Brian Stanley (Laois, Independent)

I join with the Leas-Cheann Comhairle in welcoming the visitors to the Gallery. I welcome Fintan Hourihan from the Irish Dental Association, as well as Pat Fitzpatrick. As a councillor, I met Pat Fitzpatrick a few times in his former role.

We are all elected here to be the voice of the people - Teachtaí Dála, Dáil delegates. Not to take any cheap shot, but the Government benches have been empty throughout this debate. Not one member of Government, apart from the Ministers of State, spoke. Maybe they do not see there is any problem in dental health, but I find that remarkable. Maybe they are not hearing it from constituents. We have had a range of speakers from across the Opposition benches, from Kerry to Donegal, from Dublin across to Galway, and everywhere else in between. The problems and some suggestions have been outlined, and that is welcome. I welcome the fact the Minister of State is not opposing it. I know he and the Minister of State, Deputy Butler, are sincere in what they are doing. In his closing remarks, he framed it in the context of Sláintecare, and we have to set it in that context. That means we must start providing the proper dental health services that are available to everybody.

It is like many other problems, including housing. There is no one thing that will fix any of it. There are a number of parts, and a number of them are being focused in on, in fairness, and were identified by Deputies. I also tried to do it in the motion and in the proposals I tabled.

The Minister of State, Deputy Butler, mentioned the overall budget of €230 million. That is the case, but we cannot have budgets without tracking the outcomes. Outcomes have to match any increase in budget. That needs to be clear and I am saying that as an Opposition TD. Throwing money at something will not solve it on its own.

People going abroad has been mentioned. There is even a term now I heard recently, namely, “Turkey teeth”. We have seen good and bad examples of people coming back with treatment. However, if they are going there, it is a failure.

What brought this to my attention a number of years ago, and I have raised it since joining the House – it is my 15th year here – is that an acquaintance of mine wound up nearly dying in hospital because of poor dental health. Poison got into his system. He was a fine hardy fellow and it almost killed him. It really underlined the problem for me.

I raise another issue. I watched my granddaughter go through primary school. As far as I can remember, I saw the dentist in third class – it is a few years ago now – in the dispensary in Mountrath. Everybody else also saw the dentist at that time. Here we are now, and she did not see the dentist in primary school. She came out of primary school. She and her pals - I know the kids she was going around with at the time - are now near the end of their teens. They went through secondary school and almost came out the other end without seeing the dentist. They saw the dentist in the past year. That was their first examination. It brought it all into sharp focus for me.

Under section 67 of the Health Act 1970, the HSE must provide dental treatment and appliances for those on medical cards.

We must increase the number of places. Some 65% of dentists have been unable to recruit additional people. There has been no progress on the new dental school at UCC since the then Minister, Simon Harris, turned the sod in 2019. My understanding is the funding is being withdrawn.

Only 10% of dentists work in the public dental health services. Even private dentists are saying that figure needs to be doubled. We need to double the percentage to have a representative number in the public dental system. It is like the GP situation. Not all dentists can afford to open a private practice or want to open a private practice because they would have to run a small business and there are a lot of costs associated with that. Women, because of the reality of the world we live in, need to work a 35- or 40-hour week while also having other responsibilities trying to manage their families and everything like that. They want to work a nine-to-five job, and a lot of men do, too. Men are now taking on a greater role in parenting children. We must try to get more people into the public system and the private system.

The shortcomings and the limited number of services available under the dental treatment benefit scheme have been outlined very graphically. Portugal, as I understand it, has a voucher scheme. I do not want to make this look cheap, but the voucher scheme would allow people to access the services they or their dental surgeons consider they need under the dental treatment benefit scheme. It is something the Minister of State may consider. I mentioned the six-year waiting list for orthodontic services. Nothing happens during school term in primary. Nothing happens during secondary. They then come out the other end and it is all over at that stage. The opportunity is gone, and that is really disappointing.

I will read a short letter, which is one of many letters I get. This came from somebody working in the public dental services who wanted to outline to me some staffing issues:

There have been jobs advertised and no dentist have applied. There are currently two full time dentists covering all of Laois. They are currently doing late evenings or try get through the list.

I acknowledge here the efforts of one particular HSE manager, Joe Ruane, in getting that in place. I want to acknowledge that because there are people trying to change things. I welcome that fact and I recognise the efforts of those people working late in the evening to try to do that, shorten the list and get on top of this. The letter writer goes on to say:

There are very few dentists qualifying in Ireland as college spaces are limited and non-Irish Nationals tend to go back [to their home countries] once qualified. Maybe you could speak on the dental hospitals in Dublin and Cork and maybe they could come up with a scheme that once you qualified you have to practice in Ireland for a year [or, as some Deputies have mentioned, two years]. I know two years ago 43 dentists qualified in Dublin and only 10 stayed in the Country.

I will finish there and will not read the rest of it. That to me brings home the problem we are facing. The overall dependence on foreign students has been mentioned. I have nothing against foreigners. They are welcome, particularly those who are working in our public health system, but governments of other countries are paying them to come here to train. The funding from that is supporting the dental schools. This is something I have put a lot of work into looking at over the years. In the past few months, I have decided to give this a particular focus while I am in the Dáil representing Laois during this term. We cannot have a situation where the dental schools are depending on foreign students. The spaces are taken up. We are not educating and training enough dentists to work in either the public or private systems here. We need to get on top of this.

As has already been outlined, dental care is not a luxury. We need a fix. I outlined the new dental plan, the timeline for which the Minister of State, Deputy Butler, referred to when she spoke earlier. That needs to happen a lot quicker. We also need that scheme for the under-sevens. The Minister of State knows what needs to be done in the dental schools in TCD and UCC in terms of additional funding. The structured mentorship programme and its different forms have been spoken about. It needs to be brought on stream so that people can gain work experience.

On HSE recruitment, I think it was Deputy Sherlock who mentioned a 14-month wait for one person between being told that person would be taken on and actually starting the job. People will go elsewhere. They are not going to hang around. They cannot hang around because they have to bring in money to live in an expensive economy and country.

There is also still something wrong with recruitment for the DTSS. I acknowledge the 40% increase in payments, but the scheme is not being taken up. There needs to be a dynamic advertisement and recruitment campaign for the DTSS. The services under the treatment benefit scheme need to be expanded. The voucher system also needs to be looked at as one option. I do not know all the ins and outs of it, but it certainly should be considered.

For those people with special needs, I plead with the Minister of State, because I have come across some terrible cases where people have had to have treatment under anaesthetic because they are autistic or have some other condition. That needs to be fixed in the hospitals providing those services. I have seen awful situations.

I welcome this opportunity. I know the Government is not opposing the motion and I welcome that, but let us not just go out of here this morning and nothing then happens. Let us use some of the suggestions put this morning. They are being put forward genuinely from Kerry to Donegal and Galway to Dublin. I am telling the Minister of State that the situation is really serious in Laois. It needs a fix and I plead with the Minister of State to fix this issue.

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