Thursday, 19 January 2023
Public Dental Services: Motion [Private Members]
Matt Shanahan (Waterford, Independent)
My colleague referenced the word "crisis". Every time we have a debate on healthcare, the word "crisis" crops up. Normally a crisis is seen as something that is short term and refers to some impending or looming danger. The word should not be used to describe a situation that has been in evidence for a number of years. What we are suffering in dentistry is not, in fact, a crisis but a failure to address known and increasing deficits and problems.
When it comes to dental care in Ireland, we have two streams - similar to our national healthcare -namely, public and private. We do not worry about people in the private stream because we assume that they have the financial resources to pay for services. However, we do not take account of the people in the public system who are waiting so long that they are forced into the private system and must pay for services that they find very difficult to afford. Beyond that, the Minister mentioned three schemes. The DTSS is supposed to provide dental treatment to adult medical card holders. The treatment benefit scheme, previously known as the PRSI scheme, covers adults who have sufficient PRSI contributions.
Finally, there is the public dental health service, which is largely community-based, as well as being based in some hospitals. It is supposed to treat children and adults requiring specialised and complex care. It is also supposed to support children in national schools by giving them their first access to a dentist and a dental assessment, often resulting in the diagnosis of a need for fissure seals, which are a great way of preventing future tooth decay. In addition, the HSE has a statutory requirement to provide emergency treatment, and even free orthodontic treatment, for children who have the most severe orthodontic problems. As the Minister will be aware, the waiting lists for that service are extending to ridiculous lengths. It is not even feasible for some people to consider orthodontic treatments three or four years away.
Despite the lofty ambitions of those three schemes, the departmental information and published data show a significant decline in the number of treatments being provided under the scheme. The Minister provided updated figures in his statement but, between 2019 and 2021, there was a decline of 280,000 in the number of overall treatments in the public system and a decline of 110,000 in the number of patients treated. We have seen the difficulties coming down the line.
The Minister has engaged with dentists in the private sector to try to understand the problems. The problems largely relate to adequate compensation for the work dentists are doing. As Deputy Berry stated, the stakeholders have been telling the Minister that the payment they are receiving does not make economic sense in the context of the work they are doing, and that is why they are leaving the scheme. It is not difficult to understand. The Government, in its wisdom, decided to reduce the PRSI scheme to a scale and polish. What good is that to a person who is in pain or requires an extraction? Who should pay for that?
Medical card holders are finding it difficult to access dentists in their towns and regions who are participating in the public payment schemes. These include patients with other significant health issues, as the Minister will be aware, which is all adding to the overall care burden. I will highlight an anomaly that needs to be addressed, which is the issue of autistic children in mainstream schools who do not get the same access to dental services as children in disabled schools. That needs to be addressed. We cannot have a situation like that. The parents of these kids are already facing the challenges of trying to access other disability services, such as speech and language therapy or occupational therapy, and now they have to try to figure out their route to oral supports as well.
As the Minister will be aware, oral diseases are becoming more common and they share risk factors relating to obesity, diabetes and heart disease. Our motion calls for a number of things but, in essence, we need to address the fact that more than 13,000 children are currently awaiting orthodontic treatment, we need to get dental checks done earlier and we need more adults, especially those with disabilities, who are facing delays to be able to access services, particularly under GI.
Beyond that, we need to up the numbers in the service. I am sure the Minister has heard that from the professionals. They have been telling him that more nurses and hygienists are needed and more access to work permits. They need more people in the system and they need to know what is the policy for the future. As has been stated, the private sector is largely carrying the public dental quota at the moment. That is a fact. One cannot expect professionals to go in and support the public component at their own cost. The Minister recently stated in the House that he is committed to finding a resolution. We recently received a briefing from members of the Irish Dental Association. I am not sure they share his position at the moment. I hope we will hear there has been some kind of re-grounding to all that.