I am grateful to the Chairman and members of the committee for inviting us back here today to review progress on the development and delivery of orthodontic services. The committee's report on orthodontics covered a very wide range of issues and made over 30 recommendations. With your permission, Chairman, I will briefly outline the progress on some of the key issues for service delivery identified in the report.
The Department and the health boards have worked hard to get more children into orthodontic treatment. When I reported to the committee in November 2001, there were approximately 16,100 children in treatment. I am pleased to say that since then, the health boards have taken on 200 new children for treatment every month and as a result 20,200 children are now receiving orthodontic treatment.
When I last appeared before the committee I emphasised that the provision of orthodontic services was severely restricted due to the limited availability of trained specialist clinical staff to assess and treat patients. The committee acknowledged the importance of this issue in its report and made a number of recommendations in relation to training. I am pleased to report a number of important developments in this area.
When we were here on the last occasion there were nine dentists in specialist training for orthodontics. This year we sponsored an additional 13 dentists for training. Six of these dentists are training at the Dublin Dental School and Hospital. We acknowledge the co-operation of the Dublin Dental School and Hospital, the consultant orthodontists in the regional units and the Irish Committee for Specialist Training in Dentistry, whose close involvement has enabled this programme to take place. We have agreed programmes for and funded a further five dentists from the health boards to train in Cardiff and Leeds. The boards are sponsoring a further two dentists to train in London.
The Department provided almost €1 million for this tranche of training, in addition to funding of over €500,000 for existing training programmes. With the recent qualification of two orthodontists who have already started work with the Western Health Board, there are now 20 dentists in orthodontic training for the health boards. All these dentists will have been trained to an internationally accepted standard and will be recognised as specialists once they qualify.
The Department recognises the importance of recruiting a professor at Cork Dental School. We have recently approved in principle a proposal from Cork University to further substantially improve the training facilities there for orthodontics and so enable the recruitment of a suitable candidate. This project should see the construction of a large orthodontic unit and support facilities. It will ultimately support an enhanced teaching and treatment service to the wider region under the leadership of a professor of orthodontics. A proposal to expand facilities at the Dublin Dental School for postgraduate training in orthodontics is also under active consideration.
We know we need to keep our best people in the health boards - orthodontists are specialist people who are difficult to recruit. The creation of a specialist in orthodontics post in the health boards will attract orthodontists to work in the health service on a long-term basis. The committee recognised this when it recommended that the qualifications for the grade of specialist orthodontist be directed by the Minister as a matter of urgency. I am pleased to say that this has been done and the first competitions have been held by the Local Appointments Commission.
The Department has also promoted the development of an assistant grade which will allow the orthodontist to achieve a greater caseload and so increase the number of children in treatment. The Dental Council has called this grade orthodontic therapist. The Department and the council have completed the work required to create the orthodontic therapist post and we are now bringing together the various staff associations at the Health Service Employers Agency to discuss the terms of the post in the health boards.
Following publication of the committee's report, the Department requested the chief executive officers of the health boards to consider the report and its implementation. The chief executive officers agreed to establish a review group to consider the report in tandem with assessing progress in implementing the 1998 Moran report on orthodontics and in that context preparing an action plan for orthodontics within the framework of the national health strategy. The group was made up of senior managers and orthodontists from the health boards. It has now presented a report to the Health Boards Executive which in turn has formally adopted the report subject to a small number of clarifications and reservations. The Health Boards Executive has recently sent this report to the Department where its findings are being considered.
Our aim is to develop the treatment capacity of the orthodontic service in a sustainable way over the longer term. Given the potential level of demand for orthodontic services, the provision of those services will continue to be based on prioritisation of cases based on treatment need, as happens under the existing guidelines.
The Health Boards Executive report refers, as did the Moran report, to the index of treatment need which is an alternative means of assessing children's need for orthodontic treatment. Its report recognises that the shortage of trained orthodontists currently restricts the use of this index by health boards.
I noted at my last appearance before this committee that a national survey of children's dental health was under way. The information from this survey should provide us with better information to identify accurately the number of children that would benefit from orthodontic treatment and the resources, particularly manpower, which would be needed to provide the corresponding level of care. The preliminary findings of this report are to be launched in the very near future.
We are also required to develop areas of dentistry, including those directly affected by the high level of orthodontic work now being done by health boards. We know from our previous experience that there is a strong demand for a range of health board dental services. We need to plan for all areas of dentistry on a balanced and proportionate basis.
The Department has implemented a range of measures to boost the number of children being treated in the short-term using both public and private treatment providers. For example, €5 million was provided for health boards from the treatment purchase fund. The Department directed each health board to use its allocation to treat children who were waiting longest and who most urgently needed treatment. This allocation has enabled health boards to provide additional sessions from existing staff and purchase treatment from private orthodontists. The committee has indicated in its report its support for such a public-private mix of treating children.
Orthodontics is unique in that the treatment period for a child is between 18 and 24 months and each year thousands of children, with varying degrees of need, are placed on assessment waiting lists. This undoubtedly presents challenges for service delivery and will continue to do so. However, we have made significant progress. Currently, twice as many children get orthodontic treatment as there are children waiting to be treated and almost 3,000 extra children have been getting treatment from health boards since the committee's hearings took place. Our aim is to continue to make progress and to develop a high quality, reliable and sustainable service for children and their parents.