Catherine Connolly (Galway West, Independent)
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Amendments Nos. 1 and 3 are related and will be discussed together.

Róisín Shortall (Dublin North West, Social Democrats)
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I move amendment No. 1:

In page 8, between lines 21 and 22, to insert the following: “Report into the future of regulating health and social care professionals

6.The Minister shall, within 6 months of the passing of this Act, prepare and lay a report before both Houses of the Oireachtas, and the relevant committee, setting out the implications of introducing an established criteria for determining which health and social care professions to regulate into the future under the Act of 2005.”.

I spoke about this at some length on Committee Stage. While the CORU Act is important, it is about regulating health professionals. It dates from 2005 and deals with 17 or 18 professions that were nominated for regulation. The progress on opening registers for those professions has been painfully slow. It is indefensible that things have been moving at this snail's pace. After 17 years, we are at the point where only ten registers are open. A further seven or so need to either be opened or are under consideration. We do not know where the Minister is going on this. Not only are there seven professions in respect of which registers are outstanding, it is also the case that a significant number of other professions did not appear on the original list. Some of these should have been on the list. Others have evolved into new professions in recent years.

Medical progress is moving quickly, particularly when it comes to the use of technology in diagnostics and so on. On Committee Stage, there were two particular areas I referred to. During the course of the year, a number of presentations were made to Members of the Houses. One was from the Irish Institute of Clinical Measurement Physiology, which, again, is a relatively new science. These are clinical measurement physiologists, and they have become critical people in diagnostics. They work across five disciplines in clinical measurement science. They are mainly people who operate diagnostic machinery and carry out measurements in the context of cardiology, gastroenterology, neurophysiology, respiratory issues and vascular issues. These are major areas of health and they are doing this important diagnostic work. It was put to us that in the area of cardiology, for example, Croí gave a good presentation and showed how one of its clinical measurement physiologists could operate, essentially with a laptop with the right software, and carry out large numbers of tests which, in other circumstances, a person would have to wait to see a consultant for. It makes sense to ensure that these professions are properly regulated.

I made another point before, which I want to repeat. I have had correspondence from the presidents of Dublin City University and the South East Technological University. They were talking about a high-level course they provide in their universities for athletic therapists and these are people who are working in sports organisations like the FAI and the GAA. They work in private clinics, private hospitals and other sporting and recreational settings. That is another profession that is not regulated.

There is a massive backlog that needs to be dealt with quickly because when we are talking about regulation, we are talking about patient safety and ensuring high standards. It is the professionals that are calling for this. It is not a case of the Department trying to get professions regulated; it is the professions that are calling for it because they want to ensure high standards and they should be supported in achieving those high standards by the system and the Department. I recognise that a report has been done to look at this area and to see what happens with regulating health and social care professionals in other countries. It is not necessarily the case that every profession has to be regulated, but it is important to have a system in place that identifies those professions that have the potential for high risk to patients. There is a need to make a decision. We need to hear from the Minister what his intention is going forward with these outstanding professions and what kind of approach he will take. The recommendation from the Health Research Board has been that we take a risk-based approach but we do not know the level of risk across different professions. That is why we need the Minister to prepare a report in this regard. This issue has been dragging on for a long time so we need to see movement on it.

On Committee Stage, I had an amendment that the Minister would bring forward a report - to go to the Committee on Health - on how he intends to proceed, within a three-month period of the passing of this legislation. I recognise that the Minister is well disposed to that. He said he would consider it for Report Stage, which he has done, and he has brought forward an amendment. I acknowledge the progress and movement on that but it would be better if that report was produced at the end of this process, when the legislation is completed, and that the report would go to the Committee on Health. I am okay with the six-month period, but I ask the Minister to undertake that he will do it within six months of the passing of this legislation because it is important that all of those many professions that are waiting for regulation are clear about what the future holds. I ask for a general timeframe as to what is involved.

David Cullinane (Waterford, Sinn Fein)
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I support the amendment tabled by Deputy Shortall and agree with her points on health and social care services and workers. On Second Stage and on a number of other occasions, I have raised with the Minister the sectors which are still not regulated and which still will not be captured with this Bill. Home care is one of those. The Minister will appreciate the difficulties we have in getting staff to provide home help. It is one of those areas in respect of which one of the Ministers of State at the Department of Health has commissioned a report.

There are commitments to introduce a living wage, which is all well and good. However, we have to look at not only professionalising and, if necessary, regulating but also properly resourcing those areas in order to ensure we have, at the very least, parity of pay between those who provide the service, possibly through the private sector - and we need those organisations because we are highly dependent on them - and HSE staff. There are whole areas in home care, nursing homes and elsewhere where there are real difficulties attracting staff. Many of the people in these jobs are on low pay and are not properly represented. Having a health and social care advocate now in place will help. At least when it comes on stream, it will help in lobbying for and representing that really important area, which will enable us to deliver better community services, as we all want to do. Much more attention and a sense of urgency are needed from the Government in respect of the home help sector. I just wanted to make that broader point in the context of this amendment, which was tabled by Deputy Shortall and which I support.

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank Deputy Shortall for her amendment. We had a very useful discussion on this on Committee Stage, and I committed to looking at whether we would bring forward an amendment to do what the Deputy is looking for after six months. As I said on Committee Stage, I agree that it is a useful amendment. It would be a good forcing mechanism. There have been too many delays over too many years. As has been acknowledged, the amendment I am tabling is essentially a legislatively proofed version of Deputy Shortall's amendment.

To Deputy Shortall's question about timing, I intend to commence this pretty much straight away, so the timing will be the same. At the request of my Department, the Health Research Board, HRB, has examined the approaches taken to regulation of health and social care professionals internationally. That report is now available on the Department's website. That is an important first step. We need to understand how other countries do this because, clearly, some of them are doing it better than we are. That is now done. I draw the Deputies' attention to a relatively new test required of us under EU law, that is, the EU proportionality test directive. It will have some quite big implications for regulating in this area for years to come. Officials in my Department are drawing from the report compiled by the HRB into what is happening internationally. We will have to pay attention in that regard. I will come back to this when we discuss continuing professional development for dentists and the regulation of dentists. It adds extra steps that are now required by the EU in this regard. It is a new development and we will come back to it. It will have some significant impacts on how we go about this from here on. There have been delays in the development of the policy framework, and I agree wholeheartedly with that. I want to make it clear, though - and this is really important - that the absence of statutory regulation is not a barrier to employment, be it in a private provider or in the HSE.

We had a very useful discussion on Committee Stage about quite a broad range of health and social care professionals. Deputy Shortall has referred to two of them again. There is no reason they cannot be hired now. The HSE may have chosen not to hire those to whom the Deputy referred.

Róisín Shortall (Dublin North West, Social Democrats)
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Athletic therapists.

Stephen Donnelly (Wicklow, Fianna Fail)
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Yes, athletic therapists. There is, however, no legal impediment to their being hired, so the HSE can keep an eye on that. As we invest more in prevention, Healthy Ireland and healthy living, the HSE should be very open to that. Similarly, the other group Deputy Shortall mentioned has a very direct impact, potentially, and a very direct benefit in acute care and maybe community-based care as well as diagnostics, which we are expanding a lot. If there is a clinical case for that, it can be made, and the HSE should engage with that group of people to see what can be done. It does not require regulation. They may want regulation, but it is important to say that it is not required. In fact, one of the points officials made to me after our committee session was that, actually, the voluntary providers have led the way sometimes in creating new healthcare professional roles like the exercise therapists we have just talked about. The voluntary-led or grassroots-led approach which then gets regulated afterwards is fine, so it is important that, as these healthcare professionals come on stream, the HSE can hire them.

Specifically on the amendment, as the Deputies will see, the wording I propose differs very slightly from that proposed by Deputy Shortall in that it does not reference the Act under which CORU operates. That approach is deliberate as the intention is that the work being undertaken will implement policymaking for the regulation of health and social care professionals generally and not just those identified within CORU's legislation. We just want to keep this broader than the professions currently regulated. Policy decisions around the models of regulation that might emerge or functions assigned to particular regulators, I think, are best left open. I acknowledge Deputy Shortall's very reasonable request that we understand my view at this time. My view at this time is that we should crack on with this, get this report done and pull from international best practice. Rather than trying to steer them in any particular way, I want to just let them at it in order that they can consider all options for now.

Róisín Shortall (Dublin North West, Social Democrats)
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I appreciate the Minister's collaborative approach on this and the movement he has made on the general principles of what I was trying to achieve. I am not aware of that list of the 20-plus additional professions having been published anywhere. I have looked for it. I would appreciate it if I could get a copy of it from the Minister. One of his officials might take note of that. I am also very keen to know whether the two professions to which I referred are on that list. The Minister also made the point that it is not a requirement to be a regulated professional to be employed in the public service. There is perhaps a different understanding of that on the part of those people who have qualified. I am talking in particular about athletic therapists. As I said, this is a very high-level degree course, a four-year honours degree course, and there is clinical placement after it. It may be the case that one can be employed even without one's profession being regulated, but that specific profession does not exist in the public sector. It exists in the private sector, and that is where many of the graduates are being employed. The Minister might send me a note on that, the athletic therapists in particular. How can we achieve a situation where these highly qualified people, who are in very high demand in the private sector, can access employment in the public sector? Is there a need to add that role to the list of various roles for which the HSE recruits? At the moment it does not recruit athletic therapists. Maybe the Minister would get me a note on that. I would appreciate that. On that basis, and if I could have those two pieces of information, I would be happy to withdraw my amendment in favour of the Minister's.

Stephen Donnelly (Wicklow, Fianna Fail)
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That is no problem at all. I have the table here. The Deputy may take it away with her after the debate and I will make sure that everyone gets a copy.

I want to correct myself. Clinical measurement physiologists are already employed by the HSE. Sorry, that was my mistake. I will ask the HSE for a note on athletic therapists. My understanding is the same as the Deputy's, that it is not a grade that is currently hired. Therefore, if we want to work with the HSE to create that grade, what are the sensible steps? I imagine the professional body and the universities would engage with the HSE to make a case, maybe with the CHO or a hospital group, to get it going.

Róisín Shortall (Dublin North West, Social Democrats)
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It would create a lot of additional capacity in the system.

Stephen Donnelly (Wicklow, Fianna Fail)
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Yes. I am more than happy to get the Deputy a list. The three being actively looked at and worked on are councillors and psychotherapists, psychologists and social care workers. There are two more designated in the future, so they are further along, and they are orthoptists and clinical biochemists. The list of others is as follows: acupuncturists; athletic therapists; audiologists; chiropractors; clinical measurement physiologists; clinical scientists; creative arts therapists; exercise professionals; healthcare assistants, to whom we referred earlier; hypnotherapists, music therapists; nutrition therapists; operating department practitioners; osteopaths; pharmacy technicians; physician associates; play therapists; prosthetists and orthotists; reflexologists; and relationship mentors.

Does Deputy Shortall want to come in with another word on this?

Róisín Shortall (Dublin North West, Social Democrats)
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The Minister had not actually mentioned the physiologists, many of whom are working within the health service at the moment. However, it is specifically about how we can achieve a situation where athletic therapists are recognised - I am not saying regulated - as an important profession within the health service and how provision can be made for the employment of people in that category. I would appreciate if the Minister could send me a note on that because there seems to be some concern on the part of the universities and, obviously, the graduates themselves because they cannot access work at the moment within the public service.

Marc Ó Cathasaigh (Waterford, Green Party)
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Amendment No. 2 in the name of Deputy Shortall arises out of committee proceedings.

Róisín Shortall (Dublin North West, Social Democrats)
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I move amendment No. 2:

In page 8, between lines 21 and 22, to insert the following:

“PART 3

AMENDMENT OF DENTISTS ACT 1985

Definition (Part 3)

6.In this Part, “Act of 1985” means the Dentists Act 1985.

Amendment of Act of 1985

7.The Act of 1985 is amended by the insertion of the following Part after Part IV:

“PART IVA

MAINTENANCE OF PROFESSIONAL COMPETENCE

Duty of registered dentists and registered dental auxiliary workers to maintain professional competence

38A.(1) A registered dentist and a registered dental auxiliary worker shall maintain professional competence on an ongoing basis.

(2) A registered dentist and dental auxiliary worker shall, whenever required by the Dental Council to do so, demonstrate competence to the satisfaction of the Dental Council in accordance with any requirement of the Dental Council under section 2(1).

(3) A registered dentist and a registered dental auxiliary worker co-operate with any requirements imposed on the registered dentist or the registered dental auxiliary worker by the rules.

(4) The Dental Council may, by notice in writing given to a registered dentist or a registered dental auxiliary worker, who has given an undertaking, require the registered dentist or the registered dental auxiliary worker to co-operate with such an undertaking to the satisfaction of the Dental Council.

(5) A dentist or auxiliary dental worker shall comply with a notice under subsection (4) given to him or her.

Duty of registered dentists and registered dental auxiliary workers to demonstrate professional competence to the satisfaction of the Dental Council

38B.(1) The Dental Council may require a registered dentist or a registered dental auxiliary worker to demonstrate competence to the satisfaction of the Dental Council in accordance with a professional competence scheme applicable to that dentist or dental auxiliary worker or otherwise.

(2) The Dental Council may require a registered dentist or a registered dental auxiliary worker who fails to demonstrate competence to the satisfaction of the Dental Council to attend a course or courses of

further education or training or to do anything which, in the opinion of the Dental Council, is necessary to satisfy the Dental Council as to the competence of that dentist or dental auxiliary worker.

(3) Where the Dental Council considers that a registered dentist or a registered dental auxiliary worker—

(a) who, being required under section 1(3) to co-operate with any requirements imposed on that dentist or auxiliary worker by the rules, has refused to so co-operate, has failed to so co-operate or has ceased to so co-operate,

(b) has contravened section 1(5),

(c) may pose an immediate risk of harm to the public, or

(d) may have committed a serious breach of its guidance on ethical standards and behaviour, then the Dental Council shall forthwith make a complaint to the Fitness to Practice Committee.

Duty of the Dental Council in relation to maintenance of professional competence of registered dentists and registered dental auxiliary workers

38C.(1) The Dental Council shall, not later than the first anniversary of the commencement of this section, or such longer period as the Minister for Health permits in writing at the request of the Dental Council, develop, establish and operate one or more than one scheme for the purposes of monitoring the maintenance of professional competence by registered dentists and registered dental auxiliary workers.

(2) A scheme under this section shall not be established or operated until a proposal for it has been approved by the Minister for Health and the Minister for Public Expenditure, National Development Plan Delivery and Reform.

(3) The Dental Council, in respect of a professional competence scheme—

(a) shall review the operation of the scheme periodically, and

(b) may, following such a review, make recommendations to the Minister for Health as to the steps that, in the opinion of the Dental Council, may need to be taken to improve the operation of the scheme.

Duty of employers in relation to maintenance of professional competence of

registered dentists and registered dental auxiliary workers

38D.(1) An employer of a registered dentist or registered dental auxiliary worker shall facilitate the maintenance by that dentist or dental auxiliary worker of his or her professional competence pursuant to a professional competence scheme applicable to the dentist or dental auxiliary worker concerned.

(2) Without prejudice to the generality of subsection (1), the employer may facilitate the maintenance of professional competence by a registered dentist or registered dental auxiliary worker it employs by providing learning opportunities for that dentist or dental auxiliary worker in the workplace.

Confidentiality

38E.(1) Subject to subsections (2) and (4), and to any agreement made, a person who acquires any information by virtue of the person’s performance or assistance in the performance of functions under this Act relating to any professional competence scheme shall preserve confidentiality with regard to the information and, without prejudice to the foregoing, shall not—

(a) disclose the information to another person except where the disclosure is necessary for such performance or assistance, or

(b) cause or permit any other person to have access to the information except where the access is necessary for that other person to perform or assist in the performance of functions under this Act (including the functions of the Fitness to Practise Committee).

(2) Notwithstanding subsection (1), the Dental Council may disclose information—

(a) in the form of a summary compiled from information provided in relation to registered dentists and registered dental auxiliary workers participating in a professional competence scheme if the summary is so compiled as to prevent particulars relating to the identity of any such dentist or dental auxiliary worker being ascertained from it,

(b) with a view to the institution of, or otherwise for the purposes of, any criminal proceedings or any investigation in the State, or

(c) in connection with any civil proceedings to which the Dental Council is a party.

(3) The Freedom of Information Acts 1997 and 2003 shall not apply to a record (within the meaning of those Acts) relating to any professional competence scheme.

(4) Nothing in this section shall be construed as prohibiting a disclosure of information pursuant to a court order.

(5) A person who contravenes subsection (1) shall be guilty of an offence and liable on summary conviction to a class A fine or a term of imprisonment not exceeding 6 months, or both.”.”.

This concerns regulation although not regulation that would come specifically under CORU. It is with regard to the need for the regulation of standards and continuing professional development, CPD, in particular, for the dental profession. I am taking this opportunity because we have been asked by the Irish Dental Association to seek an amendment to this legislation.

While it is not specifically within the ambit of CORU, I note that the Minister has himself put in an amendment relating to the medical profession and that he is availing of this opportunity. I welcome the fact that there is an opportunity to take some steps with regard to dentists. As I said, this is a recommendation from the Irish Dental Association. It wants to reform the legislation that governs the practice of dentistry through this opportunity before us. I hope the Minister will give positive consideration to that.

Going back to October 2021, the Irish Dental Association had engagement with the Minister's Department. It identified a number of gaps in the Dentists Act 1985 which, in its view, pose significant risk to public safety, including the failure to require dentists and dental auxiliary workers to maintain their ongoing competence. Again, we have a situation where a professional group is asking the Minister to facilitate higher standards and address the potential for risk to patients. I expect that the Minister would be very open to that, particularly as those proposals have been with his Department since October 2021. The Irish Dental Association pointed out that by law Ireland obliges all healthcare professionals except dentists to be competent to practice. This means that while dentists are ethically obliged to maintain an ongoing competence, this is not underpinned by legislation. Dentists are regulated in separate legislation in the same way as doctors and nurses. The whole question of competence and maintaining that competence is not underpinned by legislation, however. That is clearly a weakness in the system. It means the dentists are very much out of step with other regulated healthcare professionals and specifically doctors and nurses. The Irish Dental Association suggested this amendment to address the issue and circulated it to members of the committee. I have submitted this amendment on its behalf.

The proposed amendment is derived from and very similar to the Nurses and Midwives Act 2011, which is currently law. It very much uses the template of that legislation. The Irish Dental Association very much acknowledges that there are other aspects of dental legislation that require attention. There is an opportunity here to deal with the issue of CPD, however, which I hope the Minister will take.

I will also make a general point. There is no doubt that in recent years, and it is not necessarily deliberate, but we had Covid-19 and while many other issues have been happening in the health service and many other professional groups have been seeking attention for one reason or another, it is true to say that not much attention has been paid to the dental profession or to dentistry generally.

Obviously, there is the whole question of the lack of funding of the dental scheme and the impact of that on the numbers of dentists going into training and particularly those practising in the public sector. Again, many attempts have been made to raise this issue. Many of us have raised it in this Chamber from time to time by way of parliamentary questions and at the Joint Committee on Health and so on. It is an area of medicine that has not had due attention over recent years.

I acknowledge the fact that the Minister met with the Irish Dental Association very recently. I know he wants to strike a better relationship going forward and make more time to provide the kind of attention from his Department that is necessary and that is being asked for. A very good way of displaying his good faith in that regard would be to consider accepting this amendment. I made reference to it on Committee Stage. It was too late to table the amendment for that, but I did discuss it with the Minister. Now, the full amendment has been tabled for this Stage. I ask the Minister in light of all those points to look favourably on this amendment. It is about raising standards and ensuring greater protection for patients and it is about addressing issues that have been raised by those in the profession. They deserve credit for that. I appeal to the Minister to give this positive consideration.

David Cullinane (Waterford, Sinn Fein)
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I support the amendment, although much of what the Irish Dental Association is calling for can be done without this amendment or even without this Bill passing were the amendment to be accepted. Of course, I support the amendment. I engaged with the Irish Dental Association on many of these issues.

It is troubling that we have a representative body lobbying us as legislators to say that standards can and should be improved in a whole range of areas. Like Deputy Shortall, I welcome the fact that the Minister has had engagement with the Irish Dental Association on a broad range of issues. When we look at waiting times for orthodontists and public dentistry, however, it is unbelievable how long people have been waiting in some community healthcare organisation, CHO, areas. In the south east where I am from, waiting times for children for orthodontic treatment can be four years, and possibly even more for some children. It is unacceptable. That is down to a lack of capacity in the system.

There is also an issue that still has not been resolved. The latest response to a parliamentary question I got back on the dental treatment service scheme shows that less dentists were availing of that service at the start of the year than the year before. That is a steady decline all the time. In the most recent budget or perhaps the one previous to it, additional funding was made available for that particular scheme. It does not seem to have worked. The Minister in his response might be able to give the House an update on whether he has had engagement with the Irish Dental Association and what the outcome of that engagement was in terms of encouraging more dentists to participate again in the dental treatment service scheme.

What its members are ultimately looking for is a new contract. They want that new contract to be underpinned by many different things, including providing more services, some of which was actually provided for that budget provision I referenced. However, whatever was provided for the budget obviously does not seem to have cut the mustard and was not enough. We are not seeing that re-engagement with the system, which is problematic. It might be something to which the Minister can respond.

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputies. The amendment raises a very important issue. I appreciate that it is being sought by the profession. I am in full agreement that dentists, along with other healthcare professions, should strive to maintain professional competence and that regulators should have appropriate powers in this area.

I fully agree. We have a reputable dental profession and we all know that dentists take that their obligations seriously by keeping their skills updated, but that requirement is not on a statutory footing as is the case for some other healthcare professionals. We need to move on this matter and regulate for that. However, I cannot do it through this amendment. I know that the Deputy would not have expected me to do so.

Róisín Shortall (Dublin North West, Social Democrats)
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Why would the Minister think that?

Stephen Donnelly (Wicklow, Fianna Fail)
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I will go through that in a moment. I am in agreement with the intention behind the amendment, and there is work taking place. I just cannot accept the amendment in the context of this Bill, and I will explain why. However, this is a matter on which we need to work.

My Department is consulting the Dental Council of Ireland to identify the steps needed to support mandatory continuing professional development. It is something we are going to do and the Department and the Dental Council of Ireland are in discussions. It is important to note that such a requirement obviously has employment impacts for the HSE and private dental practices. I acknowledge the value of the proposed amendment and broadly agree with it. I appreciate the amendment is coming from the members' organisation. There are several reasons I just cannot accept the amendment now. One of the reasons is timing. We have to pass this Bill very soon because we want to bring UK-based medical graduates into the HSE in July. Much more work is required. We would have to bring the legislation back. We would have to amend it in the Seanad and come back before the Dáil. A lot more work would be required to get this to the place it needs to be brought. With the best will in the world, it would not be possible to do that by July and we would miss the chance to bring in the UK-trained interns, which we want to do.

There are some technical issues with the amendment, as one would expect. That is nothing out of the ordinary. There are issues in respect of compatibility with the current Dentists Act, which we would be able to iron out through the offices of the Attorney General and the Chief State Solicitor. One of the areas at issue relates to fitness to practise.

I earlier referenced the new EU directive on proportionality which would apply in this situation because we are talking about regulating a profession. The measures proposed in the amendment, which I agree with, impose a restriction on practise and, therefore, fall within the scope of the directive. It requires public consultation and useful but substantial new steps. That will take a little bit of time to do. We would not be able to enact the Bill within the time we need to do so. Even if the directive did not require pausing the Bill, which it would, my officials would need time to determine exactly what system of continuous professional development is appropriate and which we would, therefore, be referencing in the legislation.

I am open to engaging in an ongoing discussion on continuous professional development. As I said, it is something that is actively being progressed by the Department. It is just not there yet but I would very much like to come back-----

David Cullinane (Waterford, Sinn Fein)
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Is there a timeframe?

Stephen Donnelly (Wicklow, Fianna Fail)
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I will revert to the Deputy with a timeframe. I do not have one now but I will revert to him with a timeframe in that regard. We are looking at bringing in mandatory continuous professional development but we do need further engagement with the Dental Council of Ireland and with dentists, and further general consultation. That is the reason I cannot support the amendment, although I support the intention behind it.

Deputies raised a few other issues in respect of oral health and engagement with dentists. For reasons I do not fully understand, the State has had a blind spot when it comes to oral health and engagement with the Irish Dental Association. I am not quite sure why that is the case but that is my observation. We have been working to turn that around. Deputies will be aware, and Deputy Cullinane referenced, that I have allocated a significant increase in funding for oral health in recent budgets. We need to go further. Deputies will be aware that I increased the fees for the dental treatment scheme by 40% to 60%. The scheme is not working the way it needs to, but that is not an insignificant increase. We did that in just one budget. We are looking to double college places for dentistry. We do not have enough dentists so the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris and I are looking at doubling the available places. We are launching a new school programme for those aged zero to seven years, which is a preventative measure. It will take time to scale up but I think it is going to be useful when it does.

The national policy is Smile agus Sláinte but, in short, it has not had the money required to roll out these things. The chief dentist made a strong case to me in advance of last year's budget that we needed clinical leadership in the HSE, which has not been there for oral health in the past. We are now in the middle of hiring a senior clinical team within the HSE to put in place the kinds of supports that, quite frankly, I do not think are in place right now and that need to be in place.

The engagement with the Irish Dental Association has not been good. I made a point of meeting its representatives recently and it was a constructive meeting. I will be speaking at the association's conference in Kilkenny on Friday. The relationship needs to be better and, as I say, there has historically been a blind spot for a reason I do not fully understand and I am absolutely determined that we move to a better place, both in terms of the relationship but, more importantly, in terms of the provision of oral healthcare to people around the country.

I ask Deputies for their support in a request I have of the dentists and of the Irish Dental Association. I have said this directly to the dentists. I recognise, as we all do, that the dental scheme is not working. It is not fit for purpose for various reasons. I am committed to changing that. I have met dentists and work has commenced in that regard. I have also said to them that in the meantime I have a request that the members of the Irish Dental Association re-engage. We have people-----

Róisín Shortall (Dublin North West, Social Democrats)
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I am sorry for interrupting, but I remind the Chair there is very little time left. The debate is time limited.

Marc Ó Cathasaigh (Waterford, Green Party)
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I think the Minister was concluding.

Stephen Donnelly (Wicklow, Fianna Fail)
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I will do so, if I may.

Róisín Shortall (Dublin North West, Social Democrats)
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We are up against the clock.

Stephen Donnelly (Wicklow, Fianna Fail)
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Respectfully, Deputy-----

Róisín Shortall (Dublin North West, Social Democrats)
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Respectfully, we are all operating to the time limits.

Stephen Donnelly (Wicklow, Fianna Fail)
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I am in the Chair's hands.

Marc Ó Cathasaigh (Waterford, Green Party)
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It is the role of the Chair to manage the time. We have probably lost more time in the debate by not allowing the Minister to conclude. Is the Minister happy to conclude at this point?

Stephen Donnelly (Wicklow, Fianna Fail)
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I have one request of Deputies, which is that they would support my request of the Irish Dental Association and dentists to recognise that the scheme needs to be made fit for purpose. In the meantime, there are men, women and children in this country who cannot afford private care.

David Cullinane (Waterford, Sinn Fein)
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The Minister has already made that point.

Stephen Donnelly (Wicklow, Fianna Fail)
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We need dentists to re-engage with the dental treatment scheme in the short term while it is being updated.

Róisín Shortall (Dublin North West, Social Democrats)
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I did not want to divide the House on this issue because it is such a reasonable request from the Irish Dental Association. It is a no-brainer. This is an appeal for mandatory continuous professional development, which will raise standards and ensure enhanced patient safety. It would come at no cost to the State. I thought the Minister would accept the amendment because it is so reasonable. He asked for more time, which is a bit rich when we have been waiting 17 years for additional professions to be regulated under the CORU legislation. We must move on with this. The Minister has the option of delaying the commencement of this section if the Bill is passed. This does not have to happen next week. It is, however, very important that we take a decision on this point. I again appeal to the Minister to support the amendment, which I will be pressing.

Catherine Connolly (Galway West, Independent)
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I strongly support this amendment. I have kept an eye on it despite not being a member of the relevant committee. My attention was brought to the gaps, to use an inappropriate word in this context. The whole system for the provision of dental services is full of gaps. The Minister knows that I became aware of the issue as the result of a particular case in Galway, to which I will not refer. In fact, I understand the professional involved did their damnedest to provide a service notwithstanding the ill-health in question. However, what was really brought home to me was the failure of the system to deal with a situation in which somebody got sick. That was one aspect of the matter. The Dental Council of Ireland said it was up to the ill person to deal with it. I then became aware of other gaps and the failure to have ongoing education, which is the most basic requirement. I wanted to come in to make that point. I thank the Deputy for bringing forward the amendment, which I support.

Stephen Donnelly (Wicklow, Fianna Fail)
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I take Deputy Connolly's point but the continuous professional development piece is not related to that case and would not have had an impact.

In response to Deputy Shortall's point, she can divide the House if she wants. She is a seasoned and experienced Member of Parliament and has been a Minister of State at the Department of Health herself. She is fully aware that there is no chance that any Minister could accept a detailed amendment such as this on Report Stage, coming in from a professional body, without going through very significant legislative work, drafting and all manner of things. While I fully accept what has been said in raising the point, I absolutely refute the idea that the Deputy believes for one moment that any Minister, herself included when she was standing here, would ever accept an amendment in this context. However, I fully accept the intent. It is my intention to progress this and to come to the House with legislation that is fit for purpose and compliant with EU law, which the amendment before the House is not.

Róisín Shortall (Dublin North West, Social Democrats)
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I will make one brief point. This proposal has been with the Department since October 2021. We have had plenty of time to consider it and the Minister has had plenty of time to bring forward his own amendment. I am pressing the amendment because it is a very important issue.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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With the time permitted for this debate having expired, I am required to put the following question in accordance with an Order of the Dáil of 9 May: "That the amendment set down by the Minister for Health and not disposed of is hereby made to the Bill, Fourth Stage is hereby completed and the Bill is hereby passed."