I propose to take Questions Nos. 7, 13, 36, 39, 55, 63, 66, 69, 73 and 126 together.
For the past few years the Government have made available a special allocation specifically for the development of the adult dental services and the provision of orthodontic treatments. A sum of £3 million was provided by the Government in 1990 and a further £3 million was provided in 1991. The special allocation has enabled health boards to bring an additional 2,500 orthodontic cases into specialist treatment in 1990 and a similar number onto specialist treatment in 1991 and at the end of that year over 12,000 children were receiving treatment. About another 4,000 receive treatment at primary care level. The allocations made available to health boards in 1992 include a repeat of the special provisions of 1990 and 1991. At current levels of treatment health boards are completing over 5,000 cases annually.
A post of counsultant orthodontist for each health board had been approved by my Department but health boards had difficulty in filling them because those orthodontists with the qualifications necessary for appointment found private practice more attractive.
However, following a review, the pay and conditions attached to the post were significantly improved by my Department and vacancies were re-advertised by the Local Appointments Commission in 1991. As a result a number of health boards have now successfully made appointments.
The position in each health board is as follows:
Eastern:— The board proposes to make shared appointments with the Dublin Dental Hospital and interviews of candidates are due to be held this month.
Midland:— The board were unsuccessful in the Local Appointments Commission competition and have made alternative arrangements with private specialists to provide services. The board will again endeavour to fill the vacant post of consultant orthodontist in the near future.
Mid-Western:— A consultant is in post since 1985.
North-Eastern:— The board was unsuccessful in the Local Appointments Commission competition and have made alternative arrangements with private specialists to provide services. The board will again endeavour to fill the vacant post of consultant orthodontist in the near future.
North-Western:— A consultant took up duty in February, 1992.
South-Eastern:— A consultant took up duty in September, 1992.
Southern:— A consultant took up duty in January 1992.
Western:— A consultant has been appointed this month.
Five health boards, out of a total of eight, have orthodontic surgeons. The successful recruitment by health boards of consultant orthodontists will considerably improve the services provided by the boards.
At present, average waiting times for children seeking orthodontic treatment vary considerably throughout the country, but with the recruitment of the consultant orthodontists it can be expected that there will be considerable improvements in the waiting times. In this regard a primary task of the consultant orthodontist is to organise and co-ordinate orthodontic training to specialist and sub-specialist levels for health board dental staff to enable health boards to provide a greatly increased volume of service. The level of service now being provided has generated an increased expectation and consequently demand.
The provision of fixed appliance orthodontic treatment is very expensive. It is important therefore that resources be used to best advantage and for those most severely affected or handicapped. Accordingly my Department issued guidelines to health boards on the classification of cases awaiting treatment in descending order of severity or handicap. Children have been assessed for treatment by health boards in accordance with these guidelines and, where appropriate, placed on the waiting lists.
According to information supplied to my Department by the health boards the current waiting lists are as follows:—
Health Boards
|
Categories
|
A
|
B
|
C
|
Eastern
|
40
|
5,572
|
3,847
|
Midland
|
|
1,120 (B and C)
|
Mid-Western
|
|
538 (B and C)
|
North-Eastern
|
9
|
517
|
1,398
|
North-Western
|
542 (in categories broadly equivalent to A, B and C)
|
South-Eastern
|
35
|
2,492
|
337
|
Southern
|
48
|
437
|
12
|
Western
|
Nil
|
1,300
|
745
|
All health boards are reviewing their waiting lists with a view to increasing throughput of patients treated. At national level I am giving consideration to what further action is necessary in the context of 1993 estimates.