I will introduce my colleagues. Dr. John Nolan is a dentist in Glasthule, County Dublin, and he participates in the medical card scheme; Dr. Jane Rehehan, chair of our public dental surgeons group. She works in Blanchardstown, Dublin, and supervises the administration of the medical card scheme in north-west Dublin, Dr. Billy Davis, a dentist in Dublin and president of the association, and Ms Clare Dowling, an official with the association.
This scheme is essentially there to benefit the elderly and those with severe medical conditions and it is important that we see the scheme as being essential to avoid people being left in a situation where they are relying on a diet of jam and toast. The typical profile of patients is female, over 40 and wearing dentures, very often with poor diet and gum disease. I ask that members try to imagine if in the morning they lost their teeth what that would mean in terms of not being able to eat, converse, smile or talk to people. The scheme has the benefit of tipping the balance between a healthy lifestyle and ostracisation and poor health.
I am sure the committee does not want me to labour the recent background and history but, to summarise, the scheme has worked successfully for a number of decades. The HSE has now decided at 24 hours notice to effectively restrict the scheme to emergency cover only for 1.6 million people. We believe this will cause chaos, hardship and confusion to patents. In our summary, we detail that on pages 13 to 32 and if I were to ask that members only read one section, I would ask them to read the evidence given in the first tab where we give a sample of the experience of a number of dentists. We are now seeing the denial of treatment to cancer patients, special needs patients, the elderly, patients requiring dental checks ahead of major surgical operations, patients with acute infections and many others dentists believe fall into high risk circumstances. That is graphically illustrated in the examples we give.
Clearly, it has implications for the 1.6 million people and their families and for dentists. It also has implications for children and special needs patients. I listened with interest to the previous discussion and I am fearful there will be a spillover in regard to the availability of care for children with special needs. We have evidence in our submission of the cost benefit. It is a value for money scheme. Not only is prevention cheaper than short-term savings; this is an extremely cost efficient, value for money scheme. The fees paid to dentists are controlled by the State. They are half of what dentists charge ordinarily privately for most of the major treatments so there is no question it is a good scheme, which should be kept. The damage being done now is profound and will cause untold hardship for the very people who most need the assistance of the State.
The scheme operates on the basis that eligible persons are provided with routine dental treatment. That would comprise pain relief, preventative care such as cleanings and fillings, emergency care, which would be extractions or root canal treatment, and denture and denture repairs. It does not give me pleasure to remind the committee that the last time we were here we warned of the possibility of the rationing of dentures. Unfortunately, we are now seeing that come to pass and it is quite despicable that the very people who most need the assistance of the State are now being punished in addition to cutbacks to the PRSI scheme. It is important to point out that the people who hold medical cards have rights and entitlements under the Health Act 1970 and that these rights extend to include dental treatment. Therefore, there is every possibility that people may choose to go to the courts to vindicate their rights. There has been an increase of more than 300,000 in the number of medical card holders since 2005. However, in the recent budget the Government decided to restrict spending to 2008 levels, despite the fact that in the past two years alone, we have 270,000 more people whom the HSE wants treated. The funding in 2008 was obviously sufficient for 2008, but now when we have more than a quarter of a million extra — 270,000 more people — the HSE thinks the service can still be provided with 2008 funding levels.
Committee members are aware that the PRSI scheme, which benefits more than 1.5 million people, has been restricted to examination only. Therefore, in the history of the State, we are seeing an unprecedented onslaught on dental services. Unlike medical general practice, the State offers no assistance to dentistry. Dentists fully fund their own service and what little support the State offered up to now has disappeared in one fell swoop, in one budget. We are now beginning to see the consequences of that. The text of the infamous circular, which was issued at the end of April, is detailed on pages 10 and 11 of our submission, but I will not go through it now in any detail. Suffice to say, it essentially restricts treatment to emergency circumstances only. To compound matters, there has been no definition given of emergency cover and the content of the circular is as ludicrous as it is vague. We never got a commencement date and there is no definition or guidance as to what constitutes an emergency or the procedures to be followed. Legal proceedings have been commenced and two dentists have secured an injunction, confirmed by the Supreme Court, entitling them to operate the scheme which had been agreed over many years.
The consequences of the recent changes are that more than 1.6 million people will be denied routine treatments, including fillings, extractions, dentures, denture repairs and treatment of gum disease. Hospitals, HSE clinics and services for children with special needs may well become overcrowded, because the HSE continues to be statutorily bound to provide cover or dental treatment for these people. However, it now refuses to fund it, despite agreements it already has with dentists. Besides the health cost, there is a serious financial cost for a particular group, elderly people over 50. This situation is detailed in our presentation. We estimate that a person with no natural teeth will face an additional annual bill of more than €232, while somebody who retains some of his or her teeth is likely to face an annual bill of €412, despite the fact these people are entitled to free dental treatment from the State as medical card holders. Other socially disadvantaged patients will also lose out.
Evidence of the impact of the recent changes can be seen in dental surgeries. Twelve months ago, dentists with medical card patients would have seen from 15 to 20 patients a day, but that number has now reduced to two or three patients a day. The damage in terms of patients' dental health will not become apparent for some months or years and problems that are only minor in nature now will become serious. This applies in terms of dental health and the economic cost of treatment. We present examples of likely outcomes from page 17 onwards of the presentation. As can be seen, the people who are paying the price, in terms of their health, are the most vulnerable. They are people in their 80s, people with rare medical conditions, people on Warfarin, people with special needs, people who require a dental check-up prior to major invasive surgery, people who require significant periodontal treatment, patients in psychiatric institutions who have been refused treatment and patients who are routinely denied dentures. We are aware of 84-year-old patients who have been denied clearance for dentures. We have seen nervous patients who require IV sedation being denied treatment. We have seen patients who require a certificate of dental fitness prior to surgery being denied treatment. We have seen cancer patients who require surgery being denied treatment and people with diabetes and severe dental diseases denied treatment.
This is happening in a climate where HSE staff have been given no guidance on how to deal with the situation. No operational guidelines have been issued and no definitions of emergency treatment have been provided. We are seeing nothing less than chaos in dental surgeries throughout the country. This is not fair on patients, on dentists or on anyone who has anything to do with the system. Dentists are being compromised and the HSE approach is unsafe, unworkable and unethical. We have serious concerns, which are shared by other parties, that dentists are ethically compromised by this whole approach. No provision has been made or no definition provided for emergency circumstances. Patients are being denied treatment and their functional ability to eat and speak is clearly affected, which causes unnecessary pain, suffering and embarrassment. In response to a parliamentary question, the Minister for Health and Children gave a definition of an emergency for the purpose of approval of a denture and said it was pretty much linked to the functional ability to eat and speak. However, no definition has been issued to the system at large with regard to dentures or any other treatment. There is absolute chaos in the system.
On page 27 of our presentation, we provide a summary of criticisms made by four principal dental surgeons who have responsibility for the medical card scheme. Prior to Dr. Kavanagh's appointment — which we welcome — they were the only people to whom the HSE turned for advice on this scheme. A circular attached in the appendices of our presentation demonstrates that just two months after this unilateral change, there is nothing less than absolute chaos in the system. Patients are not being treated, but being put on waiting lists and left in distress, while dentists are equally distressed because they are unable to treat them. The procedure to obtain approval of requests for treatment is not feasible because the resources are not there to cope with it. The situation previously was that dentists could proceed with certain routine procedures, but had to obtain prior approval for more elaborate treatments such as dentures and root canal treatments. Now, prior approval is required for every procedure. Members can imagine the administrative chaos this causes. No guidance is being given and dentists must ring up to obtain information. The HSE does not have sufficient dentists to treat those requesting treatment. Our worst fears never envisioned the chaos that exists.
The change in practice has an impact on dentists' incomes and dentists with a heavy reliance on medical card holders are seeing a significant reduction of up to 80% in their monthly income. I have been informed that some dentists will have to close their practices and have no doubt this will happen. This will compound problems for medical card patients, who will have to travel further for more limited services. The changes also have an implication for services provided by dentists employed by the HSE to treat children under 16, the provision of the school screening programme and the care of special needs patients. Cork Deputies are well aware of particular problems in this regard and the four-year waiting list for special needs patients, which is outrageous. This problem will get worse and will spread throughout the country.
I would like to reassure the committee that the dental services scheme is a cost effective scheme that provides value for money. The National Consumer Agency carried out a survey of fees recently which demonstrated that fees paid to dentistry through medical card patients are only half the fees charged to private patients. Therefore, the scheme provides cost effective treatment and, as we say, prevention is cheaper than cure. Some of the committee members may recall that in regard to PRSI we commissioned a cost-benefit analysis which showed that the cost to the State of maintaining this scheme was between two and three times the cost of operating the scheme. Equally, to abolish the scheme, as we have seen with the social welfare scheme, there will be greater costs in the short term as well as in the medium and long term.
Since the budget, we have sought and suggested negotiations and meetings with the Minister for Health and Children. We have suggested that supplementary funding be arranged and we have had no response, good or bad, to that suggestion. Instead, what happened on 26 April is that the HSE issued a circular with 24-hour effect and we are now seeing the consequences. From reading the parliamentary questions, I know the Deputies are now beginning to get constituents knocking on their doors——