Health (Amendment) Bill, 1993: Committee and Final Stages.

Question proposed: "That section 1 stand part of the Bill".

Section 1 states:

(1) A health board shall make available without charge, for children who have attended a national school or a school standing specified in an order under section 66 (3) of the Health Act, 1970, and are of or under such age as may be specified by the Minister by regulations, such dental health services as may be so specified.

The Minister has specified that the person must be under 16 years of age. Will he be more specific and outline the service likely to be available? A reasonable screening service is offered through the schools but problems arise in the provision of orthodontic treatment. The Minister spent some time agreeing with my colleague on the Opposition benches who agrees with the people who tell me that a great many problems are merely cosmetic. There is a danger that people will seek cosmetic treatment at the expense of the taxpayer. Will he be specific on how it is proposed to categorise the people who need treatment? Category 1 patients should get the treatment as quickly as possible and although it will take up to a year that is not sufficient excuse for not attempting to tackle the problem. There is no sense in enacting this legislation unless it attempts to do something about the problem. I am sure the Minister shares my view that we do not want to find ourselves in a year's time in the same position having failed to identify the categories of people who need urgent attention. I am worried about the availability of finance and I accept the Minister's assertion that all the problems cannot be solved at once. Unless there is a commitment that those in need of urgent care will get it as and from a specific date, we are wasting our time.

A 15 year old may have an orthodontic problem that is not deemed sufficiently urgent to deal with it immediately. If the problem is not dealt with before his or her sixteenth birthday what will happen? If treatment is started before a person's sixteenth birthday will it be continued when the person is 17, 18 or 19, as the case may be? Everybody is aware of the age limit so that if it is wished to offload a category at any time, one has only to wait until the person is no longer eligible. Will the person who should have had treatment before becoming ineligible on age grounds be treated under the scheme? If category 1 patients do not get orthodontic treatment we are wasting our time.

The Minister informed the House that some £8 million will be made available for the construction on site in Trinity of a new Dublin dental school-hospital. I am sure the Minister is aware that in 1985 the then Committee on Public Expenditure examined the proposals before Government on the dental school-hospital.

The report on manpower requirements in the dental service produced by Coopers & Lybrand showed that the number of personnel required would reduce substantially between 1985 and 1990. The throughput at the Dublin dental school will be 40 approximately. Thirty-five dentists approximately are being trained at the Cork dental school, although it can train up to 50. Some years ago it trained about 45 until it was ordered by the Department of Education to reduce this number. It appears therefore, having regard to the Coopers & Lybrand report, that there is a surplus of dentists. It was implied at the time that we were educating dentists for export.

As Ministers come and go as attitudes change, can the Minister give us a cast iron guarantee about the future of the Cork dental school? There was grave disquiet that the construction of a new dental school in Dublin would eventually lead to the closure of one dental school. Is the Minister happy that the construction of a new unit in the middle of Dublin represents the best way forward? Would the population of Dublin be better served if a number of dental units were provided throughout the city? On what basis was the decision made? Was it taken on educational grounds or on the grounds of providing an efficient and effective dental service to the public?

Section 1 will enable me to extend the legal entitlement to dental services to children who have reached the age of 16. A number of specific points have been raised. In relation to the provision of orthodontic treatment there are three categories which have been agreed with the orthodontic associations. The position is that if a patient is included in category A which covers the most serious cases there is no waiting list.

That is not true.

I have checked the position with every health board and there is no waiting list. For patients included in category B there is a long waiting list, while patients included in category C which covers cosmetic treatment will not be reached.

Deputy Durkan mentioned that patients awaiting orthodontic treatment suffer pain. In general patients awaiting such treatment do not suffer pain but those in pain can avail of an emergency service and are given priority.

The Deputy also expressed concern about the age limit. If the problem is noted during the period a patient is eligible it will be treated and under the current guidelines the patient will retain entitlement. In the case of orthodontic treatment it may not be possible to provide treatment for a patient until their teeth develop. Some of those on the waiting list are in this category.

Deputy Allen referred to the Dublin dental hospital and voiced concerns about the future of the Cork dental school. I can give a cast iron guarantee that there is a need for two schools. The Dublin dental school will train dentists and provide a service in Dublin. This will include secondary and tertiary care. The Cork dental school will provide a similar service in the south. The report to which the Deputy referred is dated. The interdepartmental group which is chaired by my Department and comprises the Department of Finance and the Department of Education suggested that there was a need for a Dublin dental school, that it provided invaluable services and training and that it should be retained at its present location on the grounds of the cost involved. It would be more expensive to provide this facility at the other location considered, St. James's Hospital. That was a wise decision and it was approved by the Government. There is no question of downgrading——

Is that report available?

The report of the interdepartmental committee will not be made public. The decision to proceed with the Dublin dental school was welcomed by most practitioners in dentistry.

The Minister said that all patients included in category A are treated immediately but this is not the case. The problem is that all of the patients who should be included in category A are not included. I made the point on Second Stage that consultants are being pressurised to deal with the most serious cases. The Minister's attention was drawn to a particular case on several occasions by way of parliamentary question. Although the patient concerned was in extreme pain they were not included in category A. This was not an isolated case. The patient was told repeatedly to take medication, which did not relieve the pain. I hope the Minister will ensure that when patients are being screened they will be checked to ensure that they have not reached the stage where they require urgent treatment. Parents are paying to have this treatment carried out by private orthodontists. As a result they are subsidising the system.

Question put and agreed to.
Section 2 agreed to.
Title agreed to.
Bill reported without amendment and passed.