Marie Sherlock (Dublin Central, Labour)

I extend a sincere welcome to the Young Scientist winners. I sincerely thank Deputy Stanley for his motion. The reality is that public dental services in this country are on the brink of collapse. We know there has been an almost 40% drop in the number of dentists participating in the dental treatment services scheme over just five years. The number of directly employed HSE dentists has fallen by about one third since 2009. When we think back to those awful years post the recession, there has been no investment by the HSE since to increase the number of dentists working directly within the organisation. We know in places like Laois–Offaly that school assessments have had to be suspended. In other parts of the country, sixth-class assessments are now being conducted when the children are in sixth year of secondary school. As one dentist said to me yesterday, some of her children are now driving themselves to their appointments. That is outrageous. The critical point here is that with all these facts and figures, we have a very clear picture and it is that the public dental services are being allowed to whittle away in favour of the private provision of dental care, leaving those on low incomes and with limited means in a desperate situation.

Let us start with the public dental service. We have just 249 dentists covering the entire country, down from 330 in 2009. It is scandalous that this has been allowed to happen. As I said, this has a very real impact, particularly on low-income persons and people dependent on the medical card or with particular dental circumstances who cannot access private services. There was a time when the school assessments used to happen in second class, fourth class and sixth class. There were even senior infant assessments in some parts of the country. Now, in many parts of the country assessments are limited to sixth class, or will be in the coming months.

Of course, by the time those children get picked up, the result is that there are very high levels of decay and increased levels of extractions. The extremely important orthodontic checks are not being picked up because the dentist is the first point of contact and screening with regard to the need for an orthodontic check, especially when children are coming up to their teenage years. This is leading to much more complex and expensive care being needed as those children go into adulthood.

Not only have pay and numbers had an extraordinarily devastating impact on dental employment within the HSE over the past number of years, it is also the case that the recruitment process, where it does exist across some of the health regions, is painfully slow. One principal officer told me yesterday that it took 14 months for his role to be filled. It is not just about dentists; it is also about nurses. Another dentist working within the HSE has told me that he cannot provide clinics because he does not have the nurses available. A business case must be prepared to try to recruit a dentist. They will be lucky if that recruitment process commences by Christmas. This is completely unacceptable. It is perhaps the silent aspect of the motion before us. While we are talking about dentists, it is also about dental nurses. They are a critical part of the infrastructure because no dentist can function unless they have a dental nurse by their side.

The key devastating part of all of this is some of our most vulnerable children are those who are being hit hardest. Children with additional needs or special needs who require care under general anaesthetic are obliged to wait two years or more for that care. Kids in Kildare have to travel to Dundalk in order to be treated under general anaesthetic. Kids in Waterford have to go to Cork for such treatment. I am aware that in one part of the country adults requiring specialised care involving general anaesthetic have to wait five years for treatment. That is absolutely unacceptable.

We have to get serious about recruitment to the HSE. We also have to get serious about the dental treatment services scheme and the number of dentists who are no longer participating. There has been a drop of 38.4% in just five years. The number participating is down to 833 according to the responses received by my office to parliamentary questions I submitted. If we saw this level of drop in GP numbers in this country, it would be a national scandal. Yet, because it is dentists, we are not seeing the same reaction. We need much greater ambition and direction on the part of the Ministers of State, Deputies Butler and O'Donnell, to ensure that dental services are properly resourced.

The other big part of the jigsaw is recruitment. In reality, if you are a dental student graduating in this country, botox anaesthetics is a very lucrative path to go down. We know that some dentists are going down that path. For others, staying within private practice is certainly a much more exciting prospect because of the range of services they get to provide. There is a real issue where dentists with a number of years' service go into the public system because the range of services they provide is arguably more limited. We need to look at the schemes that existed in the past. The vocational trainee scheme, for example, was in place 20 years ago. There used to be five places across the Republic whereby a dental graduate would effectively work under the mentorship of a private dentist and within the HSE for a 12-month period. This provided fantastic training before they went out into private practice or public practice. That scheme has been gone by the wayside for many years. It needs to be reintroduced.

There is another reality within our dental schools and in the context of the profile of students within those schools. A large number of those graduating from our dental schools are not staying in this country. They are going abroad. From talking to some dentists, I understand that 20 years ago the majority of students were Irish born and from the Middle East. We are now seeing a large number of students from Canada and other parts of the world coming here, availing of world-class training, paying for it, obviously, and then leaving very quickly after graduating. This is a serious issue. The State is spending significant amounts of money on that training. Obviously, those students who are coming have to pay but there have to be real questions about the third level institutions providing dental training and about what are we doing to ensure that we retain those dentists into the future.

The system of PRSI benefits was enormously popular prior to being cut back in 2009. It was enormously popular for people in being able to go to their dentist and avail of a range of services paid for through their PRSI. That has been scaled back dramatically. People can now only avail of a very limited number of services. Ultimately, if one needs any sort of proper work done, one must go private. It is high time that we ensured an expansion of the range of benefits afforded to people by means of their PRSI. Oral care and dental care are hugely important for our population's health, and the State is doing far too little to support those involved in providing them. A crucial point is that for far too long people feared the procedures carried out by dentists; now they fear the length of time they have to wait to try to access dental procedures. That is unacceptable. If we saw the same drop in the numbers in GPs that we are seeing in HSE dentists, and those participating in the DTSS, then we would not be here in the Chamber debating with these small numbers. We would be having a much larger national conversation. We need this Government to take dental services and how they are resourced much more seriously and ensure that many of the things called for in Deputy Stanley's motion are implemented.

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