Colm Burke (Cork North Central, Fine Gael) | Oireachtas source

I thank the Deputies for tabling the motion and giving us the opportunity to discuss oral healthcare services, to provide some updates on developments in the sector and to outline the Government’s priorities to fundamentally reform these services over the coming years. I am taking this debate on behalf of the Minister.

To be clear, this Government allocates over €200 million to the provision of oral healthcare every year. This shows our commitment to delivering real change in important areas. Improvements in access to care and in reducing waiting lists over recent years have been supported by significant additional investment since 2020, including an additional €15 million in core funding to support progression of the national oral health policy, Smile agus Sláinte, and a further €17 million in one-off funding to improve access and respond to waiting lists. This investment demonstrates the increased focus placed on improving oral healthcare services. I know that the Minister for Health wants to do much more to improve oral healthcare services and to address the access issues that are still there, through implementation of the national oral health policy.

The salaried HSE public dental service, PDS, provided care to several groups of patients. Last year it provided care to over 155,000 adults and children. Those with additional needs, who cannot receive care in a general dental practice, may need special care services provided by the HSE. The PDS provides these patients with oral health examinations. Where necessary, their treatment is provided using additional supports. This service provides care to many children and adults who would not otherwise have access to oral healthcare services. The HSE public dental service also provides oral examination and treatment identified as necessary for children at three intervals, at ages six to eight years, 11 to 16 years and, subject to capacity, nine to 11 years. These ages align with second, sixth and fourth classes. Emergency care is also provided for children up to 16 years of age and for those with complex and additional needs. The Minister is aware that there are backlogs in the examination programme in particular and that these are leading to delays in children receiving their first appointment. Notwithstanding that, in the first quarter of 2024, the HSE offered oral examination appointments to 13% more sixth class children and 9% more second class children relative to the same period in 2023, and the backlog in sixth class appointments has now been cleared in most areas. However, ultimately children need access to prevention-focused oral healthcare from birth, which points not just to improved access to healthcare services, but the need to align with new evidence which requires changing the service we provide to children and their families across the public and private dental services. This needs to be addressed through implementation of the national oral health policy, which I will speak to shortly.

On orthodontic services, the public oral healthcare services provided by the State includes orthodontic treatment. Increased investment, including an additional €10 million in one-off funding in 2023, has reduced orthodontic waiting lists by 8,700 patients, or 44%, between end-March 2019 and end-December 2023. Last year, more than 2,000 patients were transferred to private care through this funding. A further €3.35 million is being invested this year on a one-off basis to support the continuation of measures to reduce orthodontics waiting lists.

Last year, through the dental treatment services scheme, DTSS, the State provided care to over 283,000 medical card holders over the age of 16. In order to address contractor concerns regarding the DTSS, a range of measures came into effect in May 2022 to introduce and reintroduce elements of preventative care. The Minister for Health also increased the fees paid to contractors for most treatment items by between 40% and 60%. Fees paid to dentists for DTSS care are now aligned with other European countries which provide comparable public dental care, noting that many European countries, especially in the southern and eastern regions, do not have any scheme in place for adults, which is free at point of access. These measures are having an impact, with access to care increasing in 2023 and increasing further again into 2024.

Comparing the claims made by DTSS contractors nationally, in 2023, 154,864 additional treatments were provided under the DTSS, with over 26,700 extra patients treated in comparison with 2022. Activity has continued to increase further into this year. Preliminary data indicates an additional 12,104 patients treated and 43,158 extra treatments provided to compared to 2023.

These are all important measures making a real difference for patients today. In tandem we are also driving fundamental reform of our healthcare services for the future. In 2019 the national oral health policy, Smile agus Sláinte, was published. This Government policy aims to radically transform our current oral healthcare service, recognising that we need an entirely new approach to oral healthcare to meet the needs of our population into the future. The policy was informed by considerable evidence inputs, including support by an oral health policy academic reference group, consultations with key stakeholders, considerable feedback from a number of consultations with front-line workers including dentists and auxiliary dental workers, and a comprehensive qualitative research project.

The policy provides a framework to comprehensively reform oral healthcare services, supported by accompanying reforms to legislation, strategic workforce planning and education and training. Collectively, these reforms will examine the scope of oral healthcare in Ireland, to ensure a focus on basic and essential oral healthcare, provided in a reoriented community-based model of care to ensure our most vulnerable can access the care they need. The State has a responsibility to do this.

This is in line with the WHO's global oral healthcare action plan. For children, the HSE is developing comprehensive prevention-focused oral healthcare packages, starting with the group aged zero to two years. The aim is to support children to attend a local dentist from birth. This represents a significant expansion of care compared with the current model, which centres on three examination appointments starting at the age of seven. This will ensure a greater emphasis on prevention and early intervention for children when required. For adult medical card holders, the HSE is committed to the design and development of packages of expanded preventative care and will consult with the profession this year on the draft design as the first phase of reform of the DTSS.

As we systematically work through the implementation of the policy, we will walk through a public conversation on what oral healthcare is needed in Ireland within the framework set out within the policy, which is, in turn, based on international evidence. This requires a substantial change in dental training and education and an enhanced role for a wider range of dental professionals on the dental team, including nurses and hygienists, in the provision of oral healthcare.

Having been impacted by the pandemic, among other things, progress on the reform envisaged in the policy has been slower than the Minister would like. However, to support a focused and structured implementation of the policy, the Department of Health and the HSE are currently developing a three-year implementation plan for the first phase to guide an acceleration of reforms. This plan will be published in the third quarter of this year, following consultation with the sector.

On legislative reform, the Minister for Health is committed to reviewing the legislation underpinning the regulation of oral healthcare professionals, the Dentists Act 1985. A priority for 2024 is to consider the development of a small number of interim enhancements to the Dentists Act in areas identified as a priority by the Dental Council and to proceed with these where appropriate. This will include provisions enabling the Dental Council to develop a statutory scheme for CPD and competence assurance for registered dentists in line with those provided for other regulated health professionals. These interim measures will progress in tandem with a wider and fundamental reform of the 1985 Act, which must align with the reform envisaged in the oral health policy.

I assure the Deputies that the Minister for Health will continue the ongoing work being delivered by his Department to fundamentally reform the oral healthcare sector through the implementation of the national oral health policy to ensure that patients can access care. The continuing investments made will mean that, through the reforms being enacted, Ireland will have a modernised oral healthcare sector designed to provide the care that patients need when and where they need it.

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