget for 2022. I wish the Minister had mentioned that in his response. The dentist also remarked that the costs in dentistry have increased exponentially since Covid-19 and this increase, will not even cover that. The dentist went on to tell me that they had resigned their DTSS contract in 2020 and was fully booked for the rest of this year and noted this story was similar with many of their colleagues. The dentist noted the DTSS is outdated in its scope and so burdened with bureaucracy that most dentists like my correspondent will never accept another DTSS contract, regardless of what increases in fees are offered.

This motion calls on the Government to review, reform and implement a renewed DTSS, to increase tax incentives for private patients receiving treatment and much more, as well as the engagement of all stakeholders. Dentists first and foremost need to be consulted about why so many are leaving the scheme. Those people have a greater level of knowledge as to what is happening on the ground than do the Department's administrators. Once those issues have been identified, we can go some way towards developing a realistic scheme that is attractive to dentists and will improve outcomes for patients.

We also recognise in the Regional Group, as stated in the motion, that the lack of primary school and early dental check-ups leads to problems further down the line. Some children are not receiving their first check-ups until secondary school age, which, coming after many essential developmental milestones such as the arrival of adult teeth, causes problems that are unnecessary and could have been prevented. We are all familiar with the phrase, "a stitch in time saves nine". Unfortunately, when it comes to dental services there are not enough stitches being sewn.

Looking at the HSE orthodontic services in County Wexford, we currently have only one of two consultant orthodontists in place, while HSE figures show that 524 children are awaiting orthodontic treatment while 93 over-18s, who were identified as needing treatment before the age of 18, are waiting for treatment. During a speech on dental services in April 2021, I referenced a letter from a parent which stated their child was assessed by a HSE orthodontist in Enniscorthy on 8 June 2018. The parent was informed the child would definitely qualify for dental treatment through the HSE as he is an extreme case but there was a four-year waiting list. The parent was extremely shocked by this but was reassured by the orthodontist as she explained this would be the optimal time for the child. The parent rang the orthodontist's department during the first lockdown but the phone was not answered and no one responded to the parent's voicemail. The parent finally managed to get through in April 2021 and was told by the secretary that the child would have to wait for another three years. That meant the waiting list had gone from four years to six years. A couple of weeks prior to that speech of April 2021, I wrote to the Minister's Department and received confirmation that the waiting list was approximately 72 months in duration. This is the reality for many parents and patients.

Oral health care is extremely important and fundamental to our overall health and well-being. Oral diseases are among the most prevalent diseases globally and have serious health and economic burdens, greatly reducing quality of life for those affected and sharing risk factors with chronic disease such as heart disease, obesity and diabetes. Our dental services are in disarray and need to be tackled head-on with sustained and meaningful action to bring about better and swifter results. This must include a top-to-bottom review and a long-term strategy for improvement, including providing additional training to allow paediatric dental services to operate where a lack of paediatric nursing staff is currently preventing dental surgery under general anaesthetic; providing additional undergraduate places for dental graduates in Irish universities; providing extra training places for auxiliary workers and a renewed vocational training scheme; improving career paths for auxiliary dental staff; reforming the work permit scheme for dentists and dental nurses; and immediately addressing the uncertainty over the public dental service. These are all necessary actions to bring about improvements.

I hope that Deputies from all parties and none will support the motion.

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