Dáil Éireann debate -
Thursday, 27 May 1999

Vol. 505 No. 5

Written Answers. - Orthodontic Services.

Derek McDowell

Question:

24 Mr. McDowell asked the Minister for Health and Children if his attention has been drawn to the severe difficulties being experienced by the regional orthodontic department at St. James's Hospital, Dublin, in regard to the recognition of training qualifications of dentists being trained there and the impact these difficulties are having on the future staffing by dentists of the service; the steps, if any, he will take to deal with these difficulties; and if he will make a statement on the matter. [13975/99]

Minister for Health and Children (Mr. Cowen)

The joint committee for specialist training in dentistry, JCSTD, a joint British-Irish body representative of the royal colleges, is the body charged with responsibility for approving post graduate training in dentistry in order to ensure that proper and consistent standards are met between these islands.

The JCSTD, through the specialist advisory committee in orthodontics and paediatric dentistry recently carried out a visitation to a number of the health board regional orthodontic units. The purpose of this visitation by the SAC was to provide independent assessment of the suitability of the trainees working in the units, the proposed training programmes and the training centres for post graduate training in orthodontics. The outcome of this visitation is awaited.

Initially it was proposed that the orthodontic unit at St. James' Hospital would be included in the visitation. However, the SAC did not consider it necessary as the committee had visited the unit in the recent past and had already approved a training programme for trainees in the unit. This training programme does not, however, have the agreement of the consultant orthodontist who heads up the unit.

It is important to the staffing of the regional orthodontic units that suitable post graduate training programmes be available to dentists working in the units and I would welcome the establishment of such programmes with the involvement of the two dental schools. However approval of training programmes is a matter for the JCST and the royal colleges.

Jack Wall

Question:

25 Mr. Wall asked the Minister for Health and Children the situation regarding the orthodontic services as they relate to children; the recommendations of the report of the orthodontic review group in this regard; the plans, if any, he has to relax the qualification criteria for children for orthodontic services; and if he will make a statement on the matter. [14080/99]

Minister for Health and Children (Mr. Cowen)

The dental health action plan provides for the development by each health board of a consultant led orthodontic service. A consultant led service ensures a service of high quality and high treatment levels. Seven of the health boards are now operating a consultant led service.

Under the action plan there has been an overall improvement in treatment levels and in waiting times.

The review group on the orthodontic services made its report to the chief executive officers of the health boards. The report of the review group recommended that all health boards use the same severity index to determine need, that resources are provided in this context and that provision of orthodontic treatment should be on the basis of priority need; that all health boards adopt the index of treatment need to prioritise patients for treatment and that appropriate training to develop assessment skills is provided; that the health board dental surgeon refer appropriate patients for assessment at regional orthodontic units through the principal dental surgeon; that orthodontic services, being secondary services should fall within the ambit of responsibility of the acute hospitals manager in each health board; that a steering-co-ordinating group be established in each health board area for dental, orthodontic and oral surgery services; that in the event of additional funding not being available, consideration should be given to the introduction of a system of charges or contributions, means tested in order to increase resources available to enhance the level of service provision; that regional orthodontic units provide courses of continuing education to maintain and upgrade skills and standards; that dental schools continue to be involved in service provision as part of their training programmes in collaboration with relevant health boards. These should be co-ordinated through the regional orthodontic unit in the appropriate health board; that a standard model for costing orthodontic treatment be developed and implemented for each regional unit; that the current policy of having a consultant led service be continued. That each health board have a consultant orthodontist and that the training of consultants in Ireland be facilitated by the regulatory and training bodies; that specialist orthodontists appropriately trained, qualified and registered be employed in regional orthodontic units to ensure the continuation of a high quality service; that regional orthodontic units be involved with the dental schools in the training of specialists on a rotational basis; that hygienists-auxiliaries be employed in regional orthodontic units to complement the role of the specialists, provided that appropriate training and registration is facilitated; that existing dentists employed in the regional orthodontic units be provided with an opportunity of achieving specialist orthodontist qualification; that the revised structure be introduced and funded on a pilot basis in two boards, initially, in order to assess its effectiveness and value for money; that a system of outcome measurement and audit be implemented in each orthodontic service whether directly provided or by service agreement. The group recommends the peer assessment review system; that post graduate training programmes be reviewed with a view to providing training at both specialist orthodontist and consultant orthodontist levels through collaborative programmes prepared and implemented by the dental schools and regional orthodontic units; that health boards as major providers of orthodontic services, as employers of orthodontic staff and as partners in training schemes, should in respect of this service seek direct representation on the dental council and the establishment of a co-ordinating body for the education and training of orthodontic professional and support staff; and that the introduction of relevant and integrated information, treatment planning and telemedicine systems be facilitated as appropriate, at each regional orthodontic unit.

Under existing guidelines for the provision of orthodontic treatment at secondary care level treatment is provided for children in categories A and B. Under the index of treatment need recommended in the report categories range from one – no need for treatment – to five – greatest need. The report states that there is general agreement that those below category four do not justify treatment at secondary care level. Treatment of all persons in categories five and four would require relaxation of exiting criteria for treatment. I have no current plans to ease the criteria for the provision of treatment but I have instructed my Department to take up with the chief executive officers this issue and other issues arising out of the report.