Dr. Joe Green:

I thank Mr. Ryan. With regard to the orthodontic question, I think the Deputy referred to the assessment system indirectly. The type of cases that are up for treatment by the HSE are very complex cases. The system we use, which is known as the modified index of treatment need, is an international grading system. The two categories within that system that are offered treatment in the HSE are grade 4 and grade 5. Typically, those cases would take at least two to three years to treat. Orthodontic treatment is not a single episode of care. As well as the active treatment, which as I said could take approximately two years, there would be at least another year in retention where the patient will be wearing retainers. The patient is within the system for a lengthy period, usually during the teens. There is huge demand on our services and the need that is being expressed has exceeded the capacity that has been available.

Over the past four years we have had a procurement arrangement in place where we have managed to place just under 2,000 patients with private service providers. That recently expired and currently there is an invitation to tender in place through eTenders. That will close in the next couple of weeks and we hope that the successful arrangement will start to allocate patients who are the longest waiting from the end of the second quarter or early in the third quarter. Currently, the capacity of that system is uncertain because it will have to await the outcome of the tender response process.