Vol. 401 No. 1
9 Proinsias De Rossa asked the Minister for Social Welfare the number of occasions on which he, or representatives of his Department, have met with representatives of the Irish Dental Association to discuss the current dispute; the date of the last meeting; if any further meetings are planned; and if he will make a statement on the matter.
The extension of the social insurance dental benefit scheme to dependent spouses, which I introduced in 1987, was opposed by the Irish Dental Association which advised their members not to sign the contract to operate the extended scheme. Some 240 dentists to date have signed agreements to operate the extended scheme. Discussions were held subsequently in an effort to find agreement with the association on the implementation of the extended scheme. A total of 18 meetings were held with the association between November, 1987 and March, 1989, when I introduced a package of improvements in the scheme.
In 1989 as part of their continued opposition to the extension of the scheme, the association called on their members to discontinue providing certain treatments under the scheme. As a result, a number of dentists are improperly charging patients fees for extractions, root canal treatment and dentures which are not in accordance with their contract.
I met the association in January this year to discuss the action and to see whether an agreed basis could now be found for operating the extended scheme. There have also been subsequent contacts at official level. Within the last month there was a meeting at official level to clarify certain details regarding dental costs supplied to me by the association. Since then my Department have been in correspondence with the association and a further meeting at official level is envisaged. In the light of these discussions I intend to meet the association to discuss what further changes in the fee structure may now be justified.
It is a great disappointment that since we last raised this issue a month ago the Minister has succeeded in having one extra dentist join his panel. We have been talking about this issue for so long and instead of things getting better they are getting worse. Will the Minister outline what he intends to do about it? I want to give my support for the scheme for insured workers and their spouses but because the decision has been taken by the Irish Dental Association to extend their dispute with the Minister, the health of insured workers and their spouses is being affected adversely to an unacceptable degree. Will the Minister decide now, once and for all, to take some positive action——
Let us have regard to brevity. We are making little or no progress today at Question Time. We are proceeding at a sluggish pace.
Will the Minister strike off the register those dentists who are refusing to treat insured workers as a first step to deal with the problem?
The Deputy has made his point.
The Dental Association have prepared costings which are currently being examined and discussions between my Department and the association will conclude soon. Many dentists are still treating. The idea is being put abroad that all dentists are making these charges. Certainly a percentage of dentists are doing so, and that raises the question of the contract. Under the terms of the contract I am empowered to take specific action against such dentists. Deputies will appreciate that while discussions continue with the Irish Dental Association I am reluctant to exercise these powers. However, I cannot indefinitely permit the situation to continue whereby patients are being refused benefits to which they are entitled. If this matter cannot be resolved through the current discussions with the association, I will be left with no option but to take the action against the dentists concerned.
Is it not a fact that the Minister could stand indicted of inactivity and a total lack of industrial relations skills? If he was a manager of an industry and he had not resolved a dispute after two years, he would neither have his position nor his industry. Is it not true that he imposed a scheme on the dentists without agreement? The net effect of his failure to resolve the issue has had the most serious consequences not just for those who were included in 1987 but for those who have been insured for a lifetime? These people cannot get basic dental treatment and are suffering as a consequence. They will not go to dentists when they realise they have to pay for the service, which they previously received free of charge. When is the Minister going to resolve this problem? If he has no serious proposal to resolve it, would he consider referring the matter to his colleague, the Minister for Labour who has a long tradition of dealing with matters like these? How much longer will the Minister allow this position to continue?
I would like to make clear that the Deputy is incorrect when she says I imposed something on dentists. I offered a separate scheme and 240 dentists have accepted it.
The Minister went ahead without their agreement.
The Deputy should listen.
Deputy Flaherty has asked some pertinent questions and she should hear the Minister's reply.
I did not impose any new scheme on dentists who did not want to take part in it. They were free to carry on under the scheme that already existed. The dentists decided, through the Irish Dental Association, to step up action against the dependent spouse's scheme. There are now 240 dentists in this scheme and over 68,000 dependent spouses have had their claims dealt with. There has been a very substantial increase in numbers treated in this area.
How many thousand people have been refused?
I ask the Deputy to desist from interrupting.
Not very many.
How would the Minister know?
The optical benefit scheme is completely open to everybody and the number of people treated under that scheme is only 86,000.
There was not a dispute there.
Over 300,000 people are receiving benefit under the dental benefit scheme at present and the Deputy should keep that in mind. It is true that some of the dentists are pursuing this programme of making charges. I know what the purpose of it is but I do not support it. These dentists are seeking an open grant-in-aid, where I make a payment to them and they can charge the client what they like, but I have made it clear I am not prepared to go along with that.
Two years later that is not good enough. The scheme is collapsing.
This matter is certainly coming near a stage of finality.
I have to dissuade Members from the notion that they may debate every question.
Obviously the 247 dentists who are operating the scheme have treated thousands of people. If there is an increase in the payment to these dentists — it is assumed there will be such an increase — will they be paid retrospectively in respect of the people they have treated since the scheme was introduced?
I have already brought in a package of £1.8 million, but this was not regarded as of any real significance. That package was introduced following discussions with the association and along the lines requested by them. It is worth £1.8 million per annum to the dentists. In the light of the current circumstances, it is possible to reconsider the matter and that is what we are doing at present. Certainly we will ensure that dentists treating people under this scheme will be looked after properly.
Because of the serious nature of the problem, will the Minister assure the House that if he has not reached an agreement with the Irish Dental Association next month, he will vastly expand the dental hospital services and recruit dentists directly into the health board system, using the vast numbers of clinics that are available throughout the country, as a way of circumventing the obstructionist strategy of the Irish Dental Association? The Minister might ask the Minister for Agriculture and Food how he managed, indirectly recruiting vets, to circumvent the actions of vets who were obstructing the bovine TB scheme. The vets who were recruited directly were far more productive than those operating under the private veterinary system. Would the Minister consider that strategy in this case?
As the Deputy may know, some of the dentists favour a situation whereby the Department of Health would deal with the dental care area, based on the medical card scheme. In that case all workers outside the medical card scheme would be treated in the private market. I take it that is not what the Deputy is talking about when he mentions the dental hospital. I am anxious to take whatever measures are necessary to ensure a continuation of treatment.
