Mary Harney (Dublin Mid West, Progressive Democrats)

In answer to Senator Browne, there is constant planning in the Department. The priority in health care at the moment is to reform the way business is done so that the allocated resources can be better used. We are very fortunate that alone of the countries in the developed world we have been able to increase funding fourfold in one decade. We have greatly enhanced and increased the number of people in training in therapies, medical education and nursing. There has been a significant increase in the number of front-line workers in the health care system. The Senator made a valid point about disease as opposed to health.

One of the issues being examined is the reform of health insurance. The Barrington group has recently reported and I will consider the report over the Easter recess. One of the issues to be considered regarding health insurance is that non-smokers are not given a bonus. Best health advice would be to offer incentives for good behaviour and the Senator has made some valid points about health promotion.

The Dental Council and the Medical Council are the bodies that must approve the location and quality of training and the HSE arranges the facilities. The original Bill as drafted provided that the HSE, in so far as was practicable, should provide competence assurance. This begged the question whether the HSE could say it did not have the resources. This provision has been removed so that competence assurance is a priority and cannot be regarded as being behind everything else. We must ensure that doctors are competent to do the job. We are significantly increasing the amount of money being spent on training and education. We have committed to give money to the Medical Council for competence assurance. The original intention was that this would be completely funded by the profession but I believed this would be an unfair and unreasonable burden on the profession and it would take a considerable time to get to where we need to be if this was the case. The State, therefore, will be involved as a co-funder. We are greatly increasing investment in medical education and training. The funding must be provided to support any increase in the number of places, and the same applies for internships.

I am familiar with the dental issues in Limerick where training was being accredited by an overseas body. The bodies certified to train orthodontists in Ireland are the domestic bodies. A report has been completed on behalf of the Joint Committee on Health and Children. It contains some strong views and I am due to meet a particular person soon to hear a different perspective.

Orthodontic treatment is a priority. It is extraordinarily expensive in this country and we must ramp up the number of orthodontists available to treat younger patients. The need for orthodontic treatment also has a significant cosmetic impact on many young children if they cannot receive the appropriate treatment. I know of a large number of people in the Dublin area who travel to Northern Ireland for orthodontic treatment. It seems to be available there much more cost-effectively than here and I am not quite certain why that is the case. I do not believe the orthodontists in Northern Ireland are of an inferior standard or quality to the orthodontists here. Availability and cost are major issues.

We will reform the Dental Council and introduce legislation. After the pharmacists and doctors, the next two areas needing regulation in a modern context will be nurses-midwives and dentists because the legislation is out of date. Many of these issues will need to be thrashed out in that context.