Thursday, 2 December 1971
Dáil Eireann Debate
Mr. L'Estrange: asked the Minister for Social Welfare if there is a danger of a breakdown in the scheme of dental benefits because of the failure of his Department and the Irish Dental Association to agree on a claim for a revision of the terms under which the dentists operate the scheme; and what action he intends taking in the matter.
Minister for Social Welfare (Mr. J. Brennan): Acting on the advice of the Irish Dental Association a number of dentists have withdrawn from my Department's dental benefit scheme but dental treatment will still be available to qualified insured persons from those dentists who have remained on the dental panel. Negotiations are still continuing between my Department and the Irish Dental Association and, in fact, representatives of the association are meeting with officers of my Department to-day.
Mr. L'Estrange: Is the Minister aware that in the last couple of months dentists in some areas were refusing to extract teeth for social welfare people, that they told them there was a row on between themselves and the Department and refused to do it? Was that in order?
Mr. Dowling: and Mr. Moore asked the Minister for Social Welfare if he will state the present position regarding the scheme of dental benefit administered by his Department, whether the scheme is being suspended as from 1st December, 1971; what  negotiations have taken place with the dentists operating the scheme; whether any new offer has been made to them; and if he will make a statement on the matter.
Mr. J. Brennan: The present position regarding the dental benefit scheme administered by my Department is that 382 dentists have withdrawn from the dental panel with effect from 1st December, 1971. The scheme has not, however, been suspended as there are still 143 dentists remaining on the panel who continue to provide services for qualified insured persons.
The Irish Dental Association's dispute with my Department is concerned mainly with the claim for increase in fees based on the report of a practice cost survey submitted by the association in May, 1971, but the issue is somewhat confused by two other claims which overlapped in time with the main claim.
The first of these claims is concerned with the agreement to which each dentist on the dental panel subscribes. A new agreement was drafted at the request of the association and as far back as October, 1970, representatives of the association assured me personally that they were satisfied with the draft and would recommend its acceptance. Despite this assurance the association again raised the matter of the agreement in April, 1971, and further concessions in the wording of certain clauses were granted to them at a meeting in May, 1971. The association are still not prepared to accept the new form of agreement principally because I have refused to concede to them the absolute right to accept or reject a patient under the scheme. They may, of course, refuse to accept a patient if they furnish a reasonable explanation to me.
The other claim was in respect of the fees payable for items of treatment of a sophisticated nature such as crowns and inlays which at the request of the association I agreed should be dealt with on a grant-in-aid basis. Three separate offers by the Department were rejected by the association.
When it became apparent that the association were not prepared to recommend to their members any form of  agreement which did not exactly conform to their terms or to agree to fees for grant-in-aid items of any lesser amount than those demanded by them I decided in September to circulate the new agreement to all panel dentists and to invite them to subscribe to it if they wished, or alternatively to continue to operate under their existing agreements, and at the same time I fixed fees which I consider not only reasonable but generous for the grant-in-aid items so that dentists performing the type of work for which these fees are payable should benefit immediately from these. I made it clear at the time that these fees could be further discussed in connection with the claim for a revision of the general scale of fees.
In regard to the main claim which is a claim for an increase in the general scale of fees the position is that the then president of the Irish Dental Association submitted in April of this year a suggested revised scale of fees which he stated would be acceptable to his association. The fees suggested, it was stated, were based on the result of a practice cost survey the report of which was not received in the Department until 17th May, 1971. The report was considered by an inter-departmental committee consisting of officials of my Department, a professional accounttant from the Department of Industry and Commerce and a representative from the Department of Health. Arising out of the examination the Irish Dental Association were asked to elucidate certain points and a supplementary report was received from the association on 20th July, 1971. Following very careful and detailed consideration of the whole matter officials of my Department met representatives of the association again on 4th November, 1971. Before this meeting, however, notices of intention to withdraw from the dental panel as from 1st December were received through the Irish Dental Association from some 350 dentists. A day-long meeting was held with representatives of the Irish Dental Association on 4th November and it was agreed that a new scale of fees should be formulated based on an agreed hourly rate of remuneration which would give a net profit of £4,500 a year to a dentist  engaged solely on work under my Department's scheme.
In order to formulate this new scale further meetings with representatives of the Irish Dental Association were held on 17th and 23rd November for the purpose of determining mutually acceptable times for the performance of the various items of work under the dental benefit scheme. It has not as yet been found possible to reach agreement on these timings, but a new scale of fees based on timings which my Department's technical advisers consider more than adequate, indeed generous, has been formulated and was due to be discussed with representatives of the Dental Association at a meeting to-day.
Mr. Moore: I do, if I am allowed to by Deputy L'Estrange. May I ask the Minister whether, as a result of today's negotiations, or the acceptance of his new offer, there will be an increase in social welfare contributions from the general body of workers?
Mr. Sherwin: Will the Minister not agree that if dentists can receive fees for specialised and more involved operations on teeth and if they are to be at a loss if they render these services to insured people it is a form of blackmail? This is a serious development. The Minister obviously does not agree.
Mr. Moore: and Mr. Dowling asked the Minister for Social Welfare the number of dentists engaged on the dental benefit scheme operated by his Department; the remuneration paid to them; and if there is normally any difficulty in securing the full complement of dentists necessary.
Mr. J. Brennan: Dentists who wish to give treatment to insured persons under my Department's dental benefit scheme enter into an agreement with me and their names are inscribed on  the dental panel. Normally there are about 500 dentists, the great majority of those in private practice, on the panel. As panel dentists are paid on a fee basis their remuneration under the scheme is dependent on the amount of work done, and the amount received by individual dentists under the scheme varies from less than £100 to more than £20,000 a year. The total amount available to all panel dentists from the scheme is at present of the order of £1,100,000.
Heretofore it has been the practice to admit all applicant dentists to the dental panel but I am considering the advisability of admitting dentists to this panel in future on a more selective basis. For example, I feel that the prescription for admission to the panel of some minimum experience in the field of practical dentistry after qualification may be desirable. Again, I feel that the number of dentists on the panel in a given area should bear some relation to insured population in that area so that, while ensuring adequate choice of dentist, a reasonable level of participation in the scheme will be available to each individual panel dentist.
Mr. Dowling: and Mr. Moore asked the Minister for Social Welfare if he will state the increase in fees for the operation of his Department's dental benefit scheme being sought by the Irish Dental Association; and the total estimated additional annual cost.
Mr. J. Brennan: Last April the Irish Dental Association submitted a claim for a general increase in the scale of fees payable to panel dentists under my Department's dental benefit scheme.  Broadly speaking, this represented an overall increase of 60 per cent on the fees then payable which already included a 17 per cent increase conceded with effect from August, 1970. This claim was supported by a practice cost survey conducted for the association by a professional accountant and submitted to my Department in May, 1971. Following examination of this survey by an inter-departmental group which included a professional accountant, agreement was reached on an hourly rate of payment in respect of work done by dentists under the dental benefit scheme and we are now trying to reach agreement on times taken to perform the various items of treatment listed on the scale of fees, but so far without success. The timings proposed by the dental association would, if accepted, result in an increase in expenditure on fees of well over 100 per cent. It is not possible at this stage to state exactly the full effect of the increase in fees being sought by the association but I may say that if their claim was to be conceded in full the additional cost to the Exchequer in respect of the basic items on the scale of fees, that is, examination, extractions, fillings and scaling, would be of the order of £1,000,000 a year.
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