Dáil Éireann debate -
Thursday, 20 Feb 2003

Vol. 561 No. 6

Ceisteanna – Questions. Priority Questions. - Social Welfare Benefits.

Michael Ring

Question:

1 Mr. Ring asked the Minister for Social and Family Affairs when the dispute with the Irish Dental Association whereby dental services were withdrawn from insured workers started; the number of weeks in the intervening period when dental services have not been available to such insured workers; the estimated saving to her Department as a result of this dispute; the number of insured workers who lost out on dental services; her proposals to compensate those workers who paid their insurance and did not get the service; the progress on the resolution of this dispute; and if she will make a statement on the matter. [5044/03]

Willie Penrose

Question:

2 Mr. Penrose asked the Minister for Social and Family Affairs the situation regarding the dispute between her Department and the Irish Dental Association regarding the payment of dental treatment fees; if it is proposed to compensate those affected during the dispute; and if she will make a statement on the matter. [4850/03]

Minister for Social and Family Affairs (Mary Coughlan):

I propose to take Questions Nos. 1 and 2 together.

Dental benefit is provided to insured workers through a panel of dentists who enter into agreements with my Department to provide treatments under the scheme on a contract basis and at fees specified in the agreements. Under these arrangements and with limited exceptions, treatments are provided to the patients either free of charge or at a reduced fee and the Department pays the balance of the cost directly to the dentist at the agreed rates.

The dispute affecting the dental benefit scheme arose because of a recommendation by the Irish Dental Association to its members to apply increased patient charges on a unilateral basis without the Minister's agreement. Dentists who choose to operate on this basis would be in breach of their contractual obligations with my Department. All dentists on the panel were, therefore, written to and advised of their obligations and asked to confirm on an individual basis if they would be honouring their contractual obligations. This process took place between March 2002 and August 2002 during which time efforts were also made, without success, to deal with the issues at the heart of the dispute. On the basis of the replies received, a countrywide list of panellists who were prepared to operate the scheme within the agreed terms was drawn up.

From the beginning of August 2002 my Department ceased to accept claims from dentists who were not prepared to provide treatment at the agreed rates. Patients were advised at this stage to check that their dentist was continuing to operate within his contract with the Department and in cases where this was not so, they were advised to use my Departments Locall service to get details of dentists adhering to the agreed fees for treatments. Patients were also advised that the Department would not be in a position to refund any costs arising from treatment provided to them as private patients.

The Locall service was heavily used by patients who were directed to alternative dentists who were providing a service at the agreed rates. In this way the scheme has continued to operate throughout the intervening period.

My Department has no information on the numbers of patients who deferred treatment pending a settlement of the dispute or on the numbers who were treated by dentists who had ceased to operate the scheme. Patients who received treatment from dentists not participating in the scheme did so outside the scope of the arrangements for the provision of dental benefit and are not entitled to refunds under the scheme. The position in this regard was made clear at the outset.

Detailed proposals aimed at ending the dispute have been worked out in negotiations over the past two weeks. The Irish Dental Association has put the proposals to its members in a postal ballot, the results of which are expected at the end of next week.

The impact of the dispute cannot be fully assessed until a resolution is achieved and treatments which may have been deferred pending a settlement are carried out. Expenditure on dental benefit in 2002 amounted to €35.1 million compared with €35 million in 2001.

Mr. Ring:

People who paid their social insurance in this case are like those who pay to insure their cars only to find out when they have a crash that they are not insured. If constituents of mine did not pay their social insurance, would the Minister's Department not pursue them? The Minister cannot say she will not compensate people who have used this service, nor can she expect a person who has a dentist he or she uses regularly to use a dentist he or she has never used before. The Minister has made no effort since last August to resolve this dispute because it saved money. She stated that the Department did not save money, but of course it did. More people are becoming eligible now simply because they were not employed in the past. Money has been saved because more people are entitled to this service. People have visited the dentist and paid their money. When they wrote to the Department, however, it would not reimburse them. What will the Minister do for these individuals?

Mary Coughlan:

I am sure the Deputy would expect me to guarantee the scheme to ensure patients were not being charged private fees. That was what was going on and as a consequence, dentists were working outside the contract with the Department. There was a publicity campaign in August, when it was decided to withdraw the contracts between the IDA and me. People were advised that if dentists were not participating in the scheme, I was not in a position to recoup private fees. We set up a panel of dentists and also provided a Lo-Call service to allow people to find out if they were entitled to their benefits, per se, and what dentists were working within the scheme. I am sure the Deputy will agree that, in the context of a dispute, it would be farcical for me to allow a system to proceed that was contrary to the contract and the common good and at the same time pay people.

I made every effort, as did my predecessor, to avert this dispute. Proposals were made which were not agreed to by the dentists and, unfortunately, we found ourselves at an impasse. I reiterated to the House that I was available for discussions and on 28 January I met the IDA with further proposals. They were negotiated and finalised by officials in my Department two weeks ago. The IDA agreed to recommend this to its dentists. I hope this will be completed next week, but, until then, I would rather not pre-empt any decision that might be made on the agreement. Unfortunately, even if I wanted to, I do not have the wherewithal to pay money back. As the Deputy will agree, not everybody who pays PRSI is entitled to dental benefit and they may not need that benefit. It is very difficult to quantify this.

I appreciate that Deputy Ring loves headlines. I did not do it to save any money.

Mr. Ring:

Of course the Minister did.

Mary Coughlan:

I did not, I did it on the basis that I had to protect the customer, the patient. In other words, it is unfair and wrong that somebody, who is part of the scheme where there are agreed procedures and an agreed amount of money is expected, to pay open grant-in-aid over and above that amount. Deputy Ring would be the first to jump up and down on the other side of the House if I allowed that to happen. Unfortunately, the dispute was protracted and we did not reach agreement. However, we have now done so and I hope that we will have the scheme back on track in the near future.

Mr. Penrose:

Would the Minister not agree that this dispute was handled in a disastrous fashion, not by her – she has only been in office for a short period – but by her predecessor? For more than two years it was relentlessly heading towards a breakdown. What sort of contractual arrangement existed between the Department and the IDA? I possess some legal knowledge. Surely any contract should have an in-built mechanism for the resolution of disputes. Was there no binding condition in the agreement that as soon as a dispute arose, it would have to be referred to arbitration?

Is the Minister aware that people from low income families, particularly women who are dependent on their spouses, deferred getting necessary dental treatment while this dispute has been ongoing? Have several million euro been saved? This had to be the case. Can the Minister confirm how much was saved as a result of this dispute? Can she give some detail of the terms of the new deal? It is important that the people know what they will get. What are the main components of this new deal? What are the improvements for the dentists that allow them to now to recommend it to their members? In November, I called for face-to-face talks to resolve this dispute. Why did they not take place until early February?

Mary Coughlan:

In answer to the question about savings, payments are made three months behind schedule and, as a consequence, the Department is not in a position to see if there have been any savings from people not taking up the scheme. The contract is not with the IDA, but with individual dentists. I am not au fait with the precise details in the contract regarding resolution of a dispute. In view of the free legal advice I am receiving in the House, we might consider that in respect of the next contract. I proposed independent agreed arbitration, but that was not acceptable to IDA Ireland.

During the dispute there were protracted difficulties concerning what the IDA perceived as increases in the cost of providing a service. Two proposals were made to resolve this, but neither was acceptable to the dentists. I and my officials offered to meet the relevant representatives on many occasions. It is unfortunate that it took until January for that meeting to take place, but, having made two proposals, we found it difficult to come up with a third proposal to resolve the dispute and protect customers. I would prefer not to publicly discuss the proposals that have been tentatively agreed between my Department and the dentists. Given that a ballot is now taking place, I do not want to be seen to be influencing the outcome in any way. At the appropriate time, when the ballot result has been made known and regardless of the outcome, I will advise Members of the proposals I have put.

An Ceann Comhairle:

The 12 minutes for this question is concluded.

Mr. Ring:

Are there no supplementary questions?

An Ceann Comhairle:

The Deputy asked a supplementary question. The 12 minutes for this question are concluded and we already lost 15 minutes at the start of Question Time.

Mr. Ring:

On a point of order, two questions were taken together. The Minister answered my question and then Deputy Penrose spoke. I am entitled to one minute.

An Ceann Comhairle:

The Deputy is not entitled to one minute. We have already lost 15 minutes from Question Time because there was a vote.

Mr. Ring:

I am not worried about the 15 minutes we lost. I am concerned about this question.

An Ceann Comhairle:

If the Deputy wants me to read out the Standing Order, it will take more time.

Mr. Ring:

I listened this morning. I do not want to hear them again today.

An Ceann Comhairle:

This is a different Standing Order.

Mr. Ring:

That is what is wrong with the House, everything is based on Standing Orders and no questions are being answered.

An Ceann Comhairle:

The Deputy knows what to do about them. When two questions are answered together, 12 minutes are allowed. Those 12 minutes are concluded and the Chair has no—

Mr. Ring:

The Ceann Comhairle let the Minister waffle on and she took up all the time. The Ceann Comhairle should play back the tape.

An Ceann Comhairle:

If the Deputy listens to the tape he may perhaps discover that he also engaged in a bit of waffling. If Deputies confine themselves to asking questions instead of making statements, there would be more time for supplementary questions.

Mr. Ring:

The Ceann Comhairle should also allow the Minister to answer within the time.

An Ceann Comhairle:

I would recommend that, but the Chair has no control over either the Deputy or the Minister

Mr. Ring:

The Ceann Comhairle has great control over this side of the House and none over the other side.

An Ceann Comhairle:

No, I allowed the Deputy to speak even though half of what he said did not constitute a question.

Mary Coughlan:

If we do not stop talking we will never get to Question No. 3.

Mr. Ring:

We will have another go in a few minutes when we get to it.