Tuesday, 26 June 2012
Topical Issue Debate
The Minister of State, Deputy Shortall, is aware of the difficulties that face homeless people. I wish to discuss the particular difficulties experienced by homeless people in accessing dental services. There are no reliable national data on the number of individuals who are homeless in this country. I have seen estimates of up to 5,000 people and concerns have also been expressed about the increase in the number of young people who are homeless.
I ask that funding be ring-fenced for dental services for the homeless in Galway and Galway city in particular. Galway Simon Community and HSE west are co-operating closely to help the homeless despite the moratorium on recruitment. Progress has also been made on funding for chiropody services for homeless people and a multi-disciplinary team has been put in place with a psychiatric nurse, a substance misuse counsellor and a designated community nurse. I pay tribute to the nurse, Ms Joan Gavin, and her team for the work they are doing. However, the homeless face major barriers to accessing dental services. They are a high risk group for oral and dental disease and dental services should form an integral part of the primary care services for these vulnerable people.
When I speak about homelessness I do not refer solely to those who are sleeping rough. Those who live in hostels, sleep on the sofas of their friends' houses or remain in hospital because they lack a home in which to recuperate are also affected by these issues. They receive limited entitlements because they are treated under the group medical card scheme but they also require dental services. Many also suffer from depression and other problems. My main request is that the Minister of State considers funding and considers ring-fencing funding for dental services for the homeless.
I thank Deputy Kitt for raising the issue, which he has been concerned about for some time. I am pleased to address dental services for homeless people in Galway. The dental treatment services scheme, DTSS, provides access to dental treatment for adult medical card holders. The service is provided by dentists contracted by the HSE. The DTSS budget for 2012 is €63 million. A free oral examination every calendar year and free emergency dental treatment are available to all eligible patients. Patients with special needs, those who have greater clinical needs and high-risk patients, including people who are homeless, receive priority for treatment. High-risk patients are those for whom untreated dental disease or the treatment of dental disease poses significant health problems.
The National Oral Health Office of the HSE issued standard operating procedures to dental contractors in November 2011 to support equitable and priority funding and provide clearer guidance to dentists on the application of DTSS prior approval requests. The procedures confirm that high risk patients are to be prioritised for approval. They receive all DTSS services that were available prior to April 2010, when services were reduced because of budgetary constraints. This includes an examination, all fillings as required and approval for complex care including root canal treatment, gum treatment and dentures. Homeless people, because of their lifestyles, tend to have a range of attendant needs including education, training, employment and housing, as well as a range of medical issues including addiction, mental health and general health issues. Addressing this range of requirements requires interaction between the HSE, Departments and statutory and non-statutory agencies. The needs of homeless people are complex and the response must be multi-faceted and complex.
The HSE has established a number of ways to bring health services to homeless people through, for example, the establishment of outreach multi-disciplinary teams that provide sessions in a range of homeless hostels and day services. The HSE gives priority to processing of medical card applications for homeless people in order to assist them in accessing available services. Of course, access to services can be arranged locally where necessary, pending a medical card being issued. Key workers for the homeless in Galway routinely link with dental services and the use of mainstream services is directed and encouraged.
The HSE is currently funding a diploma in special care for six dentists as part of an upskilling programme. Part of their training and remit includes the provision of services for homeless people and other vulnerable groups. The expertise of the graduates will be used to advise and support decision making on dental services for homeless people. I am pleased that, once qualified later this year, one of the graduates will be assigned to the HSE west area.
I thank the Minister of State and I am pleased to note that the diploma is being funded by the HSE as part of an upskilling programme. One of the six dentists will be assigned to the HSE west area. Apart from the representations made by me, the Minister of State also received representations from the Galway Simon Community, which does great work, and the multidisciplinary team under Ms Joan Gavin, which lobbied strongly for funding. I hope that what the Minister of State says will be put in place. Many people feel that, even with various limited services available and the fillings and extractions allowed under the medical card, we do not meet the needs of a vulnerable group of people. Perhaps matters will improve and I give due credit to the Minister of State for the funding of chiropody and other services. Providing services for homeless people is complex. Depression and the insecurity of people living in hostels, friends' houses or in hospital and worrying about where they will go when they are discharged must also be dealt with. I hope the extra funding for the diploma will help. Everything should be done to meet the needs of a vulnerable group of people.
I appreciate the concern of Deputy Kitt in this regard. I assure him that I will give this issue further attention in the coming months. It is a welcome development that additional dentists will be trained specifically to cater for vulnerable groups, including homeless people. The additional person in the HSE west will be a positive development. I hope I can come back to the Deputy later in the year with specific details on what is proposed. People who are homeless in the Galway area, who have medical cards, are entitled to the enhanced services currently available. I appreciate the difficulty in accessing such groups or encouraging them to avail of the services but I encourage them to take up the services available to them.