Tuesday, 21 October 2008
Postgraduate Medical Training
Not yet; next year. This matter relates to the need for the Minister for Health and Children to address the lack of specialist registrar training in maxillofacial surgery. This specialist area includes treatment of afflictions relating to facial trauma and cancer of the head, neck and tongue. It is a surgical specialty in which the lack of training is acute and disturbing. To qualify for this specialist medical field candidates need two primary degrees, one in medicine and one in dentistry. They also need a further five years' training before practising. That is an extraordinarily demanding apprenticeship, which results in candidates being particularly suited for this specialist field. Unfortunately, training facilities in Ireland are non-existent.
Maxillofacial surgery is practised in four units, namely, Cork, Limerick, Galway and in St. James's Hospital in Dublin. Each unit needs to be well staffed. Currently, anyone wishing to train in this area is obliged to go overseas for that purpose. I urge the Minister to consider the case of a constituent of mine who wishes to be trained in this specialty but who is unable to do so because training that was available through the Dublin Dental Hospital and St. James's Hospital ceased in 2002. The person in charge went overseas to continue his own training and, accordingly, the course collapsed. It means that those who need to be treated must endure longer queues. While those who work in this area are well qualified, they are getting older and are not being replaced. There is nobody there to replace them. One of the excuses often given is that there is little demand for this treatment. However, the figures available to me suggest that each year, St. James's Hospital treats 1,000 facial fractures, 100 cases of mouth cancer and 200 facial deformities. Those who are qualified to do such work are being assisted by people who have been trained in dentistry and medicine but cannot be certified because they have not done the necessary extra training in maxillofacial surgery as it is not available in Ireland.
For the sake of those who wish to practice this form of medicine and those who wish to be treated, can we not make the necessary training available to ensure we have enough suitably qualified doctors to provide the treatment? If we do not do so, people will have to go abroad or the facility in question will have to close. As no training is available in Ireland, those who wish to practice this science need to go abroad to be trained. I ask the Minister of State to consider providing the necessary funding, imposing the necessary pressure or offering the necessary incentives to the hospital to make this provision.
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.
I would like to ask two supplementary questions. When can we expect a training programme to be made available? Can the Minister of State explain what in the name of God she meant when she said "reasons cited for withdrawal of approval included a lack of complexity in workload"?
I admit that when I examined the response earlier, the phrase in question struck me as unusual. That is what the specialist advisory committee said. From the small knowledge I have of this area, I have to acknowledge that it seems to involve a hugely complex workload.
The phrase in question did not come from the Department of Health and Children. It came from the specialist advisory committee. In fairness, there were six consultant positions in Ireland when approval for the training programme was withdrawn. As there are now nine such positions, we are in a different situation as we try to get specialist approval for a training programme. The increase in the number of consultant posts over the past three years should help us to make that case. We are moving to a model that involves more consultants and fewer non-consultant doctors. We will examine the important points that are being made in the debate. I assume that the increase in the number of consultant posts will make it possible to reconsider the situation.