Vol. 419 No. 6
58 Mr. Cullimore asked the Minister for Health if he accepts that action must be taken to reduce the waiting lists for orthodontic treatment; and if he will outline the measures, if any, that will be taken to alleviate the present situation.
121 Mr. Yates asked the Minister for Health if he will outline his plans to address the continuing crisis in orthodontic care for children.
155 Mr. T. O'Sullivan asked the Minister for Health if he has satisfied himself with the level of orthodontic treatment available in each health board; and if he will make a statement on the matter.
I propose to take Questions Nos. 58, 121 and 155 together. There has been a significant improvement in the number of children undergoing orthodontic treatment as a result of the special moneys provided by the Government. At the end of 1991 approximately 12,000 were receiving specialist treatment and a further 4,000 cases were being treated at primary care level by trained dentists.
The 1992 allocation to health boards includes a repeat of the special provision to permit health boards to provide continuing orthodontic treatment for cases begun before 1992 and for new cases in 1992.
The recruitment of consultant orthodontists is essential to the development of the health board orthodontic services. Major progress in this area has now been made in the recruitment of such staff and to date appointments have been made by the Mid-Western, the North-Western and Southern health boards. Further appointments are expected within the next few months by the South-Eastern Health Board, the Eastern Health Board and the Western Health Board.
These appointments will considerably enhance the orthodontic services provided by health boards. The consultants will, in addition to their direct clinical involvement, have a major role to play in training staff to specialist and to subspecialist level.
Would the Minister agree he is expressing considerable complacency about a problem which is not within bounds? Is he aware that in the Eastern Health Board area, for example, there are 10,000 people on the waiting list for orthodontic treatment and the best throughout the health board could hope to achieve would be of the order of 2,000 per annum so that we are talking of a typical waiting time of five years for treatment. Would he also agree that the promise of the appointment of orthodontists — first promised about six years ago — has not been fulfilled and that we do not have an orthodontist in the Eastern Health Board area which has the largest population in the country? Will he agree that 2,000 patients are awaiting treatment in the Western Health Board area and that 1,000 people are awaiting treatment in the South-Eastern Health Board area and that this situation applies right across the country? Will he accept it needs more attention than the Minister is offering?
Six years ago, the Deputy's party were in power and they made those promises.
I place great priority on the dental services which, I accept, are not adequate. What I propose doing is to bring before the Government — I must get used to saying that — proposals for improving our dental services, including providing for a compulsory year after graduation of dentists which will give us an additional 50 dentists in the public dental service. That should relieve the pressure on the more experienced dentists. We are recruiting orthodontic surgeons in each health board area who will train a team to work with him. This will not solve the orthodontic service crisis overnight. I would be dishonest if I said I thought I would but the crisis will be tackled effectively. This is a big issue. Expectations are high and people want orthodontic care. The cost of private orthodontic treatment is enormous and Members know this.
Constituents who have got an estimate from their dentist for £1,500 could never afford that amount. An ordinary person could never afford to pay that amount. We must put a proper plan into operation to tackle the problem. At present there are people who will not benefit. We have to try to prioritise those with cleft palate and similar disorders in category I. Dental services for the elderly must also be provided. I invited the dental council to see me to discuss whether the denturists could be brought into the dental service. They should be able to provide a service direct to the public. I have asked the dental council to submit a proposal for the incorporation of these people into the dental service. I think we would all agree that this must be done because there are many elderly people in need of dentures who are unable to get them. I expect to have their proposal in the next few weeks.
We are talking specifically about the orthodontic services. I welcome the admission by the Minister in the House today that the orthodontic services are in crisis. I put it to the Minister that all the promises we have had repeatedly over many years of new recruitments have genuinely come under difficulties because of the lack of trained orthodontists available. Because of the nature of orthodontics and the need to have treatment in a specific time-frame — it is no use telling a young girl that in three or four years we will have it right if such a delay would be the ruination of her facial features — would he accept the suggestion, practised in the United Kingdom, of establishing a national unit that would go from health board to health board until such times each health board had sufficient orthodontists to operate within their own boundaries? At least that would get us over the short term until the ambitions the Minister has put to us in good faith are realised.
Yes, I will examine that point and I will discuss it with the Deputy. I accept we have got to do something positive about it, and I am prepared to listen to any proposals or suggestions by Deputies. I should say that in recent years special additional allocations have been made to health boards for the development of orthodontic services as follows: in 1989 an extra £300,000; in 1990 an extra £567,000; and in 1991 an extra £1 million.
Look at the waiting lists.
The allocation to health boards in 1992 includes a repeat of the special provision for the continuing improvement of orthodontic services. I know this is a big problem but I think we can tackle it. I will examine the problems and look forward to hearing from Deputy Howlin about his suggestion. I am prepared to take on board any positive suggestions that would improve the position.
(Carlow-Kilkenny): Many schoolchildren who are identified at primary school are needing orthodontic treatment simply grow out of the range where they can obtain treatment. I would ask the Minister to consider one of two options: either ensure there is an increase in the number of trainee orthodontists or, alternatively, increase orthodontists' salaries to entice them from private practice. I spent some time on a health board and during that time we appointed three orthodontists, none of whom turned up because they could not give up their private practice. The Minister will have to deal in a practical way with this problem either by paying them sufficiently to entice them from private practice or train an extra supply through the association.
We have already decided to attract them into the public dental service by allowing them certain private practice. A number of orthodontic consultants have been appointed and the advertisement is in for the Eastern Health Board area where the main problems arise. Because of the attractions we will offer and the incentive of an appointment to a dental hospital we expect to be able to appoint orthodontists of high calibre. The orthodontist can train his own team. When we appoint an orthodontist we expect him to train at least four. Subcontracting it out to the private sector would be very wrong and we would never solve the problem. I think we will have this system in operation very soon. I am taking his problem seriously and I have looked at it every single day. I have called in the officials but they assure me that before the end of the year we will have orthodontists in the other main areas and the problem will be tackled. We will not have it tackled immediately but we will make progress. I promise to keep Deputies informed as to how we are progressing because it is a serious and important issue.
