Dáil Éireann debate -
Tuesday, 29 Feb 2000

Vol. 515 No. 3

Adjournment Debate. - Orthodontic Service.

Mr. Naughten

I thank you, Sir, for giving me the opportunity to raise this important matter on the Adjournment and I thank the Minister for being present in the House. The Department of Health and Children is failing to uphold its policy on dental health. The dental health strategy of the Department states that central services are to be provided on a basis of need and not on the ability to pay or on geographic location.

This policy is being reneged on on two fronts in the Western Health Board region. First, children in the south County Roscommon area are not receiving the same level of dental service which their counterparts are receiving in other parts of the county. These children have been without any dental service for the past six months. The Department has now approved a six month pilot programme in the area, but only children in certain classes – sixth, fourth and second – will receive a service under the Department's proposals. Children in other classes will only receive an emergency service. None of the children will be provided with a service in their local health centres and they must travel to either Athlone, Ballinasloe or Roscommon to receive dental treatment.

The parents of the children involved want this pilot scheme to be immediately expanded to include all school-going children, thereby ensuring that they have the same access to treatment as other children in the county. The long-term solution to this problem can only be resolved by the appointment of a full-time dentist to the health centres in the south County Roscommon area. The health board has advertised the position on numerous occasions but has been unable to attract anyone to the post. This problem is fundamental to a community health service.

A dentist, or any other health professional, receives the same remuneration and works under the same conditions as his colleagues in Dublin 4, Galway city, Cork city or the rural parts of County Roscommon. Positions in these urban centres are more attractive to young health professionals. The Western Health Board is unable to filll a number of professional positions throughout the region. If the Minister agrees with equality of treatment, what measures will he put in place to ensure that these vacancies are filled as soon as possible?

There are two aspects to the inequality in the provision of orthodontic services for children in the Western Health Board region. First, the children must, on average, wait longer for treatment than children in neighbouring health board regions. The waiting list on a per capita basis is as bad as the worst region in the country, the Eastern Health Board region. Why should children attending the same school in Athlone be treated differently? A child in the midland region is treated twice as quickly as a child seated at the same school desk who is on the waiting list in the Western Health Board region. Is this equality?

Second, the 1985 orthodontic guidelines set by the Department are being interpreted differently by various health boards. There is a lack of standardisation of the assessments procedure between the boards. As the Western Health Board has a large waiting list, the orthodontists must strictly interpret the guidelines while other boards, such as the Midland Health Board, take a much more liberal view. This is not equality.

Children in County Roscommon are being discriminated against with the endorsement of the Department of Health and Children solely due to their geographic location. This flies in the face of the Department's guidelines and the Constitution. These issues can only be resolved by the provision of adequate funding to recruit additional dentists and orthodontists in the Western Health Board region. The Minister must not allow the current situation to continue, where children sitting at the same school desk but living in different counties receive a different health service. If grandparents live in County Westmeath parents try to transfer their children to be covered under that area to ensure they get a proper dental or orthodontic service. There is a two-tier system in terms of health board regions with a huge disparity in the service being provided in south Roscommon and south Westmeath because they are in two separate health board regions.

Minister for Health and Children (Mr. Martin)

I thank Deputy Naughten for allowing me the opportunity to discuss the orthodontic services in the Western Health Board area and the children's dental services in south Roscommon.

Orthodontic treatment services continue to be developed in accordance with the dental health action plan. The action plan provides for the development by each health board of a consultant led orthodontic service which ensures a service of high quality and high service levels. My Department has made additional resources available to the health boards to assist with the development of their orthodontic services in accordance with the action plan.

The Western Health Board, with the assistance of funding from my Department, has established a regional orthodontic unit at Merlin Park Regional Hospital. The unit is headed up by a consultant orthodontist. Three whole-time dentists and three part-time dentists currently provide services under the overall direction and supervision of the consultant. My Department has given approval for an additional £150,000 in the year 2000 for the future development of the board's orthodontic services.

The demand for orthodontics is much greater than can be provided in any developed country. The provision of fixed appliance orthodontic treatment is very expensive. It is important, therefore, that resources are used as efficiently as possible for those patients most severely affected. Accordingly, the Western Health Board, in line with the other health boards, assesses patients for treatment in accordance with guidelines issued by my Department in 1985 and, where appropriate, places individuals on waiting lists. I am concerned at the size of the waiting lists nationally and I have asked my officials to review the situation in relation to this issue. As the Deputy is aware it is not just an issue of funding. There are far more deeper issues in the service which must be addressed.

Dental treatment services for children are also being developed by health boards in accordance with the dental health action plan. For the past number of years health boards have adopted a planned targeted approach to the delivery of dental services to national school children and have phased out a demand led service. This is to ensure the optimum use of dental resources and equal access for all national school children to the same level of dental care. The school based approach puts an important emphasis on dental health education and prevention. Dental health education programmes are now available to all national schools.

Children in specific classes in national school, usually second, fourth and sixth classes, are targeted for preventive measures under the school based approach. The children in these classes are screened and referred for treatment as necessary. The programme has been specifically designed to ensure children are dentally fit before they leave national school. The small number of children who require more frequent attention are identified via this programme and the required level of advice, check-ups, treatment, etc., is provided as appropriate.

Unfortunately, some health boards can have difficulty in filling dental posts in geographically remote areas and in fully implementing the school based approach. In the case of the Western Health Board region, the board has experienced difficulty in recruiting and retaining appropriately qualified dentists to provide services in some areas such as south Roscommon. Unfortunately, this has resulted in an inability on the board's part, despite its best efforts, to provide an adequate level of service for the school children in the south Roscommon area. The board has held interviews on a number of occasions over the years in an effort to fill vacancies as they arise and staff from other countries, including Britain and Germany, have been employed at various times. It is open to any qualified dentist to respond to an advertisement placed by the board. The board is also in continuous contact with the dental training schools in an effort to recruit temporary staff.

I am pleased to inform the House that some developments are currently taking place which should help the Western Health Board with its persistent difficulties in recruiting and retaining dentists. Following successful conclusion of the negotiations carried out under the auspices of the Health Service Employers Agency, I have asked the health boards to implement revised structures for dentists employed within the health board dental services. Under these revised structures additional duties will be assigned to existing staff and additional promotional outlets will be created. The revised structures are designed to improve the efficiency and effectiveness of the dental services. It should also help to increase the attractiveness of employment within the health board dental services making the public dental services an attractive career option to new graduates as well as appealing to dentists returning to this country after working abroad. I am quite hopeful that the restructuring of services will ease recruitment difficulties being experienced by many boards.

Also, in view of the exceptional difficulties encountered by the Western Health Board and following approaches made by the board, my Department has given approval for a pilot project to be carried out in order to further address the problems being encountered in relation to recruitment and retention of dentists in the health board dental services. Under this pilot project health board dentists working after hours in certain specified areas may provide services for children who have left national school on a fee per item of service. This pilot project encompasses south Roscommon. The arrangement is to operate strictly on a pilot basis for six months and will be closely monitored by both the Western Health Board and my Department.

I am hopeful that the measures outlined above will considerably improve the dental service in the Western Health Board region and that all eligible children will receive an adequate service while in national school and thereafter up to their 14th birthday.