Vol. 399 No. 3
9 Miss Flaherty asked the Minister for Social Welfare whether the dental services for insured persons and their spouses have deteriorated radically in recent months due to the intensification of the dispute between his Department and the dentists; and if he will make a statement on the matter.
13 Proinsias De Rossa asked the Minister for Social Welfare the reason a person (details supplied) in Killarney, County Kerry is unable to have dental treatment free of charge as is his entitlement, having sufficient qualifying stamps and credits; the steps he is taking to ensure that the present dispute with some members of the Irish Dental Association is solved to ensure that all qualified persons receive treatment; and if he will make a statement on the matter.
18 Mrs. Taylor-Quinn asked the Minister for Social Welfare if he will make a statement on the on-going deterioration of dental services for insured persons and their spouses due to the worsening of the dispute with the dentists; and the efforts which are being made to resolve it.
23 Mr. Barry asked the Minister for Social Welfare when the discussion with the Irish Dental Association will conclude in order that wives of insured workers may receive treatment.
109 Mr. Bell asked the Minister for Social Welfare the plans, if any, he has to give refunds to PRSI contributors who have to pay for extractions because of the dispute between his Department and the dentists; and if he will make a statement on the matter.
111 Mr. Byrne asked the Minister for Social Welfare the number of dentists registered with his Department who have been removed for not performing extractions for insured workers and their spouses; if he is policing the dentists; the number of complaints he has received and the action he is taking against noncomplying dentists.
I propose taking Questions Nos. 9, 13, 18, 23, 109 and 111 together.
The dental benefit scheme was extended to cover dependent spouses of insured persons from October 1987. A total of 239 dentists have entered into an agreement to operate the extended scheme.
From the outset, I arranged to have details of dentists who have signed agreements covering dependent spouses made available at local offices of my Department. Any person who requires dental treatment can obtain details of their nearest participating dentists from these offices or by telephoning my Department. To date, over 66,000 claims for benefit have been received from dependent spouses of insured workers.
The extension of the scheme to dependent spouses as introduced in 1987 was opposed by the Irish Dental Association which advised their members not to sign the contract to operate the extended scheme. Last year the association as part of their continued opposition to the extension of the scheme, called on their members to discontinue providing certain treatments for all insured persons. As a result, some dentists are imposing charges on patients for extractions, root treatments and dentures.
Any person who is asked to pay charges which are not due should refuse to do so and report the matter to my Department. There is, however, no provision within the scheme whereby patients who proceed with treatment and pay such charges can be reimbursed.
The association have sought fundamental changes in the dental benefit scheme. In March 1989, following an examination of the scheme by a joint working group involving the association and officials of my Department, I introduced a package of improvements which included substantial fee increases in respect of some treatment items. I have indicated to the association that I am prepared to consider other ways in which the scheme can be improved as resources permit.
I met the association in January this year and there have been subsequent contacts at official level. Within the last ten days there was a meeting at official level to clarify certain details regarding dental costs supplied to me by the association.
I am anxious to explore any avenue for settling this matter on an agreed basis. I am very concerned, however at the fact that certain dentists were refusing to provide items of treatment provided for in their contract.
Under the terms of the contract, I am empowered to take specific actions against any dentist who is in breach of his contract. Deputies will appreciate that while discussions continue with the Irish Dental Association, I am reluctant to exercise these powers. However, I cannot indefinitely permit the situation to continue where patients are being refused benefit to which they are entitled. If this matter cannot now be resolved through discussions with the association I will have no option but to take action against the dentists concerned.
I believe the dental benefit scheme is a good scheme from which over 300,000 persons benefit every year and I am determined to preserve the scheme for the benefit of insured persons and their dependants.
In relation to the specific case mentioned in one of the questions, the person concerned is entitled to dental benefit. Unfortunately, an incorrect notification was issued to him. The claim has now been reviewed and payment will be made to his dentist in respect of the treatments contained in the claim. The person concerned has been notified accordingly.
Would the Minister accept that he is seriously out of touch with the gravity of the situation? As a result of the failure of his Department and himself to resolve the dispute with the dentists, is it not a fact that there is virtually no provision of dental treatment for insured workers and that the net effect of two years of dispute is that a scheme which was up and running and providing full cover for insured workers is now in tatters? I point to the example of a person from Finglas, in my constituency, who approached every dentist in that area and had finally to go to Swords to have an abscess treated because he was not prepared to pay for a treatment to which he was entitled. The Minister does not seem to appreciate the seriousness of the situation on the ground.
Let me answer that point first. I do not agree at all with the Deputy. I fully appreciate the situation; in fact it does not help matters to have Deputies coming in here saying that the system has broken down, because it has not. We are treating 300,000 people, and those who are not co-operating with the extension of the scheme to dependent spouses are very much in the minority. That is the reality.
The situation is worsening by the week.
The number of dependent spouses treated is continuing at roughly the same level. A total of 239 dentists have signed the contract and that is considerably more than the last time the Deputy raised a question in relation to it. The number is continually increasing.
How many dentists are refusing to sign it?
Please let me finish Deputy. Either Deputies want an extension and wish to support it and are prepared to support me in doing so, or they want to go along the lines suggested by some members of the Irish Dental Association that we should have an open-ended grant-in-aid and the dentist charges whatever he or she likes. Let us be clear that that is what we are faced with at present. As I have explained in my reply to the questions, I am having discussions with the dental association.
Three years later.
They have asked that I do not speak about these discussions while certain matters are being examined. They are being examined currently. I expect that matters will be finalised fairly shortly one way or the other and I hope they will be on an agreed basis. My duty is to protect the position of workers and have a scheme which is reasonable and is designed to cater for them and their dependant spouses.
I agree to a degree with the Minister that the scheme is essentially a good one, that is if it worked. Quite clearly it is not working and the number of representatives that all politicians are receiving is a clear indication that the extension of the dispute is having a very negative effect not only on the spouses of insured workers but also on the insured workers themselves.
A question please, Deputy.
In the light of the fact that the dispute has escalated and that insured workers are not being afforded extractions, will the Minister outline clearly what steps he intends to take to avoid the total collapse of an essentially good scheme?
As I said in my reply, I and my officials are involved in discussions with the Irish Dental Association. However, I do not accept the Deputy's assertion of the collapse or total collapse of the scheme——
Near collapse.
We are nowhere near collapse, and let us be quite clear about that. Is the Deputy trying to suggest to the media here that there is a collapse? The Deputy has already suggested that.
Why does the Minister think that people have written to us from as far away as Killarney?
It is very easy to be written to from anywhere. From the outset a number of dentists did not want an extension of the scheme. The previous Government did not attempt to extend the scheme and that lay dormant. However, I took it on board and went ahead with the extension of the scheme. Since then 66,000 dependent spouses have been treated and they continue to be treated at the rate of 2,000 extra per month. That is continuing. The number of dentists who have agreed to operate the scheme is continuing to increase but we still have the situation where dentists are conducting a campaign to prevent the operation of the scheme.
Will these people be removed from the register——
Let us hear the Minister's reply without interruption.
I have told the Deputy that there are certain options open to me and that I am in the course of discussion with the association. They have provided a new basis for this discussion quite recently and that is being examined. I have undertaken not to say any more about that at present. There is a desire among many members to have an agreed solution and I would be very anxious to see that. In my reply I have made it clear that I will have to take action at some stage if these matters are not resolved in the reasonably near future.
Could I ask——
Deputy Creed, a final question. I want to get to other questions also. We have made very little progress today.
The Minister said that 239 dentists have signed the contract. How many are refusing to sign it?
At the outset, the number of dentists——
A straight answer to a straight question.
Life is more complicated than being able to give simplistic answers. I am sorry if I give the Deputy a proper answer as distinct from a ridiculous one. At the outset, the number of dentists the Department envisaged as essential to run a scheme for the dependent spouses was 150 but that number has been long since passed. The difficulty then arises with the distribution rather than with the number of dentists. One of our problems is that our insured workers' scheme applies to almost all dentists in the country — about 630. Some of these do a very small proportion of work in the social welfare area and a very large business in the private area; others do a very large social welfare business and a very small business in the private field and there are all sorts of categories in between.
What matters at the end of the day is whether there are sufficient dentists to do the work that is required and whether there is a proper distribution. We have had difficulties with distribution. The last time questions were asked on this matter, four counties had no dentists prepared to undertake the extension to the dependent spouses but there are now only two counties in that category. To understand how the scheme works, you have to take into account the different groups working within it. One group have said that if we extend the treatment to dependent spouses, it will affect their private practice, and they are not anxious for that equation to be altered in any way. I presume that is the root of the whole question.
No. 14, please.
Would the Minister agree to reimburse insured workers and their spouses who cannot——
Next question, please, Deputy Dick Spring's question. I want to disabuse the Deputy and his colleagues of the notion that we may debate this matter now.
I lost out on about six questions——
We may not debate it now.
