Dáil Éireann debate -
Thursday, 21 Nov 2002

Vol. 557 No. 6

Written Answers. - Orthodontic Service.

Bernard J. Durkan

Question:

14 Mr. Durkan asked the Minister for Health and Children the circumstances in which, in the course of a review of those seeking orthodontic treatment in the Eastern Regional Health Authority area, it transpires that up to 50% of the patients were deemed ineligible despite having contradictory diagnoses from qualified professionals; and if he will make a statement on the matter. [22927/02]

Minister for Health and Children (Mr. Martin)

As the Deputy is aware, the provision of orthodontic treatment to eligible persons is the responsibility of the health boards-authority in the first instance. 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. 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 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, including the Eastern Regional Health Authority, ERHA, 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. Four of these dentists are for the authority and additional funding of €405,000 was provided to the authority in 2002 for this programme. 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. Under the initiative, the ERHA was allocated €2.044 million. This enabled the authority to recruit additional staff, including two consultant orthodontists and to develop new treatment facilities at Loughlinstown and at the regional orthodontic unit located at St. James's Hospital. My Department has also funded a six chair orthodontic suite for the Northern Area Health Board, which is expected to be operational in spring 2003. The authority is also validating its orthodontic waiting lists as part of this initiative.

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 to purchase treatment from private specialist orthodontic practitioners. The ERHA received €1.815 million from the fund for the treatment of cases in this way. The regional chief executive has informed me that at the end of September 2002 there were 2,990 cases in orthodontic treatment in the authority's area. I am confident the measures I have outlined will further improve the provision of orthodontic services in this area.