Mary Butler (Waterford, Fianna Fail)

I thank Deputy Stanley and his colleagues for tabling this motion and giving us the opportunity to discuss oral healthcare services. The motion is timely, given that the Minister for Health has only last week officially opened the RCSI's new dental education centre in Sandyford. The motion, which the Government is not opposing, provides a chance to update the Dáil on developments in the sector and to outline the Government’s priorities to fundamentally reform dental services. As Deputy Murphy said, it is really important that we are talking about dental treatment services and oral hygiene.

To be clear, this Government allocates over €230 million to the provision of public oral healthcare services every year across the Departments of Health and Social Protection. This ongoing investment shows our commitment to delivering real change in important areas and to addressing the challenges that we acknowledge exist in the provision of oral healthcare services. Improvements in access to care and in addressing waiting lists over recent years have been supported by significant additional investment. This included an additional €15 million in recurring HSE funding between 2022 and 2024 to support progression of the national oral health policy. A further €17 million in one-off HSE funding was provided between 2022 and 2024 to improve access and respond to waiting lists. This investment demonstrates the increased focus placed on improving oral healthcare services.

At the same time, we acknowledge much more needs to be done. The Minister for Health wants to do much more to improve oral healthcare services and to address the access issues that are still there. This will be achieved through the implementation of the national oral health policy. This year, a further €2 million is being invested to support implementation. This will increase to €4 million next year. It will support recruitment of additional dentists and dental nurses into the HSE. A further €2.85 million is also supporting continuation of successful orthodontic waiting list initiatives.

The salaried HSE oral healthcare service provides dental care to several groups of patients. Last year it provided care to over 156,000 adults and children. This includes almost 50,000 emergency appointments to eligible patients, on a same-day or next-day basis. Those with additional needs, who cannot receive care in a general dental practice, may need special care services provided by the HSE. The HSE 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.

Regarding access to public oral healthcare services for children, there are access issues in respect of the current model of service provided by the HSE. This service aims to offer the first of three appointments to children while they are in second class - at approximately seven years of age. Due to the impact of the pandemic on the operation of its dental clinics, the HSE has had to prioritise patient groups in order to ensure emergency care remains available for all eligible patients. Within the three childhood appointments, the sixth class appointment is prioritised by the HSE. This is to ensure that children receive preventative fissure sealants on their permanent molars and, for those who require it, referrals for orthodontic assessment.

It is important to note that the number of examination appointments being provided by the HSE to its target group is increasing. In 2022, 99,000 such appointments were provided. Last year, this increased to almost 107,000 appointments, including almost 15,000 appointments for children on the second class list. I acknowledge that, previously, it was second, fourth and sixth class. Sixth class is now being prioritised.

On recruitment, the RCSI proposal was really welcome, and the Minister opened the RCSI Dental Education Centre last week. The Royal College of Surgeons in Ireland will commence its new bachelor of dental surgery in September 2025. This will train students in a community-based model of dental education, significantly increasing the number of dentistry training places available nationally and expanding access to dental services. This was what Deputy O'Gorman spoke about just some minutes ago.

The new RCSI bachelor of dental surgery programme will provide for between 25 and 26 students, 20 of whom will be EU students from 2025 onwards. The RCSI will provide these 20 EU places from September and would like to be in a position, with Government support, to increase the number to 35 the following year. Over time, this will expand domestic graduate output by approximately 25% and will contribute to workforce sustainability. Overall, the RCSI has indicated it will produce 75 graduate dentists when fully operational. Within the model, the RCSI proposes to establish dental education centres that would be community based dental clinics to train students. This is really welcome. These centres are planned to be located in areas of deprivation where there is a pronounced need for greater access to community dental care and there is a dearth of both HSE infrastructure and private dentists participating in the dental treatment services scheme. The RCSI will train the dentists in their facility in Sandyford and the Connolly education centre. The RCSI also plans to train dentists in an outreach primary care centre in Ashtown, north Dublin. This is really welcome.

Last year, the State provided care to 300,000 medical card holders over the age of 16 through the dental treatment service scheme, DTSS. In order to address contractor concerns regarding the DTSS, a range of measures came into effect in May 2022. The Minister for Health also increased the fees paid to dentists for most treatment items by 40% to 60%. These measures are having an impact with access to care continuing to increase each year since they were introduced. In 2024, more than 227,000 additional treatments were provided under the DTSS, supporting more than 44,000 extra patients. Activity has continued to increase further into this year. Preliminary data from the first half of the year indicates almost 3,000 patients have been additionally treated compared to the same period in 2024.

The Department of Social Protection administers the treatment benefit scheme funded by PRSI contributions to the Social Insurance Fund. The scheme provides a financial contribution towards certain dental, optical and medical appliance services for eligible social insurance contributors. In all, more than 2.7 million contributors are eligible for services provided under this scheme. These treatments are also available to their dependent spouses or partners, if applicable. Under the dental scheme, the full cost of one oral examination per calendar year is covered. The scheme also provides a payment of €42 towards the cost of one scale and polish with the patient paying the remainder, capped at €15. Furthermore, it provides a payment of €42 towards periodontal treatment with the balance payable by the patient. All the above payments are available to eligible contributors once every calendar year.

Activity within the dental element of the scheme is increasing in both claim volumes and associated costs. In 2023, €63.7 million was spent on 1.6 million claims, while €75 million was spent on 1.7 million claims last year. The Department of Social Protection keeps schemes under regular review to ensure they meet their objectives. Any changes to the treatments available under the scheme would have to be considered in a policy and budgetary context.

There are also important measures making a real difference for patients today. In tandem, we are driving fundamental reform of our healthcare services for the future. The Government’s national oral health policy, Smile agus Sláinte, 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 provides a framework to comprehensively reform oral healthcare services, supported by accompanying reforms to legislation, strategic workforce planning and education and training. Implementation of this policy is a programme for Government commitment. To support a focused and structured implementation process, the Department of Health and the HSE are currently finalising, following the targeted external consultation, a three-year implementation plan for the first phase to guide an acceleration of reform. The Deputy asked about this when he spoke and my understanding is that this plan is currently with the HSE for further observations. Mr. Bernard Gloster, the chief executive, is part of the management team that will be signing off on it. That is where it currently stands at the moment. The plan is with the HSE and we hope to expedite it as quickly as possible to support a focused and structured implementation process. The plan will provide a multi-annual framework for policy implementation and will help to inform the necessary budgetary considerations.

I did not get to conclude my written speech because I wanted to include the piece about the RCSI, but there is a copy of it that the Deputies have all received.

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