Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I have told several Ministers about the state of services for medical cardholders and working people with PRSI contributions. Dental services for medical cardholders are already under significant pressure in all areas. I am now seeing a worrying development that causes me to question the model of contract used.

I am acutely aware of the pressure on dental services for medical cardholders in Carlow because I have been on the phone to dentists in my area asking for help with emergencies and severe cases. Subsidised dental services are currently available to medical cardholders and to qualifying workers who pay PRSI contributions but these services and general medical card and dental services are under significant threat from a recent audit decision by Revenue.

The traditional dental model operating in Ireland, the UK and Europe is that self-employed dentists, known as dental associates, who practise as a joint venture within a group, hold individual contracts with the Department of Health and the Department of Social Protection to provide a range of dental services to the general public on a fee-per-item basis. The contracts are specifically stated contracts for service and are exclusively stated for self-employed contracts.

I am assisting a group operating in Carlow which is concerned about these contracts. The contracts have been in operation and unchanged since 1993, which is almost 30 years ago. They cannot be subcontracted. Dentists who are employees cannot hold or operate these contracts legally in this manner. A recent Revenue decision to categorise these dental associates as employees in a practice in Carlow means the contract with the Department will be illegal. These dentists have paid their own taxes in order to continually hold the dental contracts. Each contract holder must produce an annual tax clearance certificate to the Department that offers the contracts to the dentist. However, Revenue has decided some self-employed dental associates are actually employees and this impacts the group operator, which has now been told these dentists are employees and not self-employed.

Revenue recently decided to recognise the traditional dental model of dental associates, which is dental principal, to be a joint venture with no VAT liability, yet Revenue is now raising assessments against group operators for PAYE and PRSI obligations that should not be there. If Revenue presses the status of dental associates as that of an employee, some dental associates in Ireland will have to resign their current contracts for service with the HSE and the Department of Social Protection, and will not be able to see patients under these schemes. This will lead to an increased crisis of access in the provision of dental services for medical cardholders and also access for PRSI contributors.

Will the Department for Social Protection revisit the current model or impress upon the Department of Finance the need to standardise the approach to the self-employed status of dental associates? As it currently stands, Revenue has opposing views on the matter in two Departments. Audit is one and VAT is the other. If dental associates are pressed to drop services for the PRSI medical cardholders, the loss to the community will be enormous. The Minister of State knows how important these services are. I urge her to speak to officials in the Department of Health and the Department of Finance to regularise the situation to prevent the loss of service to the public.

This matter was brought to my attention by some dentists in Carlow. I want clarification. The biggest issue is that this has not been reviewed in nearly 30 years. We must ensure that medical card patients get to go to the dentist. That is what the system is there for.

Anne Rabbitte (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy. I am answering this matter on behalf of the Minister, Deputy Stephen Donnelly. The objective for all of us, as public representatives, is at all times to ensure that a person who holds a medical card gets seen to.

The treatment benefit scheme provides dental, optical and medical appliances, comprising hearing aids and specialised contract lenses, to insured workers, self-employed and retired people who satisfy certain PRSI conditions. A person must have paid a specific number of PRSI contributions in the relevant tax year to qualify for treatment benefit. It is also available to the dependent spouse, civil partner or cohabitant of those who qualify. People can avail of a range of treatment either free or part-funded.

Two significant changes to the scheme were introduced by the Government this year. A new grant of €500 towards the cost of wigs and other non-surgical hairpieces was introduced for those who have suffered hair loss due to a cancer or certain types of alopecia, with nearly 900 claims paid since the scheme was introduced in May. The eligibility criteria have changed to reduce the PRSI contributions to people aged 25 to 28, which will benefit almost 80,000 young people.

The treatment benefit dental scheme provides for a free annual dental examination and an annual scale and polish treatment subject to a maximum co-payment by the customer of €15. The scheme is very popular, with 893,000 claims in 2021 at a cost of €53 million. Figures up to the end of September of this year show that 843,000 treatments were claimed which is a 10% increase on claims so far in 2022. Dentists can check a customer's eligibility online and make a claim for payment through the Department's welfare partners interface. Each month dentists are paid for treatments claimed in the previous month.

Currently the Department pays the dentist a fee of €33 for an examination and €42 towards the cost of cleaning and other treatments. Departmental officials have commenced a review of the fees and part of the process involves examining the current contract to ensure it is fit for purpose and that any changes necessary are put in place. A consultation with the relevant bodies, including the Irish Dental Association, will be undertaken as soon as practicable following consideration of the complexities involved in developing a new contract. Officials hope to be in a position to commence this engagement in the near future.

The Department is aware of the HSE contract with the dentists and will ensure that any new contracts will be mindful of the objective of the national oral health policy. A review of fees in the dental benefit scheme is a priority for the Department and the Department wants to resolve it positively and in a timely manner.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for her reply. I welcome that consultation with relevant bodies, including the Irish Dental Association, will be undertaken as soon as possible. During the Covid pandemic, older people and those with medical cards found it hard to get access to their dentist. In fairness to the dentists, they worked extremely hard. Following this consultation, we need to ensure that the most vulnerable people in our communities are looked after. They need to be able to get the full benefit with their medical card and need to be able to access the dentist. The contract that is being changed needs to include all people who are deserving of it. The consultation on the contract with the dentists needs to happen as soon as possible. I and other people want clarification on this as do people with medical cards and those who pay their PRSI contributions. I again thank the Minister of State for her answer.

Anne Rabbitte (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The treatment benefit is an important scheme for those who qualify for payment and for practitioners. It is the Department's biggest scheme in terms of claims, with more than 1.4 million claims received in 2021 and a total expenditure of €109 million. So far in 2022 some 1,342,000 claims have been received with a total expenditure of €102 million. The dental benefit scheme is the most popular component of the treatment benefit suite of schemes and, as I said earlier, 843,000 claims were paid this year, an increase of 10% on the previous year, with payments to date this year coming in at €48 million. The treatment benefit complements the HSE system of dental care by providing dental check-ups and a contribution towards scale and polish for eligible customers. Any additional oral healthcare can be co-paid.

I cannot understand how in recent months people with medical cards, particularly in my county of Galway, cannot access a dentist. Last Monday, I was with the Brothers of Charity at an award ceremony and it was the main item on the agenda. It is not the people with medical cards that is the issue here; it is the fact that they cannot get a dentist. Earlier this year, the Minister, Deputy Stephen Donnelly, made an additional €10 million available and it did not address the issue. Given that €60 million was underspent last year in dental services, one must question the obligation of the dentists within this and their willingness to come to the table to assist in finding a solution when the most vulnerable who are in pain cannot get assistance. It is beyond comprehension.