Skip to main content
Normal View

Dáil Éireann debate -
Thursday, 27 Apr 1989

Vol. 389 No. 3

Ceisteanna—Question. Oral Answers. - Dentists' Dispute with Department.

7.

asked the Minister for Social Welfare the action he intends to take to ensure that the present dispute between his Department and the Irish Dentists' Association is ended in order that the public can have access to dental care; and if he will make a statement on the matter.

12.

asked the Minister for Social Welfare if he will outline the latest position regarding the dispute with members of the Irish Dentists' Association; the action he intends to take to ensure that spouses of insured workers receive treatment to which they are entitled and that those who have paid the appropriate PRSI contributions receive all types of treatment for which they are eligible; the action he intends to take against dentists who are refusing to provide treatment; and if he will make a statement on the matter.

I propose to take Questions Nos. 7 and 12 together.

The Irish Dental Association has been in dispute with my Department since October 1987 when I extended the treatment benefits scheme to cover the dependent spouses of insured workers. Despite the association's opposition to the extension, 190 dentists to date have signed agreements to operate the extended scheme and claims in respect of around 40,000 dependent spouses have been submitted. Over £1.8 million has been paid to dentists in respect of claims from dependent spouses. Dependent spouses may obtain the names of their nearest participating dentist by contacting their local social welfare office or by telephoning my Department.

Following discussions with the Irish Dental Association I set up a joint working group to examine all aspects of the social insurance dental benefit scheme to see if improvements could be made within the limits of the existing budget. I had a further meeting with representatives of the association on 26 July last at which the findings of the working group were presented and discussed. On 20 December last I again met with the representatives of the Irish Dental Association for detailed discussions on possible improvements arising from the recommendations of the working party. Subsequently, on 10 January this year a letter setting out proposals for improvements was given to the association. Despite this, the Irish Dental Association on 14 January announced their decision to instruct their members to stop providing dentures and root canal treatment to all insured workers other than medical card holders.

Further discussions took place at official level on 24 January. At this meeting the association's representatives stated that a prerequisite for reaching agreement was the introduction of openended grant-in-aid for all but a few treatment items. They indicated that, if this was forthcoming, they would be prepared to consider special arrangements for lower income insured workers such as medical card holders. This was not acceptable to me and I decided to proceed with a set of improvements to the scheme. These were issued to all dentists on 2 February last. The Irish Dental Association then extended their instruction to members not to carry out certain treatments under the scheme to cover extractions.

A small number of complaints have been received by my Department of dentists refusing to carry out such treatments and these are being investigated at present. Where I am satisfied that the complaints are substantiated, I will have no option but to regard the dentists concerned as being in breach of their agreement with me to provide dental treatment. I will invoke the sanction, which is provided for under the contract signed by each dentist operating the scheme, by removing from my Department's dental panel dentists who are in breach of their agreements.

There can be no question of my going back on the decision to extend the dental benefit scheme to dependent spouses. Furthermore, I am not prepared to consider the introduction of a two-tier system of entitlement to dental benefit on the lines advocated by the association and I have refused to discuss any such changes in the scheme. However, I am always prepared to consider improvements in the scheme. The wide range of changes which I introduced earlier this year involved a significant increase in expenditure on the scheme and I am prepared to consider with the association any further improvements in the scheme which may be possible within the financial constraints which exist.

When did the Minister last meet the dental association to discuss their problems? Will he agree that whatever differences exist should be sorted out between the dentists and the Minister so that the innocent victims — the patients — will not suffer? May I encourage him in his suggestion that where complaints are substantiated he will have no alternative but to take action against the particular dentists for breach of contract? That would be appropriate because it is appalling that people in need of essential dental care are suffering in this dispute. Will the Minister agree to meet the dentists with a third party, an independent person, to try to iron out some of the difficulties which I understand could happen if a meeting took place?

The third party could be someone with a toothache.

The last meeting was held on 20 December. I set up the working group to consider this, we discussed their report and had the meeting. I have given the whole series of events in my reply. On 10 January the dental association got a letter setting out proposals for improvements. On 14 January the association announced their decision to instruct members to stop providing dentures and root canal treatment. Further discussions took place on 24 January at official level in the Department as normally the Minister is only occasionally involved. After that there were meetings of an informal nature with the members of the dental association——

Where do we go from here?

They set out very clearly that they want a two tier system——

Is the Minister prepared to meet them again?

If they wish to meet me to discuss the scheme I am prepared to meet them.

It is significant that the Minister has not linked Question No. 5 with the questions to which he replied. The proposal in Question No. 5 is the framework within which a solution could be found. Has the Minister closed his mind to the recommendation of the Commission on Social Welfare which involved the transfer of the dental and other treatment benefit schemes from his Department to the Department of Health so that we could have a unified dental scheme? The Minister said that 39,000 people had availed of the extension of the scheme. That was in reply to a written parliamentary question yesterday. What percentage of the total number is involved since the introduction of the scheme a year and a half ago? Following up a point made by Deputy Harney, I suggested some time ago that the Minister might look at the example in the GMS dispute where John Horgan of the Labour Court was involved as a conciliator. Will the Minister consider that route as a possible way of bringing an end to the problem which is causing so much hardship?

As I said, I am prepared to meet the dental association. I am not prepared to exclude dependent spouses or to introduce a two-tier system. This is a scheme for workers, based on their insurance, and that brings me back to the priority question for which we did not have time——

Will the Minister deal with my third question?

The social insurance treatment benefit scheme, including dental and optical benefits, is specifically designed for people insured under the social insurance system and their dependent spouses. Entitlement to treatment benefits is subject to the payment of social insurance contributions under the PRSI system administered by my Department and treatments are provided by dentists and opticians under contract to me. As it is a social insurance scheme, with entitlement determined by PRSI contributions, the most effective way to administer it is under the Department of Social Welfare as at present. The Department of Health have responsibility for dental and opthalmic services as part of their overall responsibility for health services generally. A range of treatments is provided under the health services to patients with entitlement to medical cards. However, there are fundamental differences between these arrangements and the treatment benefit scheme. I consider that the treatment benefit scheme is a very significant benefit to insured persons and their dependent spouses. The scheme is administered in an efficient and effective way at present and I do not see any advantage to be gained, in present circumstances, in transferring it to the Department of Health. It is a highly computerised scheme which is extremely efficient and one of the first requirements would be for the Department of Health to get similar computer facilities to deal with it. In determining whether a person is eligible they would still have to consult the Department of Social Welfare to find out their position in relation to social welfare contributions. Our involvement is principally one of determining a person's eligibility. When that is determined the contracted dentists supply the service and we have a very close liaison with the Department of Health.

Under the scheme, 350,000 people would be treated in a year for dental problems and there are about 400,000 people eligible for such treatment. Probably over 40,000 dependent spouses have been treated out of a total of slightly over 300,000 who are eligible for such treatment. Of course, they would not necessarily all need their teeth treated at the one time. Initially the Department's estimate was that we would require 150 dentists to operate the extended scheme but 190 dentists have now signed the new agreements. Some of those dentists do not want to participate in the extended scheme as they have very big private practices which, presumably, they want to keep. Our scheme constitutes a very small element in the work of these dentists. The figures can be very confusing as they include many people who do a small amount of work for us.

A conciliator like Mr. Horgan? The Minister should let him in.

Will the Minister indicate what proportion of dentists are in the scheme? The Minister told the House that 190 dentists are operating the scheme but I should like to know where those dentists are located. There seems to be a scarcity of them in Dublin North-West. A constituent went to four dentists, was refused treatment and, eventually, had to seek private treatment. Will the Minister agree that the dental care system is in need of radical overhaul? Will he consider establishing a dental commission to examine how best a service, both private and public, can be provided?

Several studies have been carried out on this matter. I should like to tell the Deputy that 56 practices in Dublin are operating the scheme, 35 in Cork, 15 in Donegal and 15 in Louth. Smaller practices around the country are operating the scheme. There is no dentist in Wexford offering a service and that is something that I will have to attend to in the near future. I should like to remind Members that for new dentists there is only one scheme, the extended scheme. I am prepared to listen to what the dentists have to say.

I should like to ask Deputy De Rossa to put a brief question to the Minister. I want to deal with other questions. Progress on questions today has been extremely sluggish.

This is my first intervention.

I appreciate that.

Will the Minister consider ways of informing the public of the location of the dentists who are operating the scheme so that people will not have to go walking from one dentist to another and suffer the embarrassment of being refused?

As I have said on a number of occasions, those requiring treatment should contact their local social welfare officer, employment exchange or the Department directly. Initially many people did that but we have very few complaints now. I have read a lot about complaints in the newspapers but I am aware that the system is working very effectively. Many people are being treated under the scheme which is costing more money than ever before. The Deputy may be misled into thinking that there is a major difficulty but that is not so. Obviously, I want the scheme extended throughout the country.

Those who need treatment do not know where to go.

If they contact a local social welfare officer or the Department they will be put in touch with the dentists who are operating the scheme. I accept that there was some difficulty earlier. I was asked to publish a list of the dentists operating the scheme but some dentists asked me not to do so because of the representations they were receiving from others.

Top
Share