asked the Minister for Social Welfare when it is expected that free dental treatment will be available to all who are entitled to it under the social welfare code; and if he will make a statement on the matter.
17.
Ceisteanna—Questions. Oral Answers. - Social Welfare Benefits.
2.
asked the Minister for Social Welfare his views on whether the scheme extending dental and optical benefits to spouses is a success, in view of the low take-up rate; whether all of the funding allocated to the scheme will be spent this year; and, if not, if he will ensure that any funds left over are not returned to the Exchequer but are used to boost the dental and optical schemes run for schoolchildren which are seriously lacking in resources at present.
30.
asked the Minister for Social Welfare the number of dependent spouses who have made application for dental benefit under the new dental benefit scheme for such persons; the number who received treatment; the number of dentists who are currently operating the scheme; the plans, if any, he has to ensure that this scheme is readily accessible to eligible spouses; and if he will make a statement on the matter.
I propose to take Questions Nos. 2, 17 and 30 together.
The extension of the treatment benefits scheme to the dependent spouses of insured persons took effect from 19 October 1987. Since then a total of 17,500 dependent spouses have made applications for dental benefit. Because of the fact that a course of treatment may extend over a period of time and because many claims do not reach the Department until the treatment is completed, it is not possible to say how many dependent spouses have actually received treatment in whole or in part so far. However, prior approval for treatment is sought in the majority of cases and such prior approval has been granted in 14,500 cases since 19 October 1987. A total of 23,500 dependent spouses have made applications for optical benefit and over 200 dependent spouses made applications in respect of hearing aids.
One hundred and fifty nine dentists have agreed to participate in the extended scheme up to this stage. Seven of these joined the extended scheme over the last two weeks. Since the new scheme began two dentists who were active on the panel have died and one has retired. The Optometrists Association, which represents opticians, gave its full co-operation to the extended scheme from the start and all opticians are participating.
I met the Irish Dental Association twice in 1987 and explained the Government decision to extend the scheme. On 30 November 1987, we agreed to set up a joint working group, comprising representatives of the Department of Social Welfare and of the Irish Dental Association, to examine all aspects of the social insurance dental benefit scheme. The working group is due to report to me by 30 May 1988. I understand that there may be some short delay but that the report will be ready soon after that date. I do not wish to anticipate or pre-empt the contents of the report at this stage. I expect, however, that it will clarify the issues which exist between the Irish Dental Association and the Department in relation to the social insurance dental benefit scheme and its coverage. I will then consider the report and come to a conclusion on the matters at issue at the earliest possible date. I trust that the Irish Dental Association will then be able to recommend that the remaining dentists participate in the treatment of dependent spouses under the extended scheme.
Despite the difficulties arising from the embargo by the Irish Dental Association so far, I regard the extension as a success. There has been no problem at all in relation to optical benefit and hearing aids. It is very significant also that in the cases of dependent spouses who have been treated under the scheme a pattern of treatment has emerged that shows that many of them had been in need of dental treatment for some time. In this respect, the extension has uncovered a backlog of treatment which was greater than anticipated and I trust that the dentists will be able to agree to co-operate in dealing with it under the scheme at an early date.
The estimate for the treatment benefit scheme in 1988 is £19 million. I expect that all of this money will be spent.
The dental and optical schemes for schoolchildren are operated by the health boards which come within the remit of the Minister for Health.
May I ask the Minister, despite the long and detailed response he has given, if he would not accept that the scheme is not working, in relation to the level of success it should be having? Would he accept that the lack of co-operation by the vast majority of dentists is something that should be deplored? I urge him to do something about that as a matter or urgency. In relation to the figures of expenditure that are available for the first quarter of this year it would appear — I do not think anything will happen to change the figures for the remainder of the year — that there will be significant savings in relation to dental treatment. Would the Minister assure the House that if savings are going to be made — it looks as if there will be large savings out of the £6.275 million for dental treatment — that money will be spent in up-dating and providing an adequate dental service to schoolchildren? I put it to the Minister very strongly that that service is about three years out of date. It is totally inadequate and it is a source of frustration to the administrators and the parents of children who are waiting for the service. Can the Minister assure the House that any savings that are made in relation to the dental scheme for spouses of insured workers will be spent on the scheme for schoolchildren, which, he must accept, is totally underfunded and inadequate.
The question has become over long.
The answer was rather long too.
I am glad the Deputy referred back to the reply. I was answering three questions, not just the Deputy's question, and they are complex questions. If the Deputy wants me to give a short answer that is very simple.
I accept that.
There are several elements in the question. The scheme is working satisfactorily for those who can benefit from it. The number of people who are benefiting is increasing fairly rapidly. The fact that the cost was lower in the early stages is to be expected because the numbers participating have increased as the year has gone on. As I have said, seven new dentists have joined the scheme in the last two weeks. That is reasonably significant because the embargo still applies. The dependent spouses have been very patient, as I asked them to be, because there is a total embargo on those jobs. There is a service operating throughout the country, although it is limited in some areas. There are some problems in relation to travelling a distance for the service and I accept that.
I would ask the Deputies to be patient with me at this stage. There are a number of factors concerned. The report of the joint working group will be published fairly shortly, certainly by the middle of June, although it was originally expected to be available for the end of May. There are approximately 75 new dentists coming out this year. Normally most of them would have to emigrate, but there will be work here. I accept the Deputy's concern about this, and I too am concerned. Nevertheless, I am confident that the number of those participating in this scheme will continue to increase.
In relation to health board activities as they affect children, they are the responsibility of the Minister for Health. It is important to note that there has been a considerable saving on the health board side as a result of this new scheme because many people who would have qualified for treatment provided by the health board services — medical card holders — and who have been on the waiting list are transferring to this scheme because they are eligible under it as dependent spouses. This is relieving some pressure on the health boards and will enable them to provide more services.
There is one point I wish to raise and perhaps the Minister would clarify it as he appears to have a very good understanding of the brief in front of him. Will there be savings on the dental scheme this year? The Minister spoke about the health service aspect, would he express the view that it would be in the interest of the children that all the money would be spent, even if it has to be transferred to another Department, rather than go back into the Exchequer as savings? Would the Minister recommend that move? Everybody in the House accepts that there is a three to four year waiting list for treatment for school children. If adequate treatment were provided initially this could mean a saving in the long term. Would the Minister be prepared to recommend that this money be transferred——
The Deputy adverted to that matter earlier.
But I did not get a reply.
I said we anticipate all the money in the fund will be expended. One of the reasons for this is that the cost per individual is higher than anticipated. We will be monitoring the position, but at this stage it is not anticipated that there will be savings. I will be prepared to have discussions with the Minister for Health about the health board scheme for children.
The Minister said there are 159 dentists in the scheme at the moment. How many does he estimate he would need to operate the scheme adequately.
There is an embargo and I have been trying to deliver as much as possible in those circumstances, and every Deputy is aware of that. In the Department initially we regarded 150 as the minimum number needed to operate the service. That is not to say that one can operate a satisfactory service with just that number, but that is the figure we set. Obviously, the service will become more comprehensive in the future and I hope dentists continue to join the scheme. The fact that seven dentists joined in the last two weeks is a good omen.
As only nine new dentists have joined the scheme since the Minister last reported to us on 1 March, would he not agree that that represents a very significant slowing up of new arrivals into the scheme? Does he know the number of dentists operating in the Dublin area? In the north side of the city there are no more than three dentists operating at any one time, which is almost a non-service. Does the Minister stand over his words at the annual meeting this year of the Irish Dental Association that, with or without them, he will see the full implementation of his scheme which is so badly needed, as the figures suggest?
I do not think I used those words, but I expressed my determination to proceed with this scheme and I made that very clear. The number of surgery locations in the Dublin area is 45 and the number of dentists is 42.
Perhaps I missed it in the Minister's comprehensive answer but I do not think he referred to the numbers eligible under this scheme. He gave the numbers of those who applied for treatment, but how many are eligible? He has also told us the number of dentists operating the scheme, but what is the total number of dentists who would otherwise be available to operate the scheme if there was no embargo? Does the Minister see merit in combining the scheme with that of the health boards and having a unified scheme for dental treatment in the country as opposed to dividing the resources that are available?
The number of dependent spouses eligible would be 330,000 out of a total of 1.3 million. The estimates are based on the number who would be likely to apply, but may not mean the number of people with dental problems. The number of dentists active on the panel would be 630; but, as I said, two have died and one has retired.
It is a fraction, 159 or 160.
The level of activity is another question. There is always a problem with statistics because there are some dentists who are very active in our scheme and others who would be active on the panel. The work they do under our scheme would make up only 10 per cent of their practice. One has to bear that in mind. If these 159 dentists were engaged full time under our scheme——
They might not be.
I am calling the next question.
The Deputy asked about combining the scheme with that of the health boards. That is the argument normally made by the Irish Dental Association. If we combined the two schemes we would have to introduce a means test for everybody. I am opposed to that because I see this scheme as providing treatment benefit for insured workers. If we were to make that move, the insured workers would lose benefit. That is my concern.
Surely it is more important——
I am sorry, Deputy, but I have given you a lot of latitude on this question——
My question arises directly out of the Minister's reply.
I am sorry, Deputy, but I want to deal with other questions.
A brief supplementary, please.
I hesitate to refuse the lady Member; I will allow a brief supplementary.
Would the Minister agree that the effort behind any scheme, either in health or social welfare, should be the proper treatment of as many people as possible? If a means test brings that about, is it not worth considering?
I am always very suspicious — I am not thinking of the Deputy when I say this because this question is put to me frequently outside this House, particularly by the Irish Dental Association — when the argument is put to me that we should always be concerned about the poor and those on the lowest income. It sometimes is a case of the wolf in sheep's clothing. I know exactly what it means. It means to put more people into the private sector so that we can have them as private patients and bring in these dependent spouses who have never had treatment for years. What most people in this House believed is coming out clearly, that the amount of treatment being given to the spouses is far greater than the treatment given to the men because the dental situation for women is so much worse. One can attack both situations separately. In other words, there would be ways of tackling the problem for those in the lowest income groups, many of whom come under this heading, but we must also deal with children and other categories under the health service. Different methods could be adopted to improve the position. The dentists could help out, also. The Taoiseach, when Minister for Health and Social Welfare, tried to bring in a scheme to help the position but did not get the co-operation of the dentists. My main concern would be that the effect should not be to deny many workers and their spouses in the middle income group the treatment they need.