Vol. 543 No. 1
11 Mr. Kenny asked the Minister for Health and Children the reason waiting lists for orthodontic treatment can range from two years to six years in the Western Health Board area; his views on the role of specialist orthodontists as distinct from consultant orthodontists; and if he will make a statement on the matter. [25381/01]
The provision of orthodontic treatment to eligible persons is, in the first instance, the statutory responsibility of the health boards. The chief executive officer of the Western Health Board has informed me that at the end of the September 2001 quarter there were 1,479 patients on the category B treatment waiting list with an average waiting time of 42 to 48 months. There are no patients on the board's category A treatment waiting lists and as of the end of August 2001 there were 1,604 patients in orthodontic treatment.
Patients are referred for secondary care orthodontic treatment in accordance with guidelines issued by my Department that prioritise the need for treatment based on the degree of handicap and the severity of malocclusion. Patients in category A require immediate treatment and include those with congenital abnormalities of the jaws such as cleft lip and palate and patients with major skeletal discrepancies between the sizes of the jaws. Patients in category B have less severe problems those in category A but have a definite need of treatment and are placed on the orthodontic treatment waiting list. Additional funding of £495,000 has been allocated to the Western Health Board this year for orthodontic services of which £420,000 was for an orthodontic initiative.
The chief executive officer of the Western Health Board has informed me that a specialist in orthodontics was recently recruited. The board envisages that he will start work in November this year. In addition, the board currently has two dentists in training for specialist in orthodontics qualifications. I am confident that these developments, on aggregate, will increase the number of patients receiving orthodontic treatment.
The roles of consultant orthodontists and specialist in orthodontics differ in a number of respects. Consultant orthodontists lead hospital based orthodontic departments in the health boards. In their managerial roles, they provide leadership for a team that includes specialist orthodontists, general dental surgeons, dental auxiliaries and other support staff.
Additional InformationConsultant orthodontists take full responsibility for the planning, delivery and quality of orthodontic services in the boards, including organising the assessment of patients for ortho dontic treatment and implementing my Department's guidelines for orthodontic treatment uniformly. The clinical role of consultant orthodontists comprises organising and undertaking the highest priority and complex treatments requiring multi-disciplinary intervention and ensuring the overall quality of care provided by both health board staff and private specialist orthodontic practitioners contracted to the health boards. They also take a leadership role in the academic training of consultants, specialists, general dental surgeons and dental auxiliaries in liaison with the universities and other statutory bodies.
The duty of specialists in orthodontics is to participate in the organisation and delivery of orthodontic services under the overall direction of the consultants and to provide complex orthodontic treatment to patients attending the regional orthodontic units and community dental service clinics. They co-ordinate and assist with primary orthodontic treatment carried out by general dental surgeons in the community services, participate in clinical audits, assist in the assessment of the need for treatment in accordance with the orthodontic guidelines and participate in the training of staff in courses approved by the appropriate regulatory authority.
I am prompted to ask five questions arising from the Minister's reply. Is he happy with the level of public orthodontic services when waiting times are now over four years? Which guidelines are being followed? Are they the 1985 guidelines or some modified version of them adopted in 2000 and, if so, did the Minister authorise those modifications? Am I to understand that the consultant group recently recommended and approved a motion that there be no aesthetic component involved in the assessment for orthodontic treatment? Does the Minister agree that the modified guidelines now being operated are much more stringent than those of 1985 leaving patients exposed to less than ideal treatment? Has the Minister carried out an assessment of, or monitored, the assessments and recommendations made specifically regarding the extraction of impacted canine teeth which will leave the Department open to medical and legal challenges in the years ahead?
There are modified guidelines. The health boards came forward with some modified approaches to the 1985 guidelines while new guidelines were being prepared in consultation with all concerned.
Which guidelines are being operated?
The size of the waiting lists, to a certain extent, made the new guidelines academic. They were made so not just in terms of the history of investment in orthodontics over the past ten years, or the lack of it, but to a greater extent because of the failure of all concerned to develop constructive relationships with each other in the field collegially. I have been in the Department for a year and a half and as far as I can see the whole area is bedevilled by quarrels, old rows and conflicts that militate against providing a proper service.
It is also bedevilled by greed.
We provided about £5 million to the health boards last year and I am not happy with the degree to which that money has been spent and the time it has taken to do so. I do not blame anyone in particular. In the Deputy's own area the appointment of a specialist will not take place until November even though the money was provided almost 12 months ago.
I thank the Deputy for tabling such a relevant question.
I will allow only a brief supplementary. I cannot take a long one because Deputy Neville has been waiting a long time.
The Minister is anxious to spend the money allocated. Can he not adopt a scheme whereby a refund up to a maximum of £2,000 which is the cost would be made available to the parents who have this work carried out privately? In the cases of those with medical cards the full amount would be provided and in the cases of those without one provision would be for half the amount. That would allow the Minister to spend his money and it would be a means to clear the backlog as well.
The Deputy is making a statement.
Notwithstanding all he has said, will the Minister consider, as a matter of extreme urgency, referring patients who require urgent treatment to somebody outside the health boards? Can he indicate the precise numbers waiting for treatment, not just those in the health board area referred to in the question? There is a waiting list to get on the waiting list.
I share the Minister's concern about this. Even if he does nothing else in the time left to him in office, he should sort this out. I again ask him to look at the monitoring of assessments where recommendations are made for extraction of impacted canine teeth. I have been shown disturbing evidence that would lead one to the conclusion that this amounts to mutilation and will leave the Department open to legal and medical charges. He must get a hold on this issue.
I will have that checked immediately. I am committed to resolving this issue for once and for all and determined to put in place structures to sort it out.
Investment last year was geared towards the public infrastructure of health boards. Some are on board and some are not. Regarding what Deputy McCormack said, the problem there was that the health board in Dublin came forward with the idea of tax relief.
What was the problem with that?
I said it was a great idea and that I would support it all the way. I said that I would provide funding. The health board took legal advice and found that a difficulty lies with the Health Act, 1970. The Act confers full eligibility on patients for orthodontic treatment. The legal advice in respect of the initiative suggests we would dilute that eligibility by placing an obligation on people to bear a portion of the cost. Therein lies the crux.
The Minister should get on with the business.
To address the question asked by Deputy Durkan, patients of some health boards are treated outside and that is allowed. We have also authorised, particularly within the Western Health Board, the provision of private treatment while the public infrastructure is being built up. Health boards can spend the money the Department made available to refer patients to private orthodontists. As of August 2001, 187 patients had been referred for private treatment in the Western Health Board area.
