Máire Geoghegan-Quinn
Question:5 Mrs. Geoghegan-Quinn asked the Minister for Health the improvements, if any, in the waiting lists for orthodontic services that will be carried out in 1995. [4616/95]
Ceisteanna — Questions. Oral Answers. - Orthodontic Services.
Noel Treacy
Question:29 Mr. N. Treacy asked the Minister for Health the improvements, if any, in the waiting lists for orthodontic services that will be carried out in 1995. [4572/95]
(Limerick East): I propose to take Questions Nos. 5 and 29 together.
As I outlined in my reply on 26 January 1995 to Parliamentary Question No. 5, regarding orthodontic services, it is estimated in the dental health action plan, which is now being implemented by my Department, that a total of nine consultant orthodontists, supported by appropriately trained dental staff, are required by the health board dental service to meet orthodontic treatment needs at secondary care level.
The position in each health board area regarding the recruitment of consultant orthodontists under the action plan is as follows: Mid-Western — a consultant is in post since 1985; Southern — a consultant took up duty in January 1992; North-Western — a consultant took up duty in February 1992; South-Eastern — a consultant took up duty in September 1992; Western — a consultant took up duty in October 1992; North-Eastern — the board was again unsuccessful in recent attempts to fill the vacant post through the Local Appointments Commission. The board has made arrangements with private specialists to provide services; Midland — the board was again unsuccessful in recent attempts to fill the vacant post through the Local Appointments Commission.The board has made arrangements with private specialists to provide services; Eastern — a joint appointment of a professor-consultant between the Dublin Dental Hospital and the board to replace a recent resignation is expected very shortly. The board is also awaiting a response to advertisements for a further two consultant appointments.
In addition to their own direct clinical involvement the health board consultants organise and carry out a programme of education and training in orthodontic procedures for health board dental staff. These dental staff will provide a high service level of secondary care orthodontic services under the overall direction and supervision of the consultant.
My Department and the health boards will continue to develop the orthodontic services over the course of the dental health action plan so that the level of service provision will be brought to the level of actual treatment need.
I will be making a further £1 million available this year to health boards for further orthodontic developments.
I have also recently asked my Department to review, in consultation with the health boards and their consultant orthodontists, the provision of orthodontic services throughout the country having regard to the provisions in the health strategy, the dental health action plan and the additional resources provided to health boards over the past number of years for developments in orthodontic services.
The time for dealing with priority questions has been exhausted and I am taking the reply and supplementary questions in ordinary time.
Is the Minister satisfied with the grading system in the public orthodontic service? For example, it appears that the grading system used in private orthodontic services is different from that of public orthodontic services and that decisions in public orthodontic services bear little relevance to the needs of the patients?
(Limerick East): I do not accept that is correct. There are three categories in the grading system — category A are the most severe cases such as cleft lip and cleft palate; category B are cases with functional handicap, for example, marked disproportion between the upper and lower jaw and, therefore, marked disproportion between the teeth when they close; category C are non-handicap cases but which still need treatment. The problem is not with the grading system but with the fact that, pending the appointment of consultants, health boards compiled provisional waiting lists. The consultants applied a more vigorous categorisation and some people who had previously been excluded were included while many who were on the provisional lists were excluded. We have all had the experience of parents coming to clinics saying their child was taken off the waiting list. The reason is the categorisation is in accordance with the consultants' instructions and is causing annoyance, to put it mildly, to parents who expected their children would be treated and now find they are not on the waiting list.
All I can do is develop the service in line with resources. An extra £1 million is being given this year. The problem is a difficult one. The latest figures would suggest that, in the opinion of the children and their parents, 55 per cent of them are deemed to be in need of orthodontic treatment. Much of it has to do with medical gain but some has also to do with social gain. In the health strategy there is a commitment to treatment which gives both medical and social gain. We should move away from distinctions used previously which designated some treatments as cosmetic. I do not accept that. There is a social gain.
Other health boards have a more refined system within the categorisation. They have a points system and give treatment in accordance with resources up to a certain point. The demand is far in excess of available resources. Until quite recently sufficient orthodontists were not available to do the work and now there are not sufficient of them to fill vacancies in health boards. Two vacancies exist in two major health boards.
Why does the Minister think there is such difficulty in attracting orthodontists to work in the public sector? Has he any plans to extend the training available to other dental staff to allow them carry out partial orthodontic work which would reduce the waiting lists?
(Limerick East): The primary difficulty is to get people who are prepared to work in the Irish public sector at the rates of pay provided in that sector. Consultant orthodontists are a scarce resource. The health boards and the Department have only recently moved to a consultant driven service. It is highly remumerated.
As regards training, in health boards led by consultants there is a team of dentists. A number of them are involved in training dentists up to orthodontic level. They are increasing the supply of orthodontists but, quite frequently, when they train a group who have worked with them in the health board area they may lose them to the private sector. However, it increases the supply of specialists in the community at large and the price of private treatment has come down somewhat as a result.
Is the Minister aware of the difficulties which arose in the Eastern Health Board region when a consultant orthodontist was appointed? The person appointed was a former constituent of the Minister. Is he aware of the concern raised at the time that adequate co-operation was not forthcoming? The consultant had a salary of £50,000 per year and resigned, it is alleged, because there appeared to be a conflict between what the appointed consultant understood to be the raison d'être and pressure from private consultants to continue to operate contracts within the service.
The Deputy is raising a matter from which the person involved may be readily identifiable.
(Limerick East): This matter has been in the public domain for a long time. The person in question is a consultant orthodontist in Deputy Geoghegan-Quinn's constituency and provides a good service there. It took a long time before health boards were convinced that the service should be consultant driven. There were policy and administrative difficulties within the health boards but they have now accepted this policy. In the Mid-Western Health Board a consultant orthodontist has been appointed since the mid-eighties and it is further ahead than areas such as Dublin where arrangements will be made shortly. Progress is being made. It will be a consultant driven service. They will train other dentists and bring them up to orthodontic level. As regards waiting lists, the worst cases will be taken first. Extra money will be given and £1 million extra has been provided for orthodontics.
Given the difficulties experienced in the Eastern Health Board region, will the Minister monitor on an ongoing basis the development of the orthodontic services given the huge level of dissatisfaction among the consumers of those services with the long waiting lists? Does he accept that this programme needs to be accelerated? There is a need for monitoring given that this person could be successful in another health board area having resigned from the Eastern Health Board.
(Limerick East): I accept what the Deputy said. The policy has been established and agreed and the health boards are co-operating with it. Those in most need will get priority and jumping the queue will go out the window.Some people might not like that.
So Limerick will not do better than us?
Is the Minister aware that some of those who are ineligible for State care and opt for private treatment have been so outraged at the high cost of orthodontic treatment here that they have gone to the North where similar services are approximately one-third less in price? Has he any view on that given that many people will not be eligible for the State's scheme?
(Limerick East): The scheme is not means-tested. If people have a medical or social priority for treatment they will receive it regardless of means. The parents of those children who do not get on to the public list may decide to go privately for treatment. On some occasions, it was cheaper to have the treatment carried out in Northern Ireland but the free market is something that is dear to the Deputy's party. There are more othodontists operating in Northern Ireland and, consequently, the cost of treatment is less. Orthodontic treatment qualifies for tax relief and that is a serious issue for many parents. It is not generally known that it may be claimed against income tax at the marginal rate. This means that people going privately may claim such expenditure against their income tax liability at the marginal rate of tax. Frequently, in the case of children, parents are quoted figures of £1,600 and £1,700 but if they pay tax at the top rate of 48 per cent the cost can work out at about half that amount.