I move:
That Seanad Éireann condemns the continuing failure of the Government to deal comprehensively with the acute crisis in the orthodontic service. In particular, Seanad Éireann calls on the Government to implement the following recommendations from the recent report on the orthodontic service in Ireland published by the Joint Oireachtas Committee on Health and Children:
– an expert panel consisting of three persons be established to resolve the fractious relationships within orthodontics in order that an efficient, effective and professional service can be delivered to those children who qualify for orthodontic care;
– the Department of Health and Children to prepare an orthodontic action plan within the next six months and the proposed legislation for an independent health information and quality authority to be enacted as a matter of urgency;
– guidelines for prioritising the orthodontic service to be considered by the relevant Oireachtas committee before they are amended;
– greatly enhanced training opportunities involving primary level orthodontics to be included in the primary dental degree course in Dublin and Cork; State funding for up to 18 orthodontic postgraduate training places in the Dublin Dental Hospital and school; significant increases in specialists training places and greater access to courses provided in UK and Northern Ireland dental colleges;
– specialist manpower levels based on a caseload of 250 completed cases each year per specialist orthodontist;
– a new and dynamic recruitment strategy that determines the number of and qualifications required by specialist orthodontists and seeks to attract the relevant personnel through recruitment campaigns both here and abroad;
– enhanced delivery proposals such as a review by each health board of waiting assessment lists; an automated appointment system and an accurate system of outcome measurement.
This is a comprehensive motion which goes through a group of seven representative recommendations, although there are more than this. The report was part of the work programme of the Joint Committee on Health and Children for six months. In response to the public outcry regarding problems in the orthodontic service, we set out to examine the current policy and practices as well as the education and training requirements. Uppermost in our minds were concerns about the severe delays in the provision of services. We heard a number of interesting contributions from invited groups, individuals and organisations. Mr. John Kissane reviewed the written and oral presentations and the report was agreed on 21 February.
It is worthwhile emphasising one particular point from the report, namely, the response by the Chairman, Deputy Batt O'Keeffe, to committee members. We wish this to be aired because there were contentious issues on the delivery of orthodontic services. He stated, "The Joint Committee has asked me to express its total dissatisfaction with the operations of the orthodontic service to date." This is very much in conflict with the Government amendment. He continued:
The members are not satisfied that the various stakeholders involved are working to provide a service which meets public needs. The interests of children are paramount and must take precedence over all other interests. We will have to consider the matter again if signifi cant progress is not made in implementing the recommendations in this report immediately.
It cannot be put in much stronger language. I do not expect that this will be done in the dying days of this Dáil and Seanad. I was disappointed that the Dáil had not debated the report and that it had been left to the Opposition to raise it in Private Members' business. We asked many times on the Order of Business to have it discussed.
I will focus on the first recommendation dealing with the Mid-Western Health Board, the area with which I am most familiar. It is an issue that is causing difficulty. Although I do not agree with it, it is worth looking at the recommendation, which states:
In the continued absence of agreement from all regional consultants, the areas of dispute should be referred to an expert panel. This panel should consist of an expert nominated by the three consultant orthodontists in question [Mr. Ian O'Dowling, Mr. Tony McNamara and Mr. Ted McNamara], an expert nominated by the other parties in the dispute and an independent chairman to be agreed by the two other nominees. The findings of this panel should be binding on all parties.
Three consultant orthodontists in question do not see this as resolving the issue, and, in fact, do not see this as the issue. They see the problem as lying within the Department.
The core issues have not been resolved. The waiting lists, instead of being reduced, have grown during both the Minister, Deputy Cowen's and the Minister, Deputy Martin's tenure. The kernel of the problem relates to the training programme initiated and undertaken by Mr. Ted McNamara. It was extremely effective, as is made clear in the Mid-Western Health Board's submission by Mr. Ted McNamara and Mr. John O'Brien. It started in 1985 in line with national policy and three dental surgeons were appointed. This training initiative enabled dental surgeons in the region to undertake minor cases not requiring specialist input. It suddenly ceased in May 1999 when the accrediting body failed to undertake a routine accreditation visit to the mid-west.
I do not have time to go into that now but I will put in context the waiting lists for assessment and treatment. In 1993, no one was awaiting treatment while 1,280 were on the waiting list for assessment. In 2000, 1,488 awaited treatment and 2,752 were awaiting assessment. That issue was not addressed in this huge document despite many efforts by the members. I hope it will not be consigned to the shelf but consulted.
The capacity to respond is restricted because of difficulties in the availability of trained orthodontists – a problem here and in the UK – the cessation of training and the consequent effect on the availability of the trainee resource, the cost of referring patients to the private sector, and the absence of transitional arrangements prior to the availability of the new trainees in 2004. We must bear in mind the increased risk to patients' health and safety from lack of timely intervention.
There are both long and short-term issues. The former are the appointment of appropriately qualified personnel to chairs and professorships of the dental schools in Dublin and Cork to implement training programmes, consideration of contributions from other academic institutions, the implementation of a training programme, which takes account of the academic and practical requirements in training and post-registration, and a system of staff retention. On the last point, the members of the committee clearly indicated that a cartel in the private sector made it very difficult to recruit people into the public sector, which is not addressed in the report. The other issue is having meaningful representation from the health boards' management on the dental council.
The possible solutions are a recruitment drive to attract orthodontists to the public sector, including the overseas campaign – although that is not working – and the reintroduction, on an interim basis, of the training scheme that has been in abeyance since 1999. There should be no difficulties in obtaining accreditation nor in adjusting the balance between practice and academic activity.
Why was the training scheme discontinued when there are 35,000 on the waiting lists and waiting times are increasing? Unless there is a co-ordinated approach among the key stakeholders, lists will continue to grow with all the consequences for patient health. The Minister should have shown much more leadership and not brushed this aside to be dealt with by departmental officials. He should have intervened to come up with a compromise to address the issues. The dentists who undertook training gave a good service for five years and treated many patients, but today the present clinical load is 100 to 120 over three years, which will not solve the increasing waiting lists. The matter of the fee per item of up to €3,000 is also questionable.
Children should be seen between 11 and 13, the optimum period, but must wait five years or more during which time they move from childhood to adulthood. Therefore, treatment becomes more costly. Category C patients, that is non-handicapped cases which need treatment, are not being seen at present. I hate to say so, but I believe that the Minister's Department does not want to treat these cases in the hope that the list will shrink to manageable numbers.
There must be another examination of this report and the training system, that worked so well before, must be re-activated. We want to see new thinking in the last weeks of this Administration. It is not in this report, which does not reflect the opinions of those involved, nor address the main issue, that is the waiting lists. It is shock ing that children do not receive treatment at the correct time. Orthodontic treatment is not rocket science but a dental specialisation. There is no excuse for the growing waiting lists.