Dáil debates

Thursday, 19 January 2023

Public Dental Services: Motion [Private Members]


5:15 pm

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)

I thank the Deputies for tabling this constructive motion. I have taken on board the points that have been made. I acknowledge that many Deputies in the House have raised this issue. It is one of which I am very aware and one on which were taking a lot of action. We all want to see more happen as quickly as possible. I want to lay out some of the actions we are taking.

I acknowledge that for too many people this has become very urgent. We know many dentists have left the treatment scheme. I will cover the various aspects of oral healthcare covered by the HSE. A lot of money and services are provided and many adults and children are helped every year. However, there are some significant pinch points, and for those adult and child patients, this is an urgent issue. I will come back to the DTSS in a moment.

I would like to lay out for colleagues the level of increase in investment and some of the things that are happening. We are discussing what else needs to be done. Last year, post Covid, the allocation to oral health care was more than €200 million, a sizeable investment in oral health care from Government. It shows a commitment to the best possible oral healthcare. We want this and know we are not there yet, but we are committed to improving the service year-on-year.

Some €200 million is allocated to HSE public dental services, HSE orthodontic services, the DTSS, which colleagues have discussed, and the dental treatment benefit scheme for insured, self-employed and retired workers, that is, those who have the necessary PRSI contributions. Last year, more than half a million people benefited from those services. While we in politics focus on the parts that are not working, which is where we spend the vast majority of our attention, it is important to acknowledge the work done by healthcare workers. More than half a million men, women and children received world-class dental care and oral healthcare last year, provided through Government funding and largely implemented through the HSE.

Everyone needs to have timely access to healthcare for appointments to see healthcare professionals for diagnostics and treatment, but there are challenges. It is a priority for the Government to address this in the short term, and we are taking short-term actions, as Deputies have referenced, through much-needed reform to oral healthcare in Ireland. Important structural changes are required and are being implemented.

I want to talk about the HSE public dental service. The salaried public dental service last year provided care to 143,000 adults and children. Those with additional needs who cannot receive care in a general dental practice may receive special services provided by HSE public dental services. These patients are given oral health examinations, where necessary, and treatment is provided using additional supports. The scheme also provides a targeted programme that includes screening and necessary treatment for children at important stages of development, that is, children aged six to eight years of age, those aged between 11 and 16 years and, subject to capacity, those aged between nine and 11 years. They are the three development stages addressed. Emergency care is also provided to children up the age of 16 and those with complex and additional needs.

The service provides care to many children and adults who would not otherwise have access to oral health care services. As we are all aware, coming out of the pandemic, there are backlogs in the targeted screening programme in particular. This is leading to delays in children receiving their first appointment. It is something none of us want. We know early intervention is essential in oral and many other parts of healthcare.

What are we doing about this? In the budget for this year, the Government has allocated €15 million, an unprecedented allocation, for a range of measures to protect access to services through once-off funding. A total of €5 million is being invested on a once-off basis to support the provision of care to eligible children and adults, including addressing the backlogs in targeted primary school class programmes.

On orthodontic services, the public oral healthcare service provided by the State includes orthodontic treatment. It is provided by HSE orthodontists to patients referred before their 16th birthday who have a significant need. In excess of 10,000 people are currently in active orthodontic treatment funded by the State. Given the nature of treatment, it takes several years to complete. More than 2,000 of these patients are receiving treatment with a private provider through a procurement initiative. We have allocated €4 million in additional funding for that programme for this year. It will allow us to target those who have been waiting the longest to make sure they get access to treatment and, in some cases, more complex surgical care.

Last year, through the DTSS, which is the subject of a lot of debate in the Chamber, the State provided care to more than 360,000 medical card holders. I fully acknowledge that more needs to be done and dentists have been leaving the scheme for a variety of reasons. Nonetheless, 360,000 men, women and children received oral healthcare through the scheme last year. It is important we acknowledge the work that was done to that effect.

The scheme provides basic and more complex care such as dentures and a broad range of treatments for patients with additional needs. To address contractor concerns regarding the DTSS, interim measures came into effect from 1 May last year. We also increased the fees paid to dentists for most treatments by 40% to 60%. Dentists have said they want more and are clearly making more money from private than public patients. They are choosing to spend their time treating private patients over public patients. Deputies have raised concerns around the administrative burden faced by dentists, something which has to be looked at.

One of the things we are not good at is having streamlined processes and easy access for providers. That is something I will take on board and bring back to the Department.

On the DTSS payments, we looked at November of last year, which is the most recent month for which we have information, versus the previous year. What we found is that the level of activity on the scheme is increasing, which is positive. We found that 3,000 more patients received care, year on year, and over 15,000 additional scale and polish treatments were done. That treatment is now available, as colleagues will be aware, to adult medical card holders. It was taken out of the scheme some years ago but we put it back in. I allocated €10 million to the budget for last year to put that back in, which was important. It brought medical card holders in line with people who have PRSI eligibility and it is good to know that 15,000 extra scale and polish procedures were done on foot of that. Nearly 2,000 more oral health examinations were also carried out.

I fully acknowledge there are difficulties in some parts of the country where many dentists have left the scheme. That is a real concern for me and for everyone else in this House. That said, it is positive that a lot more money is being allocated. It is important that the fees to dentists have gone up by almost 50% in one year, which is a very big increase. It is also positive that the volume of care being provided and the number of patients being seen has gone up but there is more that we need to do. We are engaging with the representative body and we need to see how we can bring a lot more dentists back into the scheme.

A sum of €5 million has been allocated on a one-off basis to support the HSE's safety net service for adult medical card holders. These are people who need emergency care but who cannot get it through the DTSS. I have allocated €5 million for a safety net fund specifically for those patients. Deputy Verona Murphy and others have raised issues affecting their constituents in this regard previously.

We need reform. The national oral healthcare policy, called Smile agus Sláinte, was approved in 2019 but it is fair to say that due to Covid-19, it was not implemented between 2019 and 2022 at anything like the level needed. One of the things that was needed was a significant increase in funding. Through last year's budget I allocated a lot of extra money to oral healthcare and then in the budget for this year, I allocated a lot more again, in order to increase services, engage with the representative bodies and reform the DTSS. We are also going to start hiring some senior clinical leadership roles into the HSE. The feedback I got from the chief dentist who works in my Department is that while the national strategy is excellent and the money that was put in place last year and this year to apply the necessary reforms is welcome, we need to have serious senior clinicians within the HSE driving the reform. On that basis, I funded those posts through the budget as well. There is a provision of an additional €15 million this year to progress implementation of the policy.

I thank Deputies for continuing to raise this issue with me. It is a priority. There has been a big backlog and we know there are challenges. I have allocated a lot of additional funding and we are now getting on with implementing the national strategy, Smile agus Sláinte. The call for a significant overhaul of the DTSS has been heard and that is something we are undertaking now. I acknowledge that this is urgent and needs to be progressed quickly.


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