Vol. 401 No. 5
17 Mr. Spring asked the Minister for Health the number of extra orthodontic cases treated in each health board area in respect of the additional allocation announced in the budget; the numbers on the waiting lists in each health board area; and if he will make a statement on the matter.
The following table gives the number of children from the top priority orthodontic waiting lists for whom the health boards have been asked to provide orthodontic treatment in the current year as a result of the special budget allocation for dental and orthodontic services:
|
Health Board |
Children |
|
Eastern |
533 |
|
Midland |
60 |
|
North-Eastern |
180 |
|
North-Western |
117 |
|
South-Eastern |
120 |
|
Southern |
187 |
|
Western |
105 |
The Mid-Western Health Board already have a fully developed orthodontic department in place. The board sought additional funds to expand their routine dental services for adults and children which had been curtailed in order to develop and staff their orthodontic department.
I am unhappy with the orthodontic waiting lists being kept by some of the health boards at present because some lists include children who have not yet been assessed in accordance with the Department of Health guidelines for the provision of this expensive treatment and therefore do not show a true picture of treatment need. My Department have asked the health boards to review their waiting lists. I expect that this review will be completed during the summer.
The question I posed relates specifically to orthodontic cases whereas the £3 million to which the Minister referred was in relation to dental treatment generally.
I did not refer to £3 million in my reply.
The Minister himself referred to it earlier. That amount was mainly gobbled up by routine adult treatment, leaving less than £1 million available to make any impact on orthdontic cases. Has there been any change in the departmental guidelines in relation to the provision of orthodontic treatment for children since the budget announcement?
We have been examining this matter particularly since August of last year. Towards the end of last year we directed the health boards to assess and treat top priority cases within their boards. We made £300,000 available for that purpose towards the end of last year. We have directed the boards to treat the 500 priority cases within the eight health boards. I am very pleased to be able to say that, as a result of our efforts, negotiations and the extra allocation, we achieved a target of 594 children being treated. Following discussions with the health boards we gave a commitment to allocate extra resources in 1990 provided they could prove conclusively they were able to deal with priority cases fairly quickly. Because of that assurance the Minister for Health was able to persuade his Cabinet colleagues to make extra funds available. The guidelines which obtain at present were drawn up when the Deputy's former party colleague was in office. Those guidelines are virtually the same except that, as a result of negotiations with the health boards, we have impressed on them the urgency for clearer assessments and quicker decisions pertaining to people on the lists. As a result of the consensus we reached and the extra funds made available we are confident that the long-standing orthodontic lists can be eradicated fairly quickly.
Before the Minister of State gets too carried away with the 594 children he says have been treated, is he not aware that there are in total some 20,000 children awaiting orthodontic treatment? Is he also aware that, under the points system, in order to receive orthodontic treatment — no matter how badly disfigured are one's top or lower teeth — one cannot gain sufficient points unless both sets of teeth are disfigured? Would he agree that this is a disgraceful position, leading to many children being left without such treatment? Would he not now agree that the only way to resolve this problem is to introduce new criteria for the recruitment of consultant orthodontists, allowing a small element of private practice?
I listened with interest to what Deputy Yates had to say. I am fully aware of the exact position prevailing at present in our dental services and within the orthodontic area also. Deputy Yates spoke of the points system. I might tell him that between the years 1983 and 1987 the scheme was absolutely denuded of resources. The Coalition Government at that time brought in certain conditions. We have improved them, making extra resources available and we are doing our utmost to ensure that maximum flexibility obtains within the service, that the most efficient expeditious method of assessment possible is used when, hopefully, we can involve not alone health board dental surgeons but also the private sector ensuring that by such co-operation, we can provide a proper level of service for our children.
Will the Department recruit orthodontists?
We have done our utmost to recruit orthodontists; our record is there.
Arising from the Minister of State's assertion that he knows all that is going on in the health services in the country——
I did not say that; I said within the dental services.
Would he respond to the specific question tabled in the name of Deputy Spring in relation to the numbers on the waiting lists in each health board area — which he has evaded responding to thus far — whether they do amount to 20,000, already referred to by Deputy Yates; whether he would acknowledge that the £300,000 constitutes a drop in the ocean in relation to orthodontics; whether he accepts that the guidelines which have been his responsibility now for three and a half years result in many health boards now announcing to potential patients that severe defects only will be treated by health board dentists or orthodontists?
First I want to clarify what I said. I did not say I knew all that was going on in the health services——
In the dental services then.
Deputy Howlin said in the health services; I said in the dental services. The Minister himself knows exactly what is going on in the overall health services.
How many are on the waiting lists?
Furthermore, I want to say to the Deputy that we allocated £300,000 extra——
How many are on the waiting lists?
Please, Deputy Howlin, you asked some questions. Would you listen to the replies?
We allocated an extra £300,000 in 1989 as a result of which——
How many are on the waiting lists?
Deputy Howlin must desist and allow the Minister to proceed without interruption.
He is evading the question.
——five hundred and ninety four cases were treated. The Minister, in his allocation this year, has provided almost £1 million extra for orthodontic treatment. We have had negotiations with the health boards, requesting them to ensure that approximately 1,300 priority cases will be commenced this year. I can tell the Deputy that, to date, treatment in 900 of those cases has begun and that the figures to which Deputy Yates referred are reasonably accurate.
That is 20,000 on the waiting lists.
Representing 5 per cent of the children of this country.
We have devoted a lot of time to this question. I will hear a brief supplementary from Deputy McCormack.
Will the Minister say when a consultant orthodontist will be appointed to the Western Health Board where the waiting period is now eight years since they are now dealing with 1983 applications?
Would the Minister say whether a problem has been encountered in recruiting orthodontists in the first instance; whether many cases that could be treated by dental surgeons, other than orthondontists, should be assessed and whether a problem has been encountered in that regard?
We have encountered, as indeed did the previous Government from 1983 to 1987, the second last Government, who failed to recruit one orthodontist——
Deputy McCormack referred to 1983 applications.
All I can tell the House is that the Western Health Board, and all the other health boards, have made substantial progress in reducing the waiting lists and, at present, have moved up to the end of 1983 in having people called from their lists whereas, when we inherited those lists, there had been people on them since 1979.
There are 520,000.
What about an orthondontic service for the Western Health Board?
We are doing our utmost to recruit. We are looking at the idea of a devolved system whereby we can involve the private sector on a part-time basis to ensure a proper service. I admit that we have a major difficulty in recruiting people into the public sector because the opportunities in the private sector are so lucrative.
