asked the Minister for Social Welfare the present position regarding the extension of the social welfare dental scheme to the spouses of insured workers; the number of dentists who are operating the scheme; the number of spouses who have received treatment; and if he will make a statement on the matter.
Ceisteanna—Questions. Oral Answers. - Social Welfare Dental Scheme.
14.
I propose to take Questions Nos. 3 and 14 together.
The extension of the treatment benefit scheme to the dependent spouses of qualified insured workers which was introduced in October 1987 represents a major advance for families covered by the social insurance system. It has opened up access to dental, optical and aural benefits to dependent spouses, mainly women working in the home, on the basis of their spouse's PRSI contributions. A total of 33,513 dental claims in respect of dependent spouses have been received to date. Those claim figures bear out the considerable demand for the extension which had been there for a number of years. One hundred and eighty dentists countrywide have signed new agreements covering the extended scheme.
As Deputies will be aware, the Irish Dental Association have opposed the extension and many of their members participating in the dental benefit scheme have refused to sign new agreements.
This is causing inconvenience to some dependent spouses seeking dental treatment. In order to keep such inconvenience to a minimum, I have arranged from the outset to supply to persons wishing to claim under the scheme the names of their nearest participating dentist. Dependant spouses may obtain these names by contacting their local social welfare office or by telephoning my Department.
I met the Irish Dental Association before Christmas to discuss the issues involved in their present action and to explore the possibility of getting the association's co-operation on the operation of the extended scheme in return for certain improvements in the scheme. Officials of my Department had a further meeting with the association earlier this week. It is clear, however, that the changes which the association are seeking in the scheme would involve either a major increase in expenditure for the social insurance fund or substantially increased contributions from certain people entitled to treatment under the scheme. I intend to bring into operation a number of improvements in the scheme immediately but I am not prepared to accede to changes in the scheme which would have either of these effects.
Recent media attention in relation to the dispute has concentrated on the threatened refusal by the association's members to undertake certain items of treatment under the scheme with effect from 30 January 1989. The items involved are root canal treatment and dentures. In the event of the threatened action proceeding, I will have no option but to remind dentists that a refusal to carry out items of treatment provided for under the scheme constitutes a breach of their agreement with me to provide dental treatment for which appropriate sanctions are provided under the contract which is signed by each dentist operating the scheme.
I assure Deputies of my concern to have the present difficulties resolved as quickly as possible. I was very glad to have been able to introduce the extended scheme and I am determined that it should operate for the benefit of all dependent spouses seeking treatment under it.
Would the Minister accept that there will be chaos as and from next week in relation to the dental services and that there is need for an urgent solution to this problem? I accept that in a broad-based approach to such a solution we will not really have a satisfactory dental system until the two systems which are in operation — the insurance-based system, the RSI system, and the means tested one run by the health boards — are unified. Would the Minister accept that this approach, which was recommended by the Commission on Social Welfare two years ago, should be adopted? Secondly, would he accept that the report issued by the joint working group last August on which there was substantial agreement could form the basis of negotiations which would lead to a solution to get out of the impasse that has developed?
First, I trust there will not be chaos in any event because the measures the dentists are proposing to take are fairly minimal at this stage. It is very difficult to bridge the gap, pardon the pun, between the two at this stage. Basically what the Irish Dental Association are saying is that they want a unified scheme based on means tests. That, of course, is totally in conflict with my position as Minister for Social Welfare. I am providing a service for those who pay the full rate of PRSI, the bulk of workers, who are making a contribution towards it. We have a very good scheme which has been working very satisfactorily. The Irish Dental Association's objection is to the extension of that scheme to dependent spouses.
A high proportion of those who are eligible for treatment under that scheme would actually come within the medical card guidelines; the figure is over 60 per cent. Some people seem to think that other people have a lot of money which they do not have. In fact the number of people on the full rate PAYE-PRSI who have very high incomes is very small. People in the higher income brackets tend to a large extent to come within the self-employed and other groups. A means test would undermine my scheme. I, as Minister for Social Welfare am there to provide a scheme and in fact, we have a very successful scheme which is working very successfully. The objection is to the extension of the scheme to dependent spouses, which scheme is working quite well at present, but with some problem areas.
I might mention to the Deputy that some 26 dentists have returned from abroad to operate this scheme; 23 have come back from the United Kingdom in the past year, three from other places, France and Germany and some other country. These dentists are coming back to operate the scheme. They regard it as a good scheme and I am prepared to look at improvements in our scheme. I accept there are problems at the health board level but I am prepared to look at improvements in our scheme and we have discussed these with the Irish Dental Association. However, I am reluctant to remove the upper limits and have an open-ended scheme where the worker can be charged an open-ended fee.
The Minister does not appear to accept the recommendation of the Commission of Social Welfare for a unified scheme, which I believe is the correct approach. Would the Minister not think it proper to put an end to the megaphone negotiations going on between himself and the dental association in the present crisis and try to hammer out a settlement based on the report of the joint working group which was completed last August? That is the basis for a solution and would the Minister finalise a solution based on that report?
I have to advise the House that the time allocated for Priority Questions is exhausted. Perhaps the Minister will reply.
I will give a very brief reply. Yes, we put to the Irish Dental Association a list of changes which would be improvements, including more frequent examination. The interval for examination is 18 months and we put the question of having more frequent examination which we would pay for and we also offered an additional fee increase for partial dentures which was an area where they felt the fee was very low. There were a number of other improvements for which I got approval and I have the resources to go ahead with them at this stage. That was not acceptable and the main problem is the problem of considerably higher fees, which would reflect more what is charged in private practice. However, I am afraid we would not be in a position to do that.
There will be a lot of toothaches in the country if the Minister does not resolve this issue.
We must now come to deal with ordinary questions.