Imelda Goldsboro (Fianna Fail)
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I welcome the Minister of State, Deputy Grealish.

Gareth Scahill (Fine Gael)
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I welcome the Minister of State to the Chamber today to answer questions on behalf of the Government. First and foremost, I congratulate him on his appointment. I also congratulate him on Galway’s win over New York at the weekend. Thankfully, he is here today and not in two weeks’ time, when Roscommon and Galway will be playing in the semi-final, or he might not be as accommodating to me.

I also acknowledge the Minister, Deputy Carroll MacNeill, with this Commencement matter, as well as for meeting with me recently with regard to the university hospital in Roscommon and the provision for the rehabilitation unit and for the refurbishment of the radiology unit. I hope that my opinion and the opinions I reflect of the people of Roscommon will be reflected in future planning by her Department.

The issue I raise today is with regard to the lack of available dentists accepting medical cards nationwide. While I was a member of the regional health forum in the west, I raised this issue and the answer I received was not sufficient, considering the number of people nationwide affected by it. The question I asked of the regional health forum was whether the HSE could confirm which dentists in Roscommon were taking medical card patients and what the accepted waiting period for an appointment was. I was referred to the fact that four dentists in County Roscommon are accepting medical card patients. However, the note also stated that some dental practices are advising that they are at capacity and are unable to take new patients. This is leading to these people being referred to dentists in other counties and is adding considerable time to the journeys of those patients.

Many years of neglect transformed what was a poor service into a state of crisis within that sector. We are dealing with an emergency where patients simply cannot be seen or patients have to travel half the length of the country to get another dentist to see them. A total of 810 dentists are signed up to the dental treatment service scheme but, according to the media, only about 600 of those are active. The lack of availability has had a dramatic effect on people’s treatment. It means they cannot access routine treatments and they are presenting very late. They are often in a lot of pain with swelling and, inevitably, teeth are having to be extracted. Dentists, in turn, are frustrated by the limited care they can provide to medical card holders because they are limited on the number of fillings they can provide under the scheme. It is a disincentive to dentists who do not want to have to resort to extractions that that is the only treatment open to them in the end. It would be like patients going to a GP and the only option for treatment they were given was amputation.

We need more dentists and we need to be able to provide more services to patients. The dental treatment scheme should be a demand-led scheme, not a budget-led scheme. Nobody can have good general health if they do not have good oral health. People are paying the price. The most vulnerable, the people who need help from the State the most, are the ones being ignored.

When will the next dental strategy be formulated to ensure we have enough dentists to meet the demand nationally for medical card holders? Can the Minister prioritise this issue for the large number of people affected by this in the Roscommon-Galway constituency, the west of Ireland and nationally?

Noel Grealish (Galway West, Independent)
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This is my first day as Minister of State in this Chamber. I thank the Senator for his warm welcome and also for the congratulations on the Galway win. I congratulate him on a great win in London also. It is leading up to a great challenge on Sunday week. I am sure I will see him in Pearse Stadium.

I am taking this debate on behalf of the Minister for Health, Deputy Carroll MacNeill. I thank the Senator for the opportunity to address the issue of dental services and recruitment of dentists for medical card holders. The dental treatment services scheme, DTSS, provides dental care free of charge to medical card holders aged 16 and over. Services are provided by private dentists and clinical dental technicians who hold a contract with the HSE to operate the DTSS. Services available annually and on demand include an examination, two fillings, emergency extractions and a scale and polish. More complex care, such as dentures, and a broader range of treatments for patients with additional needs and high-risk patients are available subject to the approval of the local HSE principal dental surgeon. To support contractors to provide care under the scheme, an additional €10 million was made available in budget 2022 to increase the preventative care available and increase the fees paid to contractors for most treatment items by between 40% and 60% from May 2022. The introduction of these measures has improved access to care for patients. In 2024, 227,691 additional treatments were provided nationally under the DTSS, with 44,208 extra patients treated when compared with 2022. The Minister acknowledges, however, that access issues remain and that complete modernisation of care, the service model and, subsequently, contractual arrangements for adult medical card holders is required.

The vision for substantial service reform is set out in the national oral health policy. Budget 2025 allocated €2 million for 2025, increasing to €4 million in 2026, to continue the implementation of the national oral health policy. The investment will also provide an additional 15 HSE dental staff to deliver oral healthcare in the community, including medical card holders. In addition to this, the HSE has sanctioned filling the existing 34.7 whole-time equivalent vacancies in the oral healthcare service and has advised that the recruitment process has commenced. This will further assist the provision of oral healthcare services by HSE dental staff to provide the care it is tasked to provide.

The plan for the first phase of policy implementation, to end in 2027, is being finalised by the Department of Health and the HSE, following targeted consultation in quarter 3 of last year. The policy highlights the need for strategic workforce planning to ensure a sufficient number of appropriately trained oral healthcare professionals, including dentists, dental hygienists, dental nurses and other auxiliary grades. It is heartening to note that, currently, we have more registered dentists in Ireland than ever before - 3,823 as of April 2025, which is an additional 171 registered dentists since April 2024. To increase this number further, the Minister for Health supports the creation of additional capacity in higher education, including in oral healthcare. Substantial modernisation of the service and contractual model, in tandem with increasing workforce capacity, will train and enable more dentists to take contracts to care for medical card holders.

The Senator asked how many dentists are in Roscommon. I will ask the Minister to reply directly to him on that.

Imelda Goldsboro (Fianna Fail)
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Before the Senator replies, I welcome students of Coláiste Ghobnatan from Ballyvourney, County Cork. They are most welcome to the Upper House this afternoon. We hope they enjoy their trip.

Gareth Scahill (Fine Gael)
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I thank the Minister of State for his detailed response. I appreciate this is not his Department. I welcome the fact the HSE has sanctioned the filling of the 34.7 positions and I look forward to those being filled. The year 2027 is still two years away. I will therefore work with the Minister and see whether anything can be fast-tracked with regard to delivering the services in our rural counties. I thank the Minister of State for coming today.

Noel Grealish (Galway West, Independent)
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I thank the Senator for raising the issue. I am sure the Minister for Health will be agreeable to meeting with the Senator and to discuss the matter further. As TDs and Senators, parents always come to us regarding the oral hygiene of students, particularly those going to the national schools and secondary schools and those who use medical cards. It is important we can try to progress and move that forward. I am sure that the Minister will be open to discussing this matter further with the Senator.