Deputy Byrne has given me notice of his intention to raise the situation in the Eastern Health Board area where almost 9,000 people are currently on the waiting list for orthodontic treatment.
Adjournment Debate. - Waiting Lists for Orthodontic Treatment.
The Minister is aware — and is indeed responsible — for the huge waiting lists in the Eastern Health Board area where thousands of patients are awaiting orthodontic care. When one sees the frightening figures of the numbers, for example, on the priority waiting lists, the real crisis in dental care becomes startlingly visible.
There are 8,951 people on the list as follows: category 1 priority, 17; category 2, 3,254, category 3, 2,545 and category 4, 1,635. There are 1,500 people awaiting categorisation, which is equal to a massive waiting list of 8,951. Even at the current rate of 2,250 health board patients completing their treatment each year, it still clearly statistically represents the equivalent of a four year waiting list. It is no wonder the waiting time is four years when only one consultant orthodontist is employed on a full-time basis — and she is only a recent recruit to the Eastern Health Board — and this is for the Dublin region which has approximately 1.25 million people. The sad state of the dental service, particularly in this city, means that it is near total collapse and affects those who cannot afford to pay the extortionate charges in the private dental sector.
How many headlines have you seen about the strike organised by the Irish Dental Association which has been running since October 1987? They will not agree terms with the Minister for Social Welfare to extend benefits to the dependants and spouses of insured workers. This dispute is hurting not only the spouses and children but also insured workers paying full PRSI who are being refused treatment or charged for extractions, root treatment and even dentures. This scandal is matched by the Government's refusal to go ahead with building the long promised Dublin dental hospital. The need to replace the existing dental hospital has been accepted by various Governments for 28 years. The present hospital has been condemned by fire officers as a hazard and they can no longer guarantee the safety of patients and staff using the building. It requires £2 million to comply with fire regulations and this would be only a temporary solution. Why should this be so? Already £1.5 million have been spent acquiring a site adjoining St. James's Hospital, including payment for detailed building plans and design fees.
The Dublin Dental Hospital is unique in so far as it caters mainly for medical card holders and the socially disadvantaged in society. It was built to cater for 2,500 people per year but caters for 1,500 people each week. A high proportion of these people are medical card holders but the hospital also specialises in the treatment of haemophiliacs, HIV positive patients, prisoners and other medically and socially disadvantaged people, many of whom would not otherwise obtain treatment. It also caters for the mentally and physically handicapped.
In addition to providing training for about 200 graduate and post-graduate dental students, the facility proposed for Dublin could also cater for 75 dental students and the library and lecture facilities could be used by students in St. James's Hospital. A sum of £14 million would complete this project; the people of the city need this hospital. If £17.5 million can be found to refurbish the Taoiseach's offices, then £14 million must be found to provide a dental hospital in Dublin. Let us put an end to the pain, suffering and uncertainty of those who have to wait between one and five years for dental treatment. I urge the Minister to look seriously at the situation and to do his best, with his ministerial colleagues, to right a wrong. Let us provide a decent public dental service to the thousands who require it.
The question related to waiting lists for orthodontic treatment. I intend to confine myself essentially to the question to do it justice and I do not intend to go over a wide range of issues which are not directly concerned.
The Government continue to pay particular attention to the provision and development of orthodontic services within the overall general provision of dental services by the health board. As part of this commitment I should like to point out that the Government made available a special allocation of £3 million in the budget for 1990 for the development of dental and orthodontic services. A further £3 million was made available as a special application in the 1991 budget and £1 million was specifically earmarked by my Department for orthodontic services. As a result of these special provisions, 2,500 children began their courses of secondary orthodontic care in 1990. The 1991 allocation has enabled these children to continue their treatment and has also enabled a further 2,500 children to begin treatment this year.
Priority in orthodontic treatment is being given to children in the most severe categories in accordance with guidelines issued to health boards by my Department. The difficulties experienced in the provision of adequate levels of orthodontic services stem to a large extent from difficulties encountered by health boards in recruiting consultant orthodontists. Recently my Department changed the conditions and salary attached to the post of consultant orthodontist which made the post more attractive. The Local Appointments Commission held a competition to fill the existing vacancies in the service with these revised conditions and salary and I am confident that a number of consultant appointments will be made to health boards as a result of this competition.
This is the background to my response to the House on the specific issue of the orthodontic services provided by the Eastern Health Board. I am confident that the House will appreciate my commitment — and the commitment of the Government — to the improvement and development of our orthodontic services.
I will now turn to the specific position in the Eastern Health Board. A consultant orthodontist recently took up duty with the Eastern Health Board and the board are at present making arrangements with her to provide a modern orthodontic service which will include the facility to train the board's dentists in this area of dental care in addition to providing treatment for patients with the most severe orthodontic conditions.
The successful recruitment of a consultant orthodontist will considerably enhance the services provided by the board. In addition to the services of the newly appointed consultant, the board also provide 20 additional consultant specialist treatment sessions per week in various clinics throughout the Eastern Health Board area. These treatment centres are in Old County Road, Crumlin, North Strand, Greystones, Leixlip and Kildare. The board completed 2,250 orthodontic treatments in 1990 and a total of 3,660 children are currently undergoing orthodontic treatment. I should like to point out that in category 1 — the category of greatest severity — the waiting list is as low as 17.
Under the tuition of consultant staff from the Dublin Dental Hospital, seven of the board's dental surgeons have been trained in the provision of secondary care orthodontics. It is proposed that, as soon as possible, the newly appointed consultant will commence orthodontic training of dental surgeons from the health board staff. A further development of this training programme will enable the less severe orthodontic cases to be treated by a specially trained dentist. The board will, therefore, be able to deal more expeditiously with cases requiring treatment and to make further considerable reductions in waiting lists.
These developments indicate that considerable progress has been made recently by the Eastern Health Board in the provision of orthodontic services. The recent appointment of a consultant orthodontist to the board marks a significant development in these services. The services will continue to develop and expand now that we are beginning to get the structure in place for their provision. I do not accept Deputy Byrne's suggestion that the service referred to tonight is near total collapse. The reverse is the case. We will see as the years go by that cases will be dealt with more expeditiously because the consultant orthodontist is in place and we are beginning to train our own personnel from the health board to deal with cases requiring less severe treatment, leaving the specialists free to deal more expeditiously with the more outstanding and more difficult cases.