Tuesday, 15 October 2002
Dáil Eireann Debate
82. Mr. Neville asked the Minister for Health and Children how many of the 31 recommendations of the Joint Committee on Health and Children report on the orthodontic service in Ireland which have been implemented; the recommendations implemented; his views on whether the lack of co-operation of all regional consultants has had serious effects on the delivery of the orthodontic service; and if he will make a statement on the allegation by a senior consultant orthodontist that it is the intention of his Department to prevent him and his colleagues delivering orthodontic services (details of letter supplied). [18162/02]
Mr. Martin: The delivery of orthodontic services is a matter for the chief executive officers of the health boards in the first instance. I understand that the chief executive officers have established a review group on the public orthodontic service which is considering the recommendations of the Joint Committee on Health and Children in the context of the historical development of the service and the national health strategy. I understand the review group is made up of senior administrative and clinical personnel within the health boards, including the senior consultant orthodontist to which the Deputy refers. The work of this group will inform the development of an orthodontic action plan, which was one of the recommendations of the joint committee.
My Department is continuing to support the development of the public orthodontic services. In line with at least five of the recommendations of the joint committee, my Department expects to fund 11 dentists this year for internationally recognised specialist in orthodontics qualifications at training programmes in Ireland and the UK. These 11 trainees are in addition to the six dentists who commenced their training last year at the Dublin Dental School and one dentist whose specialist training is nearing completion in Northern Ireland. This is an aggregate of 18 public service dentists currently in training for internationally recognised specialist in orthodontics qualifications.
These training programmes are made possible by co-operation between the health boards, the majority of consultant orthodontists and the dental teaching institutions. Recently, two dentists that had been sponsored for such specialist training have qualified and taken up duty in the Western Health Board. 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. The chief executive officer of the board has informed me that Cork University Dental School is in discussion with an interested candidate for the post, 18 months on from the post being sanctioned. Capital funding of approximately €1.269 million was provided to the orthodontics unit there for its refurbishment to an appropriate standard.
Other recommendations of the joint Oireachtas committee are also being acted upon. The grade of specialist in orthodontics has been created in the health board orthodontic service. The number of specialists in orthodontics posts for the health boards is being finalised, using the estimated number of children eligible for orthodontic treatment under the 1985 guidelines; these national manpower requirements will feed into an orthodontic action plan. Health boards are initiating reviews of their assessment waiting lists as recommended. The committee also stated that it would support a public-private mix of staff and facilities that would lead to a continuous reduction in the number awaiting treatment.
Last June, 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.
Additional information.The committee referred to the need to employ orthodontic auxiliaries in the public orthodontic service in order to increase caseloads. A scheme for the creation of this grade – to be known as orthodontic therapist – is being finalised by the Dental Council in conjunction with officials from my Department.
The number of patients in orthodontic treatment has begun to increase as the measures that I have taken to improve orthodontic services begin to take effect. The chief executive officers of the health boards have informed me that at the quarter ending June 2002 there were 19,055 patients in orthodontic treatment in the health boards. This is an increase of 1,760 patients in orthodontic treatment when compared with the number of patients in treatment in December 2001.
The Joint Committee on Health and Children has rightly drawn attention to the fact that the co-operation of all regional consultants is required for an efficient service to be delivered in all health boards. I strongly agree with the committee's view that the interests of children are paramount and must take precedence over all other interests. My Department stands ready to support increased co-operation among the relevant stakeholders. I strongly urge those involved – whether through their representation on the review group established by the chief executive officers or through a separate mediation procedure – to strive for that increased fuller co-operation.
Mr. Neville: In referring to the chief executive officer group, is the Minister aware that the consultant orthodontist to whom he referred has withdrawn from the group because the terms of reference do not address his concerns? He will not participate in the group any longer because he has lost full confidence in it. Is the Minister satisfied that a waiting list of seven to eight years for orthodontic treatment is acceptable? This has happened as a result of disputes between various groups within his Department and the health boards on how best to provide orthodontic treatment. I know the Minister is concerned about this. Surely it is time to address the differences between consultant orthodontists, the dental association and others who are in total disagreement as we witnessed at the meetings of the Joint Committee on Health and Children. Groups vigorously disputed how to provide orthodontic treatment.
Is the Minister aware that the senior consultant to whom he referred has spoken about corruption, abuses, squandered money and the unfairness of destroying good training programmes while supporting poor ones by his Department? The withdrawal of his programme has substantially increased waiting lists in the Mid-Western Health Board, Eastern Regional Health Authority and to some extent in the Western Health Board. The Minister knows exactly what I am talking about. These programmes provided a service which was independently assessed and shown to deliver trainees and service during training which substantially reduced waiting lists. The reintroduction of those would have an immediate and dramatic effect on waiting lists rather than the long-winded, long-term programme which the Minister has outlined to us. I do not know how long we will have to wait for the appointment of a professor of orthodontics in Cork.
Mr. Martin: The committee quite rightly said that the co-operation of all regional orthodontists was important and essential to the proper roll-out of the programme. As I said to the consultants concerned, I cannot deal with the sins of the past and what happened in the 1990s and 1980s. This has been an issue since I was appointed Minister two and a half years ago. I know there has been a festering row that has not been conducive to the good provision of services in the areas outlined by the Deputy. I have sought to take steps that do not reopen old sores but rather provide additional services.
I provided €5 million at the start of 2001 to appoint additional consultants. To be fair to the Eastern Region Health Authority it made significant inroads in making additional appointments. There are about 1,700 additional people receiving treatment now. We have been frustrated in the Southern Health Board area. A range of interviews took place for the position of professor of orthodontics but the person that came forward withdrew. I now understand that the process has been undertaken again and a person may be about to take up that position. Equally, we gave funding for an additional consultant in both Cork and Tralee. While a candidate has gone through the interview process, the person has yet to take up the position.
Deputy Ring last year raised the issue of putting money aside to purchase private treatments in the meantime. I am committed to building up the public service and getting more people into training and that is happening. As a short-term measure while this is coming on-stream, we decided to allocate some of the treatment purchase fund money to the health boards to allow people to receive orthodontic treatment.
Mr. Neville: Is the Minister aware that the treatment purchase has had the result of withdrawing orthodontists from the public service and having them get five times the payment to treat the same number of people?
Mr. Martin: It has been going on for ten years. I have spoken to the chief dental officer and suggested a mediation process to resolve this. The row is not just between consultants and the boards, it is also between consultants. I feel I have dealt with this in moving ahead with services. I am not going to be a prisoner of past conflicts, personnel or otherwise.
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