Dáil debates
Thursday, 1 February 2024
Saincheisteanna Tráthúla - Topical Issue Debate
Dental Services
1:20 pm
Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I welcome the Minister of State, Deputy Joe O'Brien.
Éamon Ó Cuív (Galway West, Fianna Fail)
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Go raibh maith agat, a Cheann Comhairle, as ucht as ligean dom an cheist thábhachtach seo a thógáil.
Health is very important and should be a priority but dental health is an intrinsic and very important part of the health equation for most people. It is well testified that where people do not look after their dental health, there are detrimental effects on their well-being. The reality is that the medical card dental scheme is falling apart. County Galway has a population of approximately 300,000, so we can guess that there are approximately 100,000 medical card holders. There are 24 dentists in the scheme and they obviously have a large number of private patients. Each of those dentists has to cover 4,166 medical card patients in addition to private patients. That is clearly impossible and, therefore, we have a huge challenge. In our constituency clinics, we meet all the time people with medical cards who cannot access routine, but vital, medical treatment. The reality in such cases is that many people wind up getting teeth extracted. The options when that happens are either very expensive or not very good. Taking modern dental practice into account, they are certainly suboptimal.
I recently got a heartbreaking letter from the Galway Advocacy Council. This group is supported by fáilte community services in the Brothers of Charity. This group mainly deals with people with disabilities. They said - they are people with a disability - about their experience with the dental services that if you have not seen a dentist in a year, you will drop off their books. People have to go to Shantalla clinic, which is the public clinic, for extreme emergencies to be seen because they are in pain.
Dentists are looking for bank details ahead of appointments. What is the point in having a medical card? Dental services have got worse in the past 20 years, certainly for people dependent on a medical card. Do dentists want to deal with medical card holders? Is there a lot of paperwork? People should not have to suffer or be in pain. It is wrong. Any of us who have suffered from daitheachaí or dental pain, toothache, know how excruciating it can be. What is going on in the country? That is a valid question. At a time when there is unprecedented wealth, a simple service such as a medical card dental service does not seem to exist in any meaningful fashion. People have lost interest in going to the dentist due to a lack of appointments for medical card holders and not having any money to go privately. They are losing their teeth, their smiles and their confidence and it is also affecting their health.
I beg the Minister of State - it is unfortunate that the Minister for health and no Minister of State from the Department of Health was available - and hope that he will carry the message back, that there is a crisis in the provision of dental services for medical card holders and to see a dentist privately is unaffordable.
1:25 pm
Joe O'Brien (Dublin Fingal, Green Party)
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I thank the Deputy for the opportunity to address the issue of participation of dentists in the dental treatment services scheme in County Galway.
The dental treatment services 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, 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 the approval of the local HSE principal dental surgeon.
In response to contractor concerns regarding the scheme, the Minister for Health approved measures from May 2022 providing for increased preventative care and increasing the fees paid to dentists for most treatment items by between 40% and 60%.
While the number of contractors of the scheme remains lower than before the pandemic, with 57 contractors on the scheme in County Galway at present, the number of treatments provided by contractors on the DTSS has increased since the new measures were introduced. In 2022, 40,580 treatments were provided at a cost of €2.23 million in County Galway. In 2023, 44,646 treatments were provided at a cost of €2.81 million. However, the Minister is aware that medical card holders in some areas continue to have difficulty accessing care. The HSE is required to support the provision of emergency care to adult medical card holders who are having difficulty accessing a local dentist.
The Government is committed to fundamentally reforming dental services, including the DTSS, through the implementation of the national oral health policy, Smile agus Sláinte. The Department is working closely with the HSE to ensure the establishment of focused structures to drive implementation of the policy. The HSE has 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 the policy. This will include work on planning new services for medical card holders. The policy highlights the need for strategic workforce planning to ensure a sufficient number of appropriately trained oral healthcare professionals, including dentists, dental hygienists, dental nurses and other auxiliary grades. It is heartening to note that we currently have more registered dentists than ever before. There are 3,649 at present, which is an additional 177 registered dentists since March 2023. This reflects positive trends as the comparable figure in 2018 was 3,217.
The Minister supports the creation of additional capacity in higher education, including in oral healthcare. The Higher Education Authority is undertaking a process to identify a set of options for achieving this important step towards health workforce sustainability for Ireland.
Éamon Ó Cuív (Galway West, Fianna Fail)
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I thank the Minister of State for the information, but I have to say that I know from dealing with my constituents that the lived experience, irrespective of the figures, does not concur with what was stated in the script he was provided by the Department. To be honest, a free scheme is a free scheme and the cost becomes irrelevant to the people who seek to access it. We should not give a commitment if we are not going to honour it, irrespective of the cost.
The Minister of State said there are 57 contractors. We looked for the names of the dentists on the scheme quite recently and we were given two in Galway west, nine in Galway east and 13 in the city. I will check whether there is an updated list and if it has more than doubled in the meantime, but that is certainly not the information we were given. I will raise the issue here again if the figure of 57 does not stand up in reality. As the Minister of State is aware, it is important that the facts and figures given on the record are accurate.
The lived experience is that people cannot access routine treatment. I heard what was said about emergencies, but an emergency should be an emergency. That should not be the routine way to go. We also know that, with dental health, prevention is much better than cure and that early intervention on cavities and other issues that arise with dental health is far superior to trying to solve a problem that should have been avoided.
Finally, I especially ask the Minister of State to mention to the Minister the challenge faced by those with a disability and particularly, since they raised the issue with me, with an intellectual disability. They do not have the same ability to fend for themselves in trying to negotiate a complex bureaucratic system. Will someone make sure they get access to genuine free dental care as promised?
Joe O'Brien (Dublin Fingal, Green Party)
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The Minister has made substantial additional investments in oral healthcare services in recent years, but I take the Deputy's point about the lived reality he outlined, especially regarding people with intellectual disabilities trying to negotiate complex administrative systems which are not always very user friendly. I will certainly take that point back to the Minister. I will also ask him to supply the list of 57 contractors to the Deputy. I thank him for raising the points he did. I will take the message back to the Minister for Health.