Mark Daly (Fianna Fail)
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I welcome the Minister of State, Deputy Rabbitte, to the House.

Fiona O'Loughlin (Fianna Fail)
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I thank the Cathaoirleach for selecting this matter. It is a most important issue in south Kildare and, indeed, right around the country. I thank the Minister of State for attending today's debate. I have been contacted frequently by people in south Kildare who are entitled to dental services under the terms of the medical card scheme, but who cannot avail of the services due to a lack of provision in the area. I understand the people in south Kildare are not on their own. It is happening right across the country. We all know the pain and difficulty that a dental problem causes, whether it is a toothache, a broken tooth or an issue with dental braces. I have a dental problem at the moment. I must say that my dentist has been very patient with me making appointments and changing them because of commitments in Leinster House. Generally, dental problems are very time sensitive. When something needs to be done, it needs to be done very quickly to help alleviate the pain that a person is experiencing. That is simply not happening in my area. Last month, we heard reports of dentists flooding out of the State's medical card scheme, leaving older people and those in low-income households without access to basic oral healthcare.

The figures from the start of the year show that only 660 dentists across the country have been actively treating medical card patients. There is a particular problem with dentists retiring. New dentists are coming in to take over the practices and many of them decide not to support their patients who have medical cards. It is a real problem. The number of contracted dentists is down significantly from 1,660 in 2017. We have lost 1,000 contracted dentists since then. We should bear in mind that during the two years of Covid, people suffered in silence, in many cases. Now they are trying to get the treatment they need. The demand for dental services is the same as it was in 2017, if not increased. At the same time, there has been a reduction in provision. This is leading to unacceptable waiting times. Indeed, the waiting times have no end for the patients who cannot access a dentist. When dentists drop out of the scheme, the HSE is trying to squeeze patients back into an already-overcrowded system, leading to even longer delays. I know that in response to a parliamentary question the Department of Health stated that the situation is regrettable and has led to difficulties. I ask the Minister of State whether she has any insight into why dentist are leaving the scheme. What can be done in the intervening months to see the situation improved? I understand that in April €26 million was put into the scheme. That is certainly very welcome, but it does not seem to have alleviated the problem.

Dental organisations have called for the current medical card scheme to be replaced with a voucher scheme. I understand that the Irish Dental Association has highlighted that dentists want a new scheme that reflects modern dental practice. We have to listen to them and negotiate with them. We must ensure that a plan is put in place to allow vulnerable groups to access routine dental care in their community. The announcement of increases in the fees of contracted dentists and the reintroduction of cleaning services under the scheme were both welcome and positive steps.

I wish to highlight the case of a young man with autism who I know. His dentist has opted out of the scheme. His mum has contacted 20 different dental practices and cannot get him into any of them. It is wrong. The young man has complex additional needs and relies heavily on his parents. He is in absolute agony and his mum feels helpless in supporting him. I ask the Minister of State to outline the plans in place to support the people in south Kildare with medical cards and an entitlement to dental care, but who cannot access that service at present.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Cathaoirleach. I thank Senator O'Loughlin for the opportunity to address the issue of dental services for medical card holders in south Kildare. I am taking this debate on behalf of the Minister for Health, Deputy Stephen Donnelly.

Dental treatment for medical card holders aged 16 and over is provided under the dental treatment services scheme, DTSS. Services available annually have included an examination, two fillings and emergency extractions. More complex care and a broader range of treatments for patients with special needs and high-risk patients is also provided, some of which requires prior approval.

Both the Minister and the Government have been concerned for some time that medical card patients in some parts of the country have been experiencing problems in accessing dental services. In local health office 6, which covers Kildare and west Wicklow, the numbers of private dentists who held a contract with the HSE to provide services to medical card holders stood at 58 in December 2019. This fell to 41 in December 2021 and the current figure is 38 dentists.

To address this issue, the Minister secured an additional €10 million in budget 2022 to provide for expanded dental healthcare for medical card holders, including the reintroduction of scale and polish, and the expansion of the oral health examination to emphasise preventative measures in line with the Healthy Ireland policy approach.

To address the concerns of contractors about the scheme, the Minister is using an estimated €16 million of an underspend in this year’s Estimate allocation of €56 million to award fee increases across a number of items, including fillings. The combination of these two measures represents an estimated additional investment of €26 million in the scheme this year over and above what was spent on the scheme in 2021, which was €40 million. Following consultation with the Irish Dental Association, these new measures came into effect on 1 May. The Minister hopes that this significant additional investment in the scheme will attract more dentists to treat medical card patients, including in south Kildare. In the longer term, the retention of dentists within the scheme will be examined. The Minister has been assured by the HSE that their local services on the ground will assist any persons who are still experiencing problems in accessing a service.

The Minister is aware that contractors are looking for more substantive reform of the dental treatment services scheme in the longer term. This concern is recognised and it is the Minister’s intention that this is addressed in the context of the implementation of the national oral health policy, Smile agus Sláinte, which sets out a body of substantial reform of dental services. Work is under way within the Department of Health to design a governance framework to oversee and facilitate root and branch reform of the provision of dental services in Ireland, including the dental treatment services scheme. The chief dental officer in the Department is already engaging with stakeholders on this issue and I understand that she will meet representatives of the Irish Dental Association shortly.

It is very important also to recognise the point the Senator mentioned at the end of her contribution in respect of people with additional needs and the story of that lady having to ring 20 dentists in her area. While I would like to state she is alone and unique, she is not. Unfortunately, the number of calls which are coming into my office replicate exactly what the Senator is saying. The Minister, Deputy Stephen Donnelly, is putting added investment into the sector but it does not seem to be replicated down to the delivery of service, which is a quite disappointing point.

Any of us who have had dental pain will equate it to labour, as there is nothing quite like it, to be honest. It is not right in this day and age that we should leave people to suffer. The funding is there and goodwill is being extended from the Department of Health and from the Minister. It is time now for the Irish Dental Association to engage and to reciprocate that.

Fiona O'Loughlin (Fianna Fail)
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I thank the Minister of State for her response and for her assurance that the HSE has stated that local services on the ground will assist in this regard. I will be contacting my local HSE office this afternoon and I will return with to the House with its response on this.

I acknowledge that the Department has pledged a root and branch review of the dental treatment services and to align the scheme with the national oral health policy. This must be expedited and we need to get a timeline and to see a new approach to the provision of dental services in this country. The Minister of State has acknowledged the concerns that exist and that this will be addressed in the context of the implementation of the national oral health policy but what does that implementation mean on the ground? When are we going to see a difference?

I also note the Minister of State has talked about a governance framework to oversee and facilitate this. All of this is very good, as is the fact that the chief dental officer is meeting the stakeholders but we need timelines in this regard because people simply cannot wait. People on low incomes who are having problems cannot wait.

In a final point, one dentist with whom I spoke and who has patients on the medical card scheme is now being inundated with new patients. He told me he cannot take the new patients although he is completely happy to support those patients he already has. He said, however, that if there is pressure on somebody like him, he will have to opt out of this scheme too. That is where the problems are in respect of the existing 38 dentists the Minister of State was talking about, which is that they cannot take new patients on.

Anne Rabbitte (Galway East, Fianna Fail)
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I will continue here with the script on behalf of the Minister, Deputy Stephen Donnelly. The Minister has listened to colleagues across the Chamber and I can assure them that the Minister appreciates the difficulties experienced by people accessing healthcare and is providing solutions. As I have mentioned, additional funding has been provided to resolve the current problems of access to the dental treatment services scheme. However, the Minister and the Government recognise that the current model of provision of oral healthcare is in need of fundamental reform and that has been acknowledged.

Smile agus Sláinte, the national oral health policy provides the guiding principles aligned with Sláintecare to transform our current oral healthcare services over the next eight years. This, however, is far too long a time frame. We need the here and now, that is: the short-term, medium-term and long-term measures. With the meeting of the dental officer from the Department of Health, the HSE, in conjunction with the representative bodies, perhaps we can address the timelines the Senator has spoken to because when a person is in pain, one needs immediate action and not to be wondering about reform.