Vol. 424 No. 1
7 Mrs. Owen asked the Minister for Health the number of health boards which employ consultant orthodontists; the number so employed and the length of time they are employed for; and if it is proposed to make any further appointments in the near future in view of the huge waiting lists for treatment in all parts of the country.
13 Mr. Creed asked the Minister for Health the number of people waiting for orthodontic treatment in the Southern Health Board area.
36 Mr. Farrelly asked the Minister for Health the number of people waiting for orthodontic treatment in the North Eastern Health Board area.
39 Mrs. Barnes asked the Minister for Health the number of people waiting for orthodontic treatment in the Eastern Health Board area.
55 Mr. Flanagan asked the Minister for Health the number of people waiting for orthodontic treatment in the Midland Health Board area.
63 Mr. Noonan (Limerick East) asked the Minister for Health the number of people waiting for orthodontic treatment in the Mid-Western Board area.
66 Mr. G. Reynolds asked the Minister for Health the number of people waiting for orthodontic treatment in the North Western Health Board area.
69 Mr. Connaughton asked the Minister for Health the number of people waiting for orthodontic treatment in the Western Health Board area.
73 Mr. Hogan asked the Minister for Health the number of people waiting for orthodontic treatment in the South Eastern Health Board area.
126 Mr. Durkan asked the Minister for Health the total number of children identified by the various health boards as being in need of orthodontic treatment; the number treated in the past year; the numbers still to be treated; the number of orthodontists in each health board area dealing with the problem; the average waiting time, at present, for schoolchildren seeking treatment; and if he will make a statement on the matter.
I propose to take Questions Nos. 7, 13, 36, 39, 55, 63, 66, 69, 73 and 126 together.
For the past few years the Government have made available a special allocation specifically for the development of the adult dental services and the provision of orthodontic treatments. A sum of £3 million was provided by the Government in 1990 and a further £3 million was provided in 1991. The special allocation has enabled health boards to bring an additional 2,500 orthodontic cases into specialist treatment in 1990 and a similar number onto specialist treatment in 1991 and at the end of that year over 12,000 children were receiving treatment. About another 4,000 receive treatment at primary care level. The allocations made available to health boards in 1992 include a repeat of the special provisions of 1990 and 1991. At current levels of treatment health boards are completing over 5,000 cases annually.
A post of counsultant orthodontist for each health board had been approved by my Department but health boards had difficulty in filling them because those orthodontists with the qualifications necessary for appointment found private practice more attractive.
However, following a review, the pay and conditions attached to the post were significantly improved by my Department and vacancies were re-advertised by the Local Appointments Commission in 1991. As a result a number of health boards have now successfully made appointments.
The position in each health board is as follows:
Eastern:— The board proposes to make shared appointments with the Dublin Dental Hospital and interviews of candidates are due to be held this month.
Midland:— The board were unsuccessful in the Local Appointments Commission competition and have made alternative arrangements with private specialists to provide services. The board will again endeavour to fill the vacant post of consultant orthodontist in the near future.
Mid-Western:— A consultant is in post since 1985.
North-Eastern:— The board was unsuccessful in the Local Appointments Commission competition and have made alternative arrangements with private specialists to provide services. The board will again endeavour to fill the vacant post of consultant orthodontist in the near future.
North-Western:— A consultant took up duty in February, 1992.
South-Eastern:— A consultant took up duty in September, 1992.
Southern:— A consultant took up duty in January 1992.
Western:— A consultant has been appointed this month.
Five health boards, out of a total of eight, have orthodontic surgeons. The successful recruitment by health boards of consultant orthodontists will considerably improve the services provided by the boards.
At present, average waiting times for children seeking orthodontic treatment vary considerably throughout the country, but with the recruitment of the consultant orthodontists it can be expected that there will be considerable improvements in the waiting times. In this regard a primary task of the consultant orthodontist is to organise and co-ordinate orthodontic training to specialist and sub-specialist levels for health board dental staff to enable health boards to provide a greatly increased volume of service. The level of service now being provided has generated an increased expectation and consequently demand.
The provision of fixed appliance orthodontic treatment is very expensive. It is important therefore that resources be used to best advantage and for those most severely affected or handicapped. Accordingly my Department issued guidelines to health boards on the classification of cases awaiting treatment in descending order of severity or handicap. Children have been assessed for treatment by health boards in accordance with these guidelines and, where appropriate, placed on the waiting lists.
According to information supplied to my Department by the health boards the current waiting lists are as follows:—
|
Health Boards |
Categories |
||
|
A |
B |
C |
|
|
Eastern |
40 |
5,572 |
3,847 |
|
Midland |
1,120 (B and C) |
||
|
Mid-Western |
538 (B and C) |
||
|
North-Eastern |
9 |
517 |
1,398 |
|
North-Western |
542 (in categories broadly equivalent to A, B and C) |
||
|
South-Eastern |
35 |
2,492 |
337 |
|
Southern |
48 |
437 |
12 |
|
Western |
Nil |
1,300 |
745 |
All health boards are reviewing their waiting lists with a view to increasing throughput of patients treated. At national level I am giving consideration to what further action is necessary in the context of 1993 estimates.
I call, first, Deputy Owen whose Priority Question No. 7 refers.
Is the Minister aware that on a quick calculation the figures he has read out amount to approximately 15,000 people waiting for orthodontic treatment? Is he further aware that some of these are children who had been assessed when they were nine or ten years old and that they will be parents or, perhaps, grandparents before they will receive treatment? Is he really telling us that the appointments list he has given today is a sufficient effort to remove and cut down on these lists? The figures are appalling and he must have been embarrassed to announce them today in the Chamber.
I am not embarrassed at all. I am giving factual information.
The Minister should be ashamed of them.
It is never embarrassing to me to give factual information. That is the first thing. Second, we have only 132 people in category A — that is those who are handicapped, who have harelip or cleft palate, and those who are in urgent need of treatment. Categories B and C are arbitrary. A mother may find that her children's teeth——
There is nothing arbitrary about that.
It is arbitrary because one consultant orthodontist may say that treatment is not necessary whereas his colleague may say it is absolutely essential. I have had friends who had that experience. I was surprised at that. We do not have enough orthodontic surgeons in Ireland but we will have in-house training of orthodontists.
We have heard about that.
In the years 1990 and 1991 extra funds were provided for the dental services and I hope that will continue in the years ahead so that we can get a grip on this problem.
Who will train them?
If the Deputy bears with me for a moment I will tell him. The first constructive step in that direction was to have orthodontic surgeons appointed to each health board. That was a major move in the right direction. Many dental surgeons can be trained in orthodontics as a sub-specialty.
Who will train them?
Who will pay them?
It would be my intention that we would have a compulsory vocational year for newly qualified dentists to bring them into the public dental service. I am also very anxious to have more dental hygienists so that the dental surgeons can do much more sophisticated work and in turn that there would be in-house training in the health boards for the training of dental surgeons. I am speaking as a non-dental person but I would say they can be trained in orthodontic work. I think we will make inroads on that in the years ahead. Expectations rise as people are aware that orthodontic treatment is available. It is part of increased technology and everybody wants to avail of it.
I would remind the House of the concern expressed about the other business before the House apart from the fact that Priority Questions should conclude at 3.45 p.m.
They started five minutes late.
We are into injury time.
In so far as Deputy Creed has his name to one of the questions we will allow him to put one final supplementary.
Can the Minister confirm that a review of the guidelines for eligibility is being undertaken by his Department? Because of the arbitrary review some years ago thousands of would-be patients who were badly in need of orthodontic treatment were removed from the list. Can the Minister give the number of people who would be on the list had the guidelines not been changed? In areas where the Local Appointment Commission had failed to make an appointment of an orthodontist would he consider making funds available to the affected health boards on a fee per patient basis so that the people on the waiting list could be treted by private orthodontists?
I ask the Minister to give a very short reply.
I have examined the different categories. I thought the categories which were established, categories A, B and C, were very good. In terms of priority, we all agree that those with a handicap, cleft palate and other congenital malformations of the jaw should be given priority. Category B refers to a number of other conditions which would not warrant immediate priority but which would be considered. People are placed in categories according to their need. I thought this was the fairest way to operate the system. In other cases a person's teeth may not be very straight and may have to be wired. This is not a life-saving operation, an emergency or an immediate requirement. Those people were put in other categories. The employment of orthodontic surgeons on a private basis is expensive and I thought it would be better to provide in-house training for them so they could be placed in the public dental service where they are needed. With the other measures I am planning to introduce we will get a good dental service which will operate in the best interests of patients.
