I move: "That the Bill be now read a Second Time."
It gives me great pleasure to introduce the Health (Amendment) Bill. It is part of the legislative programme under the Programme for a Partnership Government and is an integral component of a comprehensive plan to develop the dental services in this country. While progress has been made in recent years in improving the services, this has taken place in a piecemeal fashion and regrettably, deficiencies still exist in the services. These relate both to individual components of the dental services and to specific areas around the country. For example, in some areas the children's services are being provided in an unsystematic way; secondary care orthodontic services still do not meet the needs of local populations despite significant investment; oral surgery services are limited and in many areas there is effectively only an emergency dental service available for eligible adults. I am determined to address these factors. These shortcomings and deficiencies have been of concern to Deputies on all sides of the House and have been raised through parliamentary questions and Adjournment debates on a regular basis.
I am particularly concerned that dental services are provided throughout the country on an equitable, efficient and consistent basis and have undertaken a comprehensive evaluation of the situation towards developing and implementing a co-ordinated and integrated dental plan in the medium-term. As a result of this evaluation, the Government has agreed to proposals submitted by me as the basis for this plan which will be implemented in coming years.
I propose to elaborate on the details of the dental plan in the national health strategy due to be published next week but it is intended that enhanced dental service will be provided under the following headings: primary prevention, including fluoridation and health education; primary care for children; services for the handicapped and persons in institutions; secondary care orthodontics; oral surgery services and a structured approach to dental health care for adult medical card holders and their adult dependants, including an accident and emergency scheme for the eligible adult population.
This area of health care requires investment to enable it to respond to the dental needs of the population and towards that end I propose to allocate an additional £4.4 million to the services this year. It is clear that this further impetus is necessary so that the progress to date can be accelerated in a way that the dental services throughout the country are provided in an equitable, efficient and consistent manner and that variations between health boards which can adversely affect access to and the quality of the services locally are removed.
This is particularly relevant in the case of adults who are eligible for dental services under the Health Act, 1970. There are about 915,000 adult persons eligible for dental services under the Act but, regrettably, the services available for such persons have declined in recent years to the point where, in many health board areas only an accident and emergency dental service is being provided through the health board dental personnel.
My Department is having discussions with the Irish Dental Association about the introduction on a phased basis of a new dental treatment scheme for eligible adults. It is envisaged that this scheme will involve both dentists in private practice and health board dentists, the latter working in the scheme under new, restructured arrangements. The services to be provided will include routine items of treatment, an accident and emergency service and the provision of dentures for the elderly and those in need.
Against the background of the current limited and unsatisfactory dental service arrangements for eligible adults, a dental scheme along the lines of that being discussed with the Irish Dental Association would be a major public health benefit to this group of the population. A satisfactory adults dental scheme is central to the successful provision of dental services to other groups and the services to those groups are delivered by dental personnel designated to individual areas. In this regard, the overlap between the children's and adults' services have restricted the development of both areas. Considerable progress has been made to date in the discussions with the association which have been constructive and positive. There are, however, a number of issues yet to be resolved and I am hopeful that these will be finalised shortly.
The expansion of the dental services in the coming years will require inputs of dental personnel and capital. My Department is addressing the detailed resource requirements for implementing the plan in conjunction with the health boards and is having discussions with the Irish Dental Association about the adult dental treatment services.
While I acknowledge that there are many deficiencies in the dental services, especially in the adult services, there have been major improvements in the levels of oral health in the population. This is especially true for children. These improvements have been achieved mainly as a result of a decision to implement community water fluoridation as a public health measure 30 years ago. One of the fundamental objectives of the dental plan is to facilitate further improvements in the oral health of children and to sustain these improvements into adulthood.
I now propose to outline the intent and the provisions of the Health (Amendment) Bill. The purpose of the Bill is to amend the Health Act, 1970, to enable health boards to make dental services available without charge to children who have attended national or certain other schools.
The Bill is a short one. Section 1 contains the necessary provision to enable the health boards to provide the services. It also contains a provision to enable the Minister for Health to specify the nature of the service to be made available and the age of the children to be provided with the service. This will enable me to extend services to children up to age 16 on a phased basis in accordance with the provisions contained in the Programme for Government.
The extension of entitlement to dental services to children up to age 16 will be a significant development in the primary care dental services for children. When the provisions of this Bill are fully implemented, persons will be eligible for dental services under the Bill from pre-school level to adulthood. This will involve a reorganisation of the health board dental services which has also been discussed with the Irish Dental Asociation.
The Health Act, 1970, provides that health boards shall provide a dental examination and treatment service for pupils attending national school or certain other schools as may be specified by order under the Act. The purpose of this extension is to achieve continuity of dental care by bridging the gap between national school primary care dental services and the provision of adult services. Accordingly, emphasis will be placed on those adolescents who have had a previous involvement in the national school dental services.
For many years health boards have been progressively adopting a planned targeted approach to the delivery of dental services to national school children and phasing out a demand led system. This is to ensure the optimum use of dental resources and equal access for all national school children to the same level of dental care.
The school based approach puts an important emphasis on dental health education and prevention. Dental health education programmes are now available to all national schools. Children in specific classes, usually second, fourth and sixth classes, are targeted for preventive measures under the school based approach. The children in these clases are screened and referred for treatment as necessary. The provision of fissure sealants for vulnerable teeth is an important element of the preventive programme. The programme has been specifically designed to ensure that children are dentally fit before they leave national school.
The small number of children who require more frequent attention are identified and the required level of advice, check-ups, treatment, etc. is provided as necessary. An emergency service for the relief of pain and infection is available on demand.
Under existing programmes about 275,000 children are screened annually for the provision of dental treatment. About 260,000 children receive dental treatment annually. Eligibility for free dental care to children after they leave national school is limited to the dependants of medical card holders. This means that two-thirds of all adolescents lose their eligibity for free dental services before the full eruption of their permanent teeth. However, the children of non-medical card holders remain eligible for any unprovided secondary care, e.g. orthodontics in respect of defects which were diagnosed while they were still at national school.
Children often experience an increase in dental decay after they leave national school. The presence of untreated decay in the teeth of these children very often causes further complications and problems extending into adulthood and can make necessary treatment in adulthood more difficult and more expensive.
It is proposed to phase in eligibility for children up to age 16 — i.e. up to the 16th birthday — during the course of the Programme for a Partnership Government. The extension of eligibility up to age 16 — i.e. up to the 16th birthday — will give entitlement to an additional 190,000 children.
The strategic approach adopted for delivering care to national school children will be continued when extending eligibility. The extension of existing preventive programmes including health education and fissure sealing where necessary to those up to age 16 will further reduce disease levels.
Each health board will evaluate the situation in its area to determine how best to implement the screening and treatment programmes for those to whom eligibility is being extended. As over 95 per cent of these children will be living in the catchment area of their national school, it is envisaged that most health boards will do so by a follow-up on the existing national school programmes.
Section 2 of the Bill provides for title, citation and construction.
The Bill is a short but important one. It is part of a major expansion of the dental services and its implementation is being backed up by the provision of the necessary resources as are the other elements of the dental plan, which I have outlined.
I commend the Bill to the House.