Paul Coghlan (Fine Gael)
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I welcome the Minister of State, Deputy Helen McEntee, to the House.

Jennifer Murnane O'Connor (Fianna Fail)
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I thank the Minister of State for coming to the House to deal with this matter. I had hoped the Minister, Deputy Harris, would be here but I know he is a busy man.

I have been inundated with calls from people with serious concerns regarding dental care for children in CHO5. The HSE provides dental services to children up to aged 16. Children attending primary schools can be referred to dental treatment by a child health service or following a routine school visit. Children attending primary schools are screened in second, fourth and sixth class and, if necessary, are referred to the local dental clinic for treatment. Some children are referred to an orthodontic clinic for further treatment. This referral is from the principal dental surgeon in the health centre and orthodontic treatment is free. An individual's access to orthodontic treatment is determined by guidelines known as the "modified index of treatment need". Emergency services are also available to all schoolgoing children but mainly on a part-time, specific weekday basis. There is nothing but costly private dental care for children on weekends.

I recently heard from constituents who have a child with a baby tooth that would not fall out going for a two-second tweezer extraction on a Saturday that cost them €75, for which the tooth fairy gave them back €2. We all know who lost out. The Minister of State will be aware of the great benefits of the scheme. Many children are caught early and encouraged to ensure good dental hygiene and there is often a need to undertake only minimal work to prevent major work in the future. However, there is a serious problem with the scheme. Data published last month by the Irish Dental Association indicate that more than 80,000 children and adolescents are waiting for a public dental assessment or treatment, of which 22,900 are on the waiting list in CHO5, which takes in Carlow-Kilkenny, south Tipperary, Waterford and Wexford. In almost every area of society early intervention saves time, money and distress and produces far better outcomes.

How does the Minister propose to tackle the unacceptable delays in this scheme? It is not good enough that hard pressed parents are forced to pay for the treatment their child or children urgently need. Many of them cannot afford it. The aim of the scheme is to provide dental care for every child regardless of means. It is a wonderful idea but it is not working. According to the Irish Dental Association, the waiting list numbers are shocking. Its spokesperson, Dr. Gillian Smith, said that due to the delays around assessments children were enduring painful episodes and being treated with antibiotics and, often, surgery under general anaesthetic, which is costly to the State and easily prevented with early intervention.

The incredible waiting lists have been highlighted by hundreds of my constituents in just two counties in CHO5. I imagine hundreds more in the other counties are not complaining because they realise we are all being forced into a two-tier system, whether we like it. People feel they have to pay for everything. What is the Department of Health doing to reduce waiting lists in this area? On the modified index of treatment need, many children appear to be just outside the threshold. In 2013, the HSE commissioned an independent review of orthodontic services. Something is wrong if orthodontic services across the country are offering easy pay plans for taxpayers to have their children treated because the HSE is not getting the job done.

It was revealed late last year that there is a 12 month waiting list for orthodontic treatment in my area. That is a long time for a child suffering with a grade four diagnosis, which may mean speech difficulties or protruding displacement of teeth, or a child with a grade five diagnosis and abnormally arranged teeth, not to mention the child whose diagnosis is minimally outside of the guidelines in terms of access to treatment. Parents are forced to pay for this treatment. On 4 February last, the Minister, Deputy Harris, said on RTÉ radio that it is his job to look after the health of the children of Ireland. The delays in the dental assessment and treatment area are unacceptable. I hope the Minister of State will be able to answer my questions today.

Helen McEntee (Meath East, Fine Gael)
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I am taking this matter on behalf of the Minister for Health who sends his apologies for not being here. If the Senator has any follow-on questions I will, of course, raise them with him and he will respond to her directly.I thank the Senator for the opportunity to address the issue of dental services in CHO 5. Eligibility for dental services is provided for in the Health Act 1970. Dental treatment for adult medical card holders is provided under the dental treatment services scheme by contracted general dental practitioners. The HSE provides oral healthcare services to children and vulnerable people of all ages including people with special needs, people with disabilities and people who are medically compromised. It also includes cohorts such as refugees and asylum seekers. Services are provided on the basis of need and include four key areas, namely emergency care; targeted preventive and treatment services for children; planned care for children and adults with special care needs; and hospital services, including general anaesthetic services. Targeted preventive and treatment services for children emphasise prevention of dental disease through patient and parent oral health education, dietary advice and tooth-brushing instruction, along with preventive interventions such as the placement of fissure sealants on vulnerable tooth surfaces. Restorative treatment such as fillings is also available. Children in the targeted age groups are typically in first or second class and sixth class. Where resources allow, some children may also be seen in fourth class.

CHO 5, now known as South East Community Healthcare, provides community health and social care services within south-eastern counties of Waterford, Wexford, South Tipperary, Carlow and Kilkenny. Recent HSE figures indicate that as of 1 January 2019 there were 35,466 in second, fourth and sixth classes in the South East Community Healthcare area. A number of these children would have been seen during January and to date in February. It should be noted that the service which these children receive is a screening service - the Deputy is correct that prevention is the best measure against more serious challenges - provided for children at key ages to coincide with eruption of back teeth and once parental consent is given. This is an ongoing rolling programme for routine dental care. The emphasis is on preventive care such as fissure sealants and advice with fillings provided if necessary.

There are 2,198 awaiting treatment following screening. It should be noted that some children may be counted twice, for example where they are to be seen by a hygienist for preventive care and by a dentist for treatment following their assessment. Following a fire in the St. Dympna’s Hospital Carlow in November 2016, dental services ceased. This resulted in the cancellation of four surgeries for four months. Additional services using agency staff and additional clinics during evenings and weekends were used in 2017 to address the backlog in appointments. The dental service is still dealing with some backlogs in appointments as a result. The Minister is aware of this and is trying to deal with it. While there are ongoing difficulties in recruitment and retention of dentists in the South East Community Healthcare area, two vacancies were filled in 2018, and we hope to recruit more in the coming year. The HSE will continue to prioritise patients with greatest needs. Emergency care for the relief of pain and infection is available for all children aged up to 15 years, and patients with special needs on a same day or following day basis at HSE dental clinics across the country. Approximately 6,000 children attend for emergency treatment each month nationally.

The Minister is very much aware of concerns and the specific issues in this area. He is committed to filling the vacancies, reducing waiting lists and ensuring that the children, not only in this area but also surrounding areas, are treated in the appropriate manner and as quickly as possible.

Jennifer Murnane O'Connor (Fianna Fail)
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I was aware of the fire at St. Dymphna's and the resulting backlog. The two biggest issues are the out-of-hours service where if a child has a toothache on a Saturday or Sunday the parent must pay privately. Many parents do not have the money to pay for that. There are also questions of the time delay and of qualification; a child may be told that they can qualify for a brace but then it turns out that their bite is wrong or that it is a millimetre out. Some children are well deserving but parents cannot afford the treatment. We need to have a new look at the system and there should be an appeals system. There is none now and there is no way of addressing urgent cases that do not qualify under the scheme.

Helen McEntee (Meath East, Fine Gael)
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The new national oral health policy will be published shortly by the Minister for Health. Its aim is to develop models of care that will emphasise preventive care and prioritise preventive approaches from childhood to old age, support the public, ensure easy access to care and enable people to have the best oral health. Issues such as out of hours, delay and qualification may be addressed. However, as with any scheme there must be a cut-off point after which access is not possible. However, as the Senator says, there can be a fine line.