Mattie McGrath (Tipperary, Independent)
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I support the motion and recognise it is very well presented and timely. It is well overdue. It is an excellent motion and it reflects the real situation affecting so many hundreds of thousands of people. The fact that dental services are not available to them is truly shocking. It is not the first motion of its kind and it will probably not be the last. The motion calls for legislation to be brought forward by September but there is little hope of that. It is a situation that affects every one of us, our children, our grandchildren and all of the families throughout the country.

My office, like every other office, is inundated with people contacting me about appalling situations. It is so distressful for people who are trying to avail of services. I attend my dentist Daniel O'Connell on The Quay in Clonmel. He is a top-class dentist who cares for people. He has been questioning this issue with me for five or six years, with regard to the falling number of dental students and dentists, and dentists withdrawing from the scheme because it is outdated. This has not even been discussed. We have heard so much from the IMO and the new organisation for GPs about their contract and how outdated it was. They have made great progress thankfully. The dentists are the poor relation. There does not seem to be any attempt to understand or engage with their association in an effort to try to hold onto the dentists in the medical card scheme and attract new ones.

As we are speaking about dentists, the wonderful receptionist Cheryl Moore Wall was a wonderful lady. She succumbed to illness and passed away in April. She was an exceptional lady to meet and to speak to on the phone. She always organised the appointments and follow-up visits in a cheerful and helpful manner. I express my sympathies to Daniel O'Connell and his team and to Ms Moore Wall's family and her large circle of friends. Ar dheis Dé go raibh a h-anam dílis.

Deputy Shanahan referred to South East Technological University. Certainly it is a big issue and we need to promote and support that dentists may be able to study dentistry in this institution. It is a national problem and the schools and colleges we have are not able to attract students. Who oversees these issues in the Department of Health or the HSE? They cannot see this festering sore with regard to the lack of dentists. People have to travel to different counties to try to get a dentist to operate on their children under the medical card scheme. It is a very worrying situation for young people and children not to be able to access it. It is a stress to have to travel perhaps 60, 70 or 80 miles away. This is how it is in rural Ireland. We speak about Sláintecare and all kinds of healthcare on our doorstep but we do not have it. A real root and branch review has to take place.

I support the call for the legislation because it is so badly needed but will we see it and how long will it take to enact it? How long will it take for legislation to be brought forward, debated, discussed and approved? Then we will need the statutory instruments to put it in place and give effect to it. This will be a very cumbersome procedure. We need something very quickly. The figures are quite startling and the number of people waiting is shocking. The figures have already been read into the record by many other Deputies. It is outrageous. It should not be happening in a so-called First World country. We need to take this issue very seriously. Everybody is supporting the motion. Other motions have been passed but nothing has changed. We need to make a real difference and a real impact.

It is going to take a multi-agency approach from the Government. It is not going to get repaired by sticking plasters. We need a root and branch review. We need full support from the Department of Health and the Minister for Health to drive this issue once and for all. It might be classed as unseen or unheard of but it is out there and it is very serious. It affects hundreds of thousands of families. It is not acceptable.

Marian Harkin (Sligo-Leitrim, Independent)
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I thank the Social Democrats for bringing forward this important motion on the totally unacceptable lack of dentistry services in Ireland. The motion lays bare the damning statistics, which I will not repeat. They are stark. If there was only one recommendation I would ask the Government to put in place from this motion, it would be to commit to providing the required funding in budget 2025 to put the medical card scheme on a sustainable footing. The other recommendations are really important but, to me, this is a core one.

Normally when I speak, I cite lots of statistics to make the case for change and I will give the House some statistics from Sligo-Leitrim in a minute or two. Today I want to give an example of the many emails I have received which tell of the utter frustration and disbelief of parents as they seek dental care for their children who are attending primary school. My constituent wrote to me in relation to the matter of dental care for primary school children. Having contacted the dental department in Markievicz House that morning, the person was informed that unless children require urgent dental treatment, they will not be seen through the public system. The response was that children will be seen in sixth class and the dental department is currently working through a backlog of last year's primary school leavers. My constituent was informed that unless children require emergency dental treatment, the guidance is to go private as there are insufficient staff due to a number of retirements. This parent then asked if appointments for secondary school students could be made and was told they could be made only if additional treatments were required from the sixth class appointment. If children do not get the treatment in the first place, they cannot receive treatment afterwards because the system failed them in the first place. This is what is happening.

After receiving a number of these emails, we contacted the HSE. One response told us that the HSE targets children in key school years, second, fourth and sixth class, offering dental examinations, preventative care and so on. However, that is simply not happening. We got a second response from the HSE which actually tells us what is happening in reality. It tells us that in Sligo and Leitrim there has been a significant reduction in the numbers of participating dental contractors, with only one contractor providing care for medical card patients under the DTSS in County Leitrim. It tells us that Sligo and Leitrim HSE dental services now receive multiple requests for emergency care every day as patients are unable to access care with a DTSS contractor and there is no option of redirecting patients to alternative contractors due to the ever-increasing number of resignations from the service. There is no service and that is why I fully support the motion from the Social Democrats.

Thomas Pringle (Donegal, Independent)
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I am grateful for the opportunity to speak to this motion regarding dentistry services and thank the Social Democrats for bringing the motion forward. I fully support this motion and its calls for the Government to expand the capacity of public dental services for children and special care patients, reform the dental treatment service scheme, publish the dentists Bill and address the funding and capacity issues in dental education provision.

There is an ever-lengthening waiting list for vital dental treatments, as well as school screenings, yet there has been a significant decline in the number of dentists, as well as the number of oral hygienists and dental nurses available. The number of dentists has dropped by almost one quarter over the past 15 years and the Irish Dental Association has stated that at least 500 dentists are needed across the private sector and public service immediately because of the growing population and to replace those dentists who are due to retire. A past dean of the RCSI faculty of dentistry has also reiterated the fact that Ireland desperately needs more dentists and dental professionals, stating that currently, Ireland has 44 dentists per 100,000 of the population, while other European countries such as Germany and Italy have double that number. Reports have shown that Ireland has the fewest dentists out of 24 European countries and was bottom of a table measuring the proportion of general dentists to population.

It is clear that Ireland is lagging behind significantly and this is affecting many Irish people who are finding it extremely hard to access necessary dental care. A survey carried out by the Irish Dental Association in 2023 showed that one in six patients were waiting over three months for a routine appointment with their dentist, while more than half were facing delays of longer than three months for specialist care, including orthodontic and oral surgery. It has also been reported that less than half of children who should be seen under the school screening programme are actually seen, with children in some parts of the country facing a ten-year backlog in accessing the school dental screening programme. You would actually be finished school before you would see a dentist. This cannot be allowed to continue. It is in the interest of all Irish people, particularly children, for this backlog to be addressed urgently.

There is no way for this to be addressed without addressing the fact that at present, we have just two dental schools, in UCC and Trinity, producing just 80 dentists a year, approximately 50% of whom originate from the far east and Canada and who leave Ireland to return home once they graduate. Given the fact that we require at least 500 dentists immediately to deal with the backlog of people awaiting appointments, treatments and screening, it is clear that something more needs to be done and done now. I understand that there were plans for a new dental school, which have been paused due to funding constraints. Funding for this school needs to be prioritised, but the Government should also be looking at funding more dental schools throughout the country given this dental crisis. I would urge the Government to consider funding for a dental school in the north west. There is no way that we can address the severe recruitment and retention issues in the public dental sector, particularly in rural areas, without the establishment of a dental school in the north west. ATU has successfully launched many new courses for students since its establishment two years ago and it has made education so much more accessible for many in the west of Ireland. ATU should be supported in establishing a dental school to address the significant staff shortages and clinic closures that we are seeing throughout the north west and to help alleviate the current burden on the public dental service.

Some 27% of public service dentists are over the age of 55 and close to retirement. The Government needs to take drastic action and consider the solutions put forward by the Opposition today. The Government has to make more places available and we have to see more schools providing dentistry treatment. The reality is that only the elite can get in because there are so few places. By having more places, we will get more dentists and actually deal with the issues.

Violet-Anne Wynne (Clare, Independent)
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I thank the Social Democrats for using their Private Members' time this week to discuss the serious failings in respect of dentistry services. The motion acknowledges that access to dental care has been in crisis. That is especially true in counties like my constituency of Clare. Urgent action was required by Government to address the serious failings. Instead, we got gestures and token add-ons. In 2022 we saw increases in fees payable to contracted dentists for examinations and fillings and the reintroduction of cleaning for medical card patients. That was a great way to respond to the reality that people in County Clare at that time were finding it absolutely impossible to find a dentist. Why is this happening? That is the running theme I have been pointing to. There is a lack of meaningful engagement from Government towards sectors, particularly those that are collapsing, such as the dentistry sector. Piecemeal tactics are being deployed in an effort to keep the noise down. I believe that and so do my constituents.

The facts are this. The number of dentists participating in the DTSS, which is the medical card scheme, has reduced by almost 50% and not all are active. In County Clare, there is a list of dentists who are taking part in the DTSS.

When calls are made, however, it will be found that they are no longer active or no longer participating or in a position to take on any new medical card patients. For the past three years, my constituents have been inconvenienced by either having to pay more to travel outside the county to access dentists, and taking time off work and everything that comes with that, or going without treatment altogether.

This is what I fear has been lost in the debacle that is the dental service in this country. The lack of reform, action and, ultimately, solutions is having a direct impact on people's attitudes and behaviours in respect of accessing health care. The reality is far worse than what we can imagine. The Government is normalising delayed care and people receiving no care and having no options. That is not acceptable, especially when we know that oral diseases disproportionately impact the poor and socially disadvantaged members of society. Untreated tooth decay is the most common health condition according to the global burden of diseases, never mind how it affects your self-esteem.

Ossian Smyth (Dún Laoghaire, Green Party)
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I thank the Deputies across the House for their contributions to this debate. As the Minister of State, Deputy Burke, has noted, an additional €15 million in core funding since 2019 and 2020 and a further additional €17 million in once-off funding has been supporting the ongoing work to reduce waiting lists and to address access to services through policy implementation. I assure Deputies that the Minister for Health, Deputy Donnelly, and his Department appreciate the difficulties being experienced by people seeking to access oral health and that we will continue our ongoing work to address this issue.

We are easing current access issues through a range of interim measures. These include a 40% to 60% increase in payment for treatments under the dental treatment services scheme and also substantial investment in orthodontic waiting list initiatives. Ultimately, implementation of the national oral health policy will achieve the substantive service reforms required to ensure that patients can access the care they require as set out in the best international evidence and practice. In turn, we recognise that the oral health care sector must be enabled and supported to provide this evidenced-based care through an appropriate framework of professional regulation, education and training and strategic workforce planning, as well as modernised contractual arrangements.

The national oral health policy, Smile agus Sláinte, sets out the vision for the future of oral health care services in Ireland. This is a body of wide-ranging and transformative reforms and the implementation plan for the 2024-26 phase is in development to set out the key milestones and outcomes. The lengthy phase of policy development between 2014 and 2019 was fully cognisant of two policies in particular that have provided the framework for the vision of transformative change that the Smile agus Sláinte policy sets out. Smile agus Sláinte is based on technical concepts that the World Health Organisation has endorsed for several decades and which embed oral healthcare in a primary care setting rather than in an acute setting, that emphasise the integration of oral health into general health through the recognition of common disease risk factors such as diet, alcohol consumption and tobacco usage and that endorse the use of comprehensive oral healthcare packages that are prevention-focused.

Accordingly, Smile agus Sláinte reflects the ethos, practices and intentions of the WHO's global oral health resolution strategy and action plan. Smile agus Sláinte also applies the Sláintecare vision of enabling patients to access the right care in the right place at the right time in respect of oral healthcare based on the best international evidence and practice in oral healthcare. This means that the care the State is enabling the sector to provide will emphasise prevention and will aim to keep patients out of an acute setting as much as possible. The design and development of oral health care packages for adults and children under way in the HSE represents a significant expansion of preventive care.

Care in the right place, as it applies to oral healthcare, means that people of all ages should be able to access care at local dental practices of their choosing, thereby establishing a dental home for continuity of care and allowing dental practices to build enduring relationships with their patients. The public dental service will continue to play a core role in oral healthcare provision. The changes envisaged will increase the capacity of the HSE service to reorient and develop oral health promotion programmes. There will also be greater capacity to provide care to those more vulnerable groups in the community, including adults and children with additional needs and adults living in residential settings. The Sláintecare approach also means that people should have sufficient access to care from birth and across the full life course to prevent problems before they arise. This is why starting with our zero to two-year-olds, who can currently only access emergency care, is a priority. This is a considerable change. It is based on the evidence identified. The Government will work with the sector to support these developments but the sector must also recognise the shift towards a primary care-based preventative model across the life course.

A key enabler of this transition towards a Sláintecare ethos is ensuring that we have a sufficient number of appropriately trained oral healthcare professionals. In particular, we need to leverage and maximise the contribution of our hygienists, our dental nurses and other auxiliaries to provide the modernised, prevention-focused care that we are developing to the maximum extent possible. This requires changes to our educational and legislative frameworks, which are comprehended in the policy implementation plan in development. We need to consider educational models that will enable students to experience providing care in a community setting within our most vulnerable communities.

We currently have more dentists on the Dental Council's register than ever before. We had 3,661 as of 20 May, but many more are needed. There is also a need to increase the number of dental nurses and other auxiliary grades. The Department of Health is committed to the development of an oral healthcare workforce plan as set out in the national oral health policy. Dedicated resources have been set aside to advance this work. This workforce plan will consider how other dental professionals, such as an expanded role for dental hygienists, can best support the new model of oral healthcare services and how they in turn can be supported with career pathways that support staff retention. To support this work, the Department is finalising the design of the first oral healthcare workforce census skills assessment. This workforce census will gather information including the proportion of registered oral healthcare professionals who are practising in their registered profession, the services they provide and the skills they have. The census data will provide information to support the development of the sector and to support workforce planning by identifying the skills that oral healthcare professionals need to provide the new model of service set out in the policy.

The Department is also examining a mid-level professional grade for oral healthcare. Reviewing the dental teams, including the auxiliary dental workers' scope of practice, will create more capacity in our workforce by enabling direct access to the public where appropriate. Such an approach will ensure that professionals are working to the top of their licences, enhance the potential of these roles and expand our workforce capacity and our ability to meet the population's primary care dental needs. Aligned with Sláintecare's workforce reforms, introducing a mid-level professional grade is a key priority for the policy.

The Department of Health is collaborating with the Department of Further and Higher Education, Research, Innovation and Science and the Higher Education Authority and is currently working through a process to identify opportunities to build capacity in the higher education system for dentistry and to support more oral healthcare graduates. The process is designed to respond swiftly to national skills needs. Expressions of interest were sought from institutions with the capability to expand existing courses or create new ones. This expansion is being considered by the Department of Further and Higher Education, Research, Innovation and Science in the context of the budgetary process. Potential new innovative models of dental education are also being considered, with a focus on primary care.

I assure Deputies that the Minister for Health will continue the ongoing work to address the access issues affecting current healthcare services and also to progress work on the implementation of the national oral health policy that sets out a body of transformational reforms. Along with the Minister of State, Deputy Burke, I thank Deputies across the House once again for their contributions. I reiterate the Government's commitment to improving our healthcare services.

Gary Gannon (Dublin Central, Social Democrats)
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I will look at this from a different vantage than the previous speaker. When I was walking across the city this morning, I listened to the Ombudsman for Children responding to the child poverty report, which, once again, highlights that the level of child poverty in this State is increasing. Then, I came in here to talk about this motion. I thank Deputy Shortall for bringing it forward. The first call we have in our motion concerns the fact that there are an estimated 104,000 children on waiting lists for school screenings and dental services for which 208,000 children are eligible. Poverty, in and of itself, and child poverty in particular, relates to the resources people are expected to go without. The child poverty report contains mention of warm coats, a second pair of shoes and meals.

We also know that access to basic health provision is a part of poverty. One of the more important and fundamental aspects of life is basic healthcare. We have a crisis of dental healthcare in our country. Unlike most crises here, it is not experienced evenly. I can promise the Members here right now that the children on that waiting list are living in some of our most disadvantaged and deprived areas. These are the same children who are being asked to go without in terms of the conditions in which they live and who have been factored into these figures contained in the report.

That is the most shocking and scandalous part of this. It compounds the problem by piling hardship on top of hardship. I do not see an urgency to address what is happening. I do not believe the rhetoric employed by the Government. It is not going to oppose the motion, but what will it do? Will the targets be acted upon?

In the past five years there has been a 31% reduction in the number of children seen by HSE dentists. We do not need to ask where these children live. They live in the areas that are on the margins. They are at the coalface of the housing crisis and of the healthcare crisis. They are the same children who have to go without heat in the winter and who will not get to visit the cinema in summer. They are also the ones who do not get access to dental treatment. It is an absolute scandal. The number of HSE dentists declined by 23% between 2006 and 2022. In terms of access to dental care, what cohort of people in Ireland will be most impacted? Depending on their incomes, wealthier people will not have to go without dental healthcare. They will see the dentist frequently, whereas for those in other parts of the country that are underserved and under-resourced, the inequality of basic provision of healthcare will compound all the other inequalities experienced.

The number of medical card patients seen under the dental treatment service scheme, DTSS, is down 35% in the past ten years. I do not see that being addressed as a matter of urgency. If the number of people able to access dental treatment through the medical card is down, once again the people experiencing poverty are going to be impacted infinitely more. Yet, where is the urgency and the sense that this is going to impact on a societal level? It is hitting people, quite literally, in their mouths. It is a cruel, unjust form of State violence, consciously enforced upon a cohort of the population because of a state of indifference from successive Governments.

Of the 810 dentists currently signed up to the DTSS, only 600 are active. The Minister for Health announced in May 2021 that he would instruct his officials to begin talks on a new scheme as a matter of urgency. The latter are not our words, they were uttered by the Minister in 2021. As 2024 approaches its midpoint and there is no progress, I have to question the interpretation of the word "urgency". Urgency is when a mother in my constituency has to bring a child to the dentist for emerging gum disease or an accident. When they get there, they discover that they do not have access to the service.

It is extraordinary that last year 50% of the 300 students enrolled in our dental school in Cork were from overseas. The fact that they come from overseas is no reflection on those people. It is a poor reflection on the fact that this is how we are expected to finance dental training. Inevitably, those students will take the training they have been given and go back to their home countries. We will also have 150 dental students. That is a poor reflection on the State and on the priority that we place on dental and oral healthcare. It is indicative of the fact that the people most likely to suffer are those who have already been impacted through the various crises that have impacted upon this State. It is inequality, and it creates the conditions of a State that is indifferent. How could it not be? It is a State that does not seem to have in mind as a priority the people at the coalface of suffering, namely children, people on medical cards and those experiencing poverty.

Róisín Shortall (Dublin North West, Social Democrats)
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I thank everybody who contributed to the debate. I had hoped that the Minister would come in today and outline a clear plan to reform of public dentistry. However, all we got was talk. The scripts that were read out by the two Ministers of State were an absolute disgrace. The Ministers of State are either delusional or blatantly disingenuous. They displayed a complete disconnect from reality. They ignored the hundreds of thousands of people who have been failed by this Government because of its corresponding failure to provide timely dental care.

It is certainly no boast to say that €200 million was spent on dental healthcare last year. Out of a budget of €23 billion, a figure of €200 million is really pathetic. It is shameful that five years after the publication of the dental health policy document Smile agus Sláinte in 2019, we still do not have an implementation plan let alone funding for it.

A year ago, I tabled an amendment to the regulated professions legislation that would have provided for mandatory competency training schemes for dentists. The Minister acknowledged the value of that amendment but failed to support it. His excuse, as ever, was weak. During that debate the Minister claimed that his Department and the Dental Council were in discussions. They hey were not. It transpired that only very recently has any contact been made in respect of this matter. How much longer can the Minister stand over a situation where a dentist can walk out of dental school and never be asked, during the course of an entire career, to demonstrate how he or she has been keeping their skills current? How is that in the best interests of patients? I have not seen any evidence that the Minister is serious about addressing the grave deficiencies in the regulatory environment. Legislative change was listed as a key action in Smile agus Sláinte, but there is still no sign of a Bill in this regard. That is indefensible. A cat at the local veterinarian has greater protections than a patient in a dentist’s chair. That is incredible. There is virtually no regulation of dentistry. The reform proposals put forward by the Dental Council in 2021 are supported by both the regulator and the regulated. They are cost neutral. It seems to me that, not only is there a lack of interest within the Department, but also a complete lack of understanding.

When I last referred to regulation in the Dáil, I was told that HIQA, the HSE and the Health and Safety Authority could inspect dental practices. That is simply not true. None of them has the appropriate powers to protect patients. I refer here, as an example in this regard, to the 37 dentists reported to be working in Ireland who have been sanctioned in other jurisdictions. Nor can the agencies in question act in the case of an individual practising dentistry in this country who has a conviction for sexual abuse. All three agencies have very narrow remits. The Dental Council needs to have the appropriate regulatory powers.

It is all very well for the Government to say it is not opposing our motion. For that to mean anything, we need to see action and a guarantee that all primary school children will receive their three school-based screenings at the appropriate age. That has to be in place by 2027. We need action to strengthen and expand the capacity of public dental services for children and special care patients. We need the Government to commit to providing the required funding for the DTSS in budget 2025. We need it to immediately begin engagement with the sector to reform the DTSS and to commit to publishing the heads of the long-promised dentists Bill by September next. We need funding to be allocated in respect of all of those actions. We need to properly fund training places in the dental colleges in order that we have an adequate supply of new dentists coming on stream.

We need the Government to prioritise all of these actions. Otherwise, it is just engaging in a cynical exercise. Unless we see action within the kind of timescale demanded, this will all just turn out to be yet another Government charade. We need to see action now.

Ossian Smyth (Dún Laoghaire, Green Party)
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I wish to make a clarification. A number of speakers stated that the recruitment embargo affected the recruitment of dentists. It does not affect the recruitment of dentists.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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It affects consultants.