Adjournment Debate - Medical Cards

Wednesday, 12 May 2010

Dáil Éireann Debate
Vol. 708 No. 4

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Deputy Michael McGrath: Information on Michael McGrath  Zoom on Michael McGrath  I would like to share time with Deputy Clune.

Acting Chairman (Deputy Cyprian Brady): Information on Cyprian Brady  Zoom on Cyprian Brady  Is that agreed? Agreed.

Deputy Michael McGrath: Information on Michael McGrath  Zoom on Michael McGrath  I wish to raise the issue of the cuts to the dental treatment services scheme. As Deputies are aware, the scheme is designed to provide basic dental treatment to medical card holders. While I appreciate the need for budgetary cuts to ensure we get the public finances on the right path, this cut could have been managed far better. When the Minister for Finance made his Budget Statement on 9 December 2009, the HSE knew that the 2010 budget for this scheme would be €63 million. However, it decided to wait until 26 April last to issue a directive to dentists on how the scheme might come in under budget for 2010. Four months of the year had passed by the time any corrective action was taken. The depth of the cuts was far more severe and harsh than would have been required if corrective action had been taken in December, when the budget for the year was made known.

It seems from my cursory knowledge of the dental profession that the circular issued on 26 April is unworkable and impractical. As a result of the circular, a person with a medical card is no longer entitled to a basic cleaning from his or her local dentist. That is unacceptable. I will read an excerpt from an e-mail I have received from a dentist I know well:

I am embarrassed when I have to deal with my Medical Card patients because of this HSE directive. I looked after one of my patients today when he presented in pain. I was able to [836]relieve the pain by the removal of two infected teeth. He has had 5 operations on his throat over the last 3 years for cancer treatment and the remaining teeth are in a poor state. Before the HSE directive arrived, I would have filled 4 of his remaining 7 teeth to preserve them and his dignity and prevent further pain. Now I must wait under the new terms as these teeth are not causing pain, until he presents in pain, so that I can remove the offending infected and painful tooth. This will be a gradual and painful exercise that as a caring health care professional I will not tolerate. This is unethical, unprofessional and unfair. This patient has no teeth from the lower jaw that meet with the teeth in the upper jaw, that is, he has no teeth to bite with. Up until a few days ago, I would have gladly made him a set of dentures to improve his ability to chew, speak and give him some dignity in his appearance. Now I am unable to, unless he qualifies under ‘’approved emergency circumstances’’ [as set out in the HSE circular] and I have no idea how and what the qualification for this is.

That sums up very well the difficulty this directive is presenting to dentists in the profession. This is a savage cut. Sufficient funding should be made available to allow basic dental care to be provided to medial card holders. I call on the Minister to ensure that can be achieved.

Deputy Deirdre Clune: Information on Deirdre Clune  Zoom on Deirdre Clune  I am grateful for the opportunity to raise this issue, which has come about following a circular from the HSE dated 26 December 2009. As Deputy McGrath pointed out, the budget provided that expenditure on the scheme this year would be €63 million. There was no consultation with the dental profession. There are four principal dental surgeons in the State and they attempted to engage with the Department and the HSE on the changes they wanted to see implemented but their suggestions were ignored.

There is a total of 1,352 dentists in the State and a large proportion of their patients hold medical cards. They are now not entitled to basic routine dental treatments such as scale and polish, cleaning, fillings and extractions. The new guidelines have been described as “unethical, impossible to operate and a retrograde step in dental care for medical card patients”. We have reached the stage where removal of teeth will be the only option available to many dentists. Restorative and preventative treatments had advanced to ensure better quality oral care and oral hygiene for patients. Their general health will be affected by these changes. Will the Minister review the scheme and how it will be implemented? In its new guise, it will not serve patients and it will store up a great deal of trouble down the road. It needs to be addressed and examined to ensure the dental health of patients is protected.

Minister of State at the Department of Health and Children (Deputy John Moloney): Information on John Moloney  Zoom on John Moloney  I thank the Deputies for raising this matter. I also met a dentist yesterday who gave me a similar briefing to them. Clearly the impact of the changes on medical card holders may result in more cost to the State than what may be saved initially. I intend to engage with the HSE over the next few days to establish what other proposals could be made to ensure people will not be victims of this serious cutback. I will try to respond to the Deputies as quickly as I can.

I am happy to have the opportunity to address the issue of the changes to the dental treatment services scheme, DTSS. The scheme was set up in 1994 and its financial aspects are administered by the primary care reimbursement service on behalf of the HSE. It is monitored at a local level by HSE principal dental surgeons. The two objectives of the DTSS are to improve the oral health of adult medical card holders and to provide dental services to adult medical card holders in a cost-effective and equitable manner. The scheme has provided a range of basic dental treatments to adults who are medical card holders. These have included routine examinations, fillings, extractions as well as amputation of roots and the provision of dentures. The service is offered by approximately 1,400 dentists nationwide who hold contracts [837]with the HSE. The dental treatment is free to the patients and dentists working in the DTSS are reimbursed on a fee per item basis.

Expenditure on the scheme was approximately €85 million in 2009, which was a substantial increase on the 2008 figure of €63.4 million. In addition, over the past five years expenditure on the DTSS increased by approximately 60%. In view of this increased expenditure and the current position of the public finances, the Government decided in the context of the budget last December that it was necessary to reduce expenditure on the scheme. The decision was taken to limit 2010 expenditure to the 2008 level of approximately €63 million. This reduction in funding reflects the imperative to achieve overall reductions in public expenditure, while providing essential health services to patients and the public. Having carefully considered the issue, and after obtaining clinical and other advice on the issue, the HSE advised DTSS contracted dentists that the new measures would be introduced from 28 April last. These changes to the scheme will allow the HSE to contain DTSS expenditure at the 2008 level. I have taken on board the points made by both Deputies and I will make them aware of the outcome of talks with the HSE within the next two weeks.


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