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Dáil Éireann debate -
Thursday, 21 Nov 2002

Vol. 557 No. 6

Written Answers. - Orthodontic Service.

Bernard J. Durkan

Question:

199 Mr. Durkan asked the Minister for Health and Children the extent to which waiting lists for orthodontic treatment have been reduced by means other than treatment; and if he will make a statement on the matter. [23185/02]

Bernard J. Durkan

Question:

200 Mr. Durkan asked the Minister for Health and Children the number of children seeking orthodontic treatment whose cases have been reviewed in the past six months; the number of cases in respect of which treatment will take place in the next 12 months; the number who have been removed from the waiting list by other means; and if he will make a statement on the matter. [23186/02]

I propose to take Questions Nos. 199 and 200 together.

The provision of orthodontic treatment and the maintenance of orthodontic waiting list data is the responsibility of the health boards-authority in the first instance.

The reduction in the number of cases awaiting treatment is a function of a number of factors, not least of which is the increased number of cases in orthodontic treatment as a result of augmented activity levels in the regional orthodontic units.

The chief executive officers of the health boards have informed me that at the end of the September quarter there were 18,511 cases receiving orthodontic treatment in the public orthodontic service of the health boards-authority. This is an increase of 1,216 in comparison with the equivalent figure at the end of the December 2001 quarter. This increased activity level is primarily due to the broad range of measures that I have introduced into the orthodontic service.

Entitlement to secondary care 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. Cases assessed as category A have severe malocclusions and should receive urgent orthodontic care; cases assessed as category B have less severe problems and are placed on orthodontic treatment waiting lists. The number of cases treated is dependent on the level of resources available in terms of qualified staff in the area and this is reflected in the treatment waiting list. The orthodontic guidelines are used to ensure that orthodontic resources are prioritised for and applied equitably to the most severe cases. When a health board orthodontist decides that a child is in clinical need of orthodontic treatment in accordance with the criteria, he or she is then placed on a treatment waiting list. 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. It is widely recognised that decisions made in the private sector regarding orthodontic treatment are based primarily on subjective need and are not based on any evidence linking the orthodontic condition to any aspect of dental ill health. On the other hand decisions made in health boards are based on prioritised guidelines ensuring that cases are selected for treatment based on the objective severity of the condition.
I am pleased to advise the Deputy that I have taken a number of measures to improve orthodontic services on a national basis and further increase the number of cases in orthodontic treatment.
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 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 18 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 co-operation 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. Furthermore, as part of this initiative, health boards are validating their orthodontic waiting lists.
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.
My Department does not routinely collect the data requested by the Deputy. Therefore, it has asked the health boards-authority to furnish the data directly to the Deputy, where available.

Bernard J. Durkan

Question:

201 Mr. Durkan asked the Minister for Health and Children the number of positions of consultant orthodontists created in each of the health board areas in the past four years; and if he will make a statement on the matter. [23187/02]

The provision of orthodontic treatment to eligible persons is the statutory responsibility of the health boards in the first instance.

I am pleased to advise the Deputy that I have taken a number of measures to improve orthodontic services 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 18 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 co-operation 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.
The chief executive officers of the health boards-authority have informed me that the number of consultant orthodontists employed in each health board-authority is as follows:

Health Board

Consultant Orthodontist

Eastern Regional Health Authority

3

Midland Health Board

1

Mid-Western Health Board

1

North-Eastern Health Board

1

North-Western Health Board

0.5

South-Eastern Health Board

1

Southern Health Board

1

Western Health Board

1

In addition, two additional consultant orthodontic posts have been approved for the SHB and one additional post for the ERHA. There is a full-time vacancy in the NWHB area which is currently being filled on a part-time basis. Therefore, a total of 13 consultant orthodontic posts were approved for the health boards-authority by my Department. The chief executive officers of the health boards-authority have informed me that in 1999 there were seven consultant orthodontists employed by the health boards.
The chief executive officers have further informed me that at the end of the September 2002 Quarter there were 18,511 patients in orthodontic treatment in the health boards. This is an increase of 1,216 patients in orthodontic treatment when compared with the number of patients in treatment in December 2001. 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.
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