Seanad Éireann - Volume 168 - 08 November, 2001
Adjournment Matters. - Orthodontic Service.
Mr. Costello Mr. Costello
Mr. Costello: The Minister will be aware of this issue, which relates to a young girl who has had difficulty getting orthodontic treatment. This situation is replicated all over the country. It becomes very difficult and frustrating when children reach their teens, and particularly so for young girls, who are anxious to have their braces off their teeth for the various functions they may be attending. Years go by while people are on the waiting list and the orthodontic treatment people expect does not materialise.
I know there are difficulties in recruiting orthodontists but this is a very serious problem all over the country. I raised a similar issue two or three months ago but I do not think that that case is now resolved. We need to come to grips with this and to be able to tell parents that children will be dealt with within a reasonable timeframe. That has been missing over the last few years, as our timeframes have been unreasonable. The Minister should indicate what is the position regarding this case and also what are his plans to ensure that this is not an ongoing problem. We have had indications that there are plans to deal with hospital waiting lists and bed availability but this is one of the worst difficulties. I would be grateful if the Minister could give me some succour and reassurance which I can bring back to the parents of this girl. Then when I am asked in future I can say I have been assured by the Minister that the unsatisfactory system at present, where people are waiting for an unreasonable length of time, is going to end, and end within a certain timeframe.
Mr. Martin Mr. Martin
Minister for Health and Children (Mr. Martin): I thank Senator Costello for allowing me this opportunity to discuss the provision of orthodontic services.
The Eastern Regional Health Authority has advised me that the person concerned was placed on the category II orthodontic assessment waiting list in April 2001 and will be assessed in accordance with her position on the waiting list. I acknowledge the difficulty that the person and her family are enduring. The demand for orthodontics is much greater than can be provided in any developed country and the provision of fixed appliance orthodontic treatment is very expensive. It is important therefore that resources be used as efficiently as possible for those patients most severely affected. Accordingly, health boards assess patients for treatment in accordance with guidelines issued by my Department and, where appropriate, place individuals on waiting lists.
In the case in question the authority has advised me that additional orthodontic staff has been recruited to address the shortfall of qualified orthodontic staff in the region. Category I patients have now all been assessed and the  assessment of category II patients has commenced. There were difficulties in the Dublin region over the last few years which were not just resource related but progress is being made at last.
It is recognised that the waiting times for orthodontic treatment are unacceptably long. At the invitation of my Department, a group representative of health board management and consultant orthodontists reviewed the orthodontic services. The objective of this review was to ensure equity in the provision of orthodontic treatment throughout the health boards. This review has now been completed and structural changes are being introduced in the orthodontic services.
One of the recommendations of the review group was that appropriately trained, qualified and registered specialist orthodontists be employed in regional orthodontic units to ensure the continuation of a high quality service. The Dental Council has set up a specialist register which recognises a dental specialty in orthodontics. An accord has being reached between the Dental Council, the two dental schools and hospitals in Dublin and Cork and the Irish Committee for Specialist Training in Dentistry to establish specialist dental training in this country on a sound footing.
Agreement has now been reached at the Health Service Employers Agency on the creation of the specialist in orthodontics grade in the orthodontic service. In addition, six dentists for the Eastern Regional Health Authority, North Eastern Health Board and South Eastern Health Board commenced their training in October last for specialist in orthodontics qualifications. Furthermore, three dentists from the Western Health Board and North Eastern Health Board are already in specialist training for orthodontics and this brings the total number of dentists in such training to nine. Discussions on providing an additional training course to commence in 2002 are also under way. Through the postgraduate medical and dental board, funding has also been provided for the appointment of a director of specialist training for the Irish Committee for Specialist Training in Dentistry. The postgraduate director will assume his duties in January 2002 and his role will be to promote and ensure that co-ordinated postgraduate training in dentistry of a high standard is provided.
However, it will be some time before these structural changes impact significantly on service levels. The structural changes which will bear fruit in the medium to long-term are now taking place, particularly in the area of training, but in the interim, at the end of last year I asked health boards to develop proposals to make an immediate significant impact on their waiting lists. An additional investment of £5.3 million has been approved for orthodontic services this year, of which £3.7 million is to fund an initiative on orthodontic waiting lists. This will enable health boards – it has enabled some already – to recruit additional staff and engage the services of  private specialist orthodontic practitioners to treat patients.
The chief executive officers of the health boards have informed me of the following progress with their developments under the initiative: two additional consultant orthodontists, six specialists in orthodontics, one dental team and two permanent superintendent radiographers have been recruited; a six surgery facility at Loughlinstown regional orthodontic unit has been developed and is now open, and the treatment of patients there has commenced; the equipping of an additional five surgery unit at the St. James's Hospital orthodontic unit has been completed and the unit is now operational; three orthodontic managers have been recruited in the Eastern Regional Health Authority to manage the orthodontic services of the area health boards; my Department has recently approved a proposal from the Mid-Western Health Board to engage the services of private specialist orthodontic practitioners to treat patients; and my Department has also funded the recruitment of a professor in orthodontics at Cork Dental School to facilitate the development of an approved training programme leading to specialist qualifications in orthodontics – applications for the post were invited when it was advertised on 19 October last. In addition, funding has been provided for the development of new regional orthodontic units at Dundalk and Navan, both of which are operational, and the recruitment of a consultant orthodontist for the Midland Health Board who was appointed earlier this year.
The dental health action plan provides for the development of a consultant led orthodontic service by each health board which aims to ensure a service of high quality and high service levels. All of the boards have now established a consultant-led service and the Western Health Board avails of the services of private specialist orthodontic practitioners. I am confident that the setting up of a specialist register in orthodontics and creation of the grade of specialist orthodontist in the health service should mean a substantial improvement in the recruitment and retention issues and, consequently, in the efficiency and effectiveness of the orthodontic service. Should patients opt not to avail of the public orthodontic service tax relief on the cost of private orthodontic treatment, it would substantially reduce the actual cost of the treatment payable by the patient.
The chief executive officers of the health boards have informed me that at the end of the September 2001 quarter, there were approximately 16,107 patients in orthodontic treatment.
Mr. Costello Mr. Costello
Mr. Costello: Because this young lady is on the category II list, her parents believe it will be so long before the treatment would be available that they have little choice but to avail of private treatment, which would be very expensive for this low income family. They cannot leave the girl without treatment for that length of time. The category II  list is putting people on the long figure and while the treatment is readily available in the private sector, it is of course extremely expensive.
Mr. Martin Mr. Martin
Mr. Martin: I am aware of that. I outlined that there were deep structural issues which had to be resolved in the context of the Irish orthodontic service and this did not happen overnight. I inherited a situation which dates back over a decade where there were issues pertaining to training and to the relationships within the orthodontic  sector, which have not been good. The relationship between some orthodontists and their health boards throughout the country has been very poor. Even within the field itself, there have been many difficulties and the patient has suffered as a result. I am putting in the resources to make sure that we can put that to one side and in the future we will have the services in place but also, in the interim, try and provide additional resources to cut through the waiting lists.
The Seanad adjourned at 2.35 p.m. until 11 a.m. on Wednesday, 14 November 2001.
Seanad Éireann 168 Adjournment Matters. Orthodontic Service.