Patrick O'Donovan (Limerick, Fine Gael)
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I acknowledge the presence in the House of the Minister of State, Deputy Shortall. I wish her well in her role. Like other Deputies, since I was elected my attention has been drawn by a number of parents to the issues of orthodontics and dental care, especially as they relate to children. When I did some research into the operation and governance of the dental profession in Ireland, I discovered that in both 2002 and 2005, joint Oireachtas committees produced recommendations on how the dental strategy in this country should be operated. Nine years on from the 2002 report and six years on from the 2005 report, the situation is no better and is probably worse. I have spoken to parents who are frustrated because their children's teeth are getting worse as waiting times increase.

I am struck by the length of time for which the position of chief dental officer has been vacant. I understand there is an embargo on recruitment into the public sector and I appreciate the implications of the filling of posts. Having said that, the need for a chief dental officer cannot be underestimated, particularly given that the Dentists Act 1985 provided for the establishment of the grade of dental therapist, as an assistant to dentists and orthodontists, in order to help the State to reduce waiting lists. Unfortunately, that was never realised. As things stand, an Irish person who receives a dental therapy qualification in the UK is not allowed to practice in Ireland. If such a person presents himself or herself to the Dental Council, he or she will essentially be asking the council not only to ratify him or her but also to ratify the course he or she studied in the UK.

The international experience in this regard is that waiting lists for orthodontic care, especially for children in their formative years, are much shorter in countries where a different strategy is pursued. There has been a reluctance to consider such approaches in Ireland, for whatever reason. It is a pity we are still in such a position, 26 years after the original legislation was passed. I understand the Dental Council is considering giving acknowledgment to a course that can be studied in the UK. It should be noted, however, that the General Dental Council in the UK currently accepts seven courses as suitable for a person who wishes to work as a dental therapist there. None of them is currently recognised in this country.

Ireland is unique in western Europe for its failure to make great headway in increasing the number of people who receive dental treatment. I acknowledge the presence in the Chamber of the Minister, Deputy Noonan. During his tenure as Minister for Health in the rainbow coalition of the 1990s, massive progress was made at St. James's Hospital in Dublin. The strategy that was applied was different from that we are used to now. A similar strategy was applied by the former Mid-Western Health Board. All of that good work disappeared with the abolition of the health boards and the creation of the bureaucratic monster that is the HSE.

Is there an appetite for dealing with this within the Department of Health, the HSE and the dental profession itself? Having spoken to some of those who work in this sector and some of the parents of children on waiting lists, it seems there is a reluctance to deal with the issue effectively.

To cite a specific case, a journal published in 2010 in Camarthenshire in Wales indicated that orthodontic therapists could treat 2,268 children in one year. This is a substantial number of children and given that rural Wales is not much different from any area of Ireland, I ask that the Minister of State examine the issue, particularly in light of the reluctance shown to date towards implementing the recommendations made by the joint Oireachtas committee in 2002 and 2005.

While I accept that we face budgetary constraints, constituents have visited my clinic to show me pictures of their children's teeth or present their children in person in order that I can look in their mouths. I am then placed in the unenviable position of having to inform them that their child may have to wait for two or three years for treatment. I ask the Minister of State to raise this matter with the Minister for Health and I look forward to a response.

Róisín Shortall (Dublin North West, Labour)
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I thank Deputy O'Donovan for raising this issue. Oral health services span primary, secondary and tertiary care services, including acute hospitals. The Department of Health agrees objectives and performance indicators with the Health Service Executive for the public dental service and dental treatment services scheme, DTSS, and oversees the development of policy and service delivery in this regard. The DTSS is provided by contracted dental practitioners and the public dental service is provided by salaried dental staff of the HSE.

The current goal for the DTSS is the provision of a basic level of service within budget to medical card holders. Unfortunately, owing to the current position of the public finances, it has been deemed necessary to reduce the services available under the scheme. However the Health Service Executive has measures in place to ensure patients with special needs, high risk patients and those who have greater clinical needs receive priority for treatment. In addition, a free oral examination every calendar year and free emergency dental treatment with a focus on the relief of pain and sepsis are available to all eligible patients.

The current goals for the public dental service are the provision of pain and emergency services for children aged under 16 years and routine care for targeted classes of primary school children with the provision of advanced, specialist and consultant care in hospital settings. Orthodontic services, which are also delivered by salaried dental staff of the HSE, are provided to eligible patients based on the level of clinical need. Oral and maxillofacial surgery are delivered either by secondary or tertiary services. The HSE intends to review the delivery of orthodontic services and all possible avenues related to internationally recognised models of good practice will be considered in that context.

The HSE is implementing the recommendations of the strategic review of the management and delivery of dental services undertaken in 2010. This includes the development of a national oral health office and an inspectorate. A national oral health lead has been appointed on an interim basis and is leading the implementation of the recommendations, which place a particular emphasis on probity and governance issues.

The National Recovery Plan 2012-2014 provides for changes in the existing range of dental services and supports provided through the health care and social protection systems to improve access to essential dental services for those most in need. This proposal is being considered in the context of the comprehensive review of expenditure. The current moratorium on the filling of posts has meant the Department of Health has not been in a position to fill the post of chief dental officer. Future decisions on this post will be taken against the backdrop of the Department's need to balance the delivery of business priorities with falling levels of overall resources.

Patrick O'Donovan (Limerick, Fine Gael)
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While I appreciate the Minister of State's comments on the current economic climate, the appointment of auxiliary personnel working in orthodontic teams, as they are described in Finland, offers the potential to achieve much better outcomes using the same level of resources. It is an indictment of all Governments since 1985 that the model of delivering orthodontic services has not changed in the past 25 years. I welcome the Minister of State's commitment to examine this issue. At present, the role of chief dental officer is being performed in an acting capacity. The position must be afforded the priority it deserves if we are to drive forward the delivery of the orthodontic service.

Róisín Shortall (Dublin North West, Labour)
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I concur with Deputy O'Donovan that we can achieve more with existing resources and I am keen to change the way in which services are delivered. I am also sympathetic to his call for the appointment of a chief dental officer. I hope we will be able to take a decision on the matter when the position becomes clearer in the new year.