Vol. 411 No. 6
6 Mr. Durkan asked the Minister for Health if he will outline the steps he proposes to take to provide a proper orthodontic service through the various health boards throughout the country; if his attention has been drawn to the serious deficiency in such services at present; and if he will make a statement on the matter.
A special allocation of £3 million was made available in the budget for 1990 for the development of dental and orthodontic services. A further £3 million was made available as a special allocation in the 1991 budget and £1 million was specifically earmarked by my Department for orthodontic services. As a result of these special provisions an additional 2,500 children began their courses of secondary orthodontic care in 1990. The 1991 allocation has enabled these children to continue with their treatment and has enabled a further two and a half thousand children to begin treatment this year. Priority in orthodontic treatment is being given to children with the most serious orthodontic conditions in accordance with guidelines issued to health boards by my Department.
The level of orthodontic service provided by the health boards has been affected by difficulties in the recruitment of consultant orthodontists. The Local Appointments Commission recently held a competition to fill existing vacancies with improved conditions and salary and I am confident that at least two additional consultant appointments will be made to health boards as a result of this competition. The recruitment of consultant orthodontists will considerably enhance the orthodontic services provided by health boards.
As well as providing a major clinical commitment, it is envisaged that as soon as possible the newly appointed consultants will commence orthodontic training of dental surgeons from the health boards staff. This training programme will enable the less severe cases to be treated by a specifically trained dentist and the health boards will, therefore, be able to deal more expeditiously and effectively with cases requiring treatment.
The Minister's reply — for which I thank him — is thorough, laudable and plausible; but, unfortunately, it does not address the problem. Is the Minister aware that it will probably take about five years to clear the number of children on the list of orthodontic treatment given the present rate of progress? By that time most of them will have to be dealt with by private orthodontists although many parents of these children hold medical cards. The orthodontic service available throughout the country does not cover the vast majority of people eligible for it; it simply is not working. Will the Minister agree that the measures now being taken are totally inadequate to deal with the problem and will not resolve it within the next five years? At present, due to a lack of expenditure there is merely talk about the problem but nothing is happening.
I do not agree with the sentiments expressed by the Deputy because real progress will be made in regard to this issue, particularly waiting lists, when the consultant orthodontists are put in place. This has only been achieved because the Minister for Helath improved the terms and conditions to enable consultant orthodontists to be recruited. This has been effective because of the campaign in the middle of the year by the Local Appointments Commission. When the consultant orthodontists are appointed they will have an opportunity to train existing dental surgeons within the health boards to provide orthodontic care of a secondary nature so that the more severe cases can be dealt with by the consultants, which is considerable progress. Attempts were made as far back as 1983 to recruit consultant orthodontists without success. Only one consultant orthodontist was recruited since 1983, that was in 1985.
On a point of order, did the Minister intend to reply to a number of questions together?
I will be taking Questions Nos. 7 and 27 next.
A number of Deputies indicated that they wished to ask supplementaries and I am anxious to facilitate them. Of necessity, they must be very brief. I will name them: Deputy Creed, Deputy Boylan, Deputy Belton, Deputy Therese Ahearn and Deputy Byrne.
If the Minister will deal with Question No. 7 I will not ask a supplementary.
I call on Deputy Boylan.
It is strange that the Minister did not see fit to answer Question No. 30 in my name——
Please Deputy, that question——
I object to the Minister taking a number of questions. I tabled my question——
I do not have any control over that.
I tabled a relevant question——
I told the Deputy to ask a relevant question.
I have a relevant question.
The Deputy had better ask it.
I mean no disrespect but I have had a relevant question in relation to this serious ongoing problem since I came into the House in 1987. However, I only get bland answers which are of very little benefit to the children who are in acute need of treatment now.
I am still waiting for the Deputy to ask a question.
I am told by the experts in this field that there is a time-scale in relation to treatment. If treatment is not carried out at a certain age irreparable damage is caused. Earlier this year the Minister said that when an acute case was identified by the health board and a private orthodontist was available he could perform the treatment——
I ask for brevity but I am not being respected in that regard.
Is the Minister honouring the commitment he gave regarding treatment by a private orthodontist?
That is sufficient, Deputy.
Deputy Boylan referred to Question No. 30, which is very specific and requires a detailed reply. I hope we will reach his question when I can give the information sought by the Deputy. As far as this question is concerned, with the progress being made in the recruitment of consultant orthodontists and the additional allocation of resources which the Minister for Health was able to——
We have been listening to that for the last five years.
Reasonable and considerable progress will now be made.
We are not making progress.
Deputy Boylan, please.
It is not acceptable.
If it is not acceptable, you have a remedy without creating disorder in the House. Does Deputy Ahearn wish to ask a question?
Does the Minister accept that the orthodontic service is in total chaos? I stood in a corridor with 70 parents but only five children were accepted for orthodontic treatment. Is the Minister serious about increasing the finance available for the service? Furthermore, if the service is improved will he be prepared to allow those who have been turned down for orthodontic treatment but who are in urgent need of it to be reassessed?
I accept what the Deputy says in so far as there has been a lack of investment in the whole service — although not just in the last couple of years but indeed throughout the eighties — which has given rise to a growing waiting list. However, now that we have allocated additional resources to this part of the dental service we will make progress in an ordered and structured way. We are talking about the allocation of £6 million over the last two years in this general area. In conjunction with the appointment of consultant orthodontists, it will significantly improve the service, not just on an ad hoc basis but on a planned, structured basis so that nationally the waiting list can be dealt with and reduced. This is the way to deal with the problems to which the Deputies referred.
I call Deputy Belton and will hear a final question from Deputy Byrne.
Will the Minister say what health boards are involved in the two appointments? Will he also say whether he or his Department considered allocating this work on a contract basis? There is no point in the Minister saying he is dealing with the problem because he is not. Why has this urgent need not been tackled by way of contract work?
That is adequate, Deputy.
I understand that one appointment was made in the Eastern Health Board region. I do not have information in regard to the second and third appointments but I will forward it to the Deputy. The matter may well be tied into finalising contracts, etc. I should also like to point out that, pending a permanent appointment to the Southern Health Board, a consultant took up a temporary post with this board with effect from 1 September 1991.
Deputy Belton rose.
Deputy Byrne has been called.
I asked a second question.
I am sorry, Deputy, I do not have any control over the Minister's replies and very little control over Deputies' questions.
The Minister did not answer my question.
The extra resources referred to by the Minister will only allow the Eastern Health Board to service the needs of those already in the system for orthodontic service. It will not shorten the waiting time for the 9,000 people currently on the waiting list for Eastern Health Board orthodontic treatment. With 2,250 people going through the system each year and a total of 9,000 on the waiting list, it will mean that the average waiting time will continue to be four years.
Let us have brevity and relevance.
It is relevant because the resources that have been allocated will only allow those people within the system to continue their course of treatment. It will not reduce the waiting list.
If Deputies want to debate this issue they will have to find another time to do so.
Perhaps the Minister will take an opportunity to answer that point.
As I have already pointed out, as a result of the special allocations 2,500 children began courses of secondary orthodontic treatment in 1990. The additional allocations made in 1991 enable these children to continue with the treatment as well as enabling a further 2,500 children to begin treatment this year. That is significant progress in this regard.
In reply to Deputy Belton, the question of employing private orthodontists has been the practice in a number of health board regions. However, it is not accepted by the professionals in health boards as a system whereby specialist orthodontic treatment ought to be provided by the health board. That is why the recruitment of consultant orthodontists has been proceeded with. The terms and conditions have been changed in an effort to have appointments made to all health board regions so that the health boards through their own staff, facilities and professionals provide a good level of care, which is the entitlement of those who seek it.
It has not worked and the Minister knows that.
I would like to ask the Minister if it is true that children in classes lower than sixth class in national schools are not entitled to free dental treatment. If it is true, does the Minister think it is proper and will he take steps to rectify the matter?
Children in the classes referred to by the Deputy are entitled to dental treatment. As part of the restructuring of the provision of dental care to primary school going children there is detailed examination of children in specific classes. All children as they go through the primary school sector are entitled to free treatment and will be dealt with.
May I ask a final supplementary question in view of the fact that I put down a question?
We have had a virtual debate on this subject.
I would like to ask a very short question. Is the Minister aware that some of the guidelines set down by his Department exclude children as being ineligible for orthodontic treatment through the health boards despite the fact that private orthodontists have deemed them eligible for treatment?
There is no treatment for any of them.
The Minister should answer the question.
The system has collapsed.
I will answer that question with No. 7.
7 Mr. G. O'Sullivan asked the Minister for Health if his Department are considering any changes in the guidelines for orthodontic treatment for eligible patients; and if he will make a statement on the matter.
27 Mr. Creed asked the Minister for Health if he will revise his Department's guidelines for specialist orthodontic treatment.
I propose to take Questions Nos. 7 and 27 together.
Guidelines in relation to the provision of orthodontic treatment at specialist level were issued by my Department in 1979 and updated in 1985. These guidelines prioritise orthodontic treatment by the degree of handicap and severity of the orthodontic condition. Health boards have been asked to review all cases presenting for orthodontic treatment in accordance with these guidelines.
It is important that the guidelines have regard to advances and developments in the provisions of orthodontic treatment. They should be generally acceptable and be in accordance with internationally accepted norms. Accordingly, the Minister for Health, Deputy O'Hanlon, has asked the chief dental officer of the Department of Health to undertake a further review of the guidelines in consultation with consultant orthodontists to see whether any updating of the current guidelines may be necessary. We are currently working on the 1985 set of guidelines.
Would the Minister accept that there has been a reduction in the list for orthodontic treatment as a result of people fleeing the system because they have no realistic chance of getting treatment under the present guidelines which are too restrictive? Accepting that treatment is quite expensive would the Minister consider introducing a system of grant aid to patients who are eligible but have no realistic chance under the present arrangements of getting treatment? Those who remain on the list have no realistic chance of treatment and those who have some means are leaving to undergo private treatment. Would the Minister consider introducing a system of grant aid in an effort to give some realistic hope of treatment to those on the list at present?
The Deputy referred to the current guidelines as being too restrictive but I would remind him that these guidelines were drawn up in 1985.
So what?
The Government have had four years to revise them.
Order. Deputy Creed, you have asked some questions. Please be good enough to listen to the replies.
I fail to see the relevance of harping back to 1985.
Please, Deputy Creed.
The Deputy is embarrassed by what the Minister has said.
Not half embarrassed as the people over there.
The only policy of this Government is that of kicking back.
I have already made the point that these guidelines are being reviewed arising from a decision taken by my colleague, the Minister for Health, and I am sure that such a revision will meet the points made by various contributors here today. As regards grant aid, I do not believe that is the way to deal with the waiting lists which have built up over the years under different administrations. The way to proceed is to provide sufficient additional allocation of resources——
The Minister is not doing that.
——so that the personnel to whom I have already referred in an earlier reply can be recruited and additional children can be treated. Those treatments are continuing because additional resources are being made available by my colleague, Deputy O'Hanlon.
Talk to the practitioners.
It is a disaster.
The Minister knows that is not the case.
I think there is agreement on all sides of the House that this is a very important service. Would the Minister not agree that regardless of when the guidelines were laid down they are extremely restrictive? Therefore, people bringing their children to orthodontic clinics are told that their children are outside the guidelines but that they can be treated privately for £2,000? Most of these people are medical card holders. There must be some merit in reviewing the position to ensure that people who need treatment get it. The Government cannot meet the demands of those who come under the existing guidelines but there are also others in need of treatment. Would the Minister not agree that the guidelines are too restrictive?
It may be that the guidelines drawn up by the then Minister for Health, Mr. Barry Desmond, are too restrictive.
Why not change them?
I have already indicated that they are now being reviewed by the chief dental officer in my Department and I expect that the points made by the Deputy will be taken into account. The only way in which the backlog which has built up over the years can be dealt with is by the allocation of additional resources, taking into account the points made by the Deputy about the restrictive guidelines.
When can we expect new guidelines?
Is the Minister aware that under the existing guidelines as many as 10,000 people across the country who have been accepted for treatment are being told by the health officers involved that they will not get treatment, that there never will be treatment for them under the present regime? How then stands his legal commitment under the Health Act to provide service for these 10,000 people?
I would welcome receipt of information on any professional who has indicated that.
The Minister wants to hound the officials who deal with the people.
It is like the Morrison visas.
As I have already pointed out, the additional resources which we have been providing, not just on a once-off basis but for the last two years, will make an impact. The Deputy can be sure that we will endeavour to provide in so far as resources permit an additional allocation of resources for the coming year. By doing that in an ordered, structured way, using personnel recruited directly to the health service, we will begin to reduce the waiting lists and hopefully they will be reduced considerably. These waiting lists have built up over a number of years and we are now working in a structured and ordered way to deal with them.
If, as a result of the review, the guidelines are made less severe would the Minister be prepared to allow those who have been refused orthodontic treatment to be re-assessed, or will it be a case of hard luck, the child was in sixth class at the wrong time?
It is not for me to preempt the outcome of the review of the guidelines and I certainly would not want to do that here, but obviously all the factors will be taken into account. The guidelines, when they are set down, will be clearly set out so that everybody will understand who is entitled to treatment and who is not so entitled.
