Written Answers. - Orthodontic Service.

Enda Kenny

Ceist:

343 Mr. Kenny asked the Minister for Health and Children the reason orthodontic service provided under the public orthodontic service has deteriorated in the Western Health Board area in the past five years; the way in which he proposes to rectify this; if he will provide details regarding this health board area for each of the years in question; and if he will make a statement on the matter. [28092/01]

The provision of orthodontic treatment to eligible persons is the statutory responsibility of the health boards in the first instance. I recognise that the waiting times for orthodontic treatment are unacceptably long. At the invitation of my Department, 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.

Agreement has now been reached at the Health Service Employers Agency on the creation of the specialist in orthodontics grade in the orthodontic service. In addition, two dentists from the Western Health Board are currently in training for specialist dentist in orthodontics qualifications. Additional funding of £0.495 million, 0.628 million, has been allocated to the Western Health Board this year for orthodontic services of which £0.420 million, 0.533 million, was for an orthodontic initiative in the board. The chief executive officer of the Western Health Board has informed me that a specialist in orthodontics was recently recruited and the board envisages that he will start work in late November. The board has also made arrangements with private specialist orthodontic practitioners to treat patients.

Furthermore, as part of the orthodontic initiative, my Department is exploring with health boards new arrangements for the treatment of patients by health board staff in out-of-hours sessions. I am confident that these structural changes to the orthodontic service, together with the orthodontic initiative, will significantly increase the number of patients in and reduce the waiting times for orthodontic treatment.

The maintenance of orthodontic waiting lists in the Western Health Board region is the responsibility of the board. According to returns submitted to my Department, the numbers on orthodontic waiting lists maintained by the Western Health Board over the last four years are as follows:

1998

1999

2000

2001

Assessment

Treatment

Assessment

Treatment

Assessment

Treatment

Assessment

Treatment

Western HealthBoard

442

3,795

387

2,148

509

2,179

719

1,479

The chief executive officer of the board has informed me that at the end of the September 2002 quarter, there were 1,589 patients in orthodontic treatment in the board.

Enda Kenny

Ceist:

344 Mr. Kenny asked the Minister for Health and Children the level of capital and personnel resources available to each health board area to provide a public orthodontic service; the way in which this compares in each health board area three years ago; his views on the level of service provided under the public orthodontic service; and if he will make a statement on the matter. [28093/01]

Enda Kenny

Ceist:

349 Mr. Kenny asked the Minister for Health and Children if his attention has been drawn to the fact that a consultant orthodontist has in the past reduced waiting lists from 18,000 to 6,000 in two years; the reason his Department has not been more enthusiastic in implementing this type of productivity nationally when it has been shown to be so effective; and if he will make a statement on the matter. [28098/01]

I propose to take Questions Nos. 344 and 349 together.

The provision of orthodontic services is the responsibility of the health boards in the first instance. I have initiated a range of measures to substantially increase the capacity of the orthodontic services and reduce the waiting times for orthodontic treatment. At the invitation of my Department, 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.

Agreement has now been reached at the Health Service Employers Agency on the creation of the specialist in orthodontics grade in the orthodontic service. In addition, six dentists for the Eastern Regional Health Authority, North-Eastern Health Board and South-Eastern Health Board commenced their training this month for specialist in orthodontics qualifications. Furthermore, three dentists from the Western Health Board and North-Eastern Health Board are already in specialist training for orthodontics and this brings the total number of dentists in such training to nine. Discussions on providing an additional training course to commence in 2002 are also under way.
My Department has funded the appointment of a director of specialist training for the Irish committee for specialist training in dentistry through the postgraduate medical and dental board. The Director has taken up duty and will play a pivotal role in assisting the different agencies involved in dental specialist training programmes. In addition, my Department has also funded the recruitment of a professor in orthodontics at Cork University Dental School to facilitate the development of an approved training programme leading to specialist qualifications in orthodontics. Applications for the post were invited when it was advertised on 19 October last. Capital funding of approximately £1 million was also provided to the orthodontics unit there for its refurbishment to an appropriate standard.
However, it will be some time before these structural changes impact significantly on service levels. Consequently, I asked health boards to develop proposals to make an immediate significant impact on their waiting lists. An additional investment of £5.3 million, 6.729 million, has been approved for orthodontic services this year, of which £3.7 million, 4.698 million, is to fund an initiative on orthodontic waiting lists. This will enable health boards to recruit additional staff. In addition, the Eastern Regional Health Authority has developed a six surgery facility and a five surgery unit at Loughlinstown regional orthodontic unit and St. James' Hospital orthodontic unit, respectively.
Furthermore, under this initiative, my Department is exploring with health boards new arrangements for the treatment of patients, both by private specialist orthodontic practitioners and in out-of-hours sessions by health board orthodontists. My Department has also funded the development of new regional orthodontic units at Dundalk and Navan, both of which are operational, and the recruitment of a consultant orthodontist for the Midland Health Board who was appointed earlier this year.
I am confident that when fully implemented this initiative, combined with the structural changes to the orthodontic service, will significantly increase the number of patients in and reduce waiting times for treatment. The recruitment of orthodontic staff is the statutory responsibility of the health boards. The chief executive officers of the boards have informed me of the following information in relation to personnel in their orthodontic services:
2001

Health Board

Grade

ConsultantOrthodontist

SpecialistOrthodontist

SpecialistTrainee

DentalSurgeon

SWAHB/NAHB

2

3.5

2

2.4

ECAHB

1

2.4

2

0

Midland

1

1

0

0

Mid-Western

1

2.6

0

2

North-Eastern

1

4

2

0

North-Western

0.5

3

0

5

South-Eastern

1

3

1

3

Southern

1

0

0

5.21

Western

1

1 (part-time)

2

2

1999

Health Board

Number of Orthodontists and Other Dentists Providing Services

Eastern

1 Consultant Orthodontist1 Senior Registrar5 Senior Dental Surgeons with OrthodontistQualifications8 Senior Dental Surgeons

Midland

7 Orthodontists employed by Board on asessional basis

Mid-Western

1 Consultant Orthodontist6 Senior Dental Surgeons (some withOrthodontist Qualifications)

North-Eastern

1 Consultant Orthodontist5 Orthodontists employed on a sessionalbasis

North-Western

1 Consultant Orthodontist1 Senior Dental Surgeon with OrthodontistQualifications

South-Eastern

1 Consultant Orthodontist6 Senior Dental Surgeons (some withOrthodontist Qualifications)

Southern

1 Consultant Orthodontist8 Senior Dental Surgeons

Western

1 Consultant Orthodontist5 Senior Dental Surgeons

Enda Kenny

Ceist:

345 Mr. Kenny asked the Minister for Health and Children the reasons for the waiting times for orthodontic patients requiring attention; the way in which he proposes to deal with this under the public orthodontic programme; and if he will make a statement on the matter. [28094/01]

The provision of orthodontic services is the responsibility of the health boards in the first instance. I recognise that the waiting times for orthodontic treatment are unacceptably long. At the invitation of my Department, 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.

Agreement has now been reached at the Health Service Employers Agency on the creation of the specialist in orthodontics grade in the orthodontic service. In addition, six dentists for the Eastern Regional Health Authority, North-Eastern Health Board and South-Eastern Health Board commenced their training this month for specialist in orthodontics qualifications. Furthermore, three dentists from the Western Health Board and North-Eastern Health Board are already in specialist training for orthodontics and this brings the total number of dentists in such training to nine. Discussions on providing an additional training course to commence in 2002 are also under way.

My Department has funded the appointment of a director of specialist training for the Irish committee for specialist training in dentistry through the postgraduate medical and dental board. The director has taken up duty and will play a pivotal role in assisting the different agencies involved in dental specialist training programmes. In addition, my Department has also funded the recruitment of a professor in orthodontics at Cork University Dental School to facilitate the development of an approved training programme leading to specialist qualifications in orthodontics. Applications for the post were invited when it was advertised on 19 October last. Capital funding of approximately £1 million was also provided to the orthodontics unit there for its refurbishment to an appropriate standard.

However, it will be some time before these structural changes impact significantly on service levels. Consequently, I asked health boards to develop proposals to make an immediate significant impact on their waiting lists. An additional investment of £5.3 million, 6.729 million, has been approved for orthodontic services this year, of which £3.7 million, 4.698 million, is to fund an initiative on orthodontic waiting lists. This will enable health boards to recruit additional staff.

Furthermore, under this initiative, my Depart ment is exploring with health boards new arrangements for the treatment of patients, both by private specialist orthodontic practitioners and in out-of-hours sessions by health board orthodontists. My Department has also funded the development of new regional orthodontic units at Dundalk and Navan – both of which are operational – and the recruitment of a consultant orthodontist for the Midland Health Board who was appointed earlier this year. I am confident that when fully implemented this initiative, combined with the structural changes to the orthodontic service, will significantly increase the number of patients in and reduce waiting times for treatment.

Enda Kenny

Ceist:

346 Mr. Kenny asked the Minister for Health and Children if he has accepted a recommendation from the consultancy group dealing with the public orthodontic programme given recently that no aesthetic component would be considered in assessing persons for treatment; if this is now the position; and if he will make a statement on the matter. [28095/01]

Enda Kenny

Ceist:

347 Mr. Kenny asked the Minister for Health and Children the guidelines which are being operated under the public orthodontic programme; if these guidelines are the guidelines adopted in 1985 or a modified version of these; his views on whether interpretation of the guidelines is much more stringent than the 1985 guidelines intended; and if this precludes applicants from being eligible and that interpretation delivers a less than ideal service as a consequence; and if he will make a statement on the matter. [28096/01]

I propose to take Questions Nos. 346 and 347 together.

Orthodontic guidelines were issued by my Department in 1985 and are still in operation. Their purpose is to allow prioritisation of children for orthodontic treatment based on the severity of need. The guidelines are intended to enable health boards to identify in a consistent way patients in greatest need and to commence timely treatment for them. Patients assessed as category A have severe malocclusions and should receive urgent orthodontic care; patients assessed as category B have less severe problems and are placed on orthodontic treatment waiting lists. The number of cases treated will depend on the level of resources available, in terms of qualified staff, in an area.

Health board consultant orthodontists recommended that the 1985 guidelines be modified to prioritise treatment for the most severe categories of patients. My Department will be writing to the chief executive officers of the health boards concerning the operation of these modified guidelines with regard to maintaining the delivery of orthodontic services in a prioritised way.

The chief executive officer's report on ortho dontics, known as the Moran report, recommended the use of an alternative index of need. This is known as the index of orthodontic treatment need – IOTN. The chief dental officer has advised that this new index should not be implemented until its implications have been evaluated in a national survey of children's dental health. This survey is currently under way and is expected to be completed in April 2002. The purpose of the survey is to identify accurately the number of children that would benefit from orthodontic treatment and the resources needed to meet the corresponding level of care.

Enda Kenny

Ceist:

348 Mr. Kenny asked the Minister for Health and Children the methods of monitoring assessments of treatment required for orthodontic applicants which are employed by his Department; his views on whether the extraction of impacted canine teeth should occur only in exceptional circumstances; the numbers of cases in each health board area where impacted canines were extracted in each of the past five years; if he is satisfied in this regard; and if he will make a statement on the matter. [28097/01]

The performance of health boards in implementing orthodontic guidelines is being monitored by a health services research contract currently under way in health boards. The decision on whether impacted canine teeth should be extracted is a matter for a consultant orthodontist to decide, having full regard for all the clinical circumstances of each individual case.

The number of cases in each health board area where impacted canines were extracted in each of the last five years is not routinely collected by my Department. As the responsibility for the collection of this data rests with the health boards, my Department has asked the chief executive officers to reply to the Deputy directly with this information.

Question No. 349 answered with Question No. 344.