Pat Breen (Clare, Fine Gael)
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The Minister of State is aware of the critical situation with orthodontic services in the mid-west. It is not an exaggeration that orthodontic services in the mid-west are in a mess. The several reviews established in this area are also in a mess. Since 1998, five reviews have been held, three from the Department of Health and Children. This is a shocking number which gives the false impression that the Department is engaging with the problem. The Department appears to be proud of these reviews when it should be ashamed of them.

In 1998 the Moran report was produced. The Joint Committee on Health and Children carried out a review of orthodontic services in 2002. This was followed by a review by the former health board chief executive officers of the orthodontic service to consider the committee's report and assess progress on implementing the Moran report, a review of the reviews.

We were then blinded by the conclusion that the shortage of trained orthodontists was restricting the provision of orthodontic services. The committee published a follow-up to its 2002 report which recommended a return to the regional orthodontic training programme which ran successfully between 1985 and 1999 and where trainee orthodontists were treating 250 patients a year.

Not to be put off by such a simple and effective solution, the Department sanctioned yet another review called the orthodontic review group, established in April 2005 but which has yet to report although it was supposed to in June 2005. The Minister of State will go into detail about the great work this group is doing. I believe its conclusions will claim the delivery of orthodontic services through the HSE is a shambles. It will continue to be so unless firm action is taken. I do not know whether the review group will ignore the committee's recommendation that the regional training programme be reinstated.

In today's edition of The Irish Times, an eminent consultant orthodontist, Dr. Ian O'Dowling, has dissociated himself from its findings. The work of the group must be in doubt. Dr. O'Dowling directly addressed the issue of the number of children damaged, pointing out that this has not been addressed. I want an estimate of the number of children who have suffered irreversible damage to their teeth, gums and faces after orthodontic regional training programmes ended in 1999. I dread to think what the answer will be. Year after year frustrated parents of children in dire need of orthodontic services beat a path to the door of every Oireachtas Member in the country, asking what has gone wrong and why a public health service in one of the richest countries in the world is letting them down so badly.

In Clare, there were 982 patients on waiting lists last year, 682 waiting for assessment and 300 waiting for treatment. Those are staggering figures for one orthodontist, under the guidance of a consultant orthodontist, to cope with. Parents tell me of their teenage children being bullied at school, of the emotional damage done to them, and of their despair at having to wait up to four years at such a vulnerable stage in their lives.

The figures, bad as they are, do not represent the true picture because many hard-pressed parents take one look at the waiting lists and decide, correctly, that they have no option but to seek private treatment. Other children are put on the waiting lists when the specialists know they will be too old and mature to be treated properly by the time they come to the top of the list.

It is a sad situation in which even Government backbenchers feel powerless. They have no faith in the Minister for Health and Children to grasp the nettle on this issue and take on the vested interests that are frustrating the delivery of a properly run orthodontic service.

In a recent article in my local newspaper, The Clare Champion, I saw that a Fianna Fáil Senator was blaming orthodontic consultants in private practice who were "using a dominant position to prevent the delivery of the service through the public service". No doubt there is some truth in that but I was under the impression that it was the Government that formed and implemented public health policy. If it is reneging on this commitment it should come out and say so.

I urge the Minister of State to ask the Minister for Health and Children, in the few months she has left in office, to take a firm stand on this issue and to re-instate the regional training programme over the objections of the dental schools which have so spectacularly failed to come to terms with the problem. This is a big problem in Clare and the mid-west. Parents come to my office every day wanting to know why their children are not receiving treatment.

Tim O'Malley (Limerick East, Progressive Democrats)
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On behalf of the Minister for Health and Children I am happy to have the opportunity to address the issue raised by Deputy Breen. The Minister and I understand from the Health Service Executive that during a dispute in 1999-2000, some patients undergoing active orthodontic treatment had their treatment delayed. The Minister and I are not aware of any clinical evidence of irreversible damage because some patients' treatments were delayed.

We also understand from the Dental Council, which deals with serious clinical issues, that the matter has not been referred to it. If any such clinical evidence is available, it should be brought to the attention of the relevant authorities. The provision of orthodontic treatment to eligible persons is the statutory responsibility of the HSE in the first instance. The Department and the HSE have the shared objective of developing sustainable quality, standards, treatment capacity and outcomes of our orthodontic services.

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

The HSE 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 consultant orthodontists, management from the HSE, the Department and the dental schools in Cork and Dublin. The review group has concluded its meetings and is finalising its report and recommendations, which will be presented to the chief executive of the HSE soon. This will include recommendations on training. I look forward to considering this report, which my Department will receive shortly.

At the end of June 2006 there were almost 25,000 patients receiving orthodontic treatment in the public orthodontic service. Over twice as many patients are getting orthodontic treatment as are waiting to be treated. Over 5,500 extra patients are receiving treatment compared with four years ago. This tangible improvement will be further enhanced as the HSE develops the orthodontic services.

Our aim is to continue to make progress and to develop a high quality, reliable and sustainable orthodontics service for children and their parents.