Vol. 413 No. 7
9 Mr. Durkan asked the Minister for Health if she has or will review the requirements for dental and orthodontic treatment throughout the country with particular reference to long waiting lists in the Eastern Health Board area; and if she will make a statement on the matter.
Those eligible under the Health Acts for health board dental services are: (a) Medical card holders and their dependents. (b) Pre-school and national school children in respect of defects noted at child health examinations. (c) Other persons adjudged by the chief executive officer of a health board to be unable to provide a particular service for themselves without experiencing hardship. The Department have issued guidelines to the health boards concerning specialised orthodontic treatment, which I keep under review.
The guidelines were introduced to ensure that the resources for such services would be used to the best advantage and for those most severely affected or handicapped. Orthodontic cases are categorised by the guidelines into the following priority groups in descending order of handicap: Category A. The most severe cases, e.g. cleft lip and palate, somewhat less than 1 per cent of all children. Category B. Cases with severe functional handicap, e.g. marked disproportion between the upper and lower jaws, and, therefore, teeth, about 6 per cent-8 per cent of children. Category C. Non-handicapped cases but having a definite need for treatment, e.g. masticatory and/or speech impairment, about 12 per cent-16 per cent of children. A further category, sometimes called D, caters for the simpler type of case which can often be treated at primary care level by a non-specialist having sufficient skill and experience.
The position regarding orthodontic services in the Eastern Health Board area was outlined fully by my colleague, Deputy Chris Flood, Minister of State at the Department of Health, during the Adjournment Debate of 17 October 1991 at columns 919 to 922 of the Official Report. I am satisfied that, with the investment of additional funding for the third year, significant improvement is being made in the delivery of the orthodontic services in the area.
Primary dental care services are available to school children throughout the health boards. In the Eastern Health Board area the method of delivery of these services varies between community care areas. Some areas operate a demand based system under which care is provided to children whose parents seek it. A number of other areas are changing from a demand based system to a system based on need for care. With this system children in selected classes in the schools are examined in the schools and any necessary care is provided at a designated clinic.
Routine care is also being provided for adults in the health boards' clinics from the additional moneys provided by my Department for the purpose. In the six months to 30 June 1991 the Eastern Health Board provided a total of 4,600 additional treatments for adults. In addition, emergency care is available both to adults and children on a daily basis.
My Department are at present reviewing the provision of both the dental and orthodontic services to ensure that the significant resources being committed to them are utilised in the most cost effective, prioritised and equitable way.
Like other speakers, I welcome the Minister to the House to answer questions for the first time on health matters and wish her well in the future. I should make the comment that she will after a time come to be as disappointed as are those of us who are members of health boards, with the jargon used in some of the replies given to questions. May I ask her specifically if she is aware of the total number of people waiting for treatment in the Eastern Health Board area at present? Is she further aware that, even though this is the third year in which extra funding has been made available, the waiting period is as long now as it was three years ago, if not longer, and that most parents have found it is cheaper in the long run — in some cases they have remortgaged their houses — to attend a private orthodontist to get the treatment which their private medical practititioner deems necessary?
I thank the Deputy for his kind comments. In relation to the jargon used, this was one of the first things which struck me when I went to the Department; but, of necessity, I will have to learn some of it as it is medical in nature. I have a wet towel around my head each night trying to learn all these terms, but I am managing.
With regard to the question of waiting lists, as the Deputy has said, this is the third year in which additional funding has been made available. As the House will be aware, we had difficulty in recruiting qualified professional people. I agree that the question of orthodontic treatment for children requires constant vigilance. I hope we will continue to make progress and report a better rate of take-up.
Is the Minister aware that the consultant orthodontist to the Eastern Health Board has resigned her position? In light of that will she accept that the hope of the Eastern Health Board getting to grips speedily with the 9,000 children awaiting service is in serious jeopardy? Can she hold out any hope to the many families who have been told that their chances of getting care are minimal?
Last night the Deputy brought the same matter to my attention. I looked at the case of the professional person to whom the Deputy referred. I told him last night that there were underlying difficulties and I do not intend to go into them. I hope the difficulties will be cleared in regard to the new appointment.
Has the person to whom I referred entered an agreement with a group of consultants?
The Deputy mentioned a particular case here, which he also mentioned last night. I do not intend to enter into personalities but I told the Deputy last night — and I now repeat it — that there were particular difficulties which neither side was able to overcome. I hope the same position will not now pertain but I do not wish to enter into the matter any further.
The Minister has not really come to terms with the dire situation in regard to orthodontics in the Eastern Health Board region. Will the Minister agree that it is outrageous, frightening and startling that 9,000 people are on the waiting list? The rate of treatment is 2,250 per annum, which means that the minimum waiting period is four years. There is no light at the end of the tunnel.
I do not accept the Deputy's comments. I know that Opposition Members will say for quite some time that I do not know the facts. However, I intend to acquaint myself with the facts very quickly in regard to my Department. I accept that there are very long waiting lists as far as this type of treatment is concerned. How could I say otherwise? We will continue the progress made over the last three years and a determined effort — in line with what has already been done — will be advanced in this area.
Is the Minister aware of her predecessor's commitment to look at the guidelines in this area which would perhaps lead to an increase in the number of people qualifying for treatment and which would create further waiting lists? We accept the Minister's good faith in trying to improve the system but there are dreadful problems throughout the whole country, not just in the Eastern Health Board area.
We must confine ourselves to the Eastern Health Board area. We will proceed to Question No. 10.
