Donna McGettigan (Clare, Sinn Fein)
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I wish to discuss the ongoing decline in the dental scheme for medical card holders in County Clare. I have raised this issue time and again. The Irish Dental Association has also raised it and has made repeated calls for the scheme to be overhauled. The association states the scheme does not work either for dentists or patients and that a lot of lip service has been paid to it but nothing is happening.

In November 2021, as a county councillor in Clare, I tabled a motion calling for the then Minister for Health to engage with dentists in Clare to prevent a total collapse of the scheme and to ensure funding was available to boost public dentistry in the county in the coming years. At the time of this motion, there had been a 46% reduction in investment in the dental scheme between 2017 and 2021, according to the Irish Dental Association. At this time, we also saw a reduction in the number of dentists signed up to the dental scheme, resulting in only 16 dentists enrolled in Clare. We were in fear of a total collapse of the scheme.

The decline of the scheme is replicated throughout the State. The number of participating dentists has declined by 50% in the past decade. In June 2024, I submitted a parliamentary question to the Minster after several constituents contacted me to say their dentists were not offering the scheme anymore. I was shocked to find out that 12 dentists had signed up but only eight had submitted claims for reimbursement, which meant realistically we only had eight dentists. The constant crisis in UHL has also had a huge impact on dental patients. Some patients, such as children, require anaesthesia to have teeth extracted, but when UHL enacts its surge capacity, the day ward is filled with patients from accident and emergency and day procedures are cancelled. Of course, there is no dental general anaesthetic service in Ennis.

It is a near certainty that everyone in the House has constituents who are suffering due to the failure of previous Ministers to fix the dental scheme, which includes the Minister of State's constituents. People are being left in pain or, worse still, they have to watch their loved ones suffering. Dentists often detect eating disorders and certain types of cancers, so these could also be going undiagnosed. Tooth decay can have serious medical consequences if left untreated. In addition, people are only entitled to two fillings per year under the scheme, so if they have a problem with another tooth, it may have to be extracted when it could have been saved. This is causing a moral issue for dentists as they are about saving teeth.

There are nice words in the programme for Government, including that there will be new contracts, new recruits and lots of dentists, but no facts or figures. What meaningful, tangible steps will the Minister of State commit to now to address this serious issue and give some sense of reassurance to patients and their families?

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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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. The scheme provides dental care, free of charge, to medical card holders aged 16 and over. Services are provided by private dentists and clinical dental technicians who hold a contract with the HSE to operate the scheme. Services available annually and on demand include an examination, 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, is available subject to the approval of the local HSE principal dental surgeon.

To support contractors to provide care under the scheme, an additional €10 million was made available in budget 2022 to increase the preventative care available and increase by 40% to 60% from May 2022 the fees paid to contractors for most treatment items. The HSE advises that while the total number of contractors on the scheme has been reduced from 1,046 as of the end of December 2022 to 813 as of the end of December 2024, the introduction of these measures has improved access to care for patients. In 2024, 227,691 additional treatments were provided nationally under the scheme, with more than 44,208 extra patients treated when compared with 2022. The Minister acknowledges, however, that access issues remain and that complete modernisation of care, the service model and, subsequently, contractual arrangements for adult medical card holders is required. I understand where the Deputy is coming from. There are huge challenges. I see the same in the area where I live.

The vision for this service reform is set out in the national oral health policy. Budget 2025 allocated €2 million for this year, increasing to €4 million in 2026, to continue the implementation of the national oral health policy.

The programme for Government and the HSE’s national service plan for 2025 both contain commitments to implementing the national oral health policy and reforming oral healthcare services for medical card holders. The plan for the first phase of policy implementation, up to the end of 2027, is being finalised by the Department of Health and the HSE, following targeted consultation in quarter 3 of last year. The plan includes reform of services for medical card holders as one of several priority actions. I understand it is a priority.

The policy also 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 we have more registered dentists in Ireland than ever before – 3,778 as of January 2025, which means an additional 129 registered dentists since February 2024. To increase this number further, the Minister supports the creation of additional capacity in higher education, including in oral healthcare. That is so important and I really feel it will make the change. Any investment must be considered by the relevant Department in the context of the ongoing national development plan review, given the significant capital costs involved in expansion.

Substantial modernisation of the service and contractual model, in tandem with increasing workforce capacity, will train and enable more dentists to take contracts to care for medical card holders.

Donna McGettigan (Clare, Sinn Fein)
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I welcome any news that will help to bring about an increase in the service. The key trends documentation for 2024 mentions that spending on health almost doubled between 2014 and 2023, and this is reflected in the enhanced availability of services throughout the country. Why, then, do we see only half the expected number of dentists participating in the scheme? The number is not reflected in the figures. If we increase the number of dentists in this scheme, it will have to be through contact and talks with the Irish Dental Association, which I do not see mentioned in the Minister of State’s reply. I would like it to happen because the association has been calling this out for a long time.

The Minister of State referred to more money having been invested in 2024, but that is not reflected on the ground. It is not what I was hearing at any of the doors during the local and general election campaigns last year. Every single person we met who needed the services said they were not getting them.

I welcome the commitments. The Minister of State's ministerial predecessors were members of her party and her coalition partner’s party, and their record is nothing short of disgraceful. Therefore, I hope that in her new role, the current Minister of State’s record will be a better one for the affected people.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Deputy. In all our areas there have been major challenges. I work with families regularly, so I do know the challenges. I have listened to and taken on board the points the Deputy has made. I can assure her that addressing access to dental care, including for adult medical card holders, is a top priority for the Minister and the rest of the Government. A substantial additional investment in oral healthcare services has been made in recent years, but we need to address the issues that arise.

Fundamental reforms are also being progressed through the implementation of the national oral health policy. The policy sets out the vision for the future of oral healthcare services. While it will take several years to bring it to realisation, there will be early and continued emphasis on addressing the current issues.

The fundamental aspiration of the policy is that all Irish people will have their own so-called dental home, whereby they will build a lifelong relationship with a local dental practice or practices of their choosing for continuity of care. That is so important and I agree with it.

The policy has two goals: to provide the supports to enable every individual to achieve their personal best oral health and to improve access to dental care. These are so important. I am confident we can work on this, and we need to deliver on it. I will relay to the Minister my belief that we need to talk to representatives of the Irish Dental Association. That is important. I am not aware of whether meetings have taken place but I will definitely look into it and certainly bring the matter back to the Minister, Deputy Carroll MacNeill. I thank the Deputy for raising this very important Topical Issue.