Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I move:

That Dáil Éireann: acknowledges that access to dental care is in crisis and that urgent action is required by Government to address the many aspects of this crisis; notes that: — there are an estimated 104,000 children on a waiting list for the school screening dental service, out of an eligible 208,000 children;

— in the past five years there has been a 31 per cent reduction in children seen by Health Service Executive (HSE) dentists;

— the number of HSE dentists declined by 23 per cent between 2006 and 2022;

— the number of medical card patients seen under the Dental Treatment Service Scheme (DTSS) is down 35 per cent in the past ten years;

— the number of dentists participating in the DTSS has reduced by almost 50 per cent, from 1,600 to 810 in the past ten years;

— of the 810 dentists currently signed up to the DTSS only 600 are active;

— the Minister for Health announced in May 2021 that he would instruct his officials to begin talks on a new scheme as a matter of urgency, but the Irish Dental Association are still waiting for formal talks to begin;

— there is a need to address the overreliance of existing dental schools on non European Economic Area students in order to generate income;

— last year 50 per cent of the 300 students enrolled in our dental schools in Cork and Dublin were from overseas;

— plans to create a new dental school and hospital have been paused by University College Cork due to funding constraints; and

— access to operating theatres for patients who require general anaesthesia has been severely limited since the closure of the general anaesthesia clinic in St. James's Hospital in 2014; further notes that: — the National Oral Health Policy, Smile agus Sláinte, was published in 2019;

— one of the key actions in this policy was to bring forward a new Dentists Bill, as the existing legislation is almost 40 years old, however the heads of the Bill have yet to be developed;

— since 2008, the Dental Council has made five submissions to the Department of Health calling for the Dentists Act, 1985 to be replaced;

— recent reporting by RTÉ Investigates uncovered serious patient safety concerns which have eroded public confidence in dentistry;

— this includes 37 dentists who have worked in Ireland despite having been sanctioned in other jurisdictions, and a case of an individual convicted of sexual assault; and

— the Dental Council does not have the appropriate enforcement powers to take action against people practising dentistry while unregistered or to enter or inspect a dental practice; and calls on the Government to: — guarantee that all primary school children will receive their three school-based appointments at the appropriate age by 2027;

— urgently strengthen and expand the capacity of public dental services for children and special care patients;

— commit to providing the required funding in Budget 2025 to put the medical card scheme on a sustainable footing;

— immediately begin engagement with the sector to reform the DTSS;

— commit to publishing the heads of the long-promised Dentists Bill by September 2024 to ensure patient safety, the maintenance of professional competence, and to improve the regulatory framework; and

— address funding and capacity issues in dental educational provision in the coming academic year and prioritise comprehensive workforce planning to recruit and retain staff.

It is regrettable that the Minister for Health, Deputy Donnelly, has not turned up in the Dáil to listen to this debate. We have tabled this motion because access to dental care in this country is now in crisis. The current model of care for public dentistry is no longer fit for purpose. It is outdated and impoverished, and it is failing patients. For decades, it has been a Cinderella service, with successive Governments utterly neglecting it. While the current Minister for Health seems marginally more interested in reform than his predecessors, at least in terms of rhetoric, the bar was not high. Even he could hardly defend a record that includes over 100,000 children, or half of the eligible cohort, being denied school screening appointments last year alone.

Data shows that in respect of treatment under the medical card scheme, 150,000 fewer medical card patients received treatment last year than a decade ago. The medical card scheme is haemorrhaging dentists, with over 800 exiting the scheme since 2016. The Dentists Act remains largely unchanged since its enactment almost 40 years ago. By any measure, that is not a record to be proud of. The Minister, like his predecessors, has allowed almost every aspect of the service to spiral into crisis. In 1988, a Department of Health report found that the State's public dental service was failing in its statutory duty. That should give the Minister a moment of pause because 36 years later those words continue to ring true.

Following that damning 1988 report, and growing awareness of oral health inequalities, the dental health action plan was published in 1994. This was the first clear statement of the State’s aims and objectives in respect of dental care. Little did we know that it would be a quarter of a century before a Government would publish another national oral health policy. That came in 2019. In the intervening years, there were undoubtedly improvements in public dental services. For example, in 1994 the dental treatment service scheme, DTSS, for medical card holders was established. However, progress soon stalled. Even by 2002, a report commissioned by the Department described elements of the school scheme as a disgrace. In 2007, the then Minister for Health, Mary Harney, announced the development of a new oral health policy. That was followed by a two-year development process which led to the presentation of a draft plan to the Minister in 2009, but that plan never saw the light of day. It became a casualty of the economic crash and remains unpublished.

Due to this, oral health did not feature in any national health policy documents between 2001 and 2017, other than one mention of community water fluoridation. That was the extent of the interest in dental care. It would be 16 years before it received any further acknowledgment in national policy. That would come in 2017 with the Sláintecare report, which made two recommendations in respect of dental services, namely, to re-instate the pre-crash budget to the DTSS and to develop a universal package of dental care.

However, the following year the Sláintecare implementation strategy only made one passing reference to dentistry in the context of community-based care, and none of the subsequent Sláintecare action plans even mentioned oral healthcare. In 2019, however, the then Minister for Health, Deputy Simon Harris, finally published a new national oral health policy, Smile agus Sláinte. While many of its aspirations were broadly welcome, this document did not set out any roadmap for the practical delivery of its vision. This lack of focus on delivery is deeply concerning, and has led to endless talk about reform without any real reform.

It is also concerning and, quite frankly, bizarre that so little consultation with dentists and their representative body was carried out during the development of this policy. In a position paper published by the Irish Dental Association last month, its president, Dr. Eamon Croke, said that the Government launched its oral health policy "from behind a veil of secrecy, a residency it continues to inhabit". Despite numerous requests from the Irish Dental Association, the Minister and his officials have yet to explain to it how their vision is be enacted. In my view, there is one reason for that - they simply do not have a vision.

Successive Ministers have allowed every aspect of the public dental service to teeter on the edge of collapse, and it seems that the current Minister’s only solution is to outsource the problem. Instead of committing to building the capacity of public dental services, the Minister has suggested outsourcing children’s dental care to the private sector. That is not a solution. Even dentists in private practice do not think it is a good idea. They simply do not have the capacity.

Last month, a survey of Irish Dental Association members found that nine out of ten private dentists believe that the State should prioritise building the HSE dental service over a new scheme. The Minister already has a viable scheme in the existing school screening service; he just needs to prioritise staffing it. The school scheme needs at least 75 more dentists to bring it back to adequate staffing levels. It is also very disingenuous that the Minister consistently lumps dentists and doctors into the same category when citing rising recruitment figures. When we dig into the figures, we find that there are fewer dentists employed by the HSE now than in 2020.

When the spin is removed, it is clear that we are going backwards, not forwards. We now have some children receiving their first dental check-up in fourth year of secondary school, when they should have been seen on three occasions in their primary school years, during second, fourth and sixth classes.

For treatments requiring general anaesthetic, the waiting list is two years. These are serious treatments where a child needs a general anaesthetic and they have to wait two years. The delay in access to general anaesthetic treatment has been a major issue for children and special care patients since the closure of the clinic in St. James's in 2014. A new facility was earmarked for Connolly Hospital Blanchardstown but those plans have not progressed, leaving patients with complex needs languishing on waiting lists.

A complete overhaul of the medical card scheme is required. The Irish Dental Association has called for modernisation, not mere modification. Given what we know about the importance of prevention and retaining as many natural teeth as possible, it is perverse that the medical card scheme places restrictions on preventative treatments such as fillings when there is no restriction on the number of extractions . I could list countless other problems with the current model. Simply put, however, it is a relic of the 1990s and is no longer fit for purpose. The Minister, Deputy Donnelly, admitted that the State has had a blind spot when it comes to oral health. Why has he not done anything to change that? It is time for him to show urgency and act.

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