Vol. 404 No. 8
13 Mrs. T. Ahearn asked the Minister for Health the steps he intends to take to change the practice whereby only students who are deemed to be in need of orthodontic treatment in 6th class in primary school are provided with treatment, thereby eliminating many needy and deserving cases which become evident, at a late stage, to be in need of orthodontal treatment and who are excluded as they did not satisfy the guidelines when they were in 6th class.
The Health Act, 1970, requires the health boards to make dental treatment available to pre-school and national school children and to medical card holders and their dependants. Health board dentists carry out an assessment of all primary school children at about 12 years of age. This is considered to be the appropriate age to ensure that the permanent dentition is sufficiently developed to facilitate the assessment. Children so assessed and found to meet the guidelines for treatment retain eligibility for free treatment even after leaving primary school.
While only children of medical card holders retain elegibility for dental services after leaving primary school the chief executive officer of a health board can, if warranted and on hardship grounds, deem a person, other than a medical card holder, as being eligible for a particular service free of charge.
If the Deputy has a specific case in mind, I would be glad to receive the details and to look into the matter.
I submitted this question because I have several cases in mind. Will the Minister agree that children mature at different ages? What is his response to children over 12 years of age who exceed the guidelines and who are not eligible for orthodontic treatment but whose parents cannot afford it? Does the Minister intend to take any steps to ensure that such cases receive orthodontic treatment? It is my experience that once they have been deemed ineligible in sixth class in primary school they find it impossible to get such treatment.
If the Deputy forwards me information on each of the cases concerned I will pursue them with the appropriate health board as I would like to know why they were not diagnosed before leaving primary school. While I am aware that problems are being experienced in the general dental service, it was not brought to my attention that this problem existed in the orthodontic service. Most are diagnosed in primary school and many wait until they leave school before getting treatment. It is important to establish the reasons the person to whom the Deputy has referred were not diagnosed while in national school. I would be grateful if the Deputy forwards me their names.
Would the Minister not agree that the guidelines are too severe? Furthermore, if these pupils, whose names I will supply do need orthodontic treatment, will the Department provide the necessary finance and resources to the health board to ensure that they get it?
The guidelines to which the Deputy has referred were laid down by my predecessor, the former Deputy Barry Desmond in 1985 and list five different categories. I do not want to get political but there was a time when extra funds were not put into the dental service. I am very proud of the fact that we allocated an extra £3 million to that service last year and a similar sum will be provided this year. There has been a large increase in the number of people receiving treatment even though I accept that there are people still on the waiting list.
A number of Deputies are offering and I will try to facilitate them if they will be very brief.
It is obvious that the Minister is not aware that former Deputy Barry Desmond was the first Minister for Health to appoint orthodontists.
Ceist, a Theachta.
To follow up the question asked by Deputy Ahearn, the diagnosis is often made at the appropriate time but, unfortunately, treatment cannot be provided due to a shortage of orthodontists. When children leave school they are told they can only get such treatment if they pay for it. Their eligibility is only called into question at a later stage.
In my initial reply I pointed out that when the diagnosis is made before the child leaves primary school the child is entitled to treatment.
They cannot get it. Being entitled to it is one thing, getting it is another.
It is clear that too many Deputies are offering.
This is a major problem.
It is a very important question.
I agree but all questions are of equal importance to the Chair.
Would the Minister not accept that there are waiting lists for orthodontic treatment in all health board areas and that even though children may be deemed eligible for such treatment the health boards are not in a position to provide it due to a lack of funding?
I have already dealt with that question. I accept that there is a waiting list and because of my concern and that of the Ministers of State, Deputy Leyden and Deputy Treacy who had a particular interest in dentistry while in the Department, the Government provided an extra £300,000 in 1989, an extra £3 million in 1990 and a similar figure in this years budget to deal with the problem. We are making substantial progress but, just like the lists for other services, the waiting list cannot be cleared in one year. With regard to the important point made by Deputy Ferris, when the former Deputy Desmond advertised for five orthodontists the health boards were only able to recruit one. The position remains the same today. Therefore it is not fair to say that it all comes down to the lack of funding.
I was interested to hear the Minister say that if we have a problem to let him know because one could send umpteen problems. I think the problem arises from the guidelines which have been mentioned. I have no doubt that I will get the wholehearted support of Deputy Dennehy, who raised this question at the health board, in raising the question of the guidelines——
Deputy Dennehy is nodding his head vigorously.
May I ask the Minister if he proposes changing the guidelines, which are very restrictive given that children are being turned away because it is considered that all they require is cosmetic treatment? That is not the case.
Let us have brevity, please.
What they require is orthodontic treatment. Would the Minister consider reviewing the guidelines in the future?
Is the Minister aware that the reason the health boards failed to appoint consultant orthodontists is that the terms offered were not attractive? Is he further aware that category 2 patients are now being told that they will have to wait for at least two years for attention and that, ultimately, both category 1 and category 2 patients will have to seek private treatment which will have to be paid for by their parents after they leave primary school?
I accept the reason orthodontists were not attracted to the health service may well be related to the conditions of service offered, but we have now reviewed these and are making substantial progress in our efforts to make the post more attractive. However, we are still faced with the difficulty that there are insufficient orthodontists available. Even if we were to double the salary offered we would still be faced with the same problem. The answer is to train them and progress has been made with the Dental Hospital in Dublin in this regard.
A large number of Deputies are offering: Deputies Dennehy, O'Donoghue, Moynihan, Creed, Connaughton and Bruton from whom I will take the final question. I am anxious to facilitate all the Deputies.
Every Member is aware that there is a shortage of orthodontists in the public service. May I ask the Minister if there is any method of controlling the fees charged by private orthodontists given that people would be willing to pay but the fees are outlandish? As long as this remains the case they will not work in the public service.
There is no method open to my Department to control the fees charged by consultants.
The Minister has outlined what has been done in the school dental service, but I would like him to outline the position in the Killarney urban area where there are 1,200 pupils. Since the Minister terminated the scheme in June 1987 no public dental service other than emergency service — which means extractions — has been provided for those school children. Extractions are not the answer to the problem.
This question relates to a specific person, the child who leaves school and does not qualify for orthodontic treatment. I do not have the answer to the Deputy's question which relates to the dental service in Killarney but I can assure him that the ad hoc dental service only began to break down in 1985.
It was terminated in 1987.
Can we hear Deputy O'Donoghue please?
Would the Minister not agree that it is extremely difficult to attract orthodontists into the public service and that the reason for this is the severe shortage of orthodontists in the country? Would he further not agree that there is a necessity to review the educational procedure with the aim of encouraging more people to become orthodontists and that much of the work referred to orthodontists could be done by ordinary dentists?
Deputy O'Donoghue is quite right. More of the most simple type of orthodontic work is being done by dentists and more post-graduate training is available now through the dental hospitals. I have discussed with the dental hospitals how they might fit in with the facilities provided in Dublin by the Eastern Health Board to ensure that the maximum orthodontic service is available. We have provided the extra funding but there still is the problem a number of Deputies have alluded to.
Deputy Creed. I am sorry, Minister, if I cut you short.
Will the Minister accept that, with regard to those diagnosed as in need of orthodontic treatment, there is only an appropriate period thereafter in which those works can be carried out and failure to do so is leaving large numbers of young people with severe psychological scars which are preventing them taking their proper place in society? By virtue of failure to secure this treatment their confidence is shattered.
Yes, there has been a serious problem going right back through the eighties in the provision of orthodontic services and, as a result of lack of funding, my predecessor, Deputy Barry Desmond, brought in guidelines to establish who would benefit and who would not.
What is the Minister going to do about it?
We have provided the funding; we are working on the list and, of course, we would be glad to expand the number of patients——
I have to admonish Deputies that they may not shout down anyone in this House. I will not tolerate it.
It is about time you started blaming everybody.
I will take no lecture from you, Deputy Ferris, or anybody else.
It is time the Minister——
Next question. I was hoping Deputy Bruton might finalise this question by way of a supplementary.
First, one point of clarification. Last year £17 million was provided for the dental services. Will the Minister confirm it will be £3 million up on that £20 million this year? Further, will he consider some sort of scheme whereby those on the waiting list for a long time could be considered for treatment by private orthodontists from health board subvention?
I can confirm that £3 million is being provided this year in the budget as there was last year.
So, will it be £20 million in the coming year?
I have not got the exact amount that was spent last year on the dental service in each health board area. That information is not available to us yet.
The Minister published it in his book.
All I am saying is that this year £3 million is being provided.
On top of last year's provision?
Some may have spent more last year. I have not got the figures. On the question of private dentists——
Question No. 14.
What advice can the Minister give to parents of children——
