John Paul O'Shea (Cork North-West, Fine Gael)
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82. To ask the Minister for Health if there are plans to expand or improve dental facilities in Cork North-West, including the delivery of a new or upgraded facilities to meet growing demand in towns such as Macroom, Kanturk, Mallow and Millstreet; and if she will make a statement on the matter. [64083/25]

John Paul O'Shea (Cork North-West, Fine Gael)
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Are there plans to expand or improve dental facilities, including clinics, in north-west Cork? Are there plans for new or upgraded facilities to meet the growing demands of towns like Macroom, Charleville, Kanturk, Mallow and Millstreet?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank Deputy O'Shea. As he is aware, over €230 million is invested in public oral healthcare services annually. The dental treatment service scheme, DTSS, provides oral healthcare 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.

In the north Cork HSE area, there are currently 33 active DTSS contractors, which is up slightly from the 31 who were active in the same period in 2024, although it is not enough. A package of measures was introduced in 2022 to expand the care available under the DTSS and to significantly increase the fees paid to contractors by approximately 40%, which is a very significant increase. Those measures should improve access to care as indicated by patient and treatment numbers which, to be fair, have increased since 2022.

The Department and the HSE are committed to the reform of services for medical card holders, particularly in the context of the design and development of packages for expanded preventative care. That will require a multi-annual programme of work which is currently being scoped by the Department. We are also trying to improve patient access to oral healthcare in a number of different ways through the implementation of the national oral health policy, which is a complete transformation of oral healthcare services and an expansion to children and adults. I am very focused on the deficits that are there today, particularly for children. There is a three-year implementation plan for the first phase of acceleration of reforms.

When I was in Cork last week, I had the good opportunity to attend the annual conference of the Irish Dental Hygienists Association, the members of which perform enormously good preventative work, cleaning work and identifying work. I commend their work to date. Hygienists can play an important role as part of the Government's priority to improve access to preventative oral healthcare, especially for currently underserved populations including people with disabilities, people in residential homes and children in certain areas. There is a body of work there that is not yet completed but is very possible.

John Paul O'Shea (Cork North-West, Fine Gael)
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I thank the Minister for that update on dental services, particularly in north-west Cork, north Cork and mid-Cork. Certainly, there seems to be gaps in some areas where the DTSS is not available to many medical card holders. That is a serious issue we must try to alleviate. The number of contractors involved in the scheme has increased, but only slightly. As the Minister said, it is still not enough. I would like to see more people coming into that scheme and I would like it to be available for medical card holders. It is important to recognise the orthodontic team that works within the orthodontic service and not just dentists. The Minister mentioned the role of hygienists as well. I am very grateful that the Minister attended a conference in Cork last weekend to see that we can all work together collectively to ensure there is a robust orthodontic service for the people of Cork and Cork North-West going forward. It is critical that people look after dental health. It is publicly available here. It is important to avail of that service.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I will bring in Deputy Burke on the same question.

Colm Burke (Cork North-Central, Fine Gael)
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I am concerned about the whole dental service. There used to be over 1,200 dentists working privately who offered to provide a public service to medical card holders, but that figure has dropped to under 600. Since 2012 or 2013, the number of dentists employed within the HSE has dropped from over 300 to slightly over 250. Even though there has been a huge increase in our population, the number of dentists publicly employed by the HSE is less than it was ten years ago. We need to deal with this issue. Some people are waiting up to five years for orthodontic treatment. This needs to be dealt with by the Department. We need to get our head out of the sand on this matter. I am contacted every week by a huge number of people who cannot get access to dental care for their children. This really needs to be tackled.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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In fact, there are 836 contractors on the scheme as of September 2025, although that is a reduction because there was a major data clear-out. There were 1,490 in 2019, when the number was reducing, and there are now 836. A number of inactive dentists were taken off the list in 2022. I can confirm that the fees paid to private dentists to engage in this scheme have increased by 40% to 60%, depending on the nature of the treatment. It is a matter of some astonishment and some disappointment to me that more of them do not wish to engage in it. Notwithstanding that, an additional 256,000 patients have been treated since 2022. As a result of the expansion of the dental facilities in Cork North-West, for example, an additional 44,208 patients were treated in 2024 compared to 2022. I will give this data to Deputy O'Shea directly. The fees to contractors went up from €49 million to €69 million in the same two-year period. It is a very considerable expansion. Indeed, activity in north Cork has increased this year with an additional 286 treatments provided. I recognise it is not enough, but it is a very considerable expansion within a two-year period.

John Paul O'Shea (Cork North-West, Fine Gael)
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I thank the Minister for her response. I want to focus on the HSE dental services that are available to children and to adults with significant special care needs. The service provided over the last number of years has been challenged by the Covid-19 pandemic. There have been a number of challenges in terms of providing orthodontics, particularly in ensuring there are enough staff to support clinics right across Cork North-West. We have clinics in Charleville, Newmarket, Mallow and Macroom. We also have St. Finbarr's Hospital and the Cork University Dental School and Hospital in Wilton to support that. However, it has been quite challenging to get the school programmes back up and running. Obviously, there is an opportunity for children in second class and sixth class to avail of dental examinations and appointments. There has been some improvement. I encourage the Minister to see if we can work with the HSE to make more improvements in that regard and make more clinics available more locally. It is a challenge for people in Cork North-West to travel into the city to accommodate clinic appointments in St. Finbarr's Hospital or the dental hospital. More clinics around the vicinity of Cork North-West would be of huge benefit.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I commit to trying to expand access to oral health and preventative oral health in every way. We need to look at the role of dental hygienists within the dental profession. In every other aspect of workforce planning in healthcare, we recognise that we do not have enough healthcare workers to meet our need. As I mentioned earlier, we are trying to have pharmacists work at the top of their expertise in their profession in order that they can diagnose basic common conditions. We now have an agreement with them that they will do that, but they should be working at the top of their expertise. We will try to have pharmacist technicians there to support them. In the same way, there is a much bigger opportunity for dental hygienists. We have advanced nurse practitioners and clinical nurse specialists. We have all of these advances in practice. Dental hygienists can play a particularly important preventative role and community support role. I am not saying they can provide all of the treatments - of course that is not the case - but I do not think we have come to the end of workforce planning in this respect. I know the people of Deputy O'Shea's constituency would welcome the opportunity to see a dental hygienist at a much earlier stage than has been possible to date. I have some work to do to try to support that.