Seán Fleming (Laois-Offaly, Fianna Fail)
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I thank the Ceann Comhairle for selecting this issue and I also thank the Minister of State at the Department of Health for taking it. This is a long-standing issue in the midlands, especially in County Laois where I live and where I meet many students. There is a long orthodontic waiting list for school children in my constituency, It is particularly bad in County Laois. Tremendous work was done a few years ago by the HSE when it set up a clinic in Portlaoise on Saturday mornings. It ran for a long time and the backlog was cleared but the situation seems to have deteriorated again.

The issue has come into focus in recent months. I tabled a parliamentary question a month or two ago and I subsequently received a detailed reply from HSE midlands dated 4 May. I asked when the school dentist would visit Killeshin national school in County Laois, which is near Carlow town and the reply stated:

The public dental service in the midlands no longer carries out school dental screenings. Service provision for the last 15 years has been structured through screenings carried out in the dental surgery. The children in specific classes are invited to their public dental clinic for a full dental examination. Dental services in Laois screen and treat the sixth classes in national school in one academic year

This is the problem. I received a letter from the parents committee of Killeshin national school. I cite the school because the source of its problem is it is located only a few miles from Carlow town. A dental service regulation was passed in 2000 to deal with this issue.

The school dental screening programme dentists should visit primary schools each year to see children in second, fourth and sixth class. I do not mind whether the dentists come to the schools or the students are sent to the clinic by appointment. That is not the issue. I am categorically informed that in the neighbouring county of Carlow screening is carried out in second, fourth and sixth classes. The pupils are examined and treated in a fair manner.

However, that does not happen across the border in the schools in County Laois, where a number of the schools have confirmed to me that the children are 12 years of age and almost finished primary school in sixth class before they get their first screening. There is zero prospect in practically all cases of any treatment being given to them in that year. Essentially, the established practice in County Laois is that children just get a screening before they leave primary school and they are several years into their secondary school education before they get any follow-up treatment. If the Minister's information is different from mine, the information he has been given is not accurate. In many of the schools in Laois children get their first screening just before they leave at 12 years of age and many of them are between 14 and 16 years of age before they get their first dental treatment following that screening.

I presume this is due to a staffing issue. For some reason there is a big geographical divide in the country when it comes to dental screening and treatment. Children are sometimes long past doing their junior certificate before they get their first dental treatment. That is not the intention of the regulation, but that is what is happening.

Alex White (Dublin South, Labour)
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I thank the Deputy for the opportunity to address the issue of dental services for children in the midlands.

The public dental service of the HSE provides dental services for children up to 16 years of age and persons of all ages with special needs through its dental clinics. All HSE dental clinics prioritise emergency care for children up to 16 years of age, treatment for special needs patients and screening of children aged from 11 to 13 years, including referral for orthodontic services where necessary. Eleven to 13 years of age is a key age for dental assessment, since the child's permanent adult teeth have erupted, allowing a preventive sealant to be placed if necessary, and it is the usual age to refer for orthodontic and other secondary care. Other services, including screening of children of six to eight years, are provided but may be deferred in clinics where there is pressure on resources.

Usually when a child has been screened they are provided with care for their permanent primary teeth. In some cases it may be necessary to place a child, who has been examined through the school screening service, on a treatment waiting list. Treatment for a child who receives emergency care is generally confined to the relief of pain and sepsis. The aim is to ensure that all children receive equal access to screening and care at key developmental stages. However, staff retirements and the moratorium on recruitment in the public services have had an impact on the services that are provided. The HSE has had to reduce its levels of service while maintaining a priority service to emergencies, persons of all ages with special needs, orthodontic assessments and children between the ages of 11 and 13 years old.

Children who attend school in the midlands area, that is, Laois, Offaly, Longford, and Westmeath, are contacted by the HSE dental service through their school and are offered screening. For reasons related principally to quality, efficiency and effectiveness such children are usually examined in a dental surgery environment rather than in the school. This has been the case for many years in respect of all children throughout the midlands.

In the past two years the public dental service in the midlands has lost three dental surgeons. The dental services to children have therefore been reduced. The service in the Midlands generally screens and treats sixth class children in the one academic year. In some instances screening for such children may run into the following academic year. Some clinics may also get to screen younger children from other classes. Approval has been granted to recruit an additional dental surgeon for the area, which will help with service provision.

A three year project to develop a new national oral health policy is currently under way. Since the introduction of the dental health action plan in 1994 there have been changes to the oral health of the population. While the oral health of the general population has improved, inequalities remain. The vulnerability of some groups, linked to low income and-or disabilities, is of particular concern. The new policy will aim to set out how services can be best integrated with general health services and aligned with the current and future needs of the population. In developing a new national oral health policy there will be an exploration of the ways that oral health services can be provided for both adults and children.

Seán Fleming (Laois-Offaly, Fianna Fail)
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Unfortunately, the Minister has confirmed my worst fears in his statement that in the past two years the public dental service in the midlands has lost three dental surgeons. That is the issue in a nutshell. That is why the children in the midlands are losing out. This is unfair. I realise it is fashionable to knock the HSE as a national body, but the purpose of the HSE is to ensure that there is equal treatment for people across the regions and that treatment will not be based on geography. This is not just about my area. The Minister mentioned four counties in the midlands but for people who live beside Counties Kildare, Carlow and Tipperary it is not right that children from the same village are getting different treatment according to what school they attend. That is unfair.

I ask the Minister to refer back to the HSE on this issue. In cases where children in one county must go to the screening clinic in a neighbouring county, that is not a big deal. Their parents will happily do that because sometimes they are obliged to drive 20 or 30 miles to a clinic anyway. It is not fair that screening is taking place for some children a couple of times before reaching 12 years of age. The Minister has confirmed that assessments are carried out when children are aged between 11 and 13 years of age, aside from emergencies to deal with pain relief and sepsis. Children are therefore approximately 12 years old when most of them are assessed, which is just before they leave the service. I have a long list of cases in my office and I have tabled parliamentary questions on a regular basis regarding children waiting 14, 15 and 16 years for their first treatment. They are screened before they leave primary school but wait several years for treatment.

The Minister used the phrase that the children get the assessment and treatment in the one year. They get the assessment but, given that the service is down three dental surgeons, they are not getting the treatment, as the Minister is being led to believe. I am pleased that a dental surgeon is being recruited but perhaps some arrangement can be put in place for a period just to clear the backlog, as happened previously. Clinics could be opened in an area and staffed by dentists from neighbouring counties or regions to conduct a number of Saturday clinics. This happened successfully in the past. I realise there is a cost, but it would be less than the cost of having to employ a dental surgeon. I ask the Minister to consider that.

Alex White (Dublin South, Labour)
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The Deputy makes some helpful suggestions. As he acknowledged, I have not sought to deny the fact that there have been reductions in staffing as a consequence of the general cuts in health services. The Deputy is well aware of the background to that with regard to the overall spending it is possible to make available to the health services. It has been a real problem. I am glad to report that a decision has been made to recruit an additional dental surgeon. The post has yet to be filled but I am hopeful it can be filled in early course.

What the Deputy said generally about the need for dental services, treatment and checks is well taken. I am very conscious of the point he makes about teenage children. He is absolutely correct about its importance and I will take on board the suggestion he made towards the end of his contribution. We do not want to have anomalies arising between different counties if they can be avoided.