Dáil Éireann díospóireacht -
Thursday, 5 Apr 2001

Vol. 534 No. 2

Adjournment Debate. - Orthodontic Service.

Mr. S. Ryan

It gives me no joy to raise the issue of non-existent orthodontic services, particularly in the greater Dublin area. My constituency files show that, after housing and the lack of access to hospital care, the level of orthodontic services is one of the issues of most concern to parents and young people.

This is a rich country and at a time of unprecedented growth it is a scandal that almost 11,500 people are on orthodontic waiting lists in the greater Dublin area. The lists consists of children, youths and, given the length of time many people spend on the lists, young adults. The most dis turbing feature of the figures is that applicants referred by doctors in primary schools in 1995 have not been called for assessment by an orthodontist. This is a crazy situation which must be addressed urgently as it is getting out of hand.

In 1999 waiting lists in the greater Dublin area were down to about 6,000 people. However, today's figures indicate that 11,231 people are on the category two waiting list for assessment and that 280 people are on the category one list – the most serious cases. This is a scandal of which the Minister and the Department cannot be proud. The matter must be addressed. I know of a number of cases where young children and youths are assessed, have operations to insert palates but receive no further treatment for 17 months. Thankfully I raised this issue previously and suggested that the private sector be included and some progress has been made.

There has been much talk of an initiative by the Northern Area Health Board to deal with a private and public mix for orthodontic treatment. When will this initiative be announced or introduced? How much will people have to pay for this service? What will be the situation of medical card holders? Will health boards pay for private treatment for people who have been on the waiting list for seven or eight years? If health boards, the State and the Minister are not prepared to meet the requirements of those in need of basic treatment, the services should be provided by the private sector and paid for by the State. Nothing less is acceptable and the figures are an indictment of the Government's inability to deal with this issue.

Minister of State at the Department of Education and Science (Mr. O'Dea)

I apologise for the absence of the Minister, Deputy Martin, who is unavoidably absent on business. The provision of orthodontic services in the ERHA is the statutory responsibility of that authority in the first instance. The Minister is, however, unhappy with the length of the lists and waiting times for orthodontic treatment.

At the invitation of the Department of Health and Children, a group representative of health board management and consultant orthodontists reviewed the orthodontic services. The objective of this review was to ensure equity in the provision of orthodontic treatment throughout the health boards. Following this review structural changes are being introduced in the orthodontic services. These changes include the creation of the grade of specialist in orthodontics, the development of specialist training programmes and the creation of a grade of auxiliary dental worker to work in the orthodontic area.

However, it will of necessity be some time before these structural changes impact significantly on service levels. Consequently, the Minister asked health boards to develop proposals to make an immediate significant impact on their waiting lists. An additional investment of £5.3 million has been approved for orthodontic services this year, of which £3.7 million is to fund an initiative on orthodontic waiting lists. The ERHA has been allocated an additional £2.34 million this year for orthodontic services of which £1.61 million was for the orthodontic initiative.

This funding will enable a number of developments to take place. The appointment of two additional consultant orthodontists is currently in train. A third additional consultant orthodontist post has been approved by the Department and the recruitment process is currently under way. Two orthodontic specialists have been recruited and a further recruitment drive is in progress to recruit four more. Competitions in the three area health boards will be held in April and appointments to follow without delay.

A total of 12 dental surgery assistants and nine administrative support staff have been approved. Interviews for posts of dental surgery assistants in the East Coast Area Health Board have been completed and offers of employment have issued. A competition in respect of similar posts in the other area health boards is being organised. A competition to fill the posts of dental hygienist in the area health boards is also being organised.

The previously vacant post of superintendent radiographer at St. James's Hospital unit has been filled and a similar post for the Loughlinstown unit has been filled on a locum basis. A six surgery facility at the Loughlinstown regional orthodontic unit has been developed and is currently being equipped. The unit will open as soon as this process is completed. The equipping of an additional five surgery unit at the St. James's Hospital orthodontic unit will be completed over the next four weeks.

The Northern Area Health Board is currently progressing plans for the development of a new regional orthodontic unit located on the grounds of James Connolly Memorial Hospital. As part of the orthodontic initiative, the Department also approved a proposal from the ERHA for a grant-in-aid scheme. Under the scheme, patients who meet the criteria laid down for non-urgent routine treatment will be given the option of availing of treatment from a private orthodontic practitioner. A grant of 50% of the board's overall estimated cost of treatment would be paid. Parents could also avail of income tax relief on the balance where appropriate.

A grant of 100% of the board's estimated cost of treatment would be paid in respect of medical card holders. The scheme will operate on a pilot basis in the Northern Area Health Board for 12 months. A working group has been examining this proposal and hopes to finalise it in the coming weeks.

Validation of existing waiting lists is currently in progress and agreement has been reached between the ERHA and the Dublin Dental Hospital on the training of specialists to work in orthodontics. Four dentists will commence training in 2001. The chief executive officer of the ERHA has advised the Minister that improvements in the orthodontic service have already been achieved.

Category one patients, high priority cases, are currently being called for assessment and assessment of category two patients will follow shortly.

The impact of these proposals, when fully implemented, will enable treatment for an additional 3,000 patients on the assessment waiting list to commence if all staffing requirements are met and waiting times for treatment are to be significantly reduced. The ERHA is striving hard to improve its orthodontic services to an acceptable level and has the Minister's full support in doing so.

The impact of this initiative on waiting lists will be significant. This initiative combined with the structural changes being introduced will provide a secure basis for the delivery of an efficient and effective orthodontic service.