Paudie Coffey (Fine Gael)
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Before I speak to the Adjournment matter I welcome the Minister of State at the Department of Agriculture, Fisheries and Food, Deputy Seán Connick, to the House. It is my first opportunity to congratulate him publicly on his elevation to Minister of State and I wish him well. He will do his very best for the people of Wexford and the south east and I, as a fellow parliamentarian from the south east, look forward to working with him over the coming years to try to achieve what is best for that region.

I raise this matter on the Adjournment because I have heard from quite a few people that there is a lot of concern about the provision of adequate funding for the dental treatment services scheme. I understand more than €63 million was allocated for the previous two years, despite the fact that there has been a large increase in the number of medical card holders. There has been much higher demand for basic dental treatments, such as fillings, root canal treatment and other preventative treatments. My understanding is the HSE has recommended that only emergency treatments can be carried out under the scheme in future owing to the lack of funding. Perhaps the Minister of state can clarify this. Emergency treatments are extractions and antibiotics must be provided. However, no reference is made to preventative treatments such as fillings and root canals.

This policy will result in an increase in dental decay, which in turn will lead to increased costs for the health service in the future. People will lose their teeth rather than benefitting from preventative treatments. This will affect many medical card holders and dentists will be put in an unfortunate position. I cannot understand how the HSE or the Minister can ask any dentist in his or her professional capacity to prioritise patients, thereby ignoring the tooth decay being experienced by some patients, and to extract teeth rather than carry out preventative treatment. That would be a retrograde step and it would equate to professional negligence in the extreme if dentists were asked to do this.

Medical card holders will suffer most, especially children and special needs patients who find it difficult to access treatment under the current scheme. This is an important matter because tooth decay cannot only be addressed by extracting a tooth. There are consequences if inadequate provision is made to address tooth decay and oral hygiene. Other more serious health issues can arise if tooth decay is not dealt with at any early stage. Given all the advances made in dental health, this proposal would be a backward step and we could return to the standards of the 1950s, which would be a sorry outcome. It will also mean there will be increased demand on professional services in our hospitals if people experience complications as a result of tooth decay. This will create backlogs in hospitals and HSE clinics.

Will the Minister of State clarify the position on the scheme? People, especially those with medical cards, are concerned that if they cannot access preventative treatment through their dentist, the economy could be further burdened by the need, for example, to provide dentures and to address other serious health issues as a consequence of tooth decay. I hope the Minister of State has good news for medical card holders and he might reassure them that they will be able to access the service they deserve from their local dentist. They have developed good services over many years and by carrying out early prevention measures, they can address further tooth decay while stabilising the dental hygiene of their patients, thus preventing further problems.

Seán Connick (Wexford, Fianna Fail)
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On behalf of the Minister for Health and Children, I am happy to have the opportunity to address the issue raised by the Senator. I thank him for his kind words at the beginning of his contribution. We worked together on the South-East Regional Authority and I look forward to working with him in the interests of the people of south east over the coming period.

The dental treatment service scheme, DTSS, was set up in 1994 after negotiations between the health boards - now the HSE - and the Irish Dental Association. The financial aspects of the scheme are administered by the primary care reimbursement service on behalf of the HSE and it is monitored at local level by principal dental surgeons. The two objectives of the scheme are to improve the oral health of adult medical card holders and to provide dental services to adult medical card holders in a cost effective and equitable manner.

The scheme provides a range of basic dental treatments to adults who are medical card holders. The service is offered by 1,419 dentists nationwide who hold a contract with the HSE. The dental treatment is free to the patients, and dentists working under the DTSS are reimbursed on a fee per item basis. The dental treatments provided under the scheme are split into two categories which are known as above and below the line treatments. Above the line treatment currently includes main treatment items such as examinations, fillings, and extractions. These treatments can be carried out immediately by a participating DTSS dentist. Below the line require prior approval from a HSE principal dental surgeon before they can be carried out by a dentist. They include amputation of roots, protracted periodontal treatment and the provision of dentures.

Expenditure on the scheme was approximately €85 million in 2009, which was a substantial increase from the 2008 figure of €63.4 million. Over the past five years expenditure on the scheme has increased by approximately 60%. In view of this increased expenditure and the current position of the public finances, and recognising that health expenditure represents 27% of total public expenditure and is, therefore, of central importance in any strategy to achieve public expenditure savings, it was necessary to consider options to reduce the level of expenditure in the DTSS. This reduction in expenditure reflects the imperative to achieve overall reductions in public expenditure while providing essential health services to patients and the public.

The HSE has been requested to examine this issue and forward proposals to the Department that contain DTSS expenditure at the 2008 level. The executive has developed proposals aimed at containing DTSS expenditure, which the Minister for Health and Children is considering. However, it is important to note that no final decisions have yet been taken on the changes to be made to the DTSS.

Paudie Coffey (Fine Gael)
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I thank the Minister of State for his response. I note no final decision has been taken, which presents a window of opportunity. We must acknowledge the excellent preventative work carried out by dentists on the teeth of medical card holders and I have outlined the benefits of that. The Minister of State said the HSE is examining the issue. I ask him to urge the executive and the Department to negotiate with representatives of patients and dental associations. If cuts are to be made, we should come up with new initiatives to prevent tooth decay at an early age through schools and so on. Will he ask the Minister for Health and Children to ring-fence as much funding as possible to ensure prevention rather than extractions? At the end of the day, if health service costs increase as a consequence of tooth decay, this proposal would be a retrograde step. Will the Minister of State convey that message to the Minister for Health and Children in the interests of medical card holders and in the interest of preventing tooth decay?