Dáil Éireann debate -
Wednesday, 13 Nov 2002

Vol. 557 No. 2

Written Answers. - Orthodontic Service.

David Stanton

Question:

248 Mr. Stanton asked the Minister for Health and Children his views on reports that orthodontic managers in the Southern Health Board and possibly other health boards are directing consultant orthodontists not to place patients with significant orthodontic problems on their waiting list for treatment; his views on whether decisions of the orthodontic managers should overrule those of the consultant orthodontists; the health boards in which and the number of times this direction has occurred in the past 12 months; his plans to resolve the issue; and if he will make a statement on the matter. [21901/02]

Minister for Health and Children (Mr. Martin)

As the Deputy is aware, the provision of orthodontic treatment to eligible patients is the statutory responsibility of the health boards in the first instance. Entitlement to orthodontic treatment is determined by reference to orthodontic guidelines, a set of objective clinical criteria applied by health board orthodontists when assessing children's priority of need for treatment. The orthodontic guidelines were issued by my Department in 1985 and are still in use. The orthodontic guidelines are used to ensure that orthodontic resources are prioritised for and applied equitably to the most severe cases. The guidelines are intended to enable health boards to identify in a consistent way those in greatest need and to commence timely treatment for them. The decision on priority of need of treatment is independently taken by the orthodontist. Consequently, the question of an orthodontic manager rescinding a decision of an orthodontist on a person's priority of need of treatment does not arise. However, the number of cases capable of being treated will depend on the level of resources available, in terms of qualified staff and other resources, in an area, and this is reflected in the treatment waiting list.

The numbers receiving orthodontic treatment are increasing. In this regard, the chief executive officers of the health boards have informed me that at the end of the June 2002 quarter there were 19,055 persons in orthodontic treatment in the health boards. This is an increase of 1,760 patients in orthodontic treatment when compared with the number of cases in treatment in December 2001. I am committed to continuing to increase the number of cases in treatment further in view of the range of measures I have taken to improve service provision on a national basis.

The grade of specialist in orthodontics has been created in the health board orthodontic service. The introduction of this pivotal grade will have a tremendous impact on the future delivery of orthodontics in the public service. Ultimately, it will address the issues of recruitment and retention of qualified clinical personnel in the service.

This year, my Department expects to fund 11 dentists from various health boards for specialist in orthodontics qualifications at training programmes in Ireland and at two separate universities in the United Kingdom. These 11 trainees for the public orthodontic service are additional to the six dentists who commenced their training last year and one dentist whose specialist training is nearing completion. This is an aggregate of eighteen public service dentists currently in training for specialist in orthodontics qualifications. The training programmes concerned provide a broad academic background and experience in different clinical treatment methods and are made possible by cooperation between health boards, health board consultant orthodontists and dental teaching institutions.

These measures will complement the other structural changes being introduced into the orthodontic service, including the creation of an auxiliary grade of orthodontic therapist to work in the orthodontic area. The grade of 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.

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 and engage the services of private specialist orthodontic practitioners to treat patients.

Last June, my Department provided additional funding of €5 million from the treatment purchase fund to health boards specifically for the purchase of orthodontic treatment. This funding is enabling boards to provide both additional sessions for existing staff and purchase treatment from private specialist orthodontic practitioners.