Thursday, 16 November 2023
Saincheisteanna Tráthúla - Topical Issue Debate
The issue I am raising is dental services in Laois and in Offaly, which are bad in both counties. The service in Laois is the most chronic, as far as I can ascertain, in the State.
Dental services are important for oral health. If oral health is not good, general health is not good and it leads to problems down the line. This week, the Committee of Public Accounts, of which I am Chairman, received figures from the HSE, which show that the number of extractions under the dental treatment services scheme, DTSS, last year was 87,558. There were surgical extractions numbering 20,764. The fact that surgical extractions are necessary shows that we have serious problems in this State. The number of fillings provided under the scheme was 86,000.
It is clear that preventative action is not being taken. A generation is growing up without having any proper oral health checks or follow-up treatment done. This is a serious matter. The situation has deteriorated. Despite being rated one of the richest countries in the world and one of the best in Europe, we have the worst health system in terms of dental health.
I raised this issue when the Taoiseach was Minister for Health. I remember speaking to him about it inside and outside the Chamber. I am concerned about this issue, which is one I feel passionately about. I hope the Minister of State at the Department of Health, Deputy Rabbitte, will join me in trying to fix it.
There is no quick solution but it is clear that we are relying on a failed model in which we get contractors to do this work. Their fees have increased. I checked this afternoon with my secretary in Portlaoise and there is not one dentist in County Laois who will take patients under the DTSS. There is one who has some existing clients but that dentist will not take new patients. I am not blaming the individual in question who cannot handle any more patients.
The figures we got this week show there are 71 DTSS contracts in community healthcare organisation, CHO, 8. They are not in Laois. There are few of them in Offaly. I have asked for more detailed information on this.
There is no follow-up being done. On the schools scheme, of which I have first-hand experience in my family, children are not being seen in primary school. I raised this previously and will continue to do so until action is taken on it. I was seen in third class. I can remember well being terrified going to the dentist but we saw a dentist in third class. Those who needed fillings got them, as this anyone who needed an extraction. Many years later, children are not being seen until third year in secondary school, if they are lucky, although it is often fifth year. Children of 16 and 17 years of age are only being seen now. That is a problem because they may need extractions. Losing teeth is not preventative action. The Minister of State and I know the effects that this is having on their health. We have to try and fix this problem.
Efforts have been made to recruit but it is difficult to recruit dentists. They are being recruited abroad. We are training them but not employing them. Young graduate dentists need to see there are opportunities and a career path. We need to fix this by having a public dental system. I am not being ideological about this. I am only being practical. We cannot rely on the model we have.
I am taking this debate on behalf of my colleague, the Minister for Health. I thank the Deputy for the opportunity to address the issue of dental services for children and the dental treatment services scheme in Laois and Offaly.
The HSE public dental service provides dental care for children up to 16 years of age. This includes screening and necessary treatment for children 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.
At the end of July this year, the HSE had 103 whole-time equivalents providing dental services in CHO 8 across orthodontist, dentist, dental nurse and hygienist grades, an increase of five whole-time equivalents since May 2023.
The Department of Health engages with the HSE on an ongoing basis to understand and address any challenges arising in the provision of public dental services. The Minister has been assured by the HSE that it is continuing to restore dental screening and treatment to children up to 16 years of age through prioritising clinical treatment and patient groups and reallocating clinical resources according to greatest need.
The dental treatment services scheme provides dental care, free of charge, to medical card holders aged 16 and over. Services available annually and on demand include the examination, including 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 increased the fees paid to dentists and 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 have been increasing since the measures were introduced. Comparing the claims made by the DTSS contractors nationally from January to October 2023, 142,450 additional treatments have been provided under the DTSS, with more than 25,600 extra unique patients treated when compared to the same period last year. This includes an extra 870 patients in the Laois-Offaly area who accessed care, and an additional 3,524 treatments that were provided. HSE data indicate there are ten contractors operating in the DTSS in Laois-Offaly and all ten submitted claims in September 2023.
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, local HSE services makes a list of DTSS contracts available to medical card holders. In exceptional circumstances, the HSE assists patients to access emergency dental treatment by directly contacting private contractors or arranging for treatments to be provided by HSE-employed dentists. In the longer term, the Minister recognises the need for oral healthcare needs to be modernised in line with best international evidence and practice, as set out in the national oral health policy, Smile agus Sláinte. This work is under way for children aged from birth to seven years, using €4.75 million worth of funding awarded in budget 2023.
I thank the Minister of State for her reply. I will deal with the issue of school dentistry first. The problem is that the children are not being seen. In Laois, the school year being completed is 2019-20. According to the previous paragraph in the document that I got, this refers to sixth class, which means that the children are in third year or they are moving into fifth year. I can tell the Minister of State I have first-hand experience with a family member and the children of neighbours living around us who were seen in fifth year. That is not satisfactory. They have to be seen in primary school. I acknowledge the Minister of State is logical about these things and she is interested in primary care. This needs to be done in primary level for preventative treatment. It is too late by the time they get to secondary school.
The Minister of State outlined figures and the HSE will provide them, but in Laois there is not one dentist, and I defy anybody who says otherwise. We have done an extensive trawl and phoned around every dentist in the county. There is no dentist in Laois who will take a new patient under the DTSS. In emergencies, we do what the Minister of State has outlined in that we send patients to the HSE. It is a battle. They end up going to Tullamore and eventually, depending on whether it is an emergency, they may or may not get treatment. That is not acceptable and we have to fix it.
I have seen at first hand the efforts made by the HSE to recruit dentists and while I want to acknowledge that, they are failing. There is something wrong if we have a situation where we are training so many dentists every year but somehow or other there are none available They are not all going into private practice. Many of them are emigrating. If the Minister of State does nothing else, I ask her to consider this issue from the perspective of trying to capture, for want of a better term, those people, that is, to try to get some of those good dentists into work on the scheme. As for the private schemes, contracting on its own is not working and is not satisfactory. A cohort of directly-employed dentists that the HSE control, employ and manage is needed. That is the point.
I thank the Deputy. I have listened to the issue being raised today, but I have also heard it from colleagues in this Chamber. I have taken on board the points the Deputy has made. I can assure him that addressing access to dental care in Laois-Offaly, including for children and adult medical card holders, is a top priority for the Minister. The Minister has made substantial additional investment in oral healthcare services, both in 2022 and 2023. On the Deputy's query in relation to Laois, I will go back and directly ask the Minister if there are dentists providing the service under the DTSS, as he has outlined here today. I will ask him that clearly.
Fundamental reforms are being progressed through 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 health services. While it has taken a number of years to bring it to complete fruition, there will be an earlier and continued emphasis on addressing the current access issues. These 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 leaderships and to reform leadership roles to progress implementation of the policy this year. The HSE has recently appointed a strategic reform lead to drive policy implementation across the organisation and to move forward in 2024 with developing new services for both adults and children in line with this policy. I am confident that working together across the relevant Departments, agencies and other stakeholders, in line with respective roles and responsibilities, the goals of the policy will be met. I will also bring to the attention of the Minister the Deputy's query in relation to capturing the new graduates as they qualify.