Dáil Éireann debate -
Wednesday, 26 Jul 1995

Vol. 455 No. 7

Adjournment Debate. - Abolition of Health Board Grants.

Dr. O'Hanlon

Thank you for allowing me to raise this issue and I thank the Minister for attending. We welcome the new national dental scheme, but there are some problems with it. It is a regional scheme run by the board at central level, rather than the individual community care scheme that was previously in place. In addition, the emergency treatment, which was not as broad as in the past, is using a significant amount of the resources available for the scheme. For example, people requiring dentures must still wait an inordinate length of time.

With regard to social welfare recipients who are also medical card holders, formerly, such person who had paid contributions, whether they were still working, or pensioners over the age of 65 years who had contributed during their working years, were entitled to apply to their own dentists and avail of services. The Department of Social Welfare paid 50 per cent of the cost of the supply of dentures and the health boards made a payment towards the other 50 per cent. Recipients were, therefore, at no loss.

The health board contribution is no longer paid in such circumstances. Part of the problem is not only that the schemes differ fundamentally in certain respects, but that payments are now made to the private dentists through the payments board, and not directly by the health boards. Will the Minister ensure that the disadvantage which social welfare recipients who are medical card holders now find themselves at will be removed?

Will the Minister also discuss with his colleague, the Minister for Social Welfare, the question of running two parallel dental services and perhaps agree on an integrated unified dental service? The same applies to the ophthalmic service, where there are two separate schemes in operation, and to the ear, nose and throat service. At a time when the Department of Social Welfare is assuming responsibility for income allowances from the Department of Health, there is a good case for transfering the medical services provided through the Department of Social Welfare to the health boards under the aegis of the Minister for Health.

Minister for Health (Mr. Noonan,

Limerick East): I thank Deputy O'Hanlon for raising this important matter and for giving me the opportunity to reply. The provision of dental services for eligible persons is a matter for each health board in the first instance.

Regarding the background to what the Deputy describes as the payment by health boards of grants towards the cost of dental treatment for Social Welfare contributors who are medical card holders, the limited resources available to health boards for the provision of dental services were mainly directed at the improvement of the health board children's dental services. Many health boards could provide only a limited service for adults. In most cases the adult service provided amounted to an emergency service for the relief of pain.

To ensure that as many treatments as possible were provided with the resources available, some health boards in recent years introduced ad hoc arrangements under which persons with dual eligibility — persons who were entitled to treatment under the Department of Social Welfare dental treatment benefit scheme and who also had medical card entitlement — could obtain the required treatment from private dental practitioners under the dental treatment benefit scheme. Such treatment would be provided on a priority need basis. The health board involved met the cost of the patient contribution payable under the scheme. In this way the health board considered that it could obtain the maximum amount of treatments while targeting its own resources at those with medical card eligibility only.

These arrangements were as, I say, entered into on an ad hoc basis by a small number of health boards. It was a pragmatic response to the needs in particular areas. The arrangements are, I believe, still in operation in some areas. They were not general to all health boards. Following the introduction by my Department in November 1994 of the dental treatment services scheme as part of the dental health action plan, a comprehensive range of routine dental services for all adults with medical card eligibility will be phased in over the period of the plan. Private practitioners under contract to the health boards will be significant providers of adult dental services. In the initial phase of the dental treatment services scheme persons of 65 years and over in need of routine or full denture treatment have been identified as the priority group. The plan provides for the extension of the dental treatment services scheme to other identified age groups on a phased basis.

As treatment for all eligible adults is progressively phased in under the dental treatment services scheme the need for ad hoc arrangements of this nature brought to our attention by the Deputy, should no longer arise. If, however, the Deputy has in mind a specific case, perhaps he could furnish me with details and I will refer them to the health board for investigation and for direct reply to the Deputy.