Jimmy Deenihan (Kerry North, Fine Gael)
Link to this: Individually | In context

The annual report of the HSE south orthodontic service for Cork and Kerry in 2007 makes very depressing reading. It reflects the totally inadequate service in respect of orthodontic treatment in the region. The report refers to serious structural and equipment deficiencies in HSE south and the lack of apparent will to do anything about it.

As of last December, 1,049 young people in Kerry are on the waiting list for orthodontic treatment, 42 of whom have been waiting since 2002. A total of 126 people have been waiting since 2003 and 224 people have been waiting since 2007. There are 2,299 people on the waiting list in Cork-North Lee and Cork-South Lee, while in west Cork 2,002 are on the waiting list. In respect of those looked after by St. Finbarr's Hospital, a total of 3,555 people are involved. This is not the whole story because north Cork is now looked after by Cork University Hospital.

Overall, the waiting list for orthodontic treatment in the southern area has increased by 246 patients from December 2006 to December 2007. The waiting list for orthodontic assessment — an assessment to determine a child's eligibility for orthodontic treatment — was 3,071. However, owing to the fact that patients aged 12 years and over are the only patients officially placed on the waiting list, approximately 3,000 children have been referred for orthodontic assessment but have been excluded from the assessment waiting list by the protocols laid down by management.

In October 2006, two senior dental surgeons left the orthodontic service to further their education in orthodontics at the dental school and hospital in Cork. The decision by management to suppress these posts has led to a significant increase in the number of patients awaiting orthodontic treatment. It is reasonable to assume that the 246 patients, most of whom have been waiting since 2002 and 2003, failed to receive orthodontic treatment in 2007 as a direct result of the decision by management to suppress the two posts for senior orthodontists. Those waiting in Kerry since 2002 and 2003 would be treated at this stage.

In December 2006, the number of patients under orthodontic treatment was 3,400. However, this figure has not changed in the returns to the Department of Health and Children since 2003. This indicates that this figure was an arbitrary one. It is clear that the number of patients under orthodontic treatment has significantly diminished. The loss of the two senior dental surgeons has not only affected the number of patients under treatment but has seriously affected morale within the orthodontic unit. For example, the clinics in Tralee had to be reduced from three days to two days per week at the request of line management. In January 2007, the HSE directed that there should be no further treatment for any new patients in Kerry. It is clear that the decision of management to suppress the two senior dental posts and to interfere with access to the dental surgery in Tralee has had a devastating effect on the orthodontic unit's ability to reduce the number of patients currently awaiting orthodontic treatment in Kerry.

It is anticipated that the Cork and Kerry region will apply for the appointment of a second consultant and it is proposed that this consultant be placed in the new centre proposed for Cork-North Lee and Kerry. This new consultant should be housed in the new dental service that will be provided at St. Finian's Hospital in Killarney. This individual could cater for the needs of patients in Kerry and west Cork. If a second consultant orthodontist is appointed, which should happen, the appointment should be for the Kerry region. That consultant orthodontist should be assigned to the new unit at St. Finian's Hospital in Killarney.

Pat Gallagher (Donegal South West, Fianna Fail)
Link to this: Individually | In context

On behalf of the Minister for Health and Children, I am happy to have the opportunity to address the issue raised by Deputy Deenihan.

As the House will be aware, the Health Act 2004 provided for the Health Service Executive, which was established on 1 January 2005. Under the Act, the executive has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes the delivery of orthodontic services. The prioritising and resourcing of the development of orthodontic services is now a matter for the Health Service Executive.

It is important that I explain that the report referred to by Deputy Deenihan is an unofficial one, not an official Health Service Executive document. This report was not commissioned or requested by the HSE nor is it a requirement, operationally or legally, of any area of the public orthodontic service to produce such a publication. Furthermore, the author of this report did not make local HSE management aware of its existence or forward them a copy. They became aware of the existence of this unofficial report only when contacted by the local media.

The majority of the issues outlined in respect of the management and future development of the orthodontic services in Cork and Kerry in this unofficial document are under ongoing consideration. The HSE plan regarding the future model of orthodontic service delivery is clearly outlined in the strategy for the provision of orthodontic services in the HSE South, which has been produced by management in the HSE.

Most of the issues outlined in this unofficial report relating to the infrastructural deficits of the orthodontic unit in St. Finbarr's Hospital are documented in a health and safety audit commissioned by management and completed by the orthodontic department in late 2007. Local HSE management have noted that a small number of the issues relating to the infrastructure of the orthodontic unit were not previously brought to the attention of management at South Lee Local Health Office. These issues are now being examined.

The progress of local HSE management in dealing with these issues highlights the necessity and fundamental importance of staff, especially those at a consultant level, engaging openly and in a positive and constructive way with their local management to overcome difficulties and problems and achieve outcomes. Only through this process will we achieve high quality, reliable and sustainable services for patients.

I remind the House that the Joint Oireachtas Committee on Health and Children carried out a review of orthodontic services in Ireland and published two reports — one in 2002 and 2005. On foot of this, the HSE established an orthodontics review group in 2006. The group was chaired by Hugh Kane of the HSE and was made up of consultant orthodontists, a specialist orthodontist working in the HSE, representatives from the two dental schools, Trinity College Dublin and University College Cork, and the Department of Health and Children.

The terms of reference for the group were to review the recommendations contained in the joint Oireachtas committee reports on the orthodontic service in Ireland — February 2002 and June 2005; to examine the recommendations within the operational remit of the HSE and establish their status; to conduct an analysis of the HSE's existing orthodontic delivery structure and capacity; and, based on that analysis, to make recommendations in that regard, the recommendations thus made to be costed and a timeframe for their implementation proposed.

The group made recommendations in four broad areas. These are guidelines and revised eligibility criteria, training, manpower planning and service provision. These recommendations reflect many of the issues raised in the joint Oireachtas committee report of June 2005. A range of measures to improve the orthodontic services on foot of the report of the joint Oireachtas committee and the Kane report is already under way.

In addition, my ministerial colleague, Deputy Mary Harney, announced in October 2007 the research and development of a new national oral health policy. This new oral health strategy, the first such strategy in 13 years, will be undertaken by the Department of Health and Children in conjunction with the HSE. The development of this new national strategy will allow a critical examination of the many challenges and issues currently facing the dental sector in Ireland. Some of the issues which will be examined include service delivery issues such as orthodontic services. Other issues which impact on orthodontic services such as specialisation and skills-mix, including the recognition and future expansion of the role of auxiliary dental professions and the identification of appropriate training needs, will also be examined.

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. This undoubtedly presents challenges for services delivery and will continue to do so. Our aim is to continue to make progress and to develop a high quality, reliable and sustainable service in HSE South and all other areas of the executive for children and their parents.