I propose to take Questions Nos. 7 and 12 together.
The Irish Dental Association has been in dispute with my Department since October 1987 when I extended the treatment benefits scheme to cover the dependent spouses of insured workers. Despite the association's opposition to the extension, 190 dentists to date have signed agreements to operate the extended scheme and claims in respect of around 40,000 dependent spouses have been submitted. Over £1.8 million has been paid to dentists in respect of claims from dependent spouses. Dependent spouses may obtain the names of their nearest participating dentist by contacting their local social welfare office or by telephoning my Department.
Following discussions with the Irish Dental Association I set up a joint working group to examine all aspects of the social insurance dental benefit scheme to see if improvements could be made within the limits of the existing budget. I had a further meeting with representatives of the association on 26 July last at which the findings of the working group were presented and discussed. On 20 December last I again met with the representatives of the Irish Dental Association for detailed discussions on possible improvements arising from the recommendations of the working party. Subsequently, on 10 January this year a letter setting out proposals for improvements was given to the association. Despite this, the Irish Dental Association on 14 January announced their decision to instruct their members to stop providing dentures and root canal treatment to all insured workers other than medical card holders.
Further discussions took place at official level on 24 January. At this meeting the association's representatives stated that a prerequisite for reaching agreement was the introduction of openended grant-in-aid for all but a few treatment items. They indicated that, if this was forthcoming, they would be prepared to consider special arrangements for lower income insured workers such as medical card holders. This was not acceptable to me and I decided to proceed with a set of improvements to the scheme. These were issued to all dentists on 2 February last. The Irish Dental Association then extended their instruction to members not to carry out certain treatments under the scheme to cover extractions.
A small number of complaints have been received by my Department of dentists refusing to carry out such treatments and these are being investigated at present. Where I am satisfied that the complaints are substantiated, I will have no option but to regard the dentists concerned as being in breach of their agreement with me to provide dental treatment. I will invoke the sanction, which is provided for under the contract signed by each dentist operating the scheme, by removing from my Department's dental panel dentists who are in breach of their agreements.
There can be no question of my going back on the decision to extend the dental benefit scheme to dependent spouses. Furthermore, I am not prepared to consider the introduction of a two-tier system of entitlement to dental benefit on the lines advocated by the association and I have refused to discuss any such changes in the scheme. However, I am always prepared to consider improvements in the scheme. The wide range of changes which I introduced earlier this year involved a significant increase in expenditure on the scheme and I am prepared to consider with the association any further improvements in the scheme which may be possible within the financial constraints which exist.