Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I have been made aware of a crisis in the public dental service. Along with others, the Irish Dental Association has been calling for additional funding and resources for many years. There are massive issues with the public care system and our nation's dental health is suffering. I met the HSE chief last week and he told me he had specifically omitted dentists from the moratorium. Active recruitment is ongoing, therefore, but there are not enough dentists to fill the roles. We really have to have a focused discussion on this and find a solution.

In County Carlow, I have been talking to representatives of many primary schools, where there are big issues with children being assessed. Teachers at one school told me that the children there have never had a referral to the public dentist. The dental clinic in Carlow is closed for refurbishment and just one dentist covers the entire county, with just two clinics, in Tullow and Bagenalstown, available due to the pandemic. I understand that the pandemic has played a huge role in this, but children who would normally be seen in second and sixth class are now not being seen until fourth class and second year of secondary school, and that is significant. They are missing their check-ups at essential dental-development milestones, and many of the children age out of the primary school model of care, so they are dependent on their parents' means to get them to a dentist and pay for it.

In some dental practices in Carlow, it is very hard even for someone with a medical card to get signed up with a practice because a large portion of dental practices are simply refusing to sign up new patients with a medical card. Moreover, as we all know, a significant number of contracted dentists throughout the country have withdrawn from the dental treatment service scheme, as the Minister of State will be aware. I recently sought by parliamentary question a list of those dentists in Carlow still in the scheme in order that if someone came into my clinic, I could tell them which dentists were available. That was very hard because, according to the reply, there is just one such dentist in Carlow.

Good dental hygiene is essential for everyone. Most oral health conditions are largely preventable and can be treated if caught at an early stage, but we are not getting that.

More people I talk to tell me they travel abroad for dental care because they feel our system is broken. That is worrying. I wish to ask about the existing medical card entitlements, which are limited in what a patient is entitled to, if they can even find a dentist. The area of orthodontic care is expensive in private practice. The medical card programme only covers patients with front tooth problems. It does not cover molars, some of the most important teeth in a person's mouth, used particularly for chewing food. There are huge issues in the system, which is worrying. It is across the country. We must make sure young children are being assessed at an early age in primary schools. That is crucially important.

Niall Collins (Limerick County, Fianna Fail)
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I am taking this Topical Issue on behalf of the Minister for Health, Deputy Stephen Donnelly. I thank Deputy Murnane O'Connor for the opportunity to address the issue of the expansion of dental care for patients and increased fees for dental contractors. The dental treatment service scheme, DTSS, provides dental care free of charge to medical card holders aged 16 and over. Services available annually and on demand include an examination covering preventative advice, two fillings, emergency extractions and a scale and polish. More complex care such as dentures and a broader range of treatments for patients with additional needs and high-risk patients are available subject to HSE approval.

In May 2022, the Minister for Health approved measures providing for increased preventative care and increasing the fees paid to dentists for most treatment items by 40% to 60%. Fees paid to dentists for DTSS care are aligned with other European countries which provide comparable public dental care. The number of patients and treatments has been increasing since the measures were introduced. Comparing the claims made by DTSS contractors nationally from January to October 2023, 142,450 additional treatments have been provided under the scheme, with more than 25,600 extra unique patients treated compared with the same period last year.

However, the Minister is aware that medical card holders in some areas continue to have difficulty accessing care. Where access to a dentist is difficult, the local HSE service will make lists of DTSS contractors available to medical card holders. In exceptional circumstances, the HSE assists patients to access emergency dental treatment by directly contacting private contractors or arranging treatment to be provided by HSE-employed dentists. Additional funding was made available to HSE this year to provide this care when required.

For children, the HSE public dental service provides screening and necessary treatment at ages corresponding to second class, sixth class, and, subject to capacity, fourth class. Emergency care is also provided for children up to 16 years of age and for those with complex and additional needs. The HSE is continuing to restore dental screening and treatment to children up to 16 years of age by prioritising clinical treatment and patient groups and reallocating clinical resources according to greatest need.

In the longer term, the Minister for Health recognises that oral healthcare for all ages needs to be modernised in line with best international evidence and practice, as set out in the national oral health policy, Smile agus Sláinte. The work is already under way for children aged from birth to seven years using the €4.75 million funding awarded in budget 2023. The modernised services will be person-centred, prevention-focused and available locally in line with the vision set out under Sláintecare.

The Minister has supported the HSE to develop clinical leadership and to reform leadership roles to progress implementation of the policy this year. The HSE recently appointed a strategic reform lead to drive policy implementation across the organisation. This will enable the HSE to move forward in 2024 with developing new services for both adults and children in line with the policy.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Minister of State. I welcome the appointment of a strategic reform lead to drive policy. However, there is a situation in which children are going to secondary school and have not been assessed. It is a huge issue. Some parents do not have the money to bring their children to a private dentist and there is only one dentist in Carlow who covers the public scheme. Carlow in the last census had a population of more than 62,000 and it is growing. We are delighted it is growing but with that are challenges. I know the Minister of State will go back to the Minister for Health and highlight my concerns that we need to make sure children are seen in primary schools when they are meant to be seen.

Another issue came up about medical card and what it will cover when you go to the dentist. That must be looked at too. I welcome that the system is being looked at. It needs to be changed. Another area which needs to be looked at and totally reformed is the dental tax relief scheme, the MED 2 form, to increase tax relief to a minimum of 30%, expanding access to treatments and reliefs available and making applying more simple and related to the ongoing health of patients, including extractions, fillings and hygiene treatments.

Separately, many people have come to me about the tax Acts, which have not been consolidated since 1997. We must take this into account because of the challenges. We saw what happened over the past few years. It has been 26 years since this was looked at. I ask that that be looked at. I know the Minister of State is aware, as is the Minister for Health, that there are huge challenges across all of the health sector at the moment. Families are coming to me with children in primary school and they cannot access a dentist through the public health system. I know that will be looked into. Will the Minister of State come back to me with answers about it? I would really appreciate it.

Niall Collins (Limerick County, Fianna Fail)
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I have listened to the Deputy and colleagues in the Chamber and have taken onboard the points made. I assure the Deputy that addressing access to dental care, including for adult medical card holders, is a top priority for the Minister and the Government. The Minister made substantial additional investment in oral healthcare services both in 2022 and 2023. Fundamental reforms are also being progressed through the implementation of the national oral health policy, for which funding has been provided this year. The policy sets out the vision for the future of oral healthcare services. While it will take a number of years to bring to complete fruition, there will be an early and continued emphasis on addressing current access issues. The policy fundamentally aspires that all Irish people will have their own dental home where they build a life-long relationship with a local dental practice or practices of their choosing for continuity of care from birth to old age. The policy has two goals: to provide supports to enable every individual to achieve their personal best oral health; and to improve access to dental care in an equitable and sustainable manner, enabling vulnerable groups to improve their oral health. I am confident that by working together with the dental profession and all stakeholders, the goals of the policy will be met.

Marc Ó Cathasaigh (Waterford, Green Party)
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With respect to Topical Issue No. 3, I am afraid there is no Minister to take it. I will have to refer this to the Ceann Comhairle's office and ask him to take the submission of the Deputies' Topical Issue into consideration, be it tomorrow or Thursday. Currently, there is no Minister to take their Topical Issue.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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With all due respect to An Cathaoirleach Gníomhach, this is not aimed at him at all but this is very disrespectful to us. Deputy Gino Kenny and I came from a meeting in Cherry Orchard where there was a large protest by families about this urgent and distressing move, which is to take place from the hospital there to a centre in Clondalkin in the next few weeks. We came from that meeting and have sat in the campus here for the last three hours. Obviously, one is always busy and has loads to do but at 10.30 a.m. today, we got an email to say it would be taken. Now, there is nobody to take it. That is totally disrespectful not just to the Deputies here but to those families and residents who face a huge challenge. We are really disgusted.

I certainly cannot come back in the morning because I have other arrangements made for meetings and to deal with other business. This really is not on. If it is going to be rescheduled, it should definitely happen and the Minister of State, Deputy Mary Butler, must be here because she has to answer the questions. Does Deputy Kenny want it to go ahead in the morning? I certainly do not.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I have to attend the health committee. It is not going to be possible.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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The Deputy has a meeting of the health committee to attend.

Marc Ó Cathasaigh (Waterford, Green Party)
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As the Deputy will understand, I am not in a position to make a commitment one way or another from where I am currently sitting. I will speak to the Office of the Ceann Comhairle. I agree with her sentiments that it is unacceptable.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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I ask the Cathaoirleach Gníomhach to emphasise to the Ceann Comhairle that this is not just about Deputies being annoyed about having to hang around until 10.30 p.m.; it is the issue itself and the urgency with which it has to be heard in the House for all of the families and residents involved.

Marc Ó Cathasaigh (Waterford, Green Party)
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I will certainly undertake to do that.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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Go raibh maith agat.