Matt Shanahan (Waterford, Independent) | Oireachtas source

I welcome the motion, which is constructive and timely considering the present challenging trajectory of dental service provision in Ireland. Dental services are a subject that comes up repeatedly in constituency offices around the country. That is no surprise, given our increasing population and the declining investment in State-supported expenditure to dental schemes and care. The headline statistics show that the service is in crisis. Some 104,000 children, of the pool of more than 200,000 who can avail of them, are on a waiting list for school screening dental services. The number of medical card patients seen under the DTSS has declined by 35% in ten years. That is a horror statistic. At the same time, the number of dentists participating in the dental scheme has reduced by almost 50%, down to 810, in the past ten years.

The number of these who are actually practising is down to 600. As each year goes by more and more dentists are withdrawing from the DTSS. Surely this is evidence of a scheme that is not fit for purpose. Beyond all of this we have the issue of the number of dentists who graduate in this country each year. It is only 300 nationally and of these more than half are overseas students. This brings me to another interesting point, which is the issue of the South East Technological University. Dentistry is one of the programmes being bandied about as being possible for SETU. What is at play is lack of any will of Government to invest in providing increased dentistry services.

Among the main calls in the motion is to ensure by 2027 that all primary school children will receive their three school-based appointments at the appropriate age. This does not appear to be an objective that should be too difficult to achieve if the will was there to receive it. We used to be able to do this. The motion also calls for a review of the funding to expand the capacity of public dental services for children and special care patients, as well as for the medical card scheme to be resourced properly. The bones of the problem which the motion seeks to address is support for medical card patients and those who do not have medical cards trying to access private dental services. The motion also calls for the publication of a new dentists Bill by September 2024 to address the capacity issues in dental education and to prioritise comprehensive workforce planning. In other words, it calls for legislation to be published that will put out the roadmap to finally solve our problems with dental services in this country.

All of this assumes the Government has a comprehensive plan and that individual initiatives in the plan can address the limited access to services in a timely manner. Medical card holders are supposed to be able to access the DTSS and many Deputies have told the Minister of State there is ample evidence this is not happening. The treatment benefit scheme, another scheme in the service, is supposed to provide dental care for non-medical card holders if they have sufficient PRSI contributions. Anecdotal evidence suggests that dentists have also avoided providing services under this scheme and this is because of the long delays in getting reimbursed for their costs and their work.

The public dental service is also failing in its remit to provide early oral health assessment for primary schoolchildren and the primary care treatments that arise from this. Many of us are aware of parents whose children have gone into secondary school without being properly attended to under the scheme. It has already been said that many families are suffering significant additional costs in trying to access private care when they are already struggling with the cost-of-living crisis.

The situation for children with significant orthodontic requirements is even worse given the lack of access to qualified people to take on this work and the significant waiting lists. Again, as an elected representative I am constantly approached by people in this situation. It is heart rending to see people waiting years for children to have basic orthodontic treatment and to access the service.

Overall the summary is the business strategy is not working. The 2019 national oral health policy, Smile agus Sláinte, seeks to provide better care access at all levels but with a particular focus on reorienting the provision of public dental services for children away from the public dental clinics and towards the private dental sector. If we are going to do it, can we not get on with it? If we recognise that perhaps in the private sector it is possible to get value for money, then get about engaging with the dentists' representatives and reimburse them properly for their services. This policy would see treatments carried out by private dentists contracted by the HSE. The reason the policy is failing to get traction is that it has been the habitual failure of the Government to understand the costs of running a business. This is what a private dental practice is. It is a business. The logjam is in dealing with bureaucracy and delays in public procurement and reimbursement.

As I have said, there is a history of a lack of real engagement by the Government with national dentistry representatives. We have a capacity and funding issue with respect to national dentistry and orthodontic provision. We have to make steps to address both. It is the job of the Government to ensure these two objectives can be met while delivering value to the taxpayer and service to the citizen. The heads of the new dental Bill need to be published to show how the Government plans to address the continuing dysfunctional performance of our public health dental and orthodontic services.

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