Seanad debates
Thursday, 8 February 2024
Nithe i dtosach suíonna - Commencement Matters
Dental Services
9:30 am
Tim Lombard (Fine Gael)
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The Minister of State, Deputy Butler, is more than welcome. I raise the issue today of the review of dental services in west Cork, which is a very significant issue that we are trying to deal with at the moment. It is very appropriate to have a Minister of State with an understanding of west Cork with us this morning. That is very helpful.
The issue I raise is the school dental service. We are dealing with a shocking scenario whereby at the moment we have only two dental clinics open in west Cork, in the Bantry and Clonakilty areas. The clinics in Skibbereen, Schull, Castletownbere and Dunmanway were all closed. It is an amazing scenario that nearly 76% of the capacity we had for the school dental programme is not working in west Cork at the moment. There is a brand new primary care centre in Castletownbere and it is fully kitted out but there is no dentist there. In the primary care centre in Schull, a dentist was transferred from another practice. The clinic in Skibbereen closed in 2020 and the clinic in Dunmanway closed in recent weeks.
The service was ten times better ten years ago. That is a significant issue for parents of children in the more than 80 primary schools in the west Cork area. We are currently left with 2.5 dentists in the entire catchment area. I know the Minister of State understands the geography of the area. The journey from Clonakilty to Castletownbere is the same as travelling from Dublin to Kilkenny. There are 2.5 dentists covering 80 primary schools at the moment. The knock-on implication is obvious. The usual scenario is that children should go to dentists in first, third and sixth classes, but they would be lucky now to get an appointment in sixth class. Fissure seals and other such treatments are not being provided. I can only imagine the knock-on implication down the line because we are going to have huge issues regarding dental care because of the lack of dentists on the ground.
I was talking to local councillors. I met Caroline Cronin in Schull last Monday about this issue. It is frightening to think that in that part of the world down in Mizen, which is geographically tight, they cannot get a dentist in Schull. That is a huge issue for the school catchment area. We need to find out why we cannot get dentists into west Cork.What is the long-term strategy here? There is an enormous issue in respect of how we get professionals to come to geographically challenged areas. The cost of living is lower and housing is available. One would assume there are opportunities for a perfect lifestyle balance. If one comes to work in Schull, Skibbereen, Castletownbere in west Cork tomorrow, the cost of housing will be appropriate. One would assume that is what people would want but for some reason, the HSE cannot encourage or get dental graduates to come to town. We need an answer. It is frightening that four of our six dental surgeries have closed and there are now only two and a half dentists in the area. The Minister of State knows the geographical area better than any other Minister in these Houses.
This is a unique story that needs a unique answer. What are we going to do to encourage dentists to come to live in west Cork and how can we provide a service for the children that is not there at the moment?
Mary Butler (Waterford, Fianna Fail)
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I thank Senator Lombard for raising this important issue. It is a matter that comes up regularly. I thank the Senator for the opportunity to address the issue of dental and orthodontic services on behalf of the Minister for Health, Deputy Stephen Donnelly. I will be providing some figures regarding orthodontic services, in particular, but due to the ongoing Fórsa industrial action, the latest data we have is for the end of June 2023. I received confirmation this morning, as we all did, that the Fórsa industrial action has been suspended. However, I expect the backlog will take a few weeks to work through. Unfortunately, the figures I have are from the end of June and the Senator's figures are probably more live than mine.
The Senator has raised a valid question about people working in more rural, but beautiful and scenic, areas where the costs of living and houses are lower. I see that across my brief in respect of mental health. We have, for example, been unable to fill a post in south Kerry for child and adolescent mental health services, CAMHS, since 2014. That role has been funded for ten years and we have been unable to fill it. There are issues attached to it but we have found it challenging recently. In Donegal, for example, we advertised two posts related to nutrition and received no applications. There are challenges in specific areas.
I know west Cork very well and it is a beautiful part of the country, as the Senator said. It is vast and the catchment area is enormous. The Senator spoke to the point that Skibbereen and Dunmanway no longer have these services, which is worrying.
The Department of Health engages 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 identifying local resourcing challenges, prioritising clinical treatment and patient groups, and reallocating clinical resources according to greatest need. However, the Minister is aware that backlogs have arisen in the school system since the Covid-19 pandemic. As the Senator said previously, children were always seen in first or second class, third or fourth class and then fifth and sixth class. Fissure sealing is important to prevent fillings when they later go to secondary school.
The Minister recognises that oral healthcare needs to be modernised in line with best international evidence and practice, as set out in the Smile agus Sláinte policy. The development of prevention-focused oral healthcare packages for children aged from zero to two years is being prioritised this year, supported by €4.75 million allocated in the budget.
The HSE provides orthodontic treatment to those who have the greatest level of clinical need and who have been referred to the service before their 16th birthday. An orthodontic assessment determines if the referral meets the criteria for the service and, if so, what priority the patient is given. Additional investment in orthodontic services in recent years has enabled the HSE to substantially reduce waiting lists nationally, with a 47% reduction in treatment waiting lists achieved between the end of March 2019 and the end of June 2023. Under a national private procurement initiative, 2,154 patients were transferred into private orthodontic care between January and December 2023. For orthodontic patients who require surgical input, the HSE is developing a model of care for oral and maxillofacial surgery through the national clinical programme for surgery.In 2023, surgery was procured for 41 patients waiting over four years for jaw surgery, which requires a lengthy hospital stay.
I will come back in the next session.
Tim Lombard (Fine Gael)
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As the Minister of State rightly pointed out, the issue here is geographical. Unfortunately, trying to get services in locations that might not be the centre of Ireland is becoming a huge issue. How can we promote posts in those areas? As the Acting Chair is from Donegal, he probably knows this more than anyone. How can we get people to take up these posts? We have many vacancies and it is becoming a massive issue. It is across a plethora of specialties now. It is not just a dental issue rather it is across the entire medical sector.
How could we get a strategy? I suggest we need a strategy looking at these locations from Donegal to west Cork and south Kerry, as the Minister of State rightly mentioned. What do we need to do? Do we need an incentive programme? Do we need to change the package? Do we need a taxation programme? If we do not do something different, the opportunity for these people in west Cork in particular and other locations to have a service, whether it is mental health or dental, will not be there. That will be one of the big issues and big challenges.
Niall Blaney (Fianna Fail)
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Before the Minister of State replies, I welcome the students and teachers in the audience from Gaelscoil Eoin, Ballsbridge, Dublin. They are very welcome. They are all very good boys and girls. I hope they enjoy their trip around Leinster House.
Mary Butler (Waterford, Fianna Fail)
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I welcome the students from Gaelscoil Eoin. They are very welcome into the Seanad. It is lovely to see them. They are very well behaved - their teachers must be delighted. I am sure there will be no homework as a result of that.
The Senator raised some valid concerns and I think he hit the nail on the head. A couple of years ago when I was representing Ireland in Brussels on St. Patrick’s Day, I met the minister for health there. It was interesting; we were in the middle of Covid but his main concern at the time was dentistry and the shortage of it. That was his main focus. We are seeing that all across Europe now. The Senator made the points of trying to support people to move to more rural locations. It is a valid question.
On the Senator’s own area, orthodontic figures are available for the HSE south orthodontic subregion. The most recent figures from Cork and Kerry show that 860 patients had their orthodontic needs assessed in the first half of 2023 while 1,937 patients were in active treatment in the HSE. Notwithstanding that, there is quite a long waiting list, with 2,900 patients waiting on an assessment at the end of June and 2,600 patients waiting to start treatment. Even though many people are receiving treatment, many are waiting. It is an important time.
I will bring what the Senator raised back to the Minister. He is right about the bigger picture and encouraging professionals into specific areas.