Written Answers. - Orthodontic Service.
Minister for Health and Children
the reason orthodontic treatment for a person (details supplied) in County Mayo has not started.
Responsibility for the provision of orthodontic treatment to eligible persons in County Mayo rests with the Western Health Board. My Department has asked the chief executive officer to investigate the matter raised by the Deputy and to reply to him directly.
Minister for Health and Children
if he will provide a detailed response to proposals (details supplied).
The proposal that the Deputy has furnished to me was previously presented to the Joint Committee on Health and Children by its author when that committee was examining the issue of the public orthodontic service. This proposal – that responsibility for the orthodontic services within my Department be moved from "the Community Care section to the Hospital Care section", was not recommended in the report on the public orthodontic service by the joint committee.
I recognise that there are problems in the orthodontic service and I have taken a number of important steps to increase the number of cases in orthodontic treatment. However, the contention that moving the administration of the orthodontic service from the community health division to secondary care is a panacea for such problems is, at the very least, unconvincing.
In 1996, my Department wrote to the chief executive officers of the health boards recommending that a group, representative of health board management and consultant orthodontists, review the orthodontic services. The objective of this review was to ensure an adequate and equitable provision of orthodontic treatment throughout the health boards. One of the key recommendations of this review group – known as the "Moran Report"– was that appropriately trained, qualified and registered specialist orthodontists be employed in regional orthodontic units to ensure the provision of a timely and high quality service.
This was against the background of a consultant-led service that had developed in the mid 1980s. Within this service a number of dentists had worked in orthodontics under the direction and supervision of consultants with a view to achieving postgraduate qualifications in orthodontics. This informal training framework was inconsistent with the modernisation of dentistry under governing EU directives that led to the introduction of specialisation in dentistry in the 1990s. In effect, it became essential that specialist in orthodontics training programmes meet internationally recognised standards. Accordingly, with my consent the Dental Council established a specialist register with a division of orthodontics in 1999.
The Deputy should also be aware that in 1998 the then consultant orthodontist in the Eastern Health Board requested my Department to invite experts from the United Kingdom to validate a training programme for her staff. It is regrettable that the consultant subsequently refused to participate in the validation process. This sequence of events led to trainees leaving the orthodontic unit and applying elsewhere to seek specialist in orthodontics training.
Agreement has been reached at the Health Service Employers Agency on the creation of the specialist in orthodontics grade in the orthodontic service. This agreement resulted from complex and time-consuming negotiations. The introduction of the specialist grade will have a tremendous impact on the future delivery of orthodontics. Other structural changes being introduced into the orthodontic service include new specialist in orthodontics training programmes and the creation of an auxiliary grade of orthodontic therapist.
Six dentists from the Eastern Regional Health Authority, North Eastern Health Board and South Eastern Health Board commenced their training last October for specialist in orthodontics qualifications. My Department has provided €541,000 in 2002 for specialist in orthodontics training. Furthermore, three dentists from the Western Health Board and North Eastern Health Board are already in specialist training for orthodontics and this brings the total number of dentists in such training to nine. The general objective of these training programmes is to educate dentists to become specialists in orthodontics with a broad academic background and experience in different clinical treatment methods. They are made possible by co-operation between health boards, consultants and dental teaching institutions. Discussions on providing an additional training course to commence in 2002 are also under way.
The Moran report also recommended that auxiliaries be employed in the regional orthodontic units. In order to enable the achievement of greater caseloads, the Dental Council will shortly submit to my Department a draft scheme to recognise auxiliary dental workers in orthodontics. This grade – to be known as orthodontic therapist – will act as a support to the consultant orthodontist, specialists and other dentists working in the orthodontic unit thus enabling a greater volume of treatment.
My Department has funded the appointment of a director of specialist training for the Irish Committee for Specialist Training in Dentistry through the postgraduate 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. In addition, my Department has also 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 €1.27 million was also provided to the orthodontics unit there for its refurbishment to an appropriate standard.
In the short-term, I have funded an orthodontic initiative to ease current pressures on the system. Additional funding of €6.729 million was approved for orthodontic services last year of which €4.698 million was to fund an initiative on orthodontic waiting lists. This is enabling health boards to recruit additional staff, develop new treatment facilities and engage the services of private specialist orthodontic practitioners to treat patients. My Department is exploring with boards every possibility to expand the level of services in the short-term such as the use of private specialist orthodontic practitioners and the treatment of patients in out-of-hours sessions by health board orthodontists.
My Department has also funded the development of new regional orthodontic units at Dundalk and Navan – both of which are operational – and the recruitment of a consultant orthodontist for the Midland Health Board who was appointed last year.
The assertion by the author of the proposal submitted by the Deputy that fewer children are being treated now in the orthodontic service than in 1999 is at variance with treatment statistics furnished to my Department by the health boards. The chief executive officers of the health boards have informed me that at the end of the December 2001 quarter, there were 17,295 patients in orthodontic treatment in the health boards. This is an increase of 3,086 patients in orthodontic treatment when compared with the number of patients in treatment in mid-1999. I expect that the number of patients in orthodontic treatment will continue to increase as the measures that I have taken to improve orthodontic services take effect.