Dáil Éireann debate -
Wednesday, 4 Jul 2001

Vol. 540 No. 2

Written Answers. - Orthodontic Service.

Michael Ring

Question:

160 Mr. Ring asked the Minister for Health and Children the amendments which were made to the 1985 orthodontic guidelines drawn up by his Department following the report of the review group on orthodontic service; the implications of the report; and the proposals which have been implemented by the health boards as a result of the report. [20355/01]

Michael Ring

Question:

164 Mr. Ring asked the Minister for Health and Children if he will provide a copy of the guidelines for orthodontic assessment and treatment for each health board authority area; and if possible, if he will point out where these guidelines differ from the service provided in the private sector for each health board authority area. [20359/01]

Michael Ring

Question:

165 Mr. Ring asked the Minister for Health and Children if the guidelines for orthodontic assessment or treatment in the Western Health Board region have been changed in the past five years; if so, the exact changes which occurred; when they were made; and the number of people refused assessment of treatment based on the changed guidelines. [20360/01]

Michael Ring

Question:

166 Mr. Ring asked the Minister for Health and Children if he plans to amend the guidelines for orthodontic treatment; and the number of people who were refused treatment in each health board region since January. [20361/01]

Minister for Health and Children (Mr. Martin)

I propose to take Questions Nos. 160 and 164 to 166, inclusive, together.

The provision of orthodontic treatment services is the statutory responsibility of the health boards. In 1985 my Department issued guidelines to health boards on the criteria applicable in assessing priority of need for specialist orthodontic treatment; the guidelines are based on the degree of severity of malocclusion and assist in prioritising the need for treatment. A copy of these guidelines will be forwarded to the Deputy by my Department.

The report of the review group on orthodontic services is entitled The Moran Report. It recommended that all health boards use the same severity index to determine need and that provision of orthodontic treatment should continue on the basis of priority need. There have been discussions between my Department and representatives of the chief executive officers of health boards on the report and its implications. Proposals in the report are being progressively implemented. Amendments to the 1985 guidelines are being finalised with the chief executive officers of the health boards and the review group on orthodontic services.

The guidelines issued by my Department in 1985 and the proposed revision to the guidelines provide an index of severity to allow health board services determine the need for orthodontic treatment and provide services on an equitable basis. The service provided in the private sector is based on the assessment recommendations of individual orthodontists and may be based on a more lenient assessment of treatment need.

Following the Moran 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.

It will be some time before these structural changes impact significantly on service levels. Consequently, I 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. This will enable health boards to recruit additional staff and engage the services of private orthodontists to treat patients.

In the Eastern Regional Health Authority, two additional consultant orthodontists have been appointed and the recruitment of a fourth consultant orthodontist for the Northern Area Health Board is in train. Two orthodontic specialists have been recruited and the recruitment process for three managers to manage the orthodontic services in the three area health boards has been completed; two of the managers will commence duty in July and the third will take up duty next August. A six surgery facility at the Lough linstown regional orthodontic unit has been developed and is currently being equipped. The equipping of an additional five surgery unit at the St. James' Hospital orthodontic unit is being completed. The NAHB is currently progressing plans for the development of a new regional orthodontic unit to be located on the grounds of James Connolly Memorial Hospital. Agreement has been reached between the ERHA and the Dublin Dental Hospital on the training of specialists to work in orthodontics and four dentists will commence training in 2001. Validation of waiting lists is currently in progress.

The Southern Health Board's proposals include the development of new orthodontic units in Tralee and North Cork and the recruitment of two additional consultant orthodontists; both positions were advertised last week. The board also proposes to commission four additional orthodontic chairs in the orthodontic unit in St. Finbarr's Hospital and to validate waiting lists. These proposals will double the capacity of the orthodontic services and reduce waiting times from 48 months to under 12 months in the Southern Health Board.

The proposals from the Midland, Mid-Western, North Eastern, North Western, South Eastern and Western Health Boards include the use of private orthodontists, the training of two specialists in orthodontics in the Dublin Dental Hospital to commence in October 2001 and the recruitment of three additional orthodontic specialists, one senior clinical dental surgeon, four dental surgery assistants and three administrative staff. Additional sessions by health board staff and validation of waiting lists are also proposed.

The impact of the initiative in these health boards will enable an additional 2,500 patients approximately to commence treatment. The health boards have advised me that the ultimate effect of their proposals, when fully implemented, will be to increase the numbers in treatment by 5,500 per annum and significantly reduce waiting times for treatment.

The effect of the initiative is becoming evident in the short time of its existence. The chief executive officer of the Western Health Board has informed me that the numbers awaiting orthodontic treatment and assessment have been reduced by approximately 800 since the initiative commenced in the board. In addition, the chief executive officer of the ERHA has informed me that the recruitment of additional clinical staff has allowed treatment to commence or recommence for approximately 1,150 patients since September 2000.

Michael Ring

Question:

161 Mr. Ring asked the Minister for Health and Children if he will investigate the reason information on patients refused orthodontic treatment is not maintained by six of the health boards; and if he will rectify the situation to ensure equity in the provision of orthodontic treatment throughout the health boards. [20356/01]

Minister for Health and Children (Mr. Martin)

The provision of orthodontic treatment is the responsibility of the health boards in the first instance.

I am informed by the chief executive officers of the Eastern Regional Health Authority, Midland, Mid-Western, South Eastern, Southern and Western Health Boards that records are maintained on all patients who are assessed for orthodontic treatment. Records of why patients have been refused are kept on the patient's clinical charts. Statistical information in respect of these is not available.

The chief executive officer of the North Eastern Health Board has informed me that primary school children are assessed in respect of the need for orthodontic treatment and if categorised as either category A or B under the guidelines issued by my Department, are referred to the orthodontic service in the health board. Category C patients are not treated by the health board in the regional orthodontic unit and therefore no records are maintained in respect of these patients.

I am also informed by the chief executive officer of the North Western Health Board that children are assessed by the consultant orthodontist who prioritises patients again according to my Department's guidelines. Categories A and B are placed on the orthodontic waiting list according to their priority. Patients who are assigned to lower designated categories are referred to primary care services for treatment. Therefore no patients are refused treatment in his area of responsibility.

In relation to equity of services, the report of the review group on orthodontic services, entitled The Moran Report, recommended that all health boards use the same severity index to determine need and that provision of orthodontic treatment should continue on the basis of priority need. There have been discussions between my Department and representatives of the chief executive officers of health boards on the report and its implications. Proposals in the report are being progressively implemented. Amendments to the 1985 guidelines are being finalised with the chief executive officers of health boards and the review group on orthodontic services.

Michael Ring

Question:

162 Mr. Ring asked the Minister for Health and Children the average waiting lists for orthodontic treatment in each health board area; and the number of people who are on the treatment waiting list. [20357/01]

Michael Ring

Question:

163 Mr. Ring asked the Minister for Health and Children the average waiting list for ortho dontic assessment in each health board area; and the number of people who are on the assessment waiting list. [20358/01]

Minister for Health and Children (Mr. Martin)

I propose to take Questions Nos. 162 and 163 together.

The provision of orthodontic services is the responsibility of the health boards in the first instance. The chief executive officers of the health boards have informed me that the number of patients awaiting assessment and treatment in their areas of responsibility at the end of the March quarter were as follows:

		Assessment Waiting List		Treatment Waiting List
Health Board		Waiting Time (Months)		Waiting time (Months)
ERHA	10,505	up to 72	950	24
Midland	35	3	153	15
Mid-Western	2,050	24-30	1,512	24-36
North Eastern	Nil	N/A	813	24-30
North Western	390	4	2,351	32-43
South Eastern	271	2.5	576	15
Southern	5,000	Varies according to date of birth – children born in June 1987 presently being assessed	4,500	48
Western	606	3-6	2,031	42-48
Totals	18,857		12,886

Questions Nos. 164 to 166, inclusive, answered with Question No. 160.