Those eligible under the Health Acts for health board dental services are: (a) Medical card holders and their dependents. (b) Pre-school and national school children in respect of defects noted at child health examinations. (c) Other persons adjudged by the chief executive officer of a health board to be unable to provide a particular service for themselves without experiencing hardship. The Department have issued guidelines to the health boards concerning specialised orthodontic treatment, which I keep under review.
The guidelines were introduced to ensure that the resources for such services would be used to the best advantage and for those most severely affected or handicapped. Orthodontic cases are categorised by the guidelines into the following priority groups in descending order of handicap: Category A. The most severe cases, e.g. cleft lip and palate, somewhat less than 1 per cent of all children. Category B. Cases with severe functional handicap, e.g. marked disproportion between the upper and lower jaws, and, therefore, teeth, about 6 per cent-8 per cent of children. Category C. Non-handicapped cases but having a definite need for treatment, e.g. masticatory and/or speech impairment, about 12 per cent-16 per cent of children. A further category, sometimes called D, caters for the simpler type of case which can often be treated at primary care level by a non-specialist having sufficient skill and experience.
The position regarding orthodontic services in the Eastern Health Board area was outlined fully by my colleague, Deputy Chris Flood, Minister of State at the Department of Health, during the Adjournment Debate of 17 October 1991 at columns 919 to 922 of the Official Report. I am satisfied that, with the investment of additional funding for the third year, significant improvement is being made in the delivery of the orthodontic services in the area.
Primary dental care services are available to school children throughout the health boards. In the Eastern Health Board area the method of delivery of these services varies between community care areas. Some areas operate a demand based system under which care is provided to children whose parents seek it. A number of other areas are changing from a demand based system to a system based on need for care. With this system children in selected classes in the schools are examined in the schools and any necessary care is provided at a designated clinic.
Routine care is also being provided for adults in the health boards' clinics from the additional moneys provided by my Department for the purpose. In the six months to 30 June 1991 the Eastern Health Board provided a total of 4,600 additional treatments for adults. In addition, emergency care is available both to adults and children on a daily basis.
My Department are at present reviewing the provision of both the dental and orthodontic services to ensure that the significant resources being committed to them are utilised in the most cost effective, prioritised and equitable way.