Brian Stanley: Public dental services in crisis, demands urgent action

Minister, the public dental health services is in crisis. There is a shortage of dentists also in the private sector, and this is due to a lack of planning and the schemes not being properly resourced. Dental and oral health have not been made the priority that they need to be. For a relatively wealthy first world country, we have a third world dental health system. Untreated tooth decay is one of the most common health conditions according to the Global Burden of Disease Report 2019. Conditions such as stomach ulcers, gum disease, heart condition and a range of other physical health issues are caused and can be caused by poor oral health. The workforce crisis in dentistry has been well publicised over recent years, and it has not happened all of a sudden, this has crept up over a number of years. But action on this by successive governments and the HSE has been way too slow and not near the pace required to have a substantial impact. In recent years there has not been enough attention or resources put into prevention through education and public awareness campaigns. The Cure Minister comes too late, often in the form of multiple extractions and fillings. I want to address the main public schemes. The school dental scheme, the dental treatment service scheme, the treatment benefit scheme and indeed orthodontic where there is a six year waiting list for treatment for orthodontics. The school dental scheme is not providing timely and adequate treatment for primary and secondary school pupils. Children are not being seen for their first examination in second, fourth and sixth class as they should be. And in many cases they are receiving their first examination in secondary school, I am well into it. In Leish that is in fourth year, they are four years in secondary school when they are being seen first. In Offaly it is much better, three years and that is an absolute scandal in public health. In the case of Leish, according to HSE figures, 6,433 pupils are waiting on their first examination. As I said, for most of those that will come six or seven years too late and then they have to wait for treatment. In 2017, 135,662 pupils were screened and treated and this dropped to 101,112 in 2023. So we are going backwards. In the same period in Leish, and I am not too sure what happened here, and this is based in Leish Offaly, this is based on the figures I got from the HSE, it reduced them 4,300 in 2017 to 181 in 2023 and that takes, that is an interesting figure. The dental treatment services scheme for adults and medical cards is not available in many areas. In Leish for example, only one dental practice and that is based in Carlow, on the edge of Carlow Town is currently taking clients under the scheme. The budget for the scheme, for the current scheme is 73 million this year. That is a reduction of 6 million on 2010 and there has been a reduction of almost 50% in the number of dental practices taking clients under that medical card scheme. The HSE Emergency Dental Health Services is almost impossible to access. The treatment benefit scheme, which is based on PRSI for workers and retired workers, only provides for examination and cleaning. This puts lower and middle income families at a disadvantage. I am thinking here about a lot of ordinary workers and their families, no fillings and no extractions under it. Overall, Minister, 83% of dental treatment is funded by out-of-pocket payments. Children with special needs and adults that are required to have anaesthetic to access treatment, they suffer from a lack of services and there is a 2-year waiting list in hospitals for that. They are often presented and I have had cases to my constituency office about it where they present with serious levels of tooth decay and oral health issues and that needs a fix. In the Dublin Midland Health Region there are 654 children on waiting lists for that hospital treatment and in the case of adults, 102. That needs urgent attention. The Irish Dental Association highlighted that 500 additional dentists are needed immediately to address the crisis, both in private practice and in the public services. With a rising population and the high number of dentists who are going to reach retirement in the coming years, this needs a particular focus and action from Government. To underline the scale of the crisis, the overall number of dentists working in both public services and private practice has dropped by 23% in the last 15 years. Only 10% or less of dentists are working in the public services. It is estimated that 120 additional dentists are needed just to maintain the very, very basic level of services that we have at the moment. In 2023, 320 dentists were working in the public services. In 2025, that is down to 294 according to the HSE. In private practice, the Irish Dental Association states that due to workload, a quarter of dental practices will not take on new adult clients and more than a third will not take on children. It is not because they do not want them, they cannot because of workload. And while the effects of all this are across society, low and middle income households are hit the hardest. Between 2009 and 2023, there was an €800 million cut in funding for the PRSI and treatment benefit schemes. That is the medical card scheme referred to earlier. This has meant, you know, people and workers on those low and middle incomes, they have had huge negative outcomes. And unfortunately, dental health and dental treatment is often put on the back burner by families out of economic necessity. And it is so, so important, and you understand this, it is so important that this is tackled early when they are in primary school, in second class. I would also say to you, too, we need to bring forward the PROMISE scheme for under sevens. But an €800 million drop in funding for those two public schemes over a 14-year period has had a significant hit. So I am asking that the Government publish the long PROMISE new plan for dental services. I acknowledge there was a new dental school open last week, in Sandymount, the Minister for Health told me about this the other evening. I acknowledge that, but more needs to be done. We need to bring forward a plan for dental health services, a scheme for under sevens, that needs to be given priority, provide us for a significant increase in the school dental places in universities, particularly in UCC and TCD, to provide additional funding for this. We need to facilitate the reintroduction of a structured mentorship programme to allow new graduates to gain work experience, and you understand the importance of that. We need to authorise the HSE to step up recruitment for dentists to work in the school dental scheme, the public dental services, and we need to sort out the delay between dentists, the point where dentists are recruited and told that they have a position and actually start work. Because my information that I am getting, if it is correct, is that that can be six months plus Minister, and that is too long, and what is happening, and the officials need to take this on board and take it up with the HSE as well directly, is that that delay in the interim period, they emigrate or they get another job. That means we do not have them in the public sector, where we need them at the moment. You need to introduce a very dynamic advertisement and recruitment campaign for the dental treatment services scheme. I know that extra funding was provided for that, and the rates being paid has been increased, but we need to encourage more dental practices to take on medical care patients in all parts of the state. And Leish, I have highlighted this before here at this house, I have been at this since Leo Varadkar, and indeed James O'Reilly was Minister for Health. This needs to be sorted out. It is bad across the country, but there is a big hole in it in Leish, and off Leish is much better. We need to expand the range of services available under the treatment benefit scheme. Workers are working hard, they are paying tax, it has gone out of their wages before they get them. You know, they pay EYE, the universal associate charge, the PRSI, and people do not mind paying it. We need to see services for that. If people could see good services, they would not mind paying the taxes and the levies like that. We need to ensure that the HSE improve and expand the hospital services and capacity for those children and adults with special needs, and that require the treatment. I have outlined the numbers waiting, just in one area alone. And that needs to be tackled, Minister, because there is a particular need there because they have to be under anaesthetic before they have the treatment. So we are coming up to budget time, and you are being lobbied left, right and centre. You know, I can see the lobbyists coming in and out here every day, and I am sure they are coming to us as well as opposition TDs. But what I am saying to you is this, this area needs, it is not just about oral health, oral health affects all health. You need to provide a significant increase, and the one message I want to leave you with, from being chair of the Public Accounts Committee for four and a half years, there needs to be a clear tracking done between the budget going in, because if you just throw money at it, you will not get the outcomes. There needs to be clear tracking between the budget going in, and the outcomes and the services provided, that needs to correspond with the increase in budget.