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Adjournment Debate. - Orthodontic Services.

Wednesday, 12 June 1996

Dáil Éireann Debate
Vol. 466 No. 7

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Mr. Broughan: Information on Thomas P. Broughan Zoom on Thomas P. Broughan One of the greatest scandals in our health services is the lack of orthodontic treatment for the great majority of Irish citizens. Since I was elected to this House I have received countless complaints from the anxious parents of teenagers and from teenagers themselves. I found the progress made by the Department of Health and the health boards to be inexplicably slow or at times non-existent.

Orthodontic treatment is accessible only to the rich and better off families. Working parents, the unemployed and their children are effectively told to get lost again and again by the Eastern Health Board and particularly those in my area of the north side of Dublin. There is the charade of categories one. two and three waiting lists in the Eastern Health Board Region. Being placed on categories two, three or further down is a polite way to fob off parents and their teenageers. It is frustrating.

While I am certain the Minister for Health will sympathise with sensitive young people who have badly formed, or crooked teeth or a very crowded mouth, he will surely appreciate the extreme anxiety of a young boy or girl who may be jeered by classmates from wealthier families or who is deeply embarrassed by this problem at the first discos or teenage social gathering of their young lives. When young adults are at the most difficult and vulnerable stage of their development this problem occurs and has often had a detrimental impact on them

A case study from my files is typical of what children and parents suffer. The parents of an 11 year-old boy, category three on the waiting list, was placed on [2037] this list in 1988 and is still waiting eight years later for much needed treatment. The boy is in full-time education and there had not been a hint from the EHB when he will be treated. One must ask why there are such categories. This boy's parents could not afford the £3,000 necessary for private orthodontic treatment in the State or the cost of treatment in Northern Ireland.

Another young boy has been assessed as a category two case, which should have high priority for treatment, but he has been waiting almost five years. A girl on the same list has waited for the period of her second level education for treatment without any response from the EHB. She urged her father to contact me; I contacted the Minister and the EHB, yet nothing has happened.

I am aware the Minister, in his typically vigorous fashion, has tried to redirect resources to cope with this problem. During 1995 the EHB increased its number of orthodontists from two to five and the appointment of two consultant orthodontists has been approved by the Minister for the EHB. However, there has been a problem filling these posts, apparently because dentists and contultants seem to prefer the lucrative private market. As a result, the first of the consultants will only start work on 1 July next.

The Minister has also allocated funding for the construction of two new orthodontic units at Beaumont and St. James's hospitals. He has also indicated that EHB categories one and two will be reduced and that category three patients will be treated. I respect the good faith of the Minister's determination but while his plans are taking effect slowly our working class teenagers and children are suffering. They demand urgent action. If that means shaking up the lucrative dental profession, then so be it. Let us solve this problem as soon as possible.

Minister for Health (Mr. Noonan,: Information on Michael Noonan Zoom on Michael Noonan Limerick East): The provision of orthodontic treatment services for eligible [2038] children in the Dublin area is the statutory responsibility of the Eastern Health Board. Children requiring treatment are assessed by the board in accordance with the guidelines issued by my Department to which the Deputy referred. The guidelines ensure that those most in need of treatment receive it. The organisation of services within the Eastern Health Board's region is a matter for the board having regard to the principle of equity as set out in the National Health Strategy.

The Eastern Health Board has agreed with my Department a framework for the development of its orthodontic services. This framework provides for a shared consultant orthodontist with the Dublin Dental Hospital; two full-time consultant orthodontists based at Beaumont and St. James' hospitals; eight qualified orthodontists — one per dental area; ten dentists working under the direction of the two full time consultant orthodontists and support staff — dental surgery assistant and administrative staff.

The Eastern Health Board has made the following progress in implementing this framework: the shared consultant with the Dublin Dental Hospital is in place; a consultant orthodontist will take up duty with the board on 1 July. The board plans to re-advertise the second consultant post, with extensive advertising abroad and additional dentists with orthodontic qualifications have recently commenced employment with the board.

Pending the full implementation of a consultant led orthodontic service the board has also entered into arrangements with a number of private orthodontists for the provision of services.

Additional funds have been provided by my Department over recent years specifically for the development of orthodontic services in the Eastern Health Board region. Since 1995, under the Dental Health Action Plan, I have increased the annual allocation to the Eastern Health Board by £650,000 to enable the board to provide additional orthodontic treatment services. This [2039] extra funding will allow for the recruitment of additional dentists together with support staff to work under the overall direction and supervision of consultant orthodontists to provide an increased level of orthodontic treatment services.

In addition, I allocated £250,000 in capital funds to the Eastern Health Board in 1995 to provide additional facilities and specialist equipment to assist in the provision of secondary care orthodontics.

I am aware of the problems faced by the Eastern Health Board in developing its orthodontic services and the lenghty waiting times faced by many families in securing orthodontic treatment for their children. I accept that such waiting periods are undesirable. The main problem is not, however, one of resources. It is the problem faced by the board in securing the services of consultant orthodontists, who can develop its services in accordance with the strategy outlined in the Dental Health Action Plan.

Where health boards have been successful in recruiting consultant orthodontists it has considerably improved the services provided by these boards. This demonstrates clearly the success of my Department's strategy of consultantled teams for the provision of orthodontic services, I am hopeful that, with the appointment of a full-time consultant orthodontist to the Eastern Health Board, there will be a substantial improvement in the board's services and a reduction in the waiting times for treatment.

It is important to remember that a primary task of the consultant orthodontist is to organise and co-ordinate orthodontic training to sub-consultant level for health board dental staff. This enables health boards to provide a greatly increased volume of service and one of high quality. I will, in conjunction with the Eastern Health Board, continue to develop the orthodontic services over the course of the Dental Health Action Plan so that the level of [2040] service provision will be brought to the level of actual treatment need.

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