Pat Buckley (Cork East, Sinn Fein)
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I thank the Minister of State, Deputy Colm Burke, for being here tonight. I am raising the long waiting list for dentures, specifically for people over 70. I want to go back to a newspaper article in January 2009, which appeared under the subheading: "Dentures will be rationed for medical card holders as part of a wave of Health Service Executive ... cutbacks, dentists representatives warned." The article states:

The Irish Dental Association ... chief executive ... said dentures are the most expensive discretionary item provided for under the general medical card scheme.

Because of that we are getting strong indications they will be the first thing to go,” he said.

Currently, dentists can perform routine dental work, such as examinations, fillings and extractions on medical card patients without receiving authorisation from a HSE principal dental surgeon. More expensive treatment items, such as advanced gum treatment, large x-rays and dentures, must be authorised by the HSE.

In July 2023, the same chief executive said that nearly 500 more dentists were needed in order to meet demand. An article in the Irish Independent on 19 March last stated, "More than 13,000 people now on waiting lists for dental surgery".

The issue of dental services was recently raised in the Seanad by Senator Tim Lombard. The information he received is that in the Cork and Kerry region, as of last June, while 860 patients had their orthodontic needs assessed in the first six months of the year, a whopping 2,900 patients were still waiting for an assessment. While 1,937 patients were in active treatment at the time, there were 2,600 patients waiting to start treatment at the end of June. That is slightly different in that it probably relates to the younger generation, but it is still indicative of the crisis that the dental service is in. It was also stated that the HSE says that the problem is a lack of participation by private dentists in the scheme, because there is an embargo on the recruitment of its staff.

A number of people have been in contact with my office in recent months in respect of this matter. I also spoke to a very good friend of mine about it at the weekend, which prompted me to table a parliamentary question on it but I have not received a response to it yet. We will call my friend Dave from Midleton. About 15 months ago, he had problems with his dentures. He brought them to the local dentist and paid to get them fixed. The Minister of State should bear in mind that he is a pensioner. When he went on a waiting list more than a year ago he asked how long he would be waiting. They said it would be about two years. Nearly four weeks ago he again had a problem with his dentures. He went back to the dentist and paid to get them repaired. When he asked where he was on the list, he was told he would probably be waiting for two years. He said he was told that last year, so now it is three years.

There are other costs involved. I went on the patient information page on the UCC website. What this gentleman needs is a full upper and lower denture replacement. The quote I have is for €1,100. As a pensioner, there is no way he can afford that. One of the necessities in life is that we are able to eat. We can imagine what it would be like at that stage in life if we could not even put in dentures to chew food. It is absolutely ridiculous that the basic rights of the most vulnerable are being ignored and excused by waiting lists, but if a person has cash, he or she would only be waiting a couple of weeks. What will the Minister of State do for the likes of this man, and the others who have come to me? They are in fear of their life. They are afraid to ask. They are ashamed to say they cannot afford it, so they just sit there in pain.

Colm Burke (Cork North Central, Fine Gael)
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I thank Deputy Buckley for raising this matter. I am dealing with this reply on behalf of the Minister. Dentures and denture repairs for medical card holders are provided by contractors through the dental treatment services scheme, DTSS, which provides dental care, free of charge, to medical card holders aged 16 and over. Denture-related items are available from both dentists who hold a DTSS contract and contracted clinical dental technicians who only provide dentures on the scheme. Services available annually and on demand through the DTSS 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.

The DTSS contract enables patients to have a new denture provided every five years, and to have denture repairs undertaken as required. Medical card holders may choose to attend any contracted dentist or clinical dental technician to access repair or replacement dentures. In response to contractor concerns regarding the scheme, the Minister approved measures from May 2022 providing for increased preventative care and increased the fees paid to dentists for most treatment items, including dentures and denture repairs, by 40% to 60%. This has increased both the number of patients seen and the treatments provided in the DTSS.

The HSE is unaware of any waiting lists in contracted practices. However, the Minister is aware that medical card holders in some areas continue to have difficulty accessing care. While there are a significant number of contract holders, appointment availability fluctuates daily according to practice demands. The local HSE principal dental surgeon may be able to provide assistance in accessing DTSS care. The HSE is required to support the provision of emergency care to adult medical card holders who have difficulty accessing a local dentist. In the longer term, the Government is committed to fundamentally reforming dental services, including the DTSS, through implementation of the national oral health policy, Smile agus Sláinte. The policy sets out a complete transformation of oral healthcare services and expansion of the care available for both children and adults. 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 in line with the policy. This will include work on planning new services for medical card holders. The HSE is currently developing the clinical aspects of new packages of preventative care for DTSS patients, as the first phase of reform of the medical card scheme. An implementation plan for the first phase of roll-out is being developed between the Department of Health and the HSE, for consultation and then publication in the third quarter of this year. This report will be set out by the third quarter of 2024.

Pat Buckley (Cork East, Sinn Fein)
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I thank the Minister of State. I respect the response outlined. I am well aware that new dentures can be provided every five years, but that is if a patient can access a dentist.

That is the issue here. Then there is the medical stuff that goes with it. Oral health is vital. The Minister of State's written statement reads, "The HSE is required to support the provision of emergency care to adult medical card holders who have difficulty accessing a local dentist." In the case I am talking about, the gentleman was told a year and three months ago he would be waiting two years. Three weeks ago, he was told he would be waiting another two years. That is not a very proactive way to provide emergency care for adults.

When I was speaking to the gentleman, he laughed. The older generation always have a good sense of humour and a bit of fun. He said he would be like the elderly couple in the burger restaurant. The husband was sitting across from the wife and they had the burger cut in half. She was chewing her half but he had not touched his. A young couple spotted them and did not know what was going on but assumed they were sharing the burger. The young gentlemen went up, purchased another burger and dropped it at the table of the older couple. He told the man to have that burger and let his wife have the other burger. The other man said he was missing the point, that there was nothing wrong with the cost of the burger and that he was waiting for her to finish eating her half of the burger so he could use her dentures to chew his half. That is the story that gentleman told me.

The Minister of State mentioned the HSE assisting people. It assists people by telling them it is tough luck, to go away and get things fixed again and come back in two years. That has to be revisited. The written statement reads, "The HSE is required to support the provision of emergency care to adult medical card holders who have difficulty accessing a local dentist." That is where the problem is. They cannot access them and the HSE is not helping them to do it. It is just giving them the hard luck story. I do not know where we will go from here. I do not know what I will do or what I will tell this gentleman and others when I go back to my constituency at the weekend.

Colm Burke (Cork North Central, Fine Gael)
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I fully understand where the Deputy is coming from in relation to any person having difficulty accessing dental care. It is clearly set out in the statement, "The HSE is required to support the provision of emergency care to adult medical card holders who have difficulty accessing a local dentist."

Access to dental care, including for adult medical card holders, is a top priority for the Minister and Government. The Minister has made substantial additional investment in oral healthcare services in recent years. In addition to more than €200 million the Government invests in public oral healthcare services annually, €17 million in one-off funding has been invested since 2019-2020 to address service backlogs.

The national oral health policy, Smile agus Sláinte, highlights the need for strategic workforce planning to ensure a sufficient number of appropriately trained oral healthcare professionals, to include dentists, dental hygienists, dental nurses and other auxiliary grades. Maximising the contribution of all our oral healthcare professionals and allowing them work at the top of their licence is central to Smile agus Sláinte and to increasing services.

It is heartening to note we have more registered dentists in Ireland than ever before. There are 3,652 registered dentists, which is an additional 177 since March 2023. This reflects positive trends, with the comparative figure being 3,217 in 2018. That is an increase of more than 400 dentists.

The Minister supports the creation of additional capacity in higher education, including in oral healthcare. The Higher Education Authority is undertaking a process to identity a set of options to achieve this important step towards health workforce sustainability for Ireland. I am confident that, working with the dental profession and other stakeholders in line with their respective roles and responsibilities, the goals of this policy will be met.

I accept there is a need to increase the output of dentists from third-level colleges. It is not only dentists but also dental hygienists and all of that area that needs to increase because we have an increasing population. It is important to note there has been an increase in the number of dentists available to provide a service in this country. Let us keep working towards increasing it further.