Dáil Éireann debate -
Thursday, 27 Sep 2012

Vol. 776 No. 2

Other Questions

Dental Services Provision

Aengus Ó Snodaigh

Question:

6. Deputy Aengus Ó Snodaigh asked the Minister for Health the action he will take to address the prevalence of unregistered, unregulated operators providing dentures directly to consumers as highlighted by the Consumers Association of Ireland in May 2011; if his attention has been drawn to breaches of the law in this regard and the concern expressed by the Dental Council and by properly regulated and registered practitioners, as well as the false advertising by illegal operators; and if he will make a statement on the matter. [41004/12]

Deputy James Reilly

The Dental Council is the regulatory body with the authority to bring a prosecution for breaching section 51 of the Dentists Act 1985, which prohibits the practice of dentistry by unregistered persons. The council has undertaken a significant amount of work investigating the matters raised in the article referred to by the Deputy and its investigation in this regard is ongoing.

A range of initiatives has been undertaken to address the problem of unregistered practitioners. The Dental Council has, where public safety is at risk, referred complaints to the Garda Síochána for investigation and prosecution. It has approved a clinical dental technology programme, delivered at the Dublin Dental University Hospital, as a registerable qualification. The first intake of students has now completed the course and are currently registering with the Dental Council, with a second intake due to commence the programme shortly. The council has published the register of clinical dental technicians on its website and posted an advisory statement for members of the public. Discussions have commenced with the Irish Medicines Board with a view to signing a memorandum of understanding to formalise the transfer of information between it and the council. In addition, the council has obtained positive findings from the Advertising Standards Authority of Ireland in three cases concerning denturists advertising their services.

My Department and the Dental Council take the matter of illegal practice very seriously and will continue to work with the relevant authorities in addressing the issue.

Deputy Caoimhghín Ó Caoláin

The legislation allowing properly qualified and registered clinical dental technicians to supply dentures directly to the public was very welcome. It offered people greater choice by addressing a situation where such treatment could previously only be done by dentists. Is the Minister aware, however, that there are only 15 clinical dental technicians on the Dental Council register? The Consumers Association of Ireland has concluded that consumers in this country are potentially exposed to unregulated and unregistered denture providers. As such, they are at risk of receiving denture treatment from persons not adequately qualified to provide it, thus very possibly compromising their oral health.

The Minister has shown an awareness of the research in this area. Is he aware that a significant number of operators who are supplying consumers directly are in breach of the law because they are not properly qualified or registered? Has he received reports of such breaches of the law? What does he propose to do to raise awareness of this problem, which is very important in terms of consumer protection? Finally, what will he do to ensure proper compliance with the law in order to ensure consumers are protected?

Deputy James Reilly

The Deputy is correct that there are 15 clinical dental technicians on the register, but we must not forget that all of the dentists on the register are equally qualified and legally permitted to provide dentures. As I said, the Dental Council intends to pursue those practitioners who are operating without a licence and will co-operate with the Garda in bringing prosecutions against such individuals.

The Deputy may be aware that in November 1997 a denturist named Martin Kenny took a High Court case against the Dental Council and the then Minister for Health. Mr. Kenny claimed that there was a statutory obligation on the council and the Minister, under the Dentists Act 1985, to bring forward a scheme for the registration of denturists, which scheme should include a grandfather clause. A reserve judgment in the case was issued in February 2004.

Mr. Justice Gilligan rejected the plaintiff's submission that the Dentists Act 1985 imposed a mandatory obligation on the Minister and-or Dental Council to bring forward such a scheme. He also stated the Minister did not have the power to oblige the Dental Council to insert any provisions into a relevant scheme. The council is only under an obligation to exercise its discretion fairly and reasonably and if, in doing so, it reached a decision that it would not be appropriate to include a grandfather clause in any scheme proposed, the court could not interfere. It would be irresponsible of the Dental Council to compromise in any way the quality of denturists' training given the public expectation of trust in health care professionals. The schemes proposed by the Dental Council are rational. The council did not act unreasonably or unfairly and the Minister, in exercising his discretion and powers pursuant to the provisions of the Act, did so fairly and reasonably.

Deputy Caoimhghín Ó Caoláin

I have listened to the reading of the relevant judgment. What actions will the Minister and Department take in co-operation with the Dental Council? It is very serious that people can now present at the premises of a dental technician and obtain dentures or have other related needs met. We need to raise awareness of this issue because members of the public need to know there are only 15 registered and fully qualified dental technicians in the jurisdiction. Clearly, such a small number cannot cater to all those who may present to them. It is important, therefore, that every effort is employed to ensure compliance on the part of the greatest possible number. What action does the Minister propose to take to raise awareness and to deal with misleading advertising for services by people claiming to be what they are not? This is an issue the Advertising Standards Authority for Ireland has also had to address.

Deputy James Reilly

I thank the Deputy for raising this issue as this discussion, in itself, helps raise awareness. I, too, am concerned not only about this case, which involves clinical dental technicians and the provision of dentures, but about other areas where there is confusion, particularly in respect of people who describe themselves as counsellors. While some counsellors have excellent training, others may have done a course over six weekends, which is not the same thing. It is always a matter of concern to a general practitioner to ensure the person to whom he or she refers patients is suitably qualified. The same applies in respect of dentists. In addition to 15 dental technicians, many dentists can also fulfil requirements in this area and more are being trained.

The Deputy asked me specifically to outline what is being done about this matter. The Dental Council will refer complaints involving a risk to public safety to the Garda for investigation and prosecution. It has also published the register of clinical technicians on its website to enable people to ascertain whether the person they are attending is a bone fide, properly qualified, registered clinical dental technician.

This evening's debate is important because we need to disseminate information on this issue. I concur with the Deputy that we must protect members of the public from people who are not properly qualified and are passing themselves off as qualified as such persons are unable to render the services patients deserve.

Services for People with Disabilities

Brian Stanley

Question:

7. Deputy Brian Stanley asked the Minister for Health if he will confirm that the proposed cuts to funding for personal assistants for the disabled have been reversed; and if he will make a statement on the matter. [41007/12]

Deputy James Reilly

I assure the Deputy that in the context of the current financial challenges facing the Health Service Executive, I have instructed the executive to continue to provide services to people in receipt of personal assistant services in accordance with their needs. While savings have to be achieved out of the total disability budget of €1.4 billion per annum, the HSE has been requested to distribute adjustments across the sector, with a focus on cutting administration, training and travel costs and better cash management. I have also asked the HSE to work with the non-statutory agencies to minimise the impact on services within the disability sector and report regularly to me on these measures. The application of these measures will be reviewed regularly to ensure they are being applied as fairly and sympathetically as possible. I am co-operating very closely in this regard with my colleague, the Minister of State, Deputy Kathleen Lynch.

Deputy Caoimhghín Ó Caoláin

It is not over the top to ask the Minister the reason such cruel cuts to disability services were contemplated in the first instance. Why did the Minister sign off on the cuts which were announced on 30 August? He is hardly suggesting he was not aware of the announcement given that he, as he indicated, is a hands-on Minister who took responsibility and accountability back to his office from the former chief executive officer of the Health Service Executive.

A U-turn had to be done on this issue, for which credit must go to the people with disabilities and their personal assistants who held an overnight protest outside Government Buildings. They deserve commendation for their actions. What of home help hours and home care packages? Was it a case of who got to the gates of Government Buildings first? It must be accepted, following the row-back on the measures relating to personal assistants amounting to some €10 million in cuts, that the same approach must be adopted in respect of home help hours and home care packages, which account for €12.5 million of €130 million in cuts that were announced. Will the Minister take this opportunity to announce the reversal of these cuts, which will have serious consequences for many people who are dependent on services and are already creating enormous stress in the lives of people who do not know what lies ahead for them? The people in question do not deserve this.

Deputy James Reilly

I understand the value of the personal assistant service to someone who has a disability, the difference between the service being available and not being available and the counter-productive result the absence of such a service has for an individual in terms of his or her ability to maintain his or her independence and reach his or her full potential in terms of daily activities and the ability to live independently at home. The measures in question were announced on a Thursday and I appeared on radio and television the following day to assure people they would not lose their service. I issue the same assurance again.

Equally, I am convinced that home help services and, in particular, home care packages enable people to stay at home and are preferable from the point of view of the recipient and much more cost-effective from the point of view of the State. I have, however, made a point that a budget of €1.5 billion is devoted to older people, a figure that is exclusive of the money spent on the care of older people in the hospital and primary care systems. At a time of financial constraints, we must seek efficiencies. Given that we have been able to achieve such efficiencies in other services, surely it is possible to do so in a budget of €1.5 billion for the care of older people and €1.3 billion for disability.

In the past, Governments were focused on inputs, namely, how much money was being spent and how many staff were employed, whereas this Government is more focused on outcomes for patients and clients. People with disabilities are not patients because they are not ill.

We are going to do all in our power to protect clients from any reductions in budgets. I do not accept that a reduction in budget should always result in a reduction in service.

Deputy Caoimhghín Ó Caoláin

How could the Government find €10 million to reverse the reduction in personal assistant hours when it could not identify it the week before? It just beggars belief.

I want to quote a statement made on the floor of the House last week:

Do we cut home help services or impose a cap on consultants' pay? Our priority must be to protect front-line services. We cannot cut our way out of problems.

Does the Minister agree with those words? The Member who said them was the Minister's then ministerial colleague with responsibility for primary care, Deputy Shortall. I agree with her absolutely. I have no doubt that what she said last week and what the Minister has failed to do since is a significant part of the reason she is no longer his colleague at the Department of Health.

It must be recognised that cuts cannot be contemplated in areas in which the need is already much greater than current resourcing provides for. To target these areas now is absolutely scandalous. Will the Minister seize the opportunity this evening, against all that has happened since, to give some relief to those who are in great distress at the prospect of cuts to their current allocation of home help hours and home care packages?

Deputy James Reilly

I have already made it clear people will not lose their services. Those who need them will have them. The consultants' pay issue has been addressed, as we discussed earlier. I also believe the talks with the Irish Pharmaceutical Healthcare Association, IPHA, which represents the pharmaceutical industry, are approaching a conclusion and I expect the results to be beneficial to the health service and to patients. It is important to remember, when we discuss this matter, that this is an industry that employs 25,000 people directly and another 100,000 indirectly, as well as being responsible for exports worth many billions of euro. One company alone contributes €880 million to the Exchequer.

I am glad Mr. Martin Naughton, Mr. Joe Mooney and Ms Leigh Gath have agreed to advise Mr. Tony O'Brien of the HSE on the future of this service from the clients' perspective. That is an element that has been lacking in the past, and we need more involvement. The issue of Mr. Walsh and his wheelchair was discussed earlier with Deputy Joan Collins. The idea from the old days that the doctor knows best is gone, and the idea that the service provider knows best must also go. We must take into account the needs of the individuals we are supposed to be serving. That will not be achievable if we do not listen to them.

Mental Health Services Provision

Robert Troy

Question:

8. Deputy Robert Troy asked the Minister for Health the steps he has taken to date to improve mental health services for young persons; and if he will make a statement on the matter. [40689/12]

Deputy James Reilly

The development of the child and adolescent mental health service, CAMHS, has been prioritised by the HSE in recent years and considerable progress has been made to date. A special allocation of €35 million was provided in budget 2012 for mental health in line with commitments in the programme for Government. Funding from this special allocation will be used primarily to strengthen community mental health teams in both adult and children’s mental health services by ensuring that each mental health professional discipline is represented on every team by at least one person.

Of the 414 posts approved to implement the €35 million package, 150 will be allocated to CAMHS teams. The national recruitment service of the HSE is currently working to recruit the necessary personnel and the posts are at various stages in the recruitment process. It is hoped the bulk of the appointments will be made by the end of the year. It is envisaged that the completion of the multidisciplinary profile of current teams will facilitate further progress in reducing the waiting lists for CAMHS services. It is worth noting that despite an increase in demand for such services, the number of children waiting for an appointment reduced by 12% in the 12 months to June 2012.

In terms of inpatient facilities, psychiatric bed capacity for children and adolescents has increased from 12 beds in 2007 to 44 at present, with 12 in Dublin, 12 in Cork and 20 in Galway. Work on the second phase of the child and adolescent unit at St. Vincent's Hospital, Fairview, has recently been completed. This will increase capacity in Dublin from 12 to 18 beds by the end of 2012. The increase in bed capacity in recent years is reflected in an almost 50% decrease in admissions of children to adult units since 2008.

Additional information not given on the floor of the House

The Linn Dara child and adolescent mental health facility at Cherry Orchard, Dublin, has recently opened and a number of child and adolescent community mental health teams have moved into the new premises. It is expected that the day hospital will be in operation by the end of the year. It is also proposed to construct a 22-bed inpatient facility on the Cherry Orchard site and this is expected to be completed by the end of 2013 or early 2014. A ten-bed child and adolescent forensic mental health unit will be provided as part of the national forensic mental health project. The unit will be based in Portrane, coterminous with the new Central Mental Hospital, which is expected to be operational by 2016.

Deputy Billy Kelleher

Up to €24 million of the €35 million allocated was to be used for recruitment of psychologists, occupational therapists and social workers. Instead, that funding has been put towards the budget deficit. While the recruitment process is ongoing, those people already recruited will not take up their posts until December 2012 or early January 2013. In the meantime, there is a significant deficit of professionals dealing with CAMHS.

The coroner in south Kerry recently stated the area is facing epidemic numbers of suicides. The report on children who died in State care clearly stated that there was no coherent or integrated policy to deal with children and adolescents who were vulnerable. This is an urgent matter and it is not good enough for the Minister to claim he has ring-fenced €35 million when there has been a delay of a year in drawing it down. This will simply plug the hole in the budget deficit as opposed to funding services. Will the Minister agree this is a matter of urgency? Will he also agree that, in the meantime, very vulnerable people are put at further risk because of the lack of an integrated service and available professionals to give them support? On the day the House has passed the Bill dealing with the referendum on children’s rights, at the same time we are pulling resources from them.

Deputy James Reilly

My colleague, the Minister of State, Deputy Lynch, has been working hard on this issue and has done a tremendous amount of work. No one on the Government side underestimates the problem that is the tragedy of suicide. Sadly, it is something that affects a great many of us through friends or loved ones who may have taken their lives. It always leaves more questions than answers.

I believe we are going to strengthen our child and adolescent services in a major way. I accept that some of the posts have been slow to be filled but we are making progress. For example, the Linn Dara child and adolescent mental health facility in Cherry Orchard, Dublin has opened recently. Several child and adolescent community mental health teams have moved into the new premises. It is expected that the day hospital will be in operation by the end of the year. It is also proposed to construct a 22 bed inpatient facility on the Cherry Orchard site and this is expected to be completed by the end of 2013 or early 2014.

A ten bed child and adolescent forensic mental health unit will be provided as part of the national forensic mental health project. The unit will be based in Portrane, coterminous with the new central mental hospital, which is expected to be operational by 2016.

Written Answers follow Adjournment.

The Dáil adjourned at 9.40 p.m. until 2 p.m. on Tuesday, 2 October 2012.