Duncan Smith (Dublin Fingal, Labour)
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The crisis in our dental care has been discussed many times in the Chamber over the past number of months. The crisis is getting worse. The most recent estimates state that only 750 dentists remain in the dental treatment services scheme, DTSS. That is less than half the number in the scheme prior to Covid-19. Covid-19 is not the reason these dentists have exited the scheme, which covers medical card clients. Covid-19 has exacerbated this crisis, as has been the case in many areas. We are now left with a situation whereby those most vulnerable in society, who have the least discretionary funding or zero discretionary funding, are forced into a position where they must pay out of pocket for emergency dental procedures. Anyone in this Chamber, in this building or in this country who has had a toothache knows how painful it is. To have that and be unable to get treatment, to have to pay out of pocket, get loans from family to get dental extractions, is untenable and is something we cannot stand over.

It is more complex than that. I have an email from Lauren who writes on behalf of her brother, Philip, who has Down's syndrome. Philip, along with many others who have disabilities in Ireland, has major dental issues. He has no adult teeth and it is, therefore, crucial to maintain the teeth he has now. This is made more difficult due to frequent antibiotic use. The family has been informed by the HSE that dental care has ceased for individuals aged over 18 with intellectual disabilities. It has pulled funding from dentists who specialise in dentistry for people with additional needs. Given the ongoing medical card crisis, the family cannot access a dentist or a hygienist. That is just one example of the pain that a family goes through trying to access basic dental care for someone who needs it.

I have referred to the lack of access to dentists and the number of dentists who have exited the scheme. A woman in Swords advises that nobody is taking on medical card holders in the town at the moment. A woman in Swords contacted me. She is a wheelchair user. Her ability to navigate Swords is difficult, never mind having to get out to try to find a new dentist and get the much-needed care she needs. Today the Labour Party has tabled a motion on the cost of living. This is one of the many additional emergency much-needed costs that cannot be put off. Oral health is linked to good physical health. People cannot put off the care they require and they have to get loans from family for this. There is a crisis in north County Dublin and all over the country. The representative body for dentists has been seeking a meeting with the Department to discuss the DTSS, how it can be reformed and how we can get dentists back into it. This has reached crisis levels. Will the Minister of State give an update as to how she is going to resolve this and where we are in discussions with the industry? When will we be in a position where the most vulnerable in society are able to get quick access to dental treatment when they need it?

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for raising this important issue. There is nobody in this Chamber who has not been contacted in our constituency offices on this issue. I am taking this debate on behalf of the Minister for Health, Deputy Stephen Donnelly. The Minister is acutely aware that access to dental services for medical card holders under the DTSS has become an ever-increasing problem during the pandemic. The problem is that a significant number of dentists who were contracted by the HSE to treat medical card patients have chosen to leave the scheme, which has led to difficulties for medical card patients in accessing dental care. Some parts of the country have been particularly affected, an issue which is of particular concern to the Minister. The latest figures we have from the HSE suggest that 1,150 dentists are contracted to the HSE to treat medical card patients, which is approximately 300 down on the figure before the pandemic.

I understand that the reasons given by dentists for leaving the scheme are numerous, including issues around the sustainability of the scheme and the need to align it with best international practice. The Minister has listened to the concerns raised by the dentists directly, and to the Irish Dental Association, and has heard their frustrations with the scheme. They are firmly of the view that the range of services available to patients under the scheme and the fees payable to contracted dentists are out of kilter with today's environment. The Minister is keen that all of these issues are addressed as a matter of urgency. He fully accepts that there is a need to align the scheme with best international evidence and practice, as outlined in Smile agus Sláinte, the current national oral health policy that was published in 2019. Regrettably the Covid-19 pandemic caused the roll-out of the policy to be delayed and the proposed review of the scheme to be deferred. However, the Minister has given a commitment that there will be a root-and-branch review of the scheme, and his officials and the HSE expect to be in a position to begin that work by the second quarter of this year. In the meantime, he his seeking that the contracted dentists, and their representative association, the Irish Dental Association, work with him and his officials to address the immediate issues of concern and to ensure that we have a sufficient number of dentists available to provide services to medical card patients.

The Minister has also heard what the dentists have had to say about the viability of the scheme and he wants that addressed as well. The Minister secured an additional €10 million in budget 2022 to address this very problem. He hopes that agreement can be reached very quickly on how the money can be used to address some of the immediate problems with the scheme, pending the full root-and-branch review.

Officials from the Department and the HSE last met with the Irish Dental Association on 17 December. Certain proposals were put to the association and the responses to those proposals are now being actively considered by the Department and the HSE. The Minister hopes that through dialogue some interim solutions can be found as quickly as possible, for the benefit of patients and the dental community. As the Deputy quite rightly said, anyone who has ever experienced a toothache knows they cannot hang around.

In the meantime, officials are engaging with the HSE public dental service, the in-house salaried service, which is seeking to provide cover for any medical card patients who are experiencing problems in accessing a service from their local dentist.

Duncan Smith (Dublin Fingal, Labour)
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The situation is very complex. Another area of delay is the assessment of primary school children. I was very privileged to benefit from being screened in primary school, in fourth or fifth class, and being taken into what was the Eastern Health Board system at the time. Through my teenage years, right up to the week before my leaving certificate, I had everything from crowns to braces all done through the State. I was discharged a week before my leaving certificate and I will never forget it, having been captured in the fourth or fifth class. We need to get back to that quickly.

I am encouraged a meeting took place on 17 December, but my understanding from that meeting is that the Department is looking at quarter 2 of 2022 to move this process forward. That is too late. We cannot be discussing this in terms of quarters; we need to be discussing it in terms of weeks.

There has been a breakdown of trust between the dentistry world and the Department. That has to be repaired. I would ask, and I would like to put it on record, that there would be an independent chair of the discussions between the Irish Dental Association, the Government and the Department on this. That is what is happening with the consultants at the moment. That is what happened previously when the dentists had negotiations with the Government. That should happen again to rebuild trust and get to where we need to be. As I said, we must ensure those who are most vulnerable and those who need it the most get dental care. We must ensure that those children who need screening as early as possible in primary school get it in fourth class instead of hoping to get it in sixth class, if, indeed, they get it at all. This will be based on successful negotiations done quickly and which will bring about a resolution. I ask that this is raised with the Minister in the strongest possible terms.

Mary Butler (Waterford, Fianna Fail)
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Regrettably, this problem has become particularly acute during the past two years when the concentration of effort, both in the Department and the HSE, has been on the pandemic. That is not to say that officials have not been engaging with the dental profession. There has been engagement between HSE officials and the dental community throughout the pandemic on infection control measures and guidelines for safe dental practice, with a view to ensuring that a safe, satisfactory service could be continued for medical card holders.

However, the Minister acknowledges that there is an urgent need to address the fundamental issue of access to dental care. To achieve this objective, the Minister and officials wish to work in collaboration with the Irish Dental Association to address problems around access to services and to make the scheme more viable for contracting private dentists.

The €10 million the Minister has secured for this purpose represents an increase of nearly 20% on the existing budget. The Minister wants that funding invested as soon as possible, to make the scheme more attractive for practising dentists and thereby ensuring that a sufficient number of contractors will be prepared to continue to treat medical card patients. As I said, talks between the Department and the HSE with the Irish Dental Association are under way and there is hope a satisfactory conclusion can be reached by all concerns.

I will bring what the Deputy said back to the Minister because it is a very pressing issue and I agree with him on quarter 2. We need to push this rapidly.