Vol. 433 No. 7
15 Mr. Clohessy asked the Minister for Health the plans, if any, he has to ensure that children, identified in national school and put on waiting lists for orthodontic treatment who will be attending secondary school in September, will receive necessary treatment; and if he will make a statement on the matter.
Under the 1970 Health Act national school children are eligible for dental treatment in respect of defects noticed at a school dental examination. Children who have left national school remain eligible for orthodontic treatment in respect of defects which were diagnosed while they were still at national school.
In most instances, children are over 12 years of age before they are provided with orthodontic treatment because the individual's dentition has not sufficiently developed until that age.
Apart from the general rule outlined in the Minister's reply there are cases of people identified as entitled to orthodontic treatment while at national school who have seen their entitlement lapse while on the waiting list. Would the Minister agree that it is fundamentally unjust that that should happen? The parents of those children must pay very expensive fees for orthodontic treatment when those children attend secondary school. Those parents are generally in the low to middle income brackets and have to pay for everything and get very little in return for their hard work and the taxes they pay to the State.
The issue of orthodontic treatment raises a number of problems. It is an extremely expensive procedure and is relatively recent. There was no great demand for orthodontic treatment ten years ago and now there is a significant demand for it. It involves a significant cost. That service must be funded by the health service. Considerable resources have been put in place each year since 1990 and a number of initiatives have been taken. Six consultant orthodontists were appointed to the Southern Health Board, the Western Health Board, the North-Western Health Board, the South-Eastern Health Board and the Eastern Health Board. The Midland Health Board and the North-Eastern Health Board are seeking consultant posts and they have the resources to employ consultants.
There has been an increase in the number of orthodontic cases dealt with, from 3,400 in 1988 to more than 5,000 cases per year at present. In the past few weeks I have allocated an additional £700,000 to health boards to further improve orthodontic services. As resources become available I will strive to allocate them to this area.
Will the Minister indicate the number of children under 16 who are awaiting orthodontic treatment?
That is a specific question.
I do not have that figure.
I accept the Minister's point that there is a great need for improvement in all aspects of the health services and that the State cannot be expected to provide endless resources to all sectors. However, given that some people are not entitled to orthodontic and dental treatment provided by the State, will the Minister examine the high cost of these services in the private sector compared to Northern Ireland where similar services can be had for half the cost?
I propose to extend eligibility for free dental services to school children up to the age of 14 years from the end of this year and, as resources allow, up to the age of 16 in accordance with the terms of the Programme for a Partnership Government. That will cover the categories about which the Deputy has expressed concern. I have no control over the cost of private dental services. If people are contracting a service on a private basis they can demand fees off the general public. Unless they are acting in the public service I have no control over them.
(Carlow-Kilkenny): I welcome the Minister's statement that he is to increase the age limit for entitlement to these services but can his proposal be implemented? The South Eastern Health Board, particularly in regard to the Carlow-Kilkenny area, is experiencing difficulties in providing orthodontic services. Has the Minister any plans to consider the payments to orthodontists? Can we entice orthodontists into the public service?
The Deputy will be aware that we have a very competent consultant orthodontist working in the south-east since the end of last year. In fact, she is in the process of training additional dentists in orthodontistry and that is already having a dramatic impact in that area. However, these matters are progressive and as more dentists are trained and skilled in this field the throughput will be better. Also, as additional resources, in terms of people and equipment, are made available improvements will take place. However, the more resources are provided, the greater the demand. Once we have consultant orthodontists and trained dentists in every health board area a demand will arise for consultant periodontists.
I do not accept that the Minister has no responsibility for the cost of private dental services. If we are interested in cost containment in the public service the Minister must take an interest in those people who have been driven from the public health service to the private health care service. The Minister should explain how the high cost of dental and orthodontic treatment can be justified when compared to charges in Northern Ireland. The difference does not make sense to me.
I am slightly intrigued by the concern of the representative of the Progressive Democrats with curtailing the free market forces from determining the value of their work but I am encouraged by her view. I will take an interest in this. Obviously, I have a great interest in the cost of services provided by the State.
I am interested in cost containment in the public health service.
I want to contain costs to the greatest possible extent but the only way I can curtail the cost of services provided on the open market by private practitioners would be to introduce legislation and I am unsure of the constitutionality of such a measure.
