The provision of orthodontic services is the statutory responsibility of the health boards-authority in the first instance. The aim of my Department is to develop the treatment capacity of orthodontics in a sustainable way over the longer term. Given the potential level of demand for orthodontic services, the provision of those services will continue to be based on prioritisation of cases based on treatment need, as happens under the existing guidelines. The guidelines were issued in 1985 and are intended to enable health boards to identify in a consistent way those in greatest need and to commence timely treatment for them. Patients in category A require immediate treatment and include those with congenital abnormalities of the jaws such as cleft lip and palate, and patients with major skeletal discrepancies between the sizes of the jaws. Patients in category B have less severe problems than category A patients and are placed on the orthodontic treatment waiting list. Patients in category C have less severe problems than in category B. The number of cases treated is dependent on the level of resources available in terms of qualified staff in the area, and this is reflected in the treatment waiting list. In fact, the provision of orthodontic services is currently severely restricted due to the limited availability of trained specialist clinical staff to assess and treat patients. Consequently, a category C waiting list may not be maintained in some health boards.
In 1996, my Department wrote to the chief executive officers of the health boards recommending that a group, representative of health board management and consultant orthodontists, review the orthodontic service. The report of this group, known as the Moran report, referred to an index of treatment need, an alternative means of assessing children's need for orthodontic treatment.
Following the 2002 Oireachtas joint committee report on orthodontics, the Health Board Executive adopted the report of the review group set up by the chief executive officers with the following terms of reference: to review and report on progress to date on the recommendations set out in the Moran report; to consider the recommendations in the February 2002 report of the Oireachtas Joint Committee on Health and Children; and to make revised recommendations and prepare and cost an action plan in the context of the approach set out in the national health strategy, Quality and Fairness — a Health System for You. The report confirms that the shortage of trained orthodontists restricts the use of this index by health boards at present.
However, I am pleased to advise the Deputy that I have taken a number of measures to address this shortage of specialists and so increase the treatment capacity of the orthodontic service. The grade of specialist in orthodontics has been created in the health board orthodontic service. In 2003, my Department and the health boards funded 13 dentists from various health boards for specialist in orthodontics qualifications at training programmes in Ireland and at three separate universities in the United Kingdom. These 13 trainees for the public orthodontic service are additional to the six dentists who commenced their training in 2001. There is therefore an aggregate of 19 dentists in specialist training for orthodontics. These measures will complement the other structural changes being introduced into the orthodontic service, including the creation of an auxiliary grade of orthodontic therapist to work in the orthodontic area.
Furthermore, the commitment of the Department to training development is manifested in the funding provided to both the training of specialist clinical staff and the recruitment of a professor in orthodontics for the Cork Dental School. This appointment will facilitate the development of an approved training programme leading to specialist qualification in orthodontics. The chief executive officer of the Southern Health Board has reported that the professor commenced duty on 1 December 2003. In recognition of the importance of this post at Cork Dental School my Department has given approval in principle to a proposal from the school to further substantially improve the training facilities there for orthodontics. This project should see the construction of a large orthodontic unit and support facilities and will ultimately support an enhanced teaching and treatment service to the wider region under the leadership of the professor of orthodontics.
In June 2002, my Department provided additional funding of €5 million from the treatment purchase fund to health boards specifically for the purchase of orthodontic treatment. This funding is enabling boards to provide both additional sessions for existing staff and purchase treatment from private specialist orthodontic practitioners. Finally, the chief executive officers of the health boards and authorities have informed me that at the end of the December quarter 2003, there were 21,727 children getting orthodontic treatment from those authorities and boards. This means that there are more than twice as many children getting orthodontic treatment as there are children waiting to be treated, and 4,432 extra children are getting treatment from health boards and authorities since the end of 2001.