Mary Wallace (Meath East, Fianna Fail)

I thank Senator Ross for raising this important issue. The aim of specialist and senior registrar training is to produce enough trained doctors in each specialty to satisfy future national requirements for consultant appointments. To this end, the Medical Council recognises specific postgraduate training bodies which are responsible for the provision of a wide range of postgraduate training programmes. The objective is to align the intake of trainees to the specialist senior registrar grade with the anticipated job opportunities for consultants. It is important to avoid producing too many highly trained personnel for whom there might not be outlets in this country or abroad. A flexible approach is taken, however, with regard to the recommendations of the 2003 report of the national task force on medical staffing and the commitment in the programme for Government to increase significantly the number of consultant posts.

The specialty of oral and maxillofacial surgery is the surgical discipline which deals with the diagnosis, evaluation and treatment of pathological processes which affect the teeth, jaws, face, head and neck. Training includes the operative, non-operative and intensive care management and rehabilitation of disorders of the teeth, jaws, face, head and neck. As Senator Ross said, it is mandatory to be dually qualified as a doctor and as a dentist before one can begin training in oral and maxillofacial surgery. Basic qualifications must be registered with the Medical Council and the Dental Council. The dual qualification gives an understanding of the surgical anatomy and pathology of conditions affecting the face, mouth and jaws and associated structures. The skills attained during the complex and lengthy training programme are best utilised by treating complex patient cases of facial deformity, trauma, cancer and cleft lip and palate. Oral and maxillofacial surgery is one of the specialties listed in the Medical Council's register of medical specialists.

There are nine consultant oral and maxillofacial surgeon posts in Ireland. Four of the posts are based in the Dublin region, one is based in Cork, two are based in Galway and two are based in Limerick. The Comhairle na nOspidéal report on oral and maxillofacial surgery services was published in 2005, when there were six consultant posts in this specialty. It recommended an interim total of 13 consultant posts and a long-term total of 24 consultant posts. There is no higher specialist training programme in oral and maxillofacial surgery in Ireland. A training programme was previously in place, but approval for training was withdrawn by a professional specialist advisory committee. Reasons cited for withdrawal of approval included a lack of complexity in workload, limited supervised training due to the low number of consultants in the specialty for the large service workload and the lack of a formal national rotational training structure.

The Royal College of Surgeons in Ireland has been working on the development of a new, formal, higher specialist training programme in the specialty. A programme director, who is one of the existing consultants in the specialty, has been involved in drawing up a curriculum for the training programme with a view to seeking specialist advisory committee approval for a small number of specialist registrar posts in the specialty. It is expected that the increase in the number of consultant posts in oral and maxillofacial surgery over the past three years will assist in securing training approval. Considerations to be taken into account in the approval of new specialist registrar posts include the availability of funding, rotation of posts between at least two clinical sites and anticipated job opportunities for consultants in the specialty. Any potential expansion in the number of specialist registrars by the Health Service Executive must be made in the context of the employment control framework, the availability of resources and Government policy on the reduction in the number of non-consultant hospital doctors. I thank the Senator for raising this important issue.