Dáil debates

Tuesday, 10 October 2006

8:00 pm

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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I thank the Leas-Cheann Comhairle for choosing this matter. I raise it to ask the Minister for Health and Children if she is aware that the orthodontic services in the Cork-Kerry region have been severely curtailed by the departure of two dentists from the service; if she is concerned that the delay in replacing those dentists has led to the closure of the five year waiting list in this region for children to see an orthodontist; and if she will make a statement on the matter.

That the Minister for Health and Children has not come into the House to hear the debate, despite receiving almost 24 hours notice, is not just disappointing but a reflection of how seriously she takes this issue. I appreciate that the Minister of State at the Department, Deputy Tim O'Malley, is here to respond but it is not his responsibility. The Minister, Deputy Harney, should hear this debate.

Children who are waiting over four years for specialist dental treatment in the Cork-Kerry area will face further backlogs because of the delay in replacing two dentists who have left the service. Those dentists did not leave the service of their own volition. They were removed from their posts for further training and now train at the dental school. Those dentists were in their positions for ten years. There was no reason they could not have received on-the-job training but the dental service, and particularly the orthodontic service, is organised in such a way that it does not benefit the clients of the public dental service.

The current situation in Cork and Kerry is intolerable. The Minister should take note of what I am about to tell him but he is probably already aware of it, although he will not admit it. A total of 4,201 people are awaiting assessment. I am talking about children aged 12 to 16 years. A total of 3,524 are in Cork and 677 are in Kerry. A total of 3,558 patients are awaiting treatment. A total of 7,759 children are waiting to have their teeth examined. That is appalling. Of those, 72 patients in Cork and 171 patients in Kerry have been waiting more than four years for treatment. Those children are approaching their 16th birthday and will very soon be out of the scope of that service.

On the treatment waiting list, in the Cork region 767 people are waiting one to two years; 820 are waiting two to three years; 412 are waiting three to four years; and 72 are waiting four years and more. That is a total for Cork of 2,642. In Kerry, 173 people have been waiting one year, 262 have been waiting one to two years, 129 have been waiting two to three years, 181 have been waiting three to four years and 171 have been waiting four years and more. That is a total of 916. In total, 3,558 people are on a waiting list of between one and four years.

Patients are divided into three categories — A, B and C. Urgent cases — patients with cleft palate — are in category A. Patients with a large overbite are in category B and patients with severe overcrowding are in category C. Incidentally, overcrowding can often be as detrimental to one's dental health as an overbite, sometimes it can be worse. The patients in category A begin treatment immediately but the less urgent categories — B and C — are placed on the waiting list to which I have just referred. The children with what are considered less serious complaints such as overcrowding must wait a lengthy period.

Failure to deal with this waiting list means that increasing numbers of patients are forced to seek private treatment at enormous cost. Parents are taking out loans to avoid their children suffering from low self-esteem because of dental problems. Also, according to orthodontists in the Cork-Kerry region, the Department has been urging them to narrow the criteria so that it is more difficult for people to be eligible for treatment. The problem in Cork has been further compounded by the block on the Cork Dental School training programme, which is forbidden from training dentists to orthodontic level until a professor of orthodontics is appointed. The delay in that regard is scandalous. We were talking about that ten years ago but the problem persists.

In recent years progress has been made in reducing the waiting time. That was only as a result of the total dedication of a number of dentists but the waiting list has been closed and any improvements made have been set aside and will be set aside even further as a result of the delay in producing two more dentists to fit into the dental scheme. I understand no children are being assessed currently. The Minister must outline the way the Department will deal with this crisis.

I would point out to the Minister of State that a similar situation as this one occurred in Dublin five years ago. At that time the waiting list had been reduced from approximately 18,000 to 6,000 but because of the lack of urgency in replacing the two dentists involved at that time, 1,000 children whose braces were left on for too long a period without further examination ended up with severely damaged teeth as a result of the Department's inaction. I hope the Minister of State will have some good news for the children of Cork and Kerry tonight.

Tim O'Malley (Minister of State, Department of Health and Children; Limerick East, Progressive Democrats)
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On behalf of the Minister for Health and Children, Deputy Harney, I am happy to have the opportunity to address the issue raised by Deputy Lynch.

The provision of orthodontic treatment to eligible persons in the southern area of the Health Service Executive is the statutory responsibility of the Health Service Executive in accordance with the Health Act 2004. The Minister and I are aware of the waiting list for orthodontic treatment in HSE south. We are pleased to note that in the period June 2002 to June 2006, there has been a decrease of 2,326 in the assessment waiting list in this area. At the end of March 2006 there were almost 25,000 patients receiving orthodontic treatment in the public orthodontic service nationally. Over twice as many patients are getting orthodontic treatment as there are waiting to be treated. Nearly 7,000 extra patients are getting treatment now compared to four years ago. This tangible improvement will be further enhanced as the HSE develops the orthodontic services.

Developing the quality, standards, treatment capacity and outcomes of our orthodontic services in a sustainable way are objectives shared by the Department and the HSE. To ensure the best use of resources and develop treatment capacity in a sustainable manner, guidelines were introduced by the Department to enable the HSE to prioritise resources for those with the severest orthodontic condition.

The Joint Oireachtas Committee on Health and Children carried out a review of orthodontic services in Ireland which culminated in the publication of its report, The Orthodontic Service in Ireland, in 2002. The joint Oireachtas committee has also published a follow up to its 2002 report in June 2005.

The HSE has established a national orthodontic review group to draw together an agreed national approach under four principal headings: guidelines, training, service provision and manpower planning. The group consists of representatives from the Department, the dental schools in Cork and Dublin and consultant orthodontists and management from the HSE. The Minister and I are advised that this review group will conclude its report in the coming months and that will guide the implementation of service improvements in the coming year in line with the recommendations contained in the joint Oireachtas committee reports.

Training more orthodontists will make a significant impact on the increasing demand for orthodontic treatment. Until recently there was only one centre in this country offering a postgraduate course in orthodontics, the Dublin Dental School. The HSE is now funding the post of Professor of Orthodontics at the University Dental School and Hospital in Cork to the tune of €1 million. This has enabled the establishment of a postgraduate training programme in orthodontics in Cork, which has commenced with the first intake of four postgraduate students this month. This training programme will provide services for an agreed cohort of patients on the north Cork waiting list, which will help to reduce the waiting times for orthodontic assessment and treatment in the area.

The HSE will recruit a specialist orthodontist to replace the dentists who have been successful in securing specialist training places. The HSE south is also developing proposals on a waiting list initiative to reduce waiting times and ensure that treatment programmes commenced by the two dentists leaving the service will be completed in a timely fashion. Orthodontics is unique in that the treatment period for a child is between 18 and 24 months and each year thousands of children, with varying degrees of need, are placed on assessment waiting lists. Our aim is to continue to make progress and to develop a high quality, reliable, sustainable service in HSE south and all other areas of the executive for children and their parents.