With the agreement of the House, spokespersons have 20 minutes for their contributions and other Members have 15 minutes.
Health (Amendment) Bill, 1993: Second Stage.
Question proposed: "That the Bill be now read a Second Time."
Is that agreed? Agreed.
It gives me great pleasure to introduce the Health (Amendment) Bill to the Seanad today. The Bill is part of the legislative Programme for a Partnership Government and is an integral component of a comprehensive plan to develop the dental services in the country. In this context the Government has agreed to proposals submitted by me as the basis for the development of an integrated and co-ordinated dental plan which would be implemented over the next four years.
It is fair to say that this area of the health services requires investment to enable it to respond to the dental health needs of the population. Progress has been made over recent years in developing the services but it is clear that a further impetus needs to be provided so that progress made to date can be accelerated in a way that the dental services are provided in an equitable, consistent and efficient manner.
The purpose of the Health (Amendment) Bill, 1993, is to amend the Health Act, 1970, to enable the health boards to make dental services available without charge to children who have attended national or certain other schools. The Bill is a short one. Section 1 contains the necessary provision to enable the health boards to provide the services. Section 1 also contains a provision to enable the Minister for Health to specify the nature of the service to be made available and the age of the children to be provided with the service. This will enable me to extend services to children under 16 years of age on a phased basis in accordance with the provisions contained in the Programme for a Partnership Government. Senators will be aware that services are currently available to children aged 12 years.
The extension of children's entitlement to dental services to under 16 years of age will be a significant new development. The Health Act, 1970, currently provides that health boards shall provide a dental examination and treatment service for pupils attending national school or certain other schools as may be specified by order under the Act.
The Health Act, 1970, states that health boards shall provide a dental examination and treatment service for pupils attending national school or certain other schools as may be specified by order under the Act. In providing this service, health boards have been progressively adopting a systematic, targeted approach to the delivery of services with an emphasis on prevention. This includes the provision of fissure sealants and oral health education.
Currently, where resources permit, two or three classes in national school — usually second, fourth and sixth classes — are screened annually by health board dental teams, normally on the school premises. Where a further more detailed examination or treatment is required the pupils are given follow-up appointments at health board clinics. The targeted approach to the provision of dental care ensures a cost-effective use of resources and also ensures resources are directed at those most in need.
Despite deficiencies in the treatment services, particularly in the adult services, there have been significant improvements in the oral health levels of the population. This is largely due to the preventive strategy adopted in the delivery of dental services. The national fluoridation programme which commenced 30 years ago this year is a major contributor to the lowering of oral health disease levels in the younger population.
At present, eligibility for dental care ceases when a child leaves national school and this means many children lose eligibility for health board dental services before all their permanent teeth have erupted. It is important to ensure continuity of eligibility in order that children should continue to benefit from the health board preventive dental programme at an important stage of their dental development.
Section 2 of the Bill provides for the citation and collective action. With your permission, a Chathaoirligh, I will outline my plans for the dental services which I mentioned at the outset. In doing so, I will elaborate on the framework for the developments set out in the national health strategy and place the extension of eligibility proposed in the Bill in the overall context of the development plan for the services which I will implement on a phased basis over the next four years.
I propose to initiate the first phase of a major development of the dental services this year. My Department is advanced in its discussions with the relevant parties, including the health boards and the Irish Dental Association, towards achieving this objective. Consistent with my policy on health promotion, the dental plan recognises the importance of health promotion, preventive measures and education programmes as a means of improving oral health levels in the community. My Department's health promotion unit works closely with the Irish Dental Health Foundation and through the health board dental service personnel to promote the oral health message at local level through the various elements of the plan.
At this point it is appropriate to mention the current oral health status of the population. As outlined in the four year action plan for the dental services associated with the national health strategy, the key aims of the public dental services are to reduce the level of dental disease in children; to improve the level of oral health in the population overall; and to provide adequate treatment services to all eligible persons.
Significant progress has been made in achieving these aims and previous oral health goals have already been realised. For instance, the most recently available epidemiological information indicates that in an optimally fluoridated area, up to 80 per cent of five year old children are free from dental decay in their baby teeth and for 12 year old children the average number of decayed, missing or filled teeth has declined from 2.5 teeth to 1.5 teeth in the last decade.
A recent report on the oral health status of Irish adults showed evidence of a major improvement in oral health in the past ten to 15 years. There has been a considerable increase in the number of natural teeth being retained by adults in all age groups. While significant improvements in the oral health of the Irish population have been achieved to date, especially in children, the challenge now is to sustain the momentum of this improving oral health pattern on a national basis through the appropriate use of preventive and treatment services.
The dental plan will be developed and implemented in an integrated and structured manner under the headings of primary prevention, including fluoridation and health education; primary care for children; services for the handicapped and persons in institutions; secondary care orthodontic services; oral surgery services and a service for eligible adults. I am developing the health board dental services as a response to the need for increased investment in this area of health care. This should ensure a comprehensive and integrated dental service is available to eligible persons nationally and that those requiring dental services have equity of access to those services.
A fundamental objective of the development plan is the achievement of health gain by the promotion of oral health and the prevention of disease through preventive and screening programmes. The development and implementation of the plan will be conducted through the health boards. My Department, together with the boards, is currently assessing their individual resource requirements necessary to commence the implementation of the plan this year.
The development plan for the dental services will require each health board to have mechanisms in place to monitor the service on an ongoing basis. Services will be developed within set national guidelines. In order to ensure adequate control, accountability and cost-effectiveness, it will be necessary to review and revise existing services and structures to meet the needs of an improved service. Such revision should take account of the need for development and quality assurance. The concepts of control, accountability and cost-effectiveness will re-emerge in our discussions on the national health strategy.
The dental services have traditionally been prioritised to provide preventive treatment services for children, special needs groups and emergency treatments for adult medical card holders. It would not be possible to provide the services to all those eligible within existing health board dental resources and structures. Accordingly the plan provides for the existing health board permanent dental staff to concentrate on children in addition to special needs groups, together with fluoridation and the provision of orthodontics and oral surgery. A new structured arrangement for the treatment of adult medical card holders will also be introduced involving both private dental practitioners and health board personnel.
The differences in methodology as outlined between the children's and adults' services is necessary in order to provide a balanced, structured approach to the dental services generally, thus assuring optimum levels of dental care are available to all persons eligible for dental services. To achieve the objectives of equity of access, cost effectiveness and comprehensiveness which underlie the health services and are embodied in the national health strategy, it is intended that resources will be made available equitably between and within health boards in respect of the dental services.
The use of fluoride in water supplies has been a key influence on the reduction in dental caries in the population since it was introduced in 1964. Overall, 74 per cent of the population is currently serviced by fluoridated water supplies. This coverage varies between health boards however, and a considerable amount of the fluoridation plant is now 20 years old and needs to be upgraded or replaced.
It is proposed to address the objectives of wider coverage of the population and the upgrading of existing plant during the course of the plan. In addition the use of fluoride rinses will continue to be promoted as part of the promotional and preventive elements of the plan. The delivery of primary dental care services for children will be improved. Eligibility for the provision of primary care treatment to children under 16 years of age, after they leave national school, will be phased in over the period of the development plan. This is the subject of the Health (Amendment) Bill, 1993, before the House today.
The primary dental care services will continue to be provided and, as I mentioned earlier, will be developed with a strong emphasis on preventive measures and oral health education. The resource requirements for the consolidation and the further development of the primary care children's services are being assessed by the Department with the individual health boards. With the objective of developing an equitable primary dental care system throughout the country, cognisance will have to be taken of the particular requirements of individual health boards.
The range of dental services provided at primary care level will include preventive primary care dental services, such as dental health education, examination, scaling and polishing and preventive treatments such as fissure sealing and topical applications. Basic treatments, such as fillings and extractions, will also be provided.
Eligibility for the primary dental care services to persons under 16 years of age will be introduced to provide continuity of dental care for children after they leave national school. In this regard, children often experience an increase in dental decay after they leave national school. The presence of untreated decay in the teeth of these children often causes further complications and problems which extend into adulthood and can make treatment in adulthood more difficult and expensive. By providing a primary dental care service for such children, we will prevent the development of dental problems at an early stage thus minimising the impact of dental problems in the adult population.
Additional dental personnel will be required to provide for the extension of eligibility and to allow for the phased improvement in primary dental care for eligible children. As I mentioned, the purpose of this extension is to achieve continuity of dental health care by bridging the gap between national school primary care dental services and the provision of adult services. Accordingly, emphasis will be placed on those adolescents who had a previous involvement in the national school dental service.
The provision of dental health care for medically, mentally or physically compromised children and adults is one of the most important elements of the dental plan. These persons are in need of special attention as dental disease can be a major problem for them in the context of their overall health. Initially, it is essential to ensure that emergency treatment is available to all persons in this category, that regular screenings are available, and that all necessary treatments under sedation should be made available and accessible as soon as possible.
I envisage that the primary care dental services will be developed over the next four years to ensure that efficient, equitable and comprehensive services are available to eligible children, with the emphasis being placed on oral health promotion and disease prevention through systematic screening and appropriate treatment interventions.
We are also taking action to provide the dental services required at secondary care level. Arguably, the most visible of these services are the secondary care orthodontic services, but no less important are our requirements relating to secondary care oral surgery. As regards secondary care orthodontics, there have been considerable developments over the past ten years to provide an appropriate response to the orthodontic needs of the population. Guidelines in this area were introduced in 1985 which set out the priority ordering for persons requiring treatment.
In order to implement the guidelines the Department provided the resources to the health boards to recruit the relevant expertise and this has resulted, so far, in a total of six consultant orthodontists being recruited to serve the Eastern, Southern, Mid-Western, Western, North-Western and South-Eastern Health Boards. The remaining health boards have not, as yet, found it possible to recruit consultant orthodontists but have made local arrangements to provide the services.
The availability of consultant expertise has facilitated the provision of secondary care orthodontic services in a more systematic way than before. The consultants assessed existing waiting lists for secondary care orthodontic services and rationalised the list to reflect as accurately as possible the priority guidelines of the Department of Health.
Health board secondary care orthodontic services will be developed further over the period of the plan. My Department is at present in consultation with the individual health boards as to their requirements having regard to my policy of a consultant-led secondary care orthodontic service. A major aspect to the consultant's responsibilities, in addition to his or her own direct clinical involvement, will continue to be to organise and co-ordinate training for health board dentists so that ultimately a framework of orthodontic expertise is available to meet the needs of this area of the dental services.
Secondary care oral surgery services are an integral element of the dental services. At present, such services are provided from the dental hospitals and St. James's Hospital, Dublin. It is envisaged that a number of consultant posts in oral surgery will be created during the course of the plan. The number and location of these posts are being assessed by my Department in consultation with the health boards. This assessment relates to maxillofacial and oral surgery services.
There are approximately 915,000 adult persons eligible for dental services by the health boards but, regrettably, the services available to such persons have declined in recent years to the point where, in many health board areas, only an accident and emergency dental service is being provided through the health board dental personnel. My Department has almost completed discussions with the Irish Dental Association about the introduction, on a phased basis, of a new dental treatment scheme for eligible adults. One of the frustrations in trying to improve a wide range of services was the need for improving the dental services for eligible adults.
It is envisaged that this new scheme will involve dentists in private practice working in the scheme under new, restructured arrangements. The services to be provided will include routine items of treatment, an emergency service and the provision of dentures. Against the background of the current limited and unsatisfactory dental service arrangements for eligible adults, a dental scheme along the lines of that currently being discussed with the Irish Dental Association would be a major public health benefit to this group of the population. In fact, a satisfactory adults dental scheme is central to the successful provision of dental services to other groups so that services to those groups are delivered by dental personnel designated to individual areas of the dental services. In this regard, the overlap between the children's and adults' services has restricted the development of both services.
I am happy to inform the Seanad that considerable progress has been made to date in the discussions with the Irish Dental Association, which have been constructive and positive. I take this opportunity to thank the Irish Dental Association for its commitment and support.
Under the development plan, emergency treatment will be available to all adults from the outset and routine treatment will be phased in for particular groups within the eligible population over the period of the plan.
As I intimated at the outset, it is fair to say that this area of health care requires investment to enable it to respond to the dental needs of the population and towards that end, I propose to allocate an additional £4.4 million to the dental services during 1994. It is clear that this further impetus is necessary so that the progress to date can be accelerated in a way to ensure that the dental services throughout the country are provided in an equitable, efficient and consistent manner and that variations between health boards, which can adversely affect the access to and the quality of the services, are removed.
I have outlined the provisions contained in the Health (Amendment) Bill, 1993, and the reasoning behind my proposals to maintain the continuty of dental care to children under 16 years of age. I propose to develop the health board dental services over the next four years.
I welcome the interest Senators have expressed in this area over the past 16 months. There are several clients in the Public Gallery who will benefit from the provisions of this Bill when it is enacted and the dental plan which will be implemented over the next four years. I commend the Bill to the House.
I compliment the Minister for publishing the document Shaping a Healthier Future. The document states the objectives and targets, particularly in the area of health promotion and prevention over a four year period. When reading the document, I was surprised to learn that the health services cost £2.5 billion each year. I concur with the Minister that there is a need to demonstrate that the services are effective and provide value for money for the taxpayer.
Is the Senator speaking to the Bill?
Yes, this only a passing reference.
The chapter in the document which is most relevant to this debate concerns dental services. While acknowledging that substantial progress has been made since oral health goals were set in 1984, the remaining deficiencies in the public dental services will be tackled over the next few years under the following headings: dental care for children, secondary care orthodontics, oral surgery services and service for eligible adults.
The purpose of the Health (Amendment) Bill, 1993, is to extend dental eligibility to children up to the age of 16 years. While the Bill enables services to be provided, it will also have the effect of providing continued dental care by bridging the gap between national school primary dental care services and the provision of adult dental care services. The services will put an emphasis on dental health education and prevention and will enable the systematic screening and treatment of children up to 16 years. The measure will have the effect of ensuring that children are dentally fit before reaching 16 years. The Health (Amendment) Bill, 1993, when passed will extend eligibility to an additional 190,000 children for dental services over the next four years. I am a member of the Eastern Health Board and 51,000 children will benefit in that health authority.
The only reservation I have about the measure proposed by the Minister is that the £4.4 million being provided might not be sufficient. However, I take what the Minister has said as an indication of his seriousness in providing a proper dental service for children and that is welcome.
As the Minister is aware, thousands of children are on health board waiting lists awaiting orthodontal treatment. If a child is not in category one, he has little or no chance of receiving treatment. In a strange way we have become victims of our success in this area. As the Minister said, since fluoridation was put in water, dental care in children has become a thing of the past. This has resulted in healthier teeth and children rarely have teeth extracted. However, this has caused crowding in the mouth — I do not know what the medical term is — and teeth become impacted. Children with that problem require orthodontic treatment. Orthodontic treatment in the private sector is costly and it is well beyond the reach of parents on low incomes and, especially, the employed. I hope this extra fund will help reduce the list of those awaiting orthodontic treatment.
We have come a long way in our health treatment and dental care. I have just returned from South Africa. I was disturbed by the lack of facilities for a large section of the population, including housing and water facilities and medical and dental care. I was most struck by the fact that many people had not received dental care for years. Many adults now have serious orthodontic problems. While I hope the new democracy will bring in measures which will alleviate the situation, large sections of the community are past the age of getting orthodontic treatment and that is sad.
I pay tribute to those, particularly dental surgeons, who operate in our health board areas. They operate under restricted conditions and they must deal with long waiting lists. Nevertheless, they are dedicated and they provide a wonderful service. Some go beyond the call of duty in the primary care for children and provide free toothpaste and toothbrushes. I congratulate the companies which make this facility available to the dental service.
I refer now to the Dublin Dental Hospital, which is a stone's throw away from this House. I was a member of the public expenditure committee in that hospital between 1982 and 1987. A report was put before that committee which stated that a proposed new dental hospital at St. James' Hospital was not necessary. I vigorously opposed that because, as a Dubliner, I was aware of the contribution the Dublin Dental Hospital had made to this city at little or no cost. At that time the provision of a new dental hospital was under the jurisdiction of the Department of Education. I am glad that has been rectified and it is now under the control of the Minister for Health. I am satisfied that the Minister has made £8 million available for the refurbishment and extension of the Dublin Dental Hospital. In hindsight it was a good decision to leave the hospital where it was. I know the director of the hospital is satisfied with that progress.
I welcome this is important Bill and I thank the Minister for introducing it. I wish it a speedy passage through the House.
I welcome the Bill and I congratulate the Minister on his positive approach. Those who work or are involved in the health boards are aware that the age cut off is too early. Many children had only one examination in national school because they left at 12 and problems only developed when they reached 14, 15 or 16 years of age. Health boards are always passing resolutions and if the Minister looks at his files he will see many resolutions from my health board which sought to extend the age limit to 16 years. I am pleased that this is now being done.
I am pleased by the positive approach taken by the Minister. He is providing almost £4.5 million to implement this scheme in this year alone. People may say £4.5 million is not enough, but we never have enough money. When one considers that it is only 727,810 days since Our Lord was born — it is not yet a million days, only 0.75 million — it gives one an idea of what £1 million is and what £4.5 million is for six months. That is a huge investment into dental care for our young population and our children and it should solve all our problems.
I am particularly pleased that the Minister has come to an agreement with the Irish Dental Health Association. This is very important because we need the cooperation of all those involved to work out a satisfactory system and the Minister started at the right end by having discussions with them. I know the Association of Health Boards, of which I am a member, is very pleased that the problem is solved, because for a while there was edginess and disagreement.
We are particularly pleased at primary prevention, including fluoridation and health education. This is very important and I will have a little more to say about this later on today. I am pleased that the Minister has homed in on services for handicapped persons in institutions, because physically or mentally handicapped people find having dental work done much harder than ordinary people. For that reason we must ensure that proper care is taken of the health of people with any physical or mental problems because it is more important for them to have good dental care than it is for ordinary people. I am very pleased that since he took office the Minister is paying particular attention to the physically and mentally handicapped. That is a great move. We in the health boards have been advocating this and I know that the North Western Health Board has a very proud record in that regard. This may have been to our disadvantage in some ways — we did not get as much money as we should because our services were so good. However, I was pleased that it was because our services were so good.
We have the same problem in the mid-west.
Not as badly as we have it. The fluoridation of water is very important. Most county councils have done a good job. However, as the Minister said, the equipment is getting old in some cases, while in other cases it has not yet been installed. I hope that, in conjunction with the Minister for the Environment and the Minister for Health, a strategic plan will be drawn up to bring all our water fluoridation services up to standard and to get fluoridation implemented where it does not exist.
I welcome that the age limit has been extended to 16 years of age. I have no doubt that when this full plan is implemented we will have a dental health service in this country comparable with any in Europe. When this Minister and this Government leave office that will be a reality; it will be something we will be very proud of. I will be speaking later today on the health strategy, which is a great step forward. I thank the Minister for bringing forward this Bill. I welcome it as a great step forward.
On behalf of the Progressive Democrats I welcome this Bill and I congratulate the Minister on introducing it. I wish him well in bringing about its full implementation. This Bill on its own will not be sufficient to deal with the problems that the Minister has outlined. As in everything, we need money. The people will agree with me when I say that the history of dental care provision in this country is littered with many Bills and regulations which have given entitlements to people. Unfortunately, the funding has not been forthcoming and the facilities were not available to people when they needed them. Obviously, the main difficulty in implementing many Bills that come before us in this House is finding the funding necessary to do so. For this reason I welcome the Minister's announcement that he will be allocating £4.4 million for the purpose of implementing this Bill this year. It shows that he is serious in his commitment to the provisions.
Many thousands of children are on waiting lists for dental treatment, particularly orthodontic treatment, and many of them have been on these waiting lists for quite a long time. All of us have experience of parents contacting us about their children who have not been on the top priority waiting list and have not been able to receive the treatment that the provisions have said they would be entitled to. Many of the dental services have been inadequate and poorly funded. All of us agree that prevention is better than cure, and it is much cheaper in the long run. Therefore, I welcome the provisions that the Minister has outlined, both in this Bill and in the strategy for health under the dental services, for preventative measures. It is much cheaper in the long run.
It is extremely difficult for any Minister to provide funding for everything that is required but, as I said, many of the provisions that were introduced were limited to the extent of the funding provided. I hope this does not happen in this case, and I accept the Minister's commitment to ensuring that it does not. At the moment there are various categories of children in relation to orthodontic care, varying from category one down to category four; but the reality up to now is that many patients in category three and four have no hope of ever receiving treatment. They might as well really have not been on the waiting list at all.
We have seen a concentration of treatment rather than prevention due to the lack of resources. I believe that this will change with the introduction of this Bill. The cost of orthodontic treatment for many people in this country in the private sector has been prohibitive and under the present system a lot of pressure has been put on parents to provide orthodontic treatment for their children, treatment which they cannot afford and which in many cases was not really necessary. In many cases people who are good at demanding services have got them, whereas the poorer sections of the population and those who are not aware of the necessity of dental care did not avail of these services. I hope this will change under the provisions of this Bill. I believe that people who are most in need should get the treatment that they require.
We all agree that school children should be annually screened and treated, and again prevention is the key area here. The 1988 Department of Health report stated that health boards were failing in their statutory obligations to provide dental treatment for all the people they were required to provide it for, but it was due to the lack of funding. Now the Minister has outlined his intention to change that. We could examine the feasibility of the introduction of paramedics such as dental hygienists. Much work could be done by them, particularly in relation to education and oral health. Employing paramedics would not be as costly as employing dental surgeons.
We must try at all times to encourage prevention as it is much cheaper than cure. Research, as the Minister has stated, has shown that there has been an improvement in the level of oral health among Irish adults. However, the less well off members of society, and particularly women, have a much lower level of oral health and this must be improved on. The recent survey on health produced by the Irish Heart Foundation made interesting reading in relation to our teeth and the percentages of people who visited their dentist regularly. It showed that 45 per cent of people had visited their dentist in the year preceding the taking of the survey; 19 per cent had dental treatment one to three years earlier; but 36 per cent had not visited their dentist for three years or more. Women and men were equally likely to have visited their dentist in the previous year. I am glad of that. Sometimes women neglect their own health and teeth because they are much more aware of looking after everybody else in the family and they tend to put their own needs at the bottom of the pile.
The Minister's plan for the dental service is part of the health strategy document he introduced. He acknowledges the deficiency in the public health dental services and says they will be tackled over the next four years. He has produced a plan of the aims of the public dental service, including the reduction of the level of dental disease in children, the improvement of oral health and adequate treatment services to children and to all medical card holders. All of us welcome that. It will take four years to implement but he has outlined the headings. They are: primary prevention, including fluoridation; primary care for children; services for the handicapped; secondary care, orthodontic services, oral surgery services and a service for eligible adults.
This strategy will take longer than a year to implement, but the Minister also has set targets. I am glad of that, because we need something to measure what we are doing against. If we set targets today we need to be able to measure in four years' time how successful we have been in achieving these targets. I welcome the Bill and I compliment the Minister on introducing it. It will pass speedily through the House as all parties have welcomed it. I look forward to its full implementation. I wish the Minister well in his negotiations with the Irish Dental Association because it implements many of the Bill's provisions. In the past many entitlements were given but were not delivered on. I acknowledge the Minister's commitment and I wish him well.
I welcome this Bill to provide services to people up to the age of 16 years. A major concern for anybody, especially those in the PAYE sector, is the cost of dental bills if they do not have a medical card. It was always a hair raising experience to have to go to the dentist. One thinks back on old treatments; I remember many years ago that my father used to give me a taste of whiskey as it was the cheapest way of killing the pain. Hopefully, with the treatments now available to schoolchildren and the extension of the free service under this Bill, there will be no need for those old treatments.
The cost of dental treatment to parents can be great. I welcome the plan which the Minister has outlined for the next four years; it is along the lines of what the Minister has been doing since he took office and major strides have been made. This represents another £4.4 million and every health board in the country will welcome more money coming into the health service. Every health board has problems not only in relation to dental care but to all forms of health care. Therefore, when £4.4 million becomes available it is welcome.
The area I come from is serviced by the North Western Health Board and it has major problems in relation to Letterkenny. I recently visited the dental surgery in Letterkenny which has problems with the building and the service. The staff are in an impossible situation. There are plans to move the service out of the general hospital building to the old psychiatric hospital building in St. Conal's. I am not looking for all of the £4.4 million, but perhaps the Minister would consider giving some of it to enable the staff in the dental unit to provide Donegal with the service it deserves. Some of the staff are working in prefab buildings. There are long waiting lists. I hope the Minister will give serious consideration to the case put by the North Western Health Board.
Not everybody goes on to second level education and people can get lost in the system. When people go over the age of 16 or 17 it can become costly to go to the dentist. If we can include the people between the ages of 12 and 16 we will save money not only for the people themselves but also for the Department. I welcome the talks going on between the health boards and the Irish Dental Association. It is the proper way to conduct the business of health promotion.
The dental plan which the Minister outlined includes services for the handicapped and persons in institutions. This is an area in which I have many years of experience and I know the problems associated with people in institutions. A tooth extraction for somebody who is mentally handicapped can cause major problems for the person and for the staff who are bringing them for treatment. It can impose a great strain on the person involved and on the staff. I am happy that under the dental plan structures will be put in place whereby many of these problems can be avoided, because the handicapped need extra care and attention.
I welcome the Bill and I congratulate the Minister on bringing it forward.
I welcome the Minister to the House and I welcome this Bill. I have had experience over many years as a member of the Southern Health Board until 1991 and I do not think the situation has changed since then. At present only pupils up to fourth or fifth class in primary school are being examined and in some cases no services are being provided. I am aware of cases where children have left national school without getting the service and, consequently, parents have had major problems.
The Minister's proposal to extend the service to children up to 16 years of age is commendable. However, is the Minister providing an adequate service at present for those up to 12 years of age? If the children are being examined at school is the service being provided? I was a member of the Southern Health Board until recently and I have no reason to believe that the situation has changed, although I will stand to be corrected on the point. I can only gauge the system by the representations I am asked to make on behalf of others. While we welcome the Bill, we want an assurance that the necessary finances are being provided specifically for dental care.
In the Minister's statement he referred to secondary care orthodontic services and he mentioned the guidelines of 1985 — one of the most contentious documents which ever issued from any Government Department. Parents saw that their children required orthodontic treatment and might have been so advised by their GP; but the orthodontist and the health board invariably refused, saying that they had to abide by the guidelines issued to them by the Department and that the treatment being sought was cosmetic. There is a vast difference between providing what is deemed to be a cosmetic or an orthodontic treatment.
I had experience recently of a family who were so desperate that they raised £1,500 — a sum they could ill afford — because neither the orthodontist nor the officials of the health board would relent, although it was more a matter for the orthodontist. The child was conscious of her own condition and in the interests of the child the parents decided to pay the money. I ask the Minister if those strict guidelines still apply and if there is any intention of changing them. They were strict because they used the concept of cosmetic and there is a need to change that.
One welcomes any improvement in the services but I hope that the services which it is proposed to improve will be matched by financing. Do the guidelines relating to orthodontic treatment still exist and is there any intention of changing them? I am sure that as a public representative the Minister has been aware of the issue I have raised.
I thank all the Senators for their contributions. I also thank each of the Senators for the broad welcome they gave to this important legislation. The Bill comprises only two short sections, but its impact will be major. We have talked for a long time about the gap between the eligibility given to children for dental services in national school and their new eligibility when they become medical card holders. This Bill aims to bridge that gap to allow a continuum of treatment up to the age of 16.
I was concerned that, in doing something as important as this, it would not be merely cosmetic and that I would not be extending eligibility to a category for which I could not provide. I clearly stated in my Second Stage speech that the dental services have been looked at root and branch as part of the overall examination of the health service over the last 16 months in advance of publishing the national health strategy. What I am announcing today is not merely a legislative change, although that is the essence of the Bill, but a four year development plan for dental services in parallel to that, which would be of huge benefit not only to all of our children but to any eligible adults as well.
Senator Doyle welcomed the Bill and gave special mention to the Dublin Dental Hospital. I am pleased that we have resolved the difficulty which has been constantly referred to for many years, concerning the location and funding of this hospital and who should be responsible. Should it be in the capital programme for Education or Health? A commonsense approach was taken on that matter. A committee was chaired by the late Assistant Secretary of my Department, Gerry McCarthy. Senior officials of the Departments of Finance and Education also served on that committee. They concluded that the optimum solution was to leave it in the heart of Dublin city to serve its traditional population base. In conjunction with the Minister for Education, I was able to get an allocation of £8 million to build it. That is a commonsense and no-nonsense approach to solving a problem that has been around for some time and I look forward to that facility being put in place.
Senator Farrell also strongly welcomed the Bill and mentioned his regards for the mentally handicapped. I would share his sentiments in that regard. He was concerned that the investment in new resources for mental handicap services did not flow as generously to the North-Western Health Board as other health boards because the services there were so well developed. When he talks to his colleagues in the North-Western Health Board — I met a deputation from it yesterday — he will understand the reasoning behind that. Underlying the strategy of resource allocation is identifying and researching need, which will be welcomed and applauded by all sides.
Senator Honan also welcomed the Bill on behalf of the Progressive Democrats. She talked at some length about funding and the need for resourcing any proposal such as this. I sincerely hope that Senator Honan and her colleagues will be enthusiastic supporters of my increased Estimate when I look for the money and will not be tempted to accuse me of being a spendthrift because I have sought considerable extra resources to improve health services in the last 16 months. I do not shy from being labelled a spendthrift and do not apologise to anybody for seeking resources for the type of improvements people are entitled to and have sought for some time.
Senator Honan and a number of other Senators, most notably Senator Sherlock, talked about orthodontics. This area is not only a problem for our health services, but across the world. It is a relatively new demand. When we were growing up — I am not tens of decades out of primary school — it would have been unusual for people to have orthodontic treatment. There is now a huge insatiable demand for orthodontic treatment and it is extremely expensive. Experience in other countries has shown that a considerable portion of orthodontic treatment has no real benefit to the patients concerned. We must be discerning in terms of a scarce resources and an expensive procedure. We should target it to those who it can benefit most in either health or social gain. It is my objective and that of the plan to increase orthodontic provision in a line consistent with the European norm over the four years of the plan. That is as ambitious as we can be. Six orthodontic consultants have already been provided for the health boards. The resourcing and new facilities in the new Dublin Dental Hospital will also augment this provision.
The other point made by Senator Honan concerns the use of paramedics. I have indicated my willingness and enthusiasm for the employment of paramedics in the dental services. I also intend to have dental hygienists involved in the public dental service as soon as possible. Senator Maloney welcomed the Bill and talked, as is his wont, about his own area of expertise. I understand his keen interest in the health situation in County Donegal and know again, from the twice daily approaches I have got from Senator Maloney over the last 16 months, that he is most anxious to have the optimum health service available to those in his home county. I am aware of the difficulties in Letterkenny, and the capital requirements of Letterkenny are currently under consideration between my Department and the health board. I hope we can be of assistance to him in that regard.
Senator Sherlock spoke in terms of the deficiencies in the dental services. In my contribution I made no secret of the fact — some Senators who are members of health boards will recall my first visit to the Association of Health Boards last year shortly after I become Minister — that I was unhappy with the provision of dental services, especially to eligible adults. I have outlined my response today. It is easy to identify the problem but a little more difficult to identify the solutions. I have proposed and outlined a four year development plan to the House which will address the problems that, as public representatives, we all know about. This will bring about a dramatic improvement over the next four years in the quality, efficiency, effectiveness and thoroughness of dental services in this country.
I again thank all Senators who supported this Bill and appreciate their contributions and comments. I am glad it has been given such a speedy passage through Second Stage.
Question put and agreed to.
Agreed to take remaining Stages today.