Kieran O'Donnell (Limerick City, Fine Gael)

I thank the Senators for their contributions, and particularly the Fine Gael Senators for tabling the motion and providing us the opportunity to discuss dental services and outline the Government’s priority to fundamentally reform these services over the coming years. I am taking this debate on behalf of Minister for Health, Deputy Carroll MacNeill. She is not opposing the motion.

Before I begin with my formal speech, many of the issues Senators have raised have a common theme. Many are identified in the new programme for Government, which refers to increasing the number of college places, with one of the faculties being dentistry. Under the programme, the Government will: implement Smile agus Sláinte; hire more public dentists; agree a new dental treatment service scheme for medical card holders, which is the dental treatment services scheme, DTSS, and something that many of the Senators have referenced; expand access to the orthodontic scheme for children and strengthen the school dental programme; update the Dentists Act 1985, an issue that has been raised a lot in today’s debate; and recognise and regulate more dental specialties.

I recognise what many of the Senators have said about older people in nursing homes. This is something I will take up with the Minister and officials. The mobile service, which was raised by many Members, is very important.

Senator Byrne spoke about increasing the number of college places. The overarching theme was to have more young people seen for orthodontic treatment. Senator Nelson Murray spoke about student places as well as work permits. Senator Kyne, the leader of the Fine Gael group, spoke about oral health and referenced our colleague, Deputy Colm Burke’s proposals in this area.

A theme that arose was that of retired dentists and the question of whether they had a role to play - Senator Kyne mentioned this, as did many others - in examinations as opposed to clinical practice. Am I correct in that interpretation?

I take Senator Conway’s point that we need more dentists in both the public and private systems. That is in the programme for Government. Senator Costello spoke of the need to update the 1995 Act and the DTSS. Senator Ryan referred to increasing the numbers being seen, as did Senator Tully. Senator Byrne made specific reference to the mobile dentistry scheme and that the service should be fair and reliable. Senator O’Donovan referred to the mobile service and the Health Act. Senator Boyle made a telling point on nursing homes and dental care for older people.

The Government allocates over €230 million to the provision of oral healthcare every year. This shows our commitment to delivering oral healthcare services. All the points raised by the Senators will be brought back to the Minister and the officials. A senior official from the Department is attending this debate, which I felt was important.

Improvements in access to care and in reducing waiting times over recent years have been supported by significant additional investment. This includes an additional €15 million in recurring funding between 2022 and 2024 to progress the national oral health policy. A further €17 million in non-recurring funding has been invested to improve access and respond to waiting lists. A range of measures have been put in place since 2022 within the DTSS for adult medical card holders. This introduced and reintroduced elements of preventive care. The Minister for Health also increased the fees paid to contractors for most treatment items by 40% to 60%. Fees paid to dentists for DTSS care are now aligned with other European countries that provide comparable public dental care, noting that many European countries, especially in the southern and eastern regions, do not have any scheme in place for adults that is free at point of access.

Our measures are having an impact, with access to care increasing in 2022 and increasing further again into 2024. The range of treatments provided includes scale and polish, fillings and extractions. Comparing 2022 to 2024, these measures have had an impact on activity and expenditure. The fees paid to contractors increased from €49 million in 2022 to €69 million in 2024. Over 300,000 patients received care in 2024, which was an increase of 44,000 on 2022. In terms of the volume of care received, over 222,000 additional treatments were provided in 2024 versus 2022.

However, we must acknowledge that challenges still exist. People, especially children, are waiting too long for care. Our oral health service, notwithstanding the commitment and dedication of all front-line oral healthcare workers, is not aligned with WHO standards. Through implementation of the national oral health policy, the Minister for Health, Jennifer Carroll MacNeill, wants to do more to improve oral healthcare services and to address the access issues that are still there.

In 2019, the national oral health policy, Smile Agus Sláinte, was published. This Government policy aims to radically transform our current oral healthcare service, recognising that we need an entirely new approach to oral healthcare to meet the needs of our population into the future. The policy provides a framework to transform oral healthcare services in Ireland, with prevention and promotion are an integral part of all service provision. Smile agus Sláinte was informed by and aligned with other relevant Government health policies, including the primary healthcare approach, Sláintecare, our overall framework for better healthcare in Ireland, and Healthy Ireland.

The two goals of the policy are: to achieve personal best oral health across the life course from birth to old age; and to reduce oral health inequalities across the population. The current model of oral healthcare services does not adequately provide for those who need additional support to access oral healthcare, including those living in residential settings and those accessing services under the umbrella of inclusion health. The Government has provided €2 million in budget 2025 to enable the HSE to progress initial scoping work to better understand the oral healthcare needs of people living in residential settings so that the HSE can then design the oral healthcare services that best meet their needs. This may include mobile units. Senators have referred to those, so this is a positive.

For children, the HSE is progressing with the design of comprehensive and prevention-focused oral healthcare packages, starting with children aged from birth to seven years. This aims to support children to attend a local dentist from birth, representing a significant expansion of care compared to the current model, which centres on three examination appointments, starting at the age of seven.This will ensure a greater emphasis on prevention, and earlier intervention for children, where intervention is needed.

Senator Lynch made reference to fair, reliable and consistent care. I note what she said about UCC as well. We recognise that much work is still to be done here, including the design of an operating service model, the development of a contractual framework with the dentist representatives and supporting legislation. For adult medical card holders, the HSE is committed to the design and development of packages of expanded preventative care. As we work systematically through the implementation of the policy, we will walk through a public conversation on what kind of oral healthcare is needed in Ireland, within the framework set out within the policy, which is in turn based on international evidence. This requires substantial change in dental training and education, and an enhanced role for a wider range of dental professionals, including nurses and hygienists, in the dental team providing oral healthcare. Both are provided for within the programme for Government, which refers to an increased number of college places and to an expanded role for other dental professionals.

Progress on the reform envisaged in the policy has been slower than the Minister would have liked. It has been by the pandemic, among other things. However, to support a focused and structured implementation of the policy, the Department of Health and the HSE are developing an implementation plan for the 2025-27 phase of its roll-out. This plan is currently being finalised for publication.

The public oral healthcare services provided by the State include orthodontic treatment. There has been particular focus on supporting patients to access these services. A total of €17 million in non-recurring funding was provided between 2022 and 2024 to address orthodontic service backlogs. Some 511 patients were removed from the grade 4 orthodontic treatment list through this funding in 2024. In addition, a new orthognathic jaw surgery waiting list commenced in September 2023. These are complex surgeries which can require a lengthy hospital stay. Some 77 patients received this type of surgery in 2024. A further €2.85 million is being invested this year to support the continuation of measures to reduce orthodontic waiting lists.

The Minister for Health is committed to reviewing the legislation underpinning the regulation of oral healthcare professionals, the Dentists Act 1985. A priority for 2025 is the development of new provisions to amend the 1985 Act in areas which have been identified as prime concerns by the Dental Council and to proceed with these where appropriate. This will include enabling provisions for the Dental Council to develop a statutory scheme of continuous professional development, CPD, and competence assurance for registered dentists, in line with that provided for other regulated health professions. This long-overdue intervention will make CPD a mandatory requirement. We must acknowledge that the entire regulatory framework requires reform. In parallel to these interim reforms, work is commencing on a fundamental review of the Dentists Act 1985 with the ultimate aim of developing a new, modern, fit-for-purpose regulation, which aligns with the reform envisaged in the oral health policy.

I note there are now more dentists than ever registered in Ireland. There are 3,888 dentists on the Dental Council register as of June 2025. This reflects ongoing upward trends in the number of registered dentists in the State, and compares favourably with the number in April 2019, when Smile agus Sláinte was published, which as 3,100. This is an increase of over 25%.

The Government is firmly committed to ensuring that our healthcare system is supported by a steady and sustainable pipeline of highly skilled graduates, including in critical areas such as oral health and dentistry. Ensuring adequate capacity to train future dentists is part of our broader commitment to workforce planning that supports the health and well-being of our population. This is a recurrent theme with nearly all of today's contributors.

The Minister for Further and Higher Education, Research, Innovation and Science has remit over providing more funding for dentistry places through the Higher Education Authority. The Department of Health supports any expansion in the oral healthcare workforce. The Government provided €2 million in budget 2025 to support 15 additional new whole-time equivalent posts, specifically to improve staffing levels within the HSE community dental service. It is acknowledged that there are issues with the school screening programme and many Senators raised that here today. It is envisaged that funding allocated in budget 2025 for an additional 15 dental staff will go towards alleviating this as an interim measure. The focus is on continuing to build and maintain a sustainable workforce.

The National Oral Health Policy envisages major transformation of oral health services, requiring a greater role for dental contractors in providing a wider range of care through a model that focuses on primary care. It also requires a much enhanced and reoriented public dental service which will, among other things, play a key role in providing services to patient categories that are often underserved, including people with disabilities, people living in residential services and people requiring more complex oral health interventions. In building the necessary capacity to meet the current and future oral health needs of our population, we must also look to other members of the dental team to ensure they are supported to work to the top of their expertise. We will explore the opportunities for new and expanded roles within the traditional dental teams, providing opportunities for a wider scope of capacity and more opportunity for dental professionals to provide more care and a greater variety of care.

We all recognise and are sympathetic to any situation where patients are impacted financially following a sudden closure of a dental or orthodontic practice. This is something Senator Kyne referred to. Consumer law is primarily the responsibility for the Department of Enterprise, Tourism and Employment. The Minister for Health is committed to working with and supporting further consideration of safeguards or other opportunities to enhance consumer protection. The Competition and Consumer Protection Commission is the statutory body responsible for promoting compliance with, and enforcing, competition and consumer protection law in Ireland and is best placed to advise on such matters.

I thank the Fine Gael Senators for bringing forward this motion and the other Senators who have contributed. I assure the Senators that the Minister for Health, Deputy Carroll MacNeill, will continue the ongoing work being delivered by her Department to fundamentally reform the oral healthcare sector through the implementation of the National Oral Health Policy.