The provision of orthodontic services is the statutory responsibility of the health boards and authority in the first instance.
Under the Health Act 1970, a child is eligible for orthodontic treatment on the basis of defects noted at a school health examination carried out while the child is attending national school. There is no application processper se, as children in specific classes in national school, usually in second, fourth and sixth class, are dentally screened and referred for orthodontic review as necessary.
Entitlement to 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 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. The number of cases treated is dependent on the level of resources available, regarding qualified staff, in the area, and that is reflected in the treatment waiting list. In fact, the provision of orthodontic services is currently severely restricted owing to the limited availability of trained specialist clinical staff to assess and treat patients.
However, I am pleased to advise the Deputy that I have taken several measures to address that shortage.
The grade of specialist in orthodontics has been created in the health board orthodontic service. In 2003, my Department and the health boards funded 13 dentists from various health boards for specialist in orthodontics qualifications at training programmes in Ireland and at three separate universities in the United Kingdom. Those 13 trainees for the public orthodontic service are additional to the six dentists who commenced their training in 2001. Thus, there is an aggregate of 19 dentists in specialist training for orthodontics. Those 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.
Furthermore, the commitment of the Department to training development is manifested in the funding provided for both the training of specialist clinical staff and the recruitment of a professor in orthodontics for Cork Dental School. That appointment at the school will facilitate the development of an approved training programme leading to specialist qualification in orthodontics. The chief executive officer of the Southern Health Board has reported that the professor commenced duty on 1 December 2003. In recognition of the importance of that post at Cork Dental School, my Department has given approval in principle to a proposal from the school to make further substantial improvements to the training facilities there for orthodontics. That project should see the construction of a large orthodontic unit and support facilities; it will ultimately support an enhanced teaching and treatment service for the wider region under the leadership of the professor of orthodontics.
Orthodontic initiative funding of €4.698 million was provided to the health boards and authority in 2001, and that has enabled health boards to recruit additional staff, engage the services of private specialist orthodontic practitioners to treat patients and build additional orthodontic facilities.
In June 2002, my Department provided additional funding of €5 million from the treatment purchase fund to health boards specifically for the purchase of orthodontic treatment. That funding is enabling boards to provide both additional sessions for existing staff and purchase treatment from private specialist orthodontic practitioners.
Finally, the chief executive officers of the health boards and authority have informed me that, at the end of the September quarter 2003, there were 20,784 children receiving orthodontic treatment in the public orthodontic service. That means that there are over twice as many children getting orthodontic treatment as there are children waiting to be treated, and nearly 3,500 extra children have been getting treatment from health boards since the end of 2001.