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Dáil Éireann debate -
Tuesday, 5 Feb 2002

Vol. 547 No. 3

Adjournment Debate. - Orthodontic Service.

I thank you, a Leas-Cheann Comhairle, for allowing this matter to be raised. I regret having to table this Adjournment request and the Minister of State come here to reply. It is, if one likes, a drastic challenge to the Adjournment debate structure in that the question is clear, but the answer has probably been drafted long before the Minister of State stands up to give her reply.

The position regarding orthodontics and the public orthodontic service is nothing short of a national scandal. The Joint Committee on Health and Children has been dealing with this matter for a period of time and done a great deal of work under the chairmanship of Deputy Batt O'Keeffe of the main Government party. There has been a failure on the part of successive Governments and Ministers to deal with the problem. Parent X may go to see the Minister of State, Deputy Hanafin, who I am glad to see here, to say his or her child has a problem with his or her teeth which he or she regards as orthodontic. The child is assessed and if put on a list in the public service, may well wait for five to six years in the Western Health Board area before treatment is delivered. It is completely unethical and immoral to put children on lists for orthodontic treatment in the sure knowledge that they will never be called or that their parents will be forced to pay through the private sector. I am appalled at the failure of this and previous Ministers to take on the Dublin and Cork Dental Schools and their failure to recog nise, and be shielded from, the reality of the powerful cabal operating here preventing the provision of an effective public orthodontic service.

A number of guidelines are being bandied about in terms of the criteria laid down for eligibility for children. When we had no public orthodontic service guidelines were laid down in 1985 by the Department of Health which were accepted. In a reply in November and again last week the Minister pointed out that the health board consultants recommended a number of changes in the interim which was followed by a recommendation known as the Moran report from the chief executive officers of the health boards based on a system of IOTN, index of orthodontic treatment need.

I would like the Minister of State to tell the House which of these guidelines is now in operation. Are we talking solely about the 1985 guidelines? The Minister said in reply that the consultant orthodontists sent a report to him. He did not say whether he accepted it, but that his Department was writing to the health boards about changes. He did not say either whether the Moran report index is being used to any extent.

I quoted at the joint committee minutes of a meeting held between the Irish consultant orthodontists group and the Orthodontic Society of Ireland held in Dublin on 18 September 2000. The minutes are very clear in that they show that the private sector would be largely eliminated if an indexing system was introduced that was defensible both on a constitutional and legal basis because otherwise the hospital service would be overwhelmed with patients it would never be able to treat. That is taken from the minutes of a group meeting in September 2000 in terms of the relationship between the Orthodontic Society of Ireland and the ICOG.

I recognise private practice and the work it does, but the Minister of State represents the Government. There are hundreds of thousands of mothers, fathers and children who are not receiving this service and there is great confusion about eligibility and the guidelines being used. Will the Minister of State explain whether the 1985 guidelines alone are now being used? If not, has the Minister accepted the consultant orthodontists recommendations of interim changes? Are these the guidelines being used? While the study is being carried out by the Department, are there elements of the IOTN or Moran index being used? Whatever is going on, thousands of children are being eliminated from orthodontic waiting lists and waiting times have increased. This is grossly unethical, unfair and immoral.

The Minister said to me in the House, I think in November, if there was one other thing he would do during his remaining period in office it would be that he would sort this matter out. If nothing else happens between now and the time the Taoiseach goes to the country, the Government and the Minister should zero in on this scandal and sort it out once and for all.

I thank Deputy Kenny for raising the matter of the guidelines for orthodontic treatment operated by the Department of Health and Children and for allowing me this opportunity to discuss the provision of orthodontic services.

The provision of orthodontic treatment services is the statutory responsibility of the health boards in the first instance. In 1985, the 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 they are still in operation. Their purpose is to allow prioritisation of children for orthodontic treatment based on the severity of need.

The guidelines are intended to enable health boards to identify in a consistent way patients in greatest need and to commence timely treatment for them. Patients assessed as category A have severe malocclusions and should receive urgent orthodontic care – patients assessed as category B have less severe problems and are placed on orthodontic treatment waiting lists. The number of cases treated will depend on the level of resources available, in terms of qualified staff, in an area.

Health board consultant orthodontists recommended that the 1985 guidelines be modified to prioritise treatment for the most severe categories of patients. The Department of Health and Children will be writing to the chief executive officers of the health boards concerning the operation of these modified guidelines with regard to maintaining the delivery of orthodontic services in a prioritised way.

The chief executive officer's report on orthodontics, known as the Moran report, recommended the use of an alternative index of need which, as Deputy Kenny said, is known as the index of orthodontic treatment need. The chief dental officer has advised that this new index should not be implemented until its implications have been evaluated in a national survey of children's dental health. This survey is currently under way and is expected to be completed in mid-2002. The purpose of the survey is to identify accurately the number of children who would benefit from orthodontic treatment and the resources, particularly manpower, needed to meet the corresponding level of care.

The Minister, Deputy Martin, has taken a personal interest in the whole area of orthodontics and has initiated a range of measures to substantially increase the capacity of the orthodontic services and reduce the waiting time for orthodontic treatment.

Structural changes are being introduced into the orthodontic service such as the creation of the grade of specialist in orthodontics, the development of specialist training programmes and the creation of an auxiliary grade of orthodontic therapist to work in the orthodontic area.

The Department has provided additional funding of almost €1 million for orthodontic services in 2002, over half of which was for a specialist training programme. Six dentists from the health boards commenced their training for specialist in orthodontic qualifications last October. Discussions on providing an additional training course to commence in 2002 are also under way.

The Department has funded the appointment of a director of specialist training for the Irish Committee for Specialist Training in Dentistry through the Post Graduate Medical and Dental Board. The director has taken up duty and will play a pivotal role in assisting the different agencies involved in dental specialist training programmes.

Furthermore, the Department has funded the recruitment of a professor in orthodontics at Cork University Dental School to facilitate the development of an approved training programme leading to specialist qualifications in orthodontics. Capital funding of approximately €1.3 million was also provided to the orthodontics unit there for its refurbishment to an appropriate standard.

The Minister announced an orthodontic initiative last year and an additional €6.73 million was provided for orthodontic services of which €4.7 million was for this initiative. Among other things, this funding allowed health boards to recruit additional staff.

Returns from health boards indicate that some progress is being made. At the end of 2001, there were 17,295 patients in orthodontic treatment – the equivalent figure reported for mid-1999 was 14,209 patients, implying an increase of 3,086 patients in orthodontic treatment over that period.

The health boards are striving hard to improve their orthodontic services. The Minister is confident that the orthodontic initiative, combined with the structural changes being introduced, will lead to significant increases in the numbers being treated by the orthodontic service.

The Dáil adjourned at 9.05 p.m. until 10.30 a.m. on Wednesday, 6 February 2002.

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