Dáil debates

Wednesday, 23 June 2021

Saincheisteanna Tráthúla - Topical Issue Debate

Dental Services

9:32 am

Photo of Verona MurphyVerona Murphy (Wexford, Independent)
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I thank the Leas-Cheann Comhairle for the opportunity to bring this issue to the attention of the House and the Minister of State. I thank the Minister of State, Deputy Butler, for stepping in on behalf of the Minister for Health, Deputy Stephen Donnelly, whose area this is. The dental treatment services scheme, DTSS, provides access to dental treatment for adult medical card holders aged 16 years or older. Medical card holders are entitled to a free dental examination in each calendar year as well as any extractions required, along with a number of other services. Last November it was reported the number of private dentists participating in this scheme had dropped by 16%, from 16,054 to 13,093 in the ten months between January and October 2020. That is a large percentage reduction. It is estimated around 200,000 medical card holders are facing delays for treatment as result. On foot of these alarming reports I have submitted a parliamentary question to the Minister seeking a breakdown of the number of dentists per local electoral area in County Wexford. The response said there were ten dentists in Wexford and four in New Ross. Unfortunately, based on the following correspondence, it seems the situation may have worsened since those figures from last November. I quote an email from a constituent:

Dear Verona,

My dentist informed me that they have stopped treating medical card users and to contact Grogans road for further information. They told me that 4 dentists in Wexford and none in New Ross were still in the scheme. However when contacted they all told me they had left the scheme.

I am a pensioner in me 70s taking Warfarin which needs regular dental checks free under the scheme and now face heavy fees.

Is there any hope that there will be a dental medical scheme any time in the future.

It appears, therefore, that in the space of the eight months since last November, the number of dentists in the scheme from just two local electoral areas in County Wexford has reduced from 14 to 4. That is pretty alarming. I hope the Minister of State can confirm whether these figures are correct and what steps will be taken to address the issue of why so many dentists are now finding it unfeasible to continue in the scheme. I understand the Irish Dental Association, IDA, has met with Department of Health officials to discuss its concerns. I ask the Minister of State to outline in her response whether anything has happened as a result of those discussions and what solutions have been proposed.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I thank the Deputy very much for raising this very important issue. I welcome the opportunity to address the issue of the current difficulties in the dental treatment services scheme. The DTSS provides dental care, free of charge, to people with medical cards aged 16 years and over. These services are provided by independent dental practitioners who have a contract with the HSE. Patients may choose to have their treatment undertaken by any dentist who participates in the scheme.

I am aware that there has been a reduction in the numbers of dentists participating in the DTSS since the beginning of the Covid-19 pandemic. HSE figures indicate that up to the end of April 2021 approximately 213 dentists had left the scheme or had notified the HSE of their intent to leave the scheme. Of those, approximately 27 had left or had notified the HSE of their intent to leave between January and the end of April 2021, with 112 applications for new contracts being processed. To answer the Deputy's question directly, there are approximately 1,200 contracted dentists at present, with approximately 700 claiming per month.

Some people have been experiencing problems in accessing dental services close to their home as a result of dentists leaving the DTSS and there is probably not a Deputy in the House who is not aware of it. However, the HSE has assured the Department of Health that its local services on the ground will assist any individuals who are experiencing problems in accessing a service. Officials in the Department of Health have been engaging with the Irish Dental Association since the start of the pandemic. My colleague, the Minister for Health, met with IDA representatives in November 2020 to discuss their concerns and he addressed their annual conference last month. The Minister has asked officials in the Department to work with the HSE and the IDA to develop solutions that will ensure the sustainability and viability of the DTSS. The Minister is committed to ensuring all eligible persons should continue to receive the services that they deserve from their local dentist of choice.

The future provision of oral healthcare services will be informed by the national oral health policy, Smile agus Sláinte, which was published in 2019. It includes proposals for the introduction of packages of oral healthcare for adults with medical cards at different intervals during their life course. The packages will focus on preventive dental services. Routine care, including additional fillings and complex care, will continue to be available in addition to the preventive packages of care. The Minister is committed to ensuring the sustainability and viability of the DTSS. It will need to be revised to align with up-to-date best practice and evidence. This will mean - and this is the really important part - moving away from symptom-led attendance and an emergency focus, to encouraging attendance for preventive care and the provision of evidence-based oral health care tailored to each individual's needs.

There was an intention to commence a review of the contract between dental practitioners and the HSE last year. Unfortunately, due to the pandemic this was not possible. However, the Minister has asked officials in the Department to engage with the Irish Dental Association to commence this process. A meeting between the Department, the HSE and the Irish Dental Association is being organised for next week and the Minister is confident that progress will be made in resolving the current difficulties.

9:42 am

Photo of Verona MurphyVerona Murphy (Wexford, Independent)
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I thank the Minister of State for her reply. I am heartened to hear what she said because this is an urgent matter. She will have noted from the email I received from one of my constituents, which I read into the record, that this man is in his 70s and had been working. He received his over 70s medical card but it is of no benefit if he is unable to get an appointment. I heard what the Minister of State said with respect to the Irish Dental Association and the Minister. Apart from him asking his officials to engage, the number of dentists leaving the scheme is astounding. The Minister should engage directly to make sure the scheme is not eroded further or we will have a very serious crisis on our hands.

The same issue arises when it comes to doctors, although not with medical card patients. Many of my constituents email me complaining they cannot access the doctor as a private patient, for example, when they have moved into an area. One man told me recently he lives in my area but has to return to Navan for a standard GP visit.

The gentleman whose email I read into the record takes Warfarin and he does not make an appointment at the last minute. He needs regular dental check-ups. Equally, many people attending for medical or operational procedures in our hospital healthcare system have to visit the dentist before they will be given an anaesthetic. Those people cannot always pay for the service. They may be under the medical card scheme and the dental treatment services scheme. I know the Minister of State will report to the Minister the urgency of the matter and the detrimental effect it will have if the numbers leaving the scheme continue to be eroded in this vein.

If the Leas Cheann Comhairle will permit me, I would like to briefly ask the Minister of State to consider speaking with the National Immunisation Advisory Committee, NIAC, on the roll-out of the second vaccine for those in the 60 to 69 age cohort. That second vaccine is primary for the protection of those in a vulnerable age category against the Delta variant and it is important it is rolled out as soon as possible.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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To answer the second query the Deputy raised, that is ongoing and something of which I am very much aware.

As I said, the Minister, Deputy Donnelly, met the Irish Dental Association last November, he spoke at its conference last month and is acutely aware of the challenges. We have discussed it. The reason some dentists say they are leaving the scheme is that they have been seeking a review, including increases in fees, for a number of years. There have been significant changes in dental practice since the current contract was agreed, particularly during the past decade, including new radiographic standards, new technology and higher standards in infection prevention and control, which has added to the cost of running a practice. Dentists also claim the costs associated with the current Covid-19 pandemic, including the additional cost of the personal protective equipment, social distancing of patients and staff being less available, have placed an additional burden on dental practices.

There is no doubt Smile agus Sláinte, the national oral health policy, provides the guiding principles to transform our current oral healthcare service over the next eight years. I look forward to the pending meeting next week between the HSE, the Department and the Irish Dental Association because it is imperative people can get that care when they need it. As we all know, the worst pain one can ever have is toothache. I look forward to reaching a stage to which we aspire, namely, that we move away from symptom-led attendance and an emergency focus to encouraging attendance for preventative care. I will be happy to update the Deputy when we have more information.