Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I thank the Minister of State for attending to take this debate. This issue is not unique to anyone's constituency, but I hope to hear from the Minister of State what I can tell my constituents when they ring my office. I will provide an example and call the woman involved "Mary". That is not her real name, but I am sure she does not want her name used. Mary has multiple sclerosis and lives in Swords. Last June, she needed to attend a dentist. She is a medical card holder and she tried every dentist in her local area, but none of them was taking on new patients and some of them that she had previously attended had since pulled out of the scheme. The story will be similar up and down the State. She rang the HSE and, happy days, it gave her the number of a dentist a small bit outside her area. Remember, this is a woman with a significant and ongoing condition, but she said it was great anyway and she would ring the dentist. My constituency is the largest in Dublin in terms of population as well as geography, but according to the HSE, there is only one dentist in the whole of north County Dublin taking patients with medical cards. Surprise surprise, but he was full and was not taking on any more patients.

From time to time, I advise my constituents to try to attend the Dental Hospital, but that is not really an option. In the interim, routine care is being missed out on. It is not unique to my area, but we have ended up in a situation where our level of extractions is among the highest in Europe. That is because people cannot access dentists before the point where they are up all night with a toothache. I am someone who hates the dentist. Even though I know I should not, I wait until I am up all night with a toothache before going to one. For people who are trying to be proactive about their dental health, there is nothing available.

I want to hear from the Minister of State what I can tell my constituents. I understand that negotiations are ongoing with the Irish Dental Association, but what should someone who needs to see a dentist do in the meantime? I will not go through everything, given that the Minister of State will have heard it all in her own area. What can we tell people who need to access dental treatment but who do not have the necessary means? In some of the newer - I will not say "swankier" - dental practices that are chains, the first thing that people see when they walk in are large signs telling them that there are payment plans. We are in the middle of a cost-of-living crisis and people cannot afford to get their teeth done. They certainly cannot afford to be getting themselves into debt, but they are now at the stage where they have no choice. Getting a loan to have their teeth done and another loan to get them done again is not a feasible option for people on fixed incomes. They have been granted the medical card for a reason, that being, they need it.

I am at my wits' end. When people come to see me, I tell them that I will raise the issue, and I have done so. I have asked a number of parliamentary questions, which the Minister of State will know, as has my colleague, Deputy Cullinane. We have brought the issue to the Government's attention. What should I say to my constituents when they tell me that they are in pain and cannot afford to see a dentist or wait to attend the Dental Hospital?

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for raising the issue of access to dental treatment for medical card holders. She is right, and there is nothing she has said with which I could disagree. It is the same in every constituency office and the situation is difficult the length and breadth of the country, more so in some areas than others. Swords in north County Dublin has a large population.

I am taking this debate on behalf of the Minister for Health, Deputy Stephen Donnelly. Dental treatment for medical card holders aged 16 years and over is provided under the dental treatment services scheme, DTSS. Services available annually have included an examination, two fillings and emergency extractions. Deputy O'Reilly is right, in that some of us - it might be because of our age - find it difficult to face going to a dentist and we leave it too long whereas others are proactive and go every six months for scaling and polishing, at which point problems they might have show up. More complex care and a broader range of treatments for patients with special needs and high-risk patients is also provided, some of which requires prior approval.

The Government has been concerned for some time that medical card patients in some parts of the country have been experiencing problems in accessing dental services.To help address the issue, the Minister secured an additional €10 million in budget 2022 to provide for expanded dental health care for medical card holders, including the reintroduction of scale and polish. To address the concerns of contractors about the scheme, by whom I mean the dentists who deliver it, the Minister is using an estimated €16 million of an underspend in this year's Estimate allocation to award fee increases across a number of items, including fillings. The combination of these two measures represents an estimated total additional investment of €26 million in the scheme over and above its €40 million spend in 2021. Following consultation with the Irish Dental Association, these new measures came into effect on 1 May. The Minister hopes that this significant additional investment in the scheme will attract more dentists to treat medical card patients.

One of the questions that has to be addressed is that of why so many dentists do not want to participate in the scheme and are leaving it. I believe that 42% of people have a medical card or doctor-only card. That is two in every five people who may need to access a dentist using a medical card. This can cause difficulties if you are in pain and cannot access a dentist. The number of patients being seen and the numbers of treatments being provided under the DTSS have started to increase in recent months. Patients are also accessing the reintroduced preventative scale and polish, which is a positive development.

Reintroduction of the scale and polish is in line with the preventative ethos of the national oral health policy, Smile agus Sláinte. I have been assured by the HSE that the local services on the ground will assist any persons who are still experiencing problems in accessing a service. I take on board the experience of Deputy O'Reilly's constituent who we called "Mary". It can be quite difficult for some people who do not have transport.

The Minister is aware that contractors are looking for more substantive reform of the dental treatment services scheme in the longer term. This concern is recognised. It is the Minister's intention that this is addressed in the context of the implementation of the national oral health policy, Smile agus Sláinte, which sets out a body of substantial reforms of dental services. Work is under way within the Department of Health to design a Government framework to oversee and facilitate root and branch reform.

To answer the Deputy's question, an extra €26 million has been provided this year on top of the original budget spend. Slowly but surely, we are seeing increases in the number of people being treated. However, I accept that it is slow.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I thank the Minister of State. I will highlight one of the sentences in her reply:

I have been assured by the HSE that the local services on the ground will assist any persons who are still experiencing problems in accessing a service.

I refer the Minister of State back to the direct experience of the woman to whom I spoke. She said she contacted the HSE about the dentist and the medical card issue and was told there was only one dentist in Balbriggan. That was the extent of the service. The Minister of State said the HSE assured her that "local services on the ground will assist", but they directed this woman to a dentist only for her to find, notwithstanding the difficulties in getting there, and she was going to go, that the dentist is not taking on any new patients. That was the extent of the help. Is it possible that in each of our local areas we might have a telephone number or nominated person? I do not want someone's name; I am just talking about a telephone number. We do not want to be torturing someone; I get that. That could be co-ordinated. If the Minister of State is correct when she says that more dentists are going to come on stream - I have no reason to dispute it - that information needs to be in the HSE. There needs to be a person whom people like Mary can contact directly. The HSE assured the Minister of State that local people are helping. I mean no disrespect to the people in the HSE who are working hard when I say they are not helping. It is no help to Mary be told to go to a dentist in Balbriggan, which will be tough for her to get to - that is grand; she will do that - when that dentist is not taking on any patients. The difficulty is when a person makes all the telephone calls. I spoke to someone who rang 29 dentists in one day and was told "No" every single time. This person was waiting and thinking that the dentist she previously attended was going to reopen. She rang continuously and then eventually snapped, as one would do. She made all of those telephone calls in one day and got a "No" every single time. Where can I direct people in my constituency to get the help that the HSE assured the Minister of State they will be given?

Mary Butler (Waterford, Fianna Fail)
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As I mentioned, additional funding has been provided to resolve the current problems with accessing the dental treatment services scheme. The preventive scale and polish, which has been reintroduced, is being accessed by patients. However, the Minister and the Government recognise that the current model of provision of oral healthcare is in need of fundamental reform. I think we all agree on that. The Smile agus Sláinte oral health policy provides the guiding principles aligned with Sláintecare. It will support the provision of all levels of care and has two goals, which are to provide the supports to enable each individual to achieve his or her personal best oral health and to reduce oral health inequalities across the population. That is what we are really talking about today by enabling vulnerable groups to access oral healthcare and improve their oral health.

I have taken on board everything the Deputy said. I had a case where I was contacted by somebody in a direct provision centre in Carrick-on-Suir, which is not in my constituency but is only a few miles down the road. Again, I was able to go through the HSE and refer her on. It did take a few days, however, and the person was in a lot of pain. I accept and acknowledge that.

I am hopeful about the extra funding of €26 million that has been provided this year on top of the funding that was already there. We are seeing slowly but surely that some people are coming back. I am also hearing on the ground that if a person goes to a dentist privately, the waiting lists have gotten longer than they were previously. I do not know whether that is a challenge with regard to the number of dentists we have in the country. I know from personal experience that a member of my own family had to wait four weeks for a routine check-up, which was not the case previously. It is certainly something that is very much on the Minister's agenda. It is on all of our agendas because we are coping with it every day of the week. I thank the Deputy very much for her question.