Thank you, a Leas-Cheann Comhairle, for selecting my matter for the Adjournment. Given the competition behind me I am finding it difficult.
Adjournment Debate. - Orthodontic Service.
May we have quietness in the lobby for Deputy Ring?
I appreciate I am being given the respect I deserve. The reason I seek to raise this matter on the Adjournment is that I am concerned at what is happening in the Western Health Board in relation to the orthodontic service. In 1999 children in the Western Health Board area were told they would have to wait two years for orthodontic service. By the end of that year they were told they would have to wait three years. The most recent letter from the health board has indicated it will be three and a half years before any child will be seen in the Western Health Board area. In 1999 not one child was taken off the orthodontic service waiting list. That is a disgrace.
In 1997, when the Minister for Health and Children, Deputy Cowen, appointed two orthodontists to the health board, he said he hoped these appointments would deal with the waiting list problem. Nothing has happened since. In the Belmullet region the last permanent full-time dentist was appointed in 1994. That person left in 1995, a temporary replacement was appointed in January of last year and that person left in August. There are 23,907 children, nationally, waiting for orthodontic services. In 1996 there were 1,367 on the Western Health Board list, in 1997 there were 3,036, in 1998 there were 3,838 and in 1999 the waiting list had grown to 4,438. It is disgraceful that a waiting list should be allowed to grow to such an extent in four years of such prosperity. There are two full-time dentists and one part-time dentist working in the orthodontic units and there is no consultant orthodontist in the Mayo area. Something is very wrong.
The health board recently advised parents to use private orthodontists and avail of tax relief for those costs. Does the Minister realise that most of the people concerned are on low income? Some are on social welfare and hold medical cards. These people cannot afford to pay up to £3,000 to private dentists. Many are not liable for tax and cannot avail of tax relief. I ask the Minister to stop the health board from writing to parents with this advice. A further large number of children are waiting to be assessed for treatment.
The Minister for Health and Children must discover why the health board has allowed the waiting list to grow to such length in such a short time. He must recruit orthodontists, if necessary from outside the EU. He must bring orthodontists from the other health board areas or, if necessary, from Northern Ireland to places such as Belmullet where there is no orthodontic surgeon. The orthodontic service has collapsed. It is not right that young children should suffer ridicule at school because they have prominent teeth. The Minister must deal with this crisis.
I thank Deputy Ring for allowing me this opportunity to discuss the orthodontic services in the Western Health Board area.
Orthodontic treatment services continue to be developed in accordance with the dental health action plan. The action plan provides for the development by each health board of a consultant led orthodontic service which ensures a service of high quality and high service levels. My Department has made additional resources available to the health boards to assist with the development of their orthodontic services in accordance with the action plan.
The Western Health Board with the assistance of funding by my Department has established a regional orthodontic unit at Merlin Park Regional Hospital . The unit is headed by a consultant orthodontist. Three full-time staff and three sessional orthodontists currently provide services under the overall direction and supervision of the consultant. My Department has given approval for an additional £150,000 in the year 2000 for the further development of the board's orthodontic servcices.
The demand for orthodontics is much greater than can be provided in any developed country. The provision of fixed appliance orthodontic treatment is very expensive. It is important, therefore, that resources be used as efficiently as possible for those patients most severely affected. Accordingly, the Western Health Board, in line with the other health boards, assesses patients for treatment in accordance with guidelines issued by my Department in 1985 and, where appropriate, places individuals on waiting lists. I am concerned at the size of the waiting lists nationally and I have asked my officials to review the situation in relation to this issue.
Unfortunately, the Western Health Board, in line with other health boards, is experiencing difficulty in filling orthodontic posts. The problems encountered in the recruitment and retention of appropriately qualified orthodontists has resulted in an inability on the Western Health Board's part, despite its best efforts, to provide the desired level of service. The board has held inteviews on a number of occasions over the years in an effort to fill vacancies as they arise and staff from other countries, including Britain and Germany, have been employed at various times. The board has also experienced a high turnover of staff who reached specialist level.
As yet, there is no recognised specialist grade of orthodontist in the public health sector. However, quite recently my predecessor gave consent to the Dental Council for the speciality of orthodontics to be recognised for registration purposes and I am confident that once the specialist register is up and running this will help to improve recruitment and retention issues and, consequently, help to improve the efficiency and effectiveness of the orthodontic sevice. The existence of a recognised specialist orthodontist grade should increase the attractiveness of employment within the health board service.
One of the main contributory factors why targets are not being met in health board orthodontic units is that the majority of support staff available to consultants have been trainees and are, therefore, not capable of treating the target number required of a specialist. At present, two of the staff in the regional orthodontic unit in Galway are pursuing a specialised qualification in orthodontics – M.Orth. I applaud the Western Health Board staff in their efforts to improve the service. I am optimistic that the service provided will improve immeasurably due to the additional expertise acquired by the staff once they have completed their specialist training.
I understand that the total number of children on the treatment waiting list at 1 January 2000 was 4,438 and that the current average waiting time for treatment under the orthodontic programme in the Western Health Board area is two and a half to three years, with all patients being taken off the list in strict order of priority in accordance with my Department's guidelines. I have been assured that a delay in providing orthodontic treatment does not in any way impact on a successful clinical outcome. My Department's target is that no child should be more than two years on a waiting list for teatment. The Western Health Board is committed to reducing waiting times progressively over the next few years. However, this is dependent on the recruitment and retention of appropriately qualified staff. It should be noted that in respect of urgent or priority cases in the Western Health Board area no delay whatsoever is occasioned and treatment is provided immediately for such patients.
The Western Health Board's year 2000 service plan provides for the appointment of additional senior dental surgeons and necessary support staff, together with plans for the development of the oral surgery unit. The board intends that an audit will be undertaken to assess the impact of new technologies on orthodontic treatment practices, waiting lists and waiting times. I am reassured that the Western Health Board is striving to bring its orthodontic service to optimal levels and I will continue to monitor progress with interest and give any additional support I can.