Matt Shanahan: Warns of systemic failure in dental services
Matt Shanahan spoke in the House about failings in public dental services, arguing the situation is a long-term failure rather than a short-term crisis. He urged urgent action on falling treatment numbers, lengthy orthodontic waiting lists (more than 13,000 children) and improved access for vulnerable patients.
Decline in public treatments
Shanahan highlighted official data showing a sharp fall in public dental activity between 2019 and 2021 - a drop of 280,000 treatments and 110,000 fewer patients treated. He said this decline undermines the ambitions of the Dental Treatment Services Scheme (DTSS), the treatment benefits (PRSI) scheme and the public dental health service.
Two-tier system and private costs
He warned that Ireland effectively operates two streams of dentistry - public and private - and that people are being forced from the public system into private care they can ill afford. Shanahan argued policymakers have not properly accounted for the growing number of public patients who face long waits and high out-of-pocket costs.
Children's dental care and orthodontic waiting lists
Shanahan pressed for earlier dental checks in schools, prevention measures such as fissure seals, and faster access to orthodontic care. He noted statutory obligations for emergency treatment and free orthodontics for the most severe cases, but said waits of three to four years are now common and unacceptable for families.
Access for autistic and disabled children
He raised a specific access gap for autistic children in mainstream schools who, he said, do not receive the same dental supports as children in special schools. Shanahan said this inequity compounds pressures on parents already seeking other disability services - speech and language, occupational therapy and more.
Workforce, compensation and policy demands
Shanahan flagged workforce shortages and compensation issues - dentists are reportedly leaving public schemes because current payments are not economic and PRSI cover was reduced in scope to scale-and-polish. He called for more nurses, hygienists, clearer future policy, work permits where needed and for the minister to re-engage with the profession to find a resolution.
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The Minister, my colleague, has referenced the word crisis. It seems every time we have a healthcare debate now in the House we have the word crisis cropping up time and time again. Normally a crisis is seen as something short-term, some impending looming danger. It shouldn't actually be a situation that's been in evidence for a number of years. So I would say what we're suffering in dentistry is not in fact a crisis but a failure to address known increasing deficits and problems. When it comes to dental care in Ireland, we have basically two streams of dentistry similar to our national healthcare, we have the public and the private stream, and we essentially don't worry about the private because we assume that people have the financial resources to pay for it, but we don't actually take account of the people in the public system who are now waiting so long. They are forced into their private system to pay for services they actually find very, very difficult to afford. Beyond that, the three schemes that you mentioned, Minister, and essentially the DTSS is supposed to be providing dental treatments to adult medical cardholders. We then have the treatment benefits scheme, which was the old PRSI scheme to cover adults that have sufficient PRSI contributions made, and finally the public dental health service, which is largely community-based and some hospital-based, that is supposed to treat children and adults requiring specialised and complex care. That service is also supposed to support the national school children to have their first access and dental assessment, often resulting in the need for fissure seals, which are a great prevention for future onward tooth decay. In addition, a statutory requirement is there for the HSE to provide emergency treatment and even free orthodontic treatment for children who have the most severe orthodontic problems. Minister, as you know, the waiting lists for that are extending now to ridiculous lengths. It is just not even feasible for some people to consider orthodontic treatments three and four years away. Despite the lofty ambitions of these three schemes, the Department of Information and the published data show a significant downward decline in the number of treatments being provided under the scheme. I know you have given us updated figures in your statement, but just looking from 2019 to 2021, there was a decline in the number of overall treatments of 280,000 in the public system and a decline in the number of patients treated of 110,000. So, as I say, we have seen the difficulties coming down the line, Minister. I know you have engaged with the private sector in terms of the dentists to try and understand what the problems are, but they are largely based on adequate compensation for the work that they are doing. The stakeholders have been telling you, Minister, that the repayment that they are receiving, as Deputy Barrie has said, for the work that they are doing is just not economic. That is why they are leaving the scheme. It is not hard to understand. Government, in their wisdom, in terms of the PRSI scheme, decided to reduce that to a scale and polish. What good is that to somebody coming in who is in pain or requires an extraction and who should pay for that? Medical cardholders are finding it extremely difficult to access dentists in their own towns and regions while participating in the public payment schemes. These include patients with very significant other health issues, Minister, as you know, which is all adding to the overall care burden. I have to highlight one misnomer here, Minister, and I think this needs to be addressed, which is the issue of autistic children in mainstream schools who do not get the same access to dental services as children in disability in disabled schools. That needs to be addressed, Minister. We cannot have a situation like that. These are kids and their parents are already facing the challenges of trying to access other disability services, speech and language, OT, and now they have to go off and try to figure out their route to oral supports as well. Oral diseases, as you know, are becoming more common and they share, as has been said already, the risk factors to obesity and to diabetes and heart disease. Our motion has basically called for a number of things, Minister, but in essence we need to address the more than 13,000 children presently awaiting orthodontic treatment. We need to get the dental checks done earlier and we need more and more adults and those, especially with disabilities, who are facing delays, to be able to access the services, particularly under GI. Beyond that, Minister, we need to up the numbers in the service. This, I am sure you have got back from the professionals. They have been telling you they need more nurses, more hygienists, more access to work permits. They need more people in the system and they need to know what is the policy for the future. As has been said already, Minister, the private sector is largely carrying the public dental quota at the moment. That is the fact of life. You cannot expect, as has been said, professionals to go in and support the public component at their own cost. I know you have said recently in the dial here that you are absolutely committed to finding a resolution. We had a briefing recently from members of the Dental Association. I am not sure that they share your position at the moment. I would hope, Minister, that we will hear that there has been some kind of regrounding to all of that. Thank you. Thank you very much. Good morning.
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