David Cullinane
Question:12. Deputy David Cullinane asked the Minister for Health his plans for arresting the collapse of the dental treatment services scheme; and if he will make a statement on the matter. [26379/22]
View answerThursday, 26 May 2022
Questions (12)
Oral answers (8 contributions)
This question is about the dental treatment services scheme, DTSS. I am aware there have been talks between the Minister and the Irish Dental Association, IDA, over the last number of months and that some movement has been made. Unfortunately, from the association's perspective, it does not appear to be enough. I am seeking an update from the Minister on the current position. Does he believe we can attract more dentists into the DTSS given the impact it is having on medical card holders?
The Government and I have been concerned for some time that medical card patients in some parts of the country have been experiencing problems in accessing dental services. The problem became particularly acute over the last couple of years as a significant number of contracted dentists chose to opt out of the DTSS. I secured an additional €10 million in budget 2022 to invest in the scheme. That is a combination of an increase in fees and the reintroduction of scale and polish.
To address the concerns of contractors about the viability of the scheme, I have also used approximately €16 million of an underspend in this year’s Estimate to increase the fees as well. Essentially, the spend on the DTSS last year was approximately €40 million and this year we are allocating €66 million. It is an additional €10 million and an allocation of a projected underspend of €10 million to an increase in fees. It is a very significant projected increase in the DTSS this year. Following consultation with the Irish Dental Association, the measures came into effect from 1 May. I am happy to talk through the increases if that is useful.
I hope this substantial investment and significant increase in the fees will encourage more dentists to stay in the scheme and, indeed, encourage dentists to return to it. However, that is not enough. These are interim measures. What is required is a root-and-branch reform of the scheme. The scheme was put in place many years ago and it is not fit for purpose now. This year, the Department, the HSE and the IDA will be involved in a fundamental review of the scheme to look at a scheme that is fit for purpose for today and into the future.
It looks like it is root canal treatment.
A sticking plaster solution is not going to work. I welcome the fact that funding has been increased. However, additional funding can be provided, and we have just discussed home care supports where the funding is available, but we cannot get the staff to provide the service. Telling people that the funding is there is no comfort to them when the service is not being provided. Obviously, we have to fix the scheme and get dentists back into it.
There is a wider issue here as well, and it is happening across primary care. We are at the mercy of independent GPs to deliver universal GP care if that is where we want to go. It is the same with independent dentistry. Obviously, there is a role for independent practice, but we also need to consider directly hired dentists to work in the public system if we want to guarantee services for medical card holders. What has happened here is that medical card holders have been left high and dry, and I am sure the Minister will accept that. In many parts of the country people who have medical cards cannot get access to dental treatment simply because the scheme has collapsed. We have to examine new and innovative ways to address that.
There are dentists employed directly by the State in community health centres across the country. I brought my child to one quite recently. It is an interesting proposal. Should we look at substantially increasing that with more directly employed dentists? It is certainly something I would not rule out and it could be examined. In the meantime, however, the vast majority of care is provided by contracted dentists.
I am not sure I would characterise it as a sticking plaster. If we are moving from a €40 million investment to a €66 million investment in one year, that is more than a sticking plaster. It is a very significant interim measure. The reality is that the scheme we have was designed in the 1990s. It is not fit for purpose and has to be examined. The cost of care has to be examined as well as part of that.
It is a sticking plaster solution if the money is not spent. That is the point. I welcome the fact that the Minister has committed the additional funding. He has gone some way to address some of the issues. I am not blaming all this on the HSE or on the Minister. I want all parties to come to the table to resolve this issue. The people I am focused on are the medical card holders who cannot get access to care. We can tell them we have provided more funding and there is a pot of money available, but if their dentist is not providing the service it is no use to them. Many of them do not have access to a public dentist to provide the treatment they need. The access does not happen in most areas because we simply do not have enough dentists.
We have to do the root-and-branch reform the Minister mentioned. I appeal to the Irish Dental Association and to dentists to engage with the Minister and the HSE and to come back into the scheme. However, from their perspective, it has to be on the basis of the root-and-branch reform taking place and a clear commitment that it will happen.
More needs to be done. It will be a sticking plaster solution if people cannot get access to the services I am talking about.
There is no doubt that more is needed. We have this short-term measure and the review, but more needs to be done. We are also looking at training and retention of dental graduates. We are looking at the numbers graduating and the mix between EU and non-EU graduates who are coming in and training. That has to be looked at. We are looking at that for medical students as well, as I know the Deputy will be aware. Ultimately, I agree with the Deputy. We need a new, sustainable, long-term scheme that makes sure everybody, whether on a medical card or not, can get access to affordable, high-quality oral healthcare when they need it. Unfortunately, at the moment, that simply is not the case for too many people.
Before we move on, cuirim céad míle fáilte roimh na ndaltaí scoile thuas staighre.