I welcome this debate and thank Sinn Féin for putting forward the motion. It is a really welcome debate and it follows on from the work done by the joint Oireachtas committee and the report we published on this matter. I sometimes wonder if I live in a different country when I hear some speeches from Ministers talking about the money they have invested and that their ongoing investment shows their commitment to delivering services, progressing reforms and addressing challenges. From what we have heard tonight, none of that is happening. The Government is not showing commitment to services, progressing reforms and addressing challenges. The evidence sadly speaks for itself and it is not the rosy picture that is presented by the Minister of State, unfortunately. There is a long history here of dysfunction when it comes to oral health policy in the State. Successive Governments have utterly neglected public dental services. The first clear statement of the State's aims and objectives for dental services was first published in 1994. That was called the dental health action plan. That plan led to the development of the dental treatment service scheme for medical card holders but it would take a quarter of a century for another dental policy to be published. In 2007, the then Minister for Health, the former Deputy Mary Harney, announced the development of a new oral health policy and although a draft plan was presented to the Minister in 2009, it was never published. In the years between 2001 and 2017, aside from one mention of community water fluoridation, oral health did not feature in any of the national healthcare policy documents. That only changed with the publication of Sláintecare. Then, in 2019, a new oral health policy was finally published, Smile agus Sláinte, 25 years after Ireland's first and only dental policy plan had been published. What we see over the period and the history of the State is neglect of this area and a failure to plan and put policies in place. Even sometimes when policies are formed, there is a failure to implement, prioritise, publish and resource them. It is not just the current Government that is failing on this; there is a track record of failure from successive Governments that have led us to the state we are in today. On Smile agus Sláinte, in 2019 the oral health policy did not set out a roadmap for the practical delivery of its vision. It was developed without proper consultation with dentists and allied healthcare professionals. In 2024, the former president of the Irish Dental Association, IDA, Dr. Eamon Croke, said that the 2019 policy "was launched from behind a veil of secrecy". While Dr. Croke said that the IDA may share and support many of the 2019 plans and their aspirations, the Department of Health had yet to articulate how its vision would be enacted, a situation that prevails to this day. In January of this year, the Department of Health told the health committee that a three-year implementation plan to progress phase 1 of the 2019 plan was in development. This is now seven years after the plan was put in place that we were still waiting for the implementation plan. The implementation has been described as imminent since 2024. We are led to believe that this implementation plan will finally be published this year. However, in January, the Minister said it was at an advanced stage, while in April, she said her goal was to publish it in the coming weeks. It is now the end of June and we still do not have that implementation plan for a policy that was published seven years ago - back in 2019. If that does not tell you how much of a priority this issue is for the Government, I do not know what will. In the Minister of State's speech this evening, she said it is currently being finalised. I would ask the Minister of State, in her closing address, to give us a solid timeline. We have been told for many months that it was coming to the end. We would like to know exactly when the Minister intends to publish that. We have been waiting, as I said, since 2019 for this. I do not think it is unreasonable to give the Dáil a final date on when that implementation plan will be published. On the Oireachtas health committee's report, which was published previously, this followed engagement with stakeholders. The health committee published its report on dental services back in April. This report included 19 recommendations, with the first three all relating to implementation of that 2019 plan. We found there had been no noticeable improvement in dental services since 2019. There was no noticeable improvement over a seven-year period. There had been no progress, according to the report produced across the parties, including Government members of the joint committee. In fact, the situation has gotten worse and not better. Children are leaving primary school without being screened. The medical card scheme is haemorrhaging dentists. The laws governing dentistry are over 40 years old and they are putting the public at risk. The Dental Council of Ireland has been calling for a new Act and additional powers since 2008. It urgently needs powers to investigate, enter and inspect dental practices. Here are just some examples of instances in which it has not got the powers to act. There was an unregistered person convicted of sexual assault practicing as a dentist. There was an unregistered dentist offered dental treatments, including X-rays, from the sitting room of an apartment in central Dublin. Three unregistered dentists were operating pop-up clinics in Munster and Connacht. These are the kinds of patient safety issues we have here - people convicted of sexual assault practicing of dentists; clinics in apartments across the State; and unregistered dentists. We need regulatory reform that is supported by both the regulator and the regulated. In regard to children's dental services, children should be screened three times before leaving primary school but some children are not being seen until transition year. If that is not a failing on behalf of the State, I do not know what is. This is because of understaffing and under-resourcing of the school screening programme. Check-up targets have been missed on a massive scale. In 2023, only half of the eligible population of children were screened. Half of the children who were entitled to this completely missed the screening. This is really important screening to check on children and it just being missed. They are being completely failed and neglected and it is utterly unacceptable. We urgently need the strategic workforce plan, as recommended by the health committee. We need to know what the capacity requirements of a school screening programme are if it is to deliver a service that actually works for people. At present, the Department simply does not know how many public dentists are needed. All we know is that we do not have enough, and that the number of public dentists delivering the dental scheme has dropped by 30 since 2012. We are seeing a fall in the number. Despite what the Minister of State may talk about, investment in services and the number of dentists working in the public dental scheme is dropping. We need to make public dentistry an attractive option for dentists. That includes the development of new and attractive public dental contracts to support the public model. Outsourcing children's dental services to the private market is not the answer. Scaling up the public service is. That should be a priority and it should be a matter of real concern to the Minister of State that we have children in the State who are entitled to these screenings who are missing them. It being half of the eligible population, it is really utterly unacceptable. The concerns we have do not just extend to children; they also extend to adults on the medical card and medical card patients. Under the medical card scheme, private dentists are contracted by the HSE to provide services to medical card patients but this scheme is haemorrhaging dentists and medical card patients are paying the price. In 2015, there were around 1,600 dentists participating in the scheme but, by last year, that had halved to 800. The scheme is no longer fit for purpose and the health committee, in our report, called on the Minister to enter immediate talks with the Irish Dental Association to replace it with a new scheme, one that allows dentists to provide medical card patients with the best care and not just emergency care. It is unacceptable in the current scheme that the number of fillings per year is limited but the number of extractions is not. As a result, people are having teeth removed when they could have had fillings and prevention. This is not the proactive, preventative type of care that should be provided in our public dental scheme. This scheme is a relic of the 1990s. It is no longer fit for purpose. We need modernisation and mere modification will not be enough. The scheme must be completely modernised. In the health committee's dental report, we also called for the development of a strategic workforce plan not just for dentists but for allied dental healthcare professionals. We also recommended that the roles of those dental health professionals should be expanded, allowing direct access without the need for referral. In the context of the national oral health policy's aims to move from an outdated curative care model to a prevention first model, direct access from dental hygienists is particularly important. The Minister of State has already said that work is under way to develop a policy paper on direct access for dental hygienists. This needs to be accelerated. Unnecessary barriers to direct access must be removed. Allowing direct access for dental hygienists will increase capacity, enable earlier interventions, reduce waiting times and allow dentists to focus on more complex and high-need care. This is already in place in the UK. A 2023 UK General Dental Council evaluation paper found no evidence of patient safety concerns associated with direct access to dental hygienists and therapist practices when their defined scope and appropriate referral pathways are in place. I met with the Irish Dental Hygienists Association earlier this year and it did excellent work in putting forward a case for direct access. Patients should have the option of accessing care from dental hygienists without needing to see a dentist first. Advancing this practical and evidence-based reform should not be put on the long finger any longer. It is a key reform and it will help dentists, patients and the public at large. The Government is not doing enough here. It is not investing enough. The issue is not being prioritised. The reforms to the dental Act that are needed have not been progressed. I say this all the time when we have statements the House; we could be progressing reforms to legislation, including the dental Act. I have real concerns about the school screening programme and the number of children who are being absolutely failed, are not getting the appointments they need and are being completely neglected. We heard at the health committee that in some cases, people are driving themselves to their first screening when they should have been screened in primary school. It is not good enough. It is utterly unacceptable. I urge the Minister of State and the Minister to get a grasp on this issue. For our part, the health committee has set out a series of recommendations. We have laid out clearly exactly what needs to be done step by step. I urge the Minister of State to engage with that report and the recommendations and progress the reforms needed because people deserve access to good quality public dental care. The least people should get in this Republic is access to good quality healthcare, particularly children, medical card holders and others who have been failed and failed by successive governments. The time for reform is now. I urge the Minister of State to listen to what we are saying and prioritise this issue because together, by working with the health committee and the recommendations we put forward, we can make real progress on this issue. However, it needs to become more of a priority for the Minister of State, her Department, her officials and the Minister.

Sentiment score: 0.04