Seán Kyne (Fine Gael)
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I welcome the Minister of State. I thank the Cathaoirleach for selecting this Commencement debate this morning on the issue of dental services. I am a member of the Joint Committee on Health. The Irish Dental Association came before the Joint Committee on Health on 5 July regarding issues within the dental service. The chief executive of the association, Fintan Hourihan, and others have expressed on the record their concern about the medical card scheme and the chronic delays in delivering the school screening programme. They are concerned about the staffing and resourcing of the dental sector, based on research in September 2022 which showed that the majority of vacancies in the dental sector cannot be filled. At that time two thirds of practices that had tried to recruit dentists in the previous 12 months could not fill the vacancies, and neither could half of the practices that attempted to recruit nurses or hygienists. Mr. Hourihan went on to say that the situation is stark, more so in the public sector where the HSE is obliged to provide care for children and for special care patients, including an orthodontic services for children with severe orthodontic needs.

I acknowledge that the budget announced last year provided funding of €4.75 million to support the development of a new prevention-focused oral healthcare system for children from birth to the age of seven. Obviously children are the most vulnerable people in our society. Unfortunately, they will continue to fall behind with their oral health, according to Mr. Hourihan, and will shoulder the burden of a system that has been underfunded for some time. The analysis shows that an extra 500 dentists throughout the public and private sectors are required to adequately meet the needs of the rising population and to replace retiring dentists. He recommends various measures to improve the supply of dentists, including significant investment in and expansion of the two dental schools in Cork and Dublin because Ireland does not produce enough dentists. He was cautiously optimistic about the recent announcement of increased college places by the Minister, Deputy Harris. I certainly welcome that.

At that committee I asked whether, given that numbers are ramping up and investment is being made in the colleges, there could be a role for retired dentists in ensuring the school screening programme is taken up and all the necessary checks are done for all our primary school children throughout the country. Unfortunately, based on the evidence, that is not happening. Some schools or classes have been skipped. Mr. Hourihan said that as long as dentists are registered to practice with the Dental Council of Ireland, they are entitled to see patients. He said that although there would be no reason due to age that they could not contribute to the school screening service, flexibility within the employment rules and policies of the HSE would be needed to allow that to happen. However, it is possible and could happen. He said it would require the HSE to revisit some of its employment practices. A person's entitlement to practise as a dentist is not linked to age but to whether they have a license from the Dental Council of Ireland.

I am calling for an examination of whether there is a basis for a short-term intervention to use dentists who have retired but would be in a position to work in the school screening service and would be happy to do so, on a part-time basis if preferred. This would not be actual dental work but school screening work to allow students and children to be assessed for ongoing developmental issues of their teeth. I look forward to the Minister of State's reply.

Mary Butler (Waterford, Fianna Fail)
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I am taking this debate on behalf of the Minister for Health, Deputy Stephen Donnelly. I thank the Senator for the opportunity to address the issue of capacity in the HSE’s public dental service to provide care, particularly to children in primary school. The salaried HSE public dental service provides care to several groups of patients, including those with complex and additional needs. In addition, the public dental service also provides a programme which includes screening and necessary treatment for children at ages corresponding to second class, sixth class and, subject to capacity, fourth class. Emergency care is also provided for children up to 16 years of age and those with complex and additional needs. This service provides care to many children and adults who would not otherwise have access to oral healthcare services. The Minister for Health is aware that, coming out of the pandemic, there are backlogs in the targeted primary school screening programme in particular, leading to delays in children receiving their first appointment. Officials in the Department of Health engage with the HSE on an ongoing basis to understand and address any challenges arising in the provision of public dental services. The Minister has been assured by the HSE that it is continuing to restore dental screening and treatment to children up to 16 years of age through recruitment initiatives to fill vacancies that have arisen or may arise, prioritising clinical treatment in patient groups and reallocating clinical resources according to greatest need.

Regarding capacity and recruitment, it is extremely heartening to note that we currently have more registered dentists in Ireland than ever before, with 3,581 at present, which represents an additional 109 registered dentists since March 2023. This reflects positive trends with the comparative figure being 3,217 in 2018. However, I accept that our population is growing every day. The Minister for Health supports the creation of additional capacity in higher education, including in oral healthcare, to which the Senator referred in regard to the Minister, Deputy Harris. The Higher Education Authority, HEA, is undertaking a process to identify a set of options to achieve this important step towards health workforce sustainability for Ireland.The HSE has confirmed that for August 2023, 802 whole-time equivalents were working in the public dental service across all grades, including 244 dentist whole-time equivalents. Concerted efforts are ongoing within the HSE to address any current vacancies. A number of community healthcare organisations, CHOs, have run competitions for dentists, dental nurses and dental hygienists to fill vacancies, with panels created from the recruitment competitions. These positions are available for any person who meets the required eligibility criteria to apply. That comes back to the point raised by the Senator, which is a very fair and reasonable ask he has made regarding retired dentists, a short-term intervention and a school screening programme.

As the Senator will know, we require a sufficient number of appropriately trained oral healthcare professionals, including dentists, hygienists, clinical dental technicians, orthodontic therapists, dental nurses and other supporting oral healthcare workers. The Department of Health has commenced work on a workforce census across the oral healthcare sector with a view to ascertaining the current skill mix within our workforce so that we can support future training needs.

Seán Kyne (Fine Gael)
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I thank the Minister of State for the response. I am heartened that she believes there is merit in the suggestion and I hope she will be able to bring it back to the Minister, Deputy Donnelly.

As the Minister of State said in her response, the public dental service provides a programme for second class, sixth class and, subject to capacity, fourth class. There is a capacity issue, and therefore, thinking of schoolchildren in Galway and every county, I am asking whether this short-term intervention using retired dentists would allow for an improvement in capacity and in the number of pupils being assessed in that critical period of fourth class, for example, to identify any problems that are developing in children's oral health and allow them to be assessed.

I welcome the investment by the Government and that the Minister, Deputy Harris, is looking at the number of places, but this will take time to get through the system. Therefore, I ask again that the Minster of State bring this back to the Minister in terms of a short-term intervention.

Mary Butler (Waterford, Fianna Fail)
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I will take it back. As we have said, we require a sufficient number of appropriately trained oral healthcare professionals, including dentists, hygienists, clinical dental technicians, orthodontic therapists, dental nurses and other supporting oral healthcare workers. The Senator mentioned employment rules and flexibility. The HSE national oral health office works with the HSE national HR, recruitment reform and resourcing programme on identifying and resourcing challenges that may be experienced by the dental and oral health professions. As I have said, I think the Senator's ask is fair the way he has set it out regarding screening programmes. I will certainly bring it back. Given the Department of Health has commenced work on a workforce census across the oral healthcare sector, I think that is an area it could look at as well.