I thank the Chairman for his invitation to address the committee today. The Irish Dental Association's detailed submission reflects its great concern at the lack of understanding of dentistry, dentists and their patients. I propose to draw the committee's attention to a number of the specific challenges in the dentistry sector. I will also offer an insight into the association's commitment to enhancing the care it offers patients.
Good oral health is an integral part of the overall health of the population. Healthy mouths, gums and teeth are essential for everyone. In my brief presentation, I wish to focus on the haemorrhaging of dentists from the medical card scheme, which is designed to cater for the neediest members of society. I also wish to highlight certain difficulties in the provision of services to children and special needs patients who are seen by HSE dentists. It is no exaggeration to suggest that we are seeing a crisis in community care for patients. The number of dentists who treat at least ten medical card patients a month has decreased to approximately 700. One third of dentists do not participate in any way in the medical card scheme. There are blackspots, where few dentists participate in the scheme, in many parts of the country. Patients in such areas have to travel great distances to be seen for treatment.
It is unacceptable that significant waiting lists of patients who are waiting to be seen by general practitioners are being allowed to develop. Some 1,500 adults are waiting to be treated in Sligo. The number of dentists in County Meath who participate in the medical card scheme decreased from 36 to seven over a short period of time. Such developments reflect the State's inability to fund this service adequately. Difficulties have arisen because it is considered that a review of the scheme, in partnership with the Irish Dental Association, might be contrary to the Competition Act 2002. I am sure the committee has heard plenty about that. As no State funding is available for investment in dental practice facilities, improvements have to be funded solely from funds generated by dentists. The dental profession is unique in this regard, as no other profession is expected to develop and enhance its practice facilities without State funding or assistance.
It is instructive to compare the funding that is made available when medical card patients are treated by dentists to the funding that is made available when the same patients are treated by medical general practitioners. The average payment to each participating doctor in the general medical services scheme is over €190,000, whereas the average payment to each dentist is just €40,000. The State offers allowances and grants of approximately €60,000 to each doctor, but it offers nothing to dentists. The total amount of money paid to dentists — more than €55 million — is equivalent to the amount it pays in respect of the employment of secretarial and nursing staff by general practitioners. I emphasise that the Irish Dental Association believes that the level of funding given to general practitioners is entirely appropriate. The association is calling for steps to be taken to bring funding for dentists to a similar level, at least, thereby enhancing services for patients in better facilities and offering a wider range of treatments. Child dental services in the HSE have been rationed over a number of years. It is not an exaggeration to state that the association believes that services for adults are about to be similarly rationed. In short, we expect that the provision of dentures to patients will be rationed, as a result of the inadequate funding of this sector.
The short-sighted decision made by the Government in this year's budget to restrict tax relief on dental work will result in poorer levels of oral health. Tax relief on all medical expenses has been capped at 20% since the beginning of this month. This measure is deterring and unfairly penalising patients who require dental work. In effect, it cuts in half the only support offered by the State to many dentists who receive no other support or funding. We believe the relief should be restored at the higher rate to better promote oral health. The Government recently decided to amend the Competition Acts to enable the Irish Medical Organisation to represent general practitioners in negotiations with the Health Service Executive and the Department of Health and Children. The same principle of partnership should be applied to enable the Irish Dental Association to engage directly with the HSE and the Department. In the case of the IMO, the Government believes direct engagement is "necessary and desirable" so that primary care can be improved in the interests of "the overall efficacy of the public health system".
When I read a summary of the presentation the HSE made to the joint committee yesterday, I noted the absence of any reference to oral health. Unfortunately, this omission is symptomatic of the total lack of attention the HSE pays to oral health. We would welcome an opportunity to engage with the HSE on the provision of more extensive care for greater numbers of patients through investment, innovation and reform. The IDA wishes to be involved in discussions — our door will always be open. A properly resourced public dental service is necessary if we are to be able to continue to provide dental care to children, adolescents and special needs patients. The restrictions on the employment of dental staff have had a significant and adverse effect on the provision of services by dentists employed by the HSE. The association is seeking an explicit commitment to prioritising the employment of front-line clinical staff. It is calling for the immediate appointment of a senior dentist within the clinical care directorate, as announced by the HSE. That is necessary if dental services are to be managed and planned in a systematic manner that places a particular focus on patients.
The association wishes to make a number of recommendations in respect of orthodontic services. They are detailed in our submission. We recognise the need to review the regulation of the profession. We fully support any reforms that promote the highest standards of professional care and treatment and protect the public. We are ready to engage constructively with the Oireachtas in framing and developing legislation to ensure that changes are appropriate, relevant and enjoy the confidence of society and the dental profession. We recognise the need to enhance the strong support of the public for dental services and the profession in Ireland. We are committed to developing a system of alternative dispute resolution to ensure patient concerns are addressed in a timely, fair and comprehensive manner, with a view to offering an alternative to costly and time consuming legislation.
We emphasise the need to develop specialist care services in areas such as paediatric dentistry, special care dentistry, oral surgery and dental public health, which must be done on a nationwide basis. There is no opportunity for dental care to be provided in the vast majority of hospitals owing to the absence of anaesthetic cover. There is a dire need for the provision of such care to enhance services for patients.
While our submission contains many other matters and recommendations for change, I have kept my presentation brief. However, my colleagues and I will be pleased to answer members' questions.
