I move: That Dáil Éireann: notes that: — the School dental programme for children is not providing adequate and timely treatment for primary and secondary school students; — children are not seen for their first screening examination in second, or even fourth or sixth class in primary schools and in many areas, they are receiving their first examination in fourth year in secondary school; — in Co. Laois, based on Health Service Executive (HSE) figures of 6,433 are waiting on their first exam invitation, and that is being provided seven years late; — in 2017, 135,662 pupils were screened and treated, and this dropped to 101,112 in 2023, and in the same period in Co. Laois and Co. Offaly it reduced from 4,300 to 181; — the Dental Treatment Services Scheme (DTSS) for adults with medical cards is not available in many areas, in Co. Laois for example just one dental practice currently takes clients under this scheme; — the budget for the scheme in the current year is €73 million, a reduction of €6 million from 2010; — the HSE emergency dental service is almost impossible to access; — the Treatment Benefit Scheme based on Pay Related Social Insurance (PRSI), only provides for examination and polishing which puts lower- and middle-income families at a disadvantage; and — children or people with special needs, that require anaesthesia cannot access treatment due to a lack of staff in hospitals, and there is a two-year waiting list; and calls on the Government to: — publish the promised dental services plan; — provide for a significant increase in Dental School places in University College Cork and Trinity College Dublin, and provide additional funding for this; — facilitate the re-introduction of a structured mentorship programme to allow new graduates to gain work experience; — authorise the HSE to step up recruitment for dentists to work in the School dental programme, and in public dental services; — introduce a dynamic advertising and recruitment campaign for the DTSS, to encourage dental practices to take medical card patients in all parts of the State; — expand the range of services available under the PRSI based Treatment Benefit Scheme; — ensure the HSE improve and expand hospital services and capacity for children and adults who have special needs, and require treatment under general anaesthetic; and — provide for a significant increase in the forthcoming budget for dental services. The public dental health service is in crisis and there is also a shortage of dentists in the private sector. This is due to a lack of planning and the schemes not properly being resourced. Dental and oral health have not been made the priority 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 conditions and a range of other physical health issues are caused by poor oral health. The workforce crisis in dentistry has been well publicised in recent years. This has not happened all of a sudden; it has crept up over several years. Action on this by successive Governments and the HSE has been way too slow and at nowhere near the pace required to have a substantial impact. In recent years, insufficient attention and resources have been put in to prevention through education and public awareness campaigns. The cure comes too late, often and most likely in the form of multiple extractions and fillings. I want to address the main public schemes, namely, the school dental scheme, the dental treatment services scheme, the treatment benefit scheme and orthodontics, for which there is a six-year waiting list for treatment. 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. In many cases, they receive their first examination well into secondary school. In Laois, children are four years into secondary school when they are first seen. In Offaly, it is not much better, at three years. This is an absolute scandal in public health. In the case of Laois, according to HSE figures, 6,433 pupils are waiting on their first examination. As I said, for most of those pupils this will come six or seven years too late, and they will then have to wait for treatment. In 2017, 135,662 pupils were screened and treated. This figure dropped to 101,112 in 2023. We are going backwards. I am not too sure what happened but these are figures I got from the HSE. In Laois, the number of pupils screened and treated reduced from 4,300 in 2017 to 181 in 2023. Those are interesting figures. The dental treatment services scheme for adults on medical cards is not available in many areas. For example, for people in Laois, only one dental practice currently takes clients under the scheme and it is based on the edge of Carlow town. The budget for the current scheme is €73 million this year. That is a reduction of €6 million on the allocation in 2010. There has been a reduction of almost 50% in the number of dental practices taking clients under the scheme. The HSE's emergency dental health service is almost impossible to access. The treatment benefit scheme for workers and retired workers, which is based on PRSI, only provides for examinations and cleaning. This puts low- and middle-income families at a disadvantage. I refer here to ordinary workers and their families who get no fillings or extractions under the scheme. Overall, 83% of dental treatment is funded by means of out-of-pocket payments. Children with special needs and adults who require anaesthesia to access treatment suffer from a lack of services. There is a two-year waiting list in hospitals for such treatment. I have had representations at my constituency office about this. Patients often present with serious levels of tooth decay and oral health issues. That needs to be fixed. In the Dublin and midlands health region, there are 654 children and 102 adults on waiting lists for hospital treatment. That matter requires urgent attention. The Irish Dental Association has highlighted the fact that 500 additional dentists are needed immediately to address the crisis in private practice and the public system. Given the rising population and the high number of dentists who will reach retirement in the coming years, this needs a particular focus on the part of and action from Government. To underline the scale of the crisis, the overall number of dentists working in both public and private practice has dropped by 23% in the past 15 years. Less than 10% of dentists are working in the public service. It is estimated that 120 additional dentists are needed just to maintain the very basic level of service we have at present. In 2023, 320 dentists were working in the public service. By 2025, according to the HSE, that had dropped to 294. In the context of private practice, the Irish Dental Association has found that due to workload, one quarter of dental practices are not taking on new adult clients and more than one third will not take on new children. This is not because they do not want to do so; they cannot do it due to their workload. While the effects of this are felt across society, low- and middle-income households are hit the hardest. Between 2009 and 2023, there was a cut of €800 million in funding for the PRSI scheme and the treatment benefit scheme, or medical card scheme, to which I referred earlier. This has meant that workers on low and middle incomes have suffered hugely negative outcomes. Unfortunately, dental health and dental treatment are often put on the back burner by families out of economic necessity. We all know how important it is that dental health is tackled early, namely when children are in second class in primary school. We also need to bring forward the promised scheme for children under seven. The €800 million cut in funding for those two public schemes over a 14-year period has had a significant effect. I urge the Government to publish the long-promised new plan for dental services. I acknowledge that a new dental school was opened in Sandymount last week. The Minister for Health told me about it the other day. While I acknowledge that development, more needs to be done. We need to bring forward a plan for our dental health services, and a scheme for children under seven must be given priority. There must also be a significant increase in the number of dental school places in universities, particularly UCC and TCD, and additional funding for this. We need to facilitate the reintroduction of a structured mentorship programme to allow new graduates to gain work experience. I am sure the Minister of State understands the importance of that. We need to authorise the HSE to step up recruitment for dentists to work in the school dental scheme and public dental services. We need to sort out the delay between the point at which dentists are recruited and told they have a position and when they start work. The information I have, if it is correct, is that such delays can be for six months or more, which is too long. Officials need to take this on board and take it up with the HSE directly because what is happening is that in the interim, those recruited either emigrate or get another job. That means that we do not have them in the public system where they are needed. We need to introduce a very dynamic advertising and recruitment campaign for the dental treatment services scheme. Extra funding was provided for that. The rates being paid have been increased, but we need to encourage more dental practices to take on medical card patients in all parts of the State. I have been highlighting this issue since former Deputies Varadkar and James Reilly served as Ministers for Health. It needs to be sorted out. The situation across the country is bad, but there is a really big hole in the service in Laois and Offaly is not much better. We need to expand the range of services available under the treatment benefit scheme. Workers are working hard and paying their taxes - PAYE, USC and PRSI - which are gone out of their wages before they get them. They do not mind paying their taxes but they need to see services for that money. If people could see good services, they would not mind paying their taxes and levies. We need to ensure that the HSE improves and expands hospital services and capacity for those children and adults with special needs who require treatment. I have outlined the numbers waiting in just one area, and that needs to be tackled. There is a particular need there because such patients have to be under anaesthetic before they can be treated. We are coming up to budget time. The Government is being lobbied left, right and centre. I see lobbyists going in and out of here every day. They are coming to us, as Opposition Deputies, as well. This is not just about oral health. Oral health affects all health. The Government needs to provide a significant increase in funding. The one message I want to leave with the Minister of State, having chaired the Committee of Public Accounts for four and a half years, is that we need clear tracking of the budget going into dental services. If we just throw money at it, we will not get the outcomes we want. There needs to be clear tracking of the budget going in and the outcomes and services being provided, and that needs to correspond to increases in the budget.

Sentiment score: 0.02

I join with the Leas-Cheann Comhairle in welcoming the visitors to the Gallery. I welcome Fintan Hourihan from the Irish Dental Association, as well as Pat Fitzpatrick. As a councillor, I met Pat Fitzpatrick a few times in his former role. We are all elected here to be the voice of the people - Teachtaí Dála, Dáil delegates. Not to take any cheap shot, but the Government benches have been empty throughout this debate. Not one member of Government, apart from the Ministers of State, spoke. Maybe they do not see there is any problem in dental health, but I find that remarkable. Maybe they are not hearing it from constituents. We have had a range of speakers from across the Opposition benches, from Kerry to Donegal, from Dublin across to Galway, and everywhere else in between. The problems and some suggestions have been outlined, and that is welcome. I welcome the fact the Minister of State is not opposing it. I know he and the Minister of State, Deputy Butler, are sincere in what they are doing. In his closing remarks, he framed it in the context of Sláintecare, and we have to set it in that context. That means we must start providing the proper dental health services that are available to everybody. It is like many other problems, including housing. There is no one thing that will fix any of it. There are a number of parts, and a number of them are being focused in on, in fairness, and were identified by Deputies. I also tried to do it in the motion and in the proposals I tabled. The Minister of State, Deputy Butler, mentioned the overall budget of €230 million. That is the case, but we cannot have budgets without tracking the outcomes. Outcomes have to match any increase in budget. That needs to be clear and I am saying that as an Opposition TD. Throwing money at something will not solve it on its own. People going abroad has been mentioned. There is even a term now I heard recently, namely, “Turkey teeth”. We have seen good and bad examples of people coming back with treatment. However, if they are going there, it is a failure. What brought this to my attention a number of years ago, and I have raised it since joining the House – it is my 15th year here – is that an acquaintance of mine wound up nearly dying in hospital because of poor dental health. Poison got into his system. He was a fine hardy fellow and it almost killed him. It really underlined the problem for me. I raise another issue. I watched my granddaughter go through primary school. As far as I can remember, I saw the dentist in third class – it is a few years ago now – in the dispensary in Mountrath. Everybody else also saw the dentist at that time. Here we are now, and she did not see the dentist in primary school. She came out of primary school. She and her pals - I know the kids she was going around with at the time - are now near the end of their teens. They went through secondary school and almost came out the other end without seeing the dentist. They saw the dentist in the past year. That was their first examination. It brought it all into sharp focus for me. Under section 67 of the Health Act 1970, the HSE must provide dental treatment and appliances for those on medical cards. We must increase the number of places. Some 65% of dentists have been unable to recruit additional people. There has been no progress on the new dental school at UCC since the then Minister, Simon Harris, turned the sod in 2019. My understanding is the funding is being withdrawn. Only 10% of dentists work in the public dental health services. Even private dentists are saying that figure needs to be doubled. We need to double the percentage to have a representative number in the public dental system. It is like the GP situation. Not all dentists can afford to open a private practice or want to open a private practice because they would have to run a small business and there are a lot of costs associated with that. Women, because of the reality of the world we live in, need to work a 35- or 40-hour week while also having other responsibilities trying to manage their families and everything like that. They want to work a nine-to-five job, and a lot of men do, too. Men are now taking on a greater role in parenting children. We must try to get more people into the public system and the private system. The shortcomings and the limited number of services available under the dental treatment benefit scheme have been outlined very graphically. Portugal, as I understand it, has a voucher scheme. I do not want to make this look cheap, but the voucher scheme would allow people to access the services they or their dental surgeons consider they need under the dental treatment benefit scheme. It is something the Minister of State may consider. I mentioned the six-year waiting list for orthodontic services. Nothing happens during school term in primary. Nothing happens during secondary. They then come out the other end and it is all over at that stage. The opportunity is gone, and that is really disappointing. I will read a short letter, which is one of many letters I get. This came from somebody working in the public dental services who wanted to outline to me some staffing issues: There have been jobs advertised and no dentists have applied. There are currently two full time dentists covering all of Laois. They are currently doing late evenings or try get through the list. I acknowledge here the efforts of one particular HSE manager, Joe Ruane, in getting that in place. I want to acknowledge that because there are people trying to change things. I welcome that fact and I recognise the efforts of those people working late in the evening to try to do that, shorten the list and get on top of this. The letter writer goes on to say: There are very few dentists qualifying in Ireland as college spaces are limited and non-Irish Nationals tend to go back [to their home countries] once qualified. Maybe you could speak on the dental hospitals in Dublin and Cork and maybe they could come up with a scheme that once you qualified you have to practice in Ireland for a year [or, as some Deputies have mentioned, two years]. I know two years ago 43 dentists qualified in Dublin and only 10 stayed in the Country. I will finish there and will not read the rest of it. That to me brings home the problem we are facing. The overall dependence on foreign students has been mentioned. I have nothing against foreigners. They are welcome, particularly those who are working in our public health system, but governments of other countries are paying them to come here to train. The funding from that is supporting the dental schools. This is something I have put a lot of work into looking at over the years. In the past few months, I have decided to give this a particular focus while I am in the Dáil representing Laois during this term. We cannot have a situation where the dental schools are depending on foreign students. The spaces are taken up. We are not educating and training enough dentists to work in either the public or private systems here. We need to get on top of this. As has already been outlined, dental care is not a luxury. We need a fix. I outlined the new dental plan, the timeline for which the Minister of State, Deputy Butler, referred to when she spoke earlier. That needs to happen a lot quicker. We also need that scheme for the under-sevens. The Minister of State knows what needs to be done in the dental schools in TCD and UCC in terms of additional funding. The structured mentorship programme and its different forms have been spoken about. It needs to be brought on stream so that people can gain work experience. On HSE recruitment, I think it was Deputy Sherlock who mentioned a 14-month wait for one person between being told that person would be taken on and actually starting the job. People will go elsewhere. They are not going to hang around. They cannot hang around because they have to bring in money to live in an expensive economy and country. There is also still something wrong with recruitment for the DTSS. I acknowledge the 40% increase in payments, but the scheme is not being taken up. There needs to be a dynamic advertisement and recruitment campaign for the DTSS. The services under the treatment benefit scheme need to be expanded. The voucher system also needs to be looked at as one option. I do not know all the ins and outs of it, but it certainly should be considered. For those people with special needs, I plead with the Minister of State, because I have come across some terrible cases where people have had to have treatment under anaesthetic because they are autistic or have some other condition. That needs to be fixed in the hospitals providing those services. I have seen awful situations. I welcome this opportunity. I know the Government is not opposing the motion and I welcome that, but let us not just go out of here this morning and nothing then happens. Let us use some of the suggestions put this morning. They are being put forward genuinely from Kerry to Donegal and Galway to Dublin. I am telling the Minister of State that the situation is really serious in Laois. It needs a fix and I plead with the Minister of State to fix this issue.

Sentiment score: 0.06