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Dáil Éireann debate -
Wednesday, 16 May 2001

Vol. 536 No. 3

Adjournment Debate. - Orthodontic Service.

Most people are perplexed that in this Celtic tiger economy there has been such a breakdown in our health services. There are waiting lists for all sorts of illnesses, and we hear of delays even where patients require emergency operations.

One of the most extraordinarily long lists is in relation to orthodontic treatment in the Dublin area. I raise on the Adjournment as a last resort a case I want to bring to the attention of the House. I have fought for more than two years to get the young lady in question the dental treatment that she has been diagnosed as needing for more than seven and a half years. When the young lady was ten, the dental service attending the primary school in which she was a pupil indicated that she needed orthodontic treatment, and she was put on a list. When she was 13 or 14 I met her mother on a walkabout in the area in which she lives, Drumcondra, Dublin 9, which is the Taoiseach's constituency, as it is mine. This young lady's parents have been to the Taoiseach and to others in the effort to get dental treatment for her. It took me the best part of a year to get her an appointment to be assessed, and that assessment was done two years ago. Her parents contacted me again to thank me for getting the assessment and said they had been given to understand that their daughter would have been treated by now. I was amazed to hear that she had not been treated.

I have had the most extraordinary difficulty in tracking down who in the health board was responsible for this service, but it appears nobody is because of the mess the Government has made of the health boards in the Dublin region. Even when there was only one health board, the Eastern Health Board, it was difficult to get information. The reorganisation into an Eastern Regional Health Authority and three area health boards, has given rise to the most convoluted problems even in tracking down somebody to talk to. That is especially true if the person happens to live in one health board and the service they seek is provided in another health board area.

I have been in touch with the Eastern Regional Health Authority, the Northern Area Health Board, and the Eastern Regional Health Board. I have been in touch with health centres and dental headquarters, with the dental service in St. James's Hospital, which it took me two weeks to get through to on the telephone. I have been misled several times. I have been told to ring Roselawn Health Centre, St. James's Hospital, and the headquarters of the Northern Area Health Board in Swords.

After weeks of effort on my part as a Dáil Deputy, I eventually spoke to the deputy chief executive. One can only imagine the difficulties ordinary citizens must have. After all that effort, I was told by a senior person in the dental service at St. James's that the health board might pay most of the cost. Then I got some data on it, to the effect that a scheme might be introduced whereby the patient would pay 50% of the cost. I understand that scheme is not yet in operation. In any event my constituent cannot afford it. I received a letter from the deputy chief executive of the Northern Area Health Board in the past few weeks – seven and a half years after my constituent was first diagnosed – informing me that it will be another six months before it will be possible to say when she can have an appointment and, at that stage, she might be told she can have an appointment in 2002 or in 2003 or in 2004. This is a disgrace and I want the Minister to account to this House and tell me when this girl and others like her will get their treatment.

I thank Deputy Mitchell for raising this matter and for allowing me this opportunity to discuss the provision of orthodontic services.

The responsibility for providing services to this young girl rests with the Eastern Regional Health Authority. Inquiries have been made of the ERHA and the Minister has been advised that the person was placed on the category II orthodontic assessment waiting list in November 1994. High priority cases – category I – are dealt with on a priority basis. She was assessed and deemed eligible for treatment by the authority in February 1999 but, due in part to the loss of qualified orthodontic staff, there were delays in providing orthodontic treatment. The ERHA has advised the Minister that it hopes to issue this young person with an appointment in the coming weeks

The Minister recognises that the waiting times for orthodontic treatment are unacceptably long. At the invitation of the Department, a group representative of health board management and consultant orthodontists reviewed the orthodontic services. The objective of this review was to ensure equity in the provision of orthodontic treatment throughout the health boards. Following this review structural changes are being introduced in the orthodontic services. These changes include the creation of the grade of specialist in orthodontics, the development of specialist training programmes and the creation of a grade of auxiliary dental worker to work in the orthodontic area.

However, it will be some time before these structural changes impact significantly on service levels. Consequently, the Minister asked health boards to develop proposals to make an immediate significant impact on their waiting lists. An additional investment of £5.3 million has been approved for orthodontic services this year, of which £3.7 million is to fund an initiative on orthodontic waiting lists. The ERHA has been allocated an additional £2.34 million this year for orthodontic services, of which £1.61 million was for the orthodontic initiative. The chief executive officer of the ERHA has advised the Minister of the following developments in the region in relation to its initiative to improve its orthodontic services: an additional consultant orthodontist has been appointed and the recruitment of another two consultant orthodontists is currently in train—

I was told that two years ago. Here we go again.

It will happen this time.

Two orthodontic specialists have been recruited and a further recruitment drive is in progress to recruit four more; interviews to recruit three managers to manage the orthodontic services in the three area health boards have taken place and their appointments are under way; interviews for posts of dental surgery assistants in the East Coast Area Health Board have been completed and offers of employment have issued – a competition in respect of similar posts in the other area health boards is being organised; a competition to fill the posts of dental hygienist in the area health boards will be organised in the coming weeks; a six surgery facility at Loughlinstown Regional Orthodontic Unit has been developed and is currently being equipped; the equipping of an additional five surgery unit at the St. James's Hospital Orthodontic Unit is being completed; the Northern Area Health Board is currently progressing plans for the development of a new regional orthodontic unit located on the grounds of James Connolly Memorial Hospital; the working group established in the ERHA to report on the implementation of the grant-in-aid scheme is currently continuing its work to finalise the scheme; validation of existing waiting lists is currently in progress; agreement has been reached between the ERHA and the Dublin Dental Hospital on training of specialists to work in orthodontics, and four dentists from the ERHA will commence training in 2001.

The initiative in the ERHA will enable an additional 3,000 patients on the assessment waiting list to commence treatment. The ERHA is striving hard to improve its orthodontic services to an acceptable level and has the Minister's full support in doing so.