A Limerick-based consultant orthodontist has claimed many patients offered treatment have been put on waiting lists with the knowledge that they will be too old and mature to be treated properly by the time they come to the top of the list.
Mr Ted McNamara, a senior consultant orthodontist with the Mid-Western Health Board, said there has never been a proper orthodontic service and the Department of Health's unwillingness to support a proper regional training programme for dentists is adding to the waiting list problem. He has been supported by his colleague on the Southern Health Board, Mr Ian O'Dowling, consultant orthodontist.
"Traditionally, we have never had a proper orthodontic service in the country. The Department of Health is strangling us," Mr McNamara said.
A Department spokesman rejected the allegation, stating that £3.7 million had been approved this year to fund an orthodontic initiative, including the recruitment of extra staff, and the provision of new facilities and arrangements for the treatment of patients.
The Mid-Western Health Board currently has 1,075 on its waiting list for treatment, while the assessment waiting list is now at nearly 3,500. Nationally, there are 23,686 patients on the assessment waiting list following referral by a dentist, and 11,995 on the treatment waiting list, according to the Department. A year ago, there were 18,000 people awaiting treatment, and 12,000 are waiting to be assessed.
Currently, about 16,100 are receiving treatment and earlier this month, the Minister for Health, Mr Martin, told the Joint Committee on Health and Children that the Department's objective was "to increase this figure significantly".
The provision of services was restricted by the limited availability of trained specialist staff. "This shortage has resulted from the difficulties we have had in agreeing arrangements for training programmes." Both Mr McNamara and Mr O'Dowling argue Mr Martin needs to develop proper plans to enable regional consultants train dentists as specialist orthodontists.
They say the Department needs to provide clarification on the guidelines for treating people. "It is just daft. It is almost as if the Minister is trying to exclude people from being eligible from treatment and reduce the waiting list that way," Mr O'Dowling said.
Currently, the Department does not officially recognise specialist orthodontists employed by health boards, although agreement was recently reached on the establishment of this grade after "complex and time-consuming negotiations", according to Mr Martin .
Officially, these specialists are being paid the same salary as dentists. Unofficially, Mr McNamara says, some health boards have been providing a top-up payment for the speciality treatment. Mr McNamara said that, as a result, salary rates across health boards could vary by as much as £9,000. "There is total chaos throughout the country. Specialist orthodontists are not recognised anywhere in the public health service," he said.
He was the first regional consultant orthodontist to be appointed in the State and is frustrated at the efforts he made to train orthodontists only to have them leave public service. He believes every health board needs a team of up to 15 orthodontists working under a consultant orthodontist.
"We have to advertise at salaries which will attract badly needed orthodontists. We have lost a number of orthodontists from this board in whom I have invested a considerable amount of personal effort in teaching and training."
This also creates a difficulty for existing patients. They can be left in mid-treatment if their orthodontist leaves suddenly. They have to be transferred to other specialists who already have a full complement of patients. The prohibitive costs of private treatment mean it is not an option for many patients.
"Patients and parents are frustrated and angry and this anger is taken out on the staff in the orthodontic department who are in the front line and who are powerless to deal with what is a national problem."
Mr McNamara set up a training programme for dentists in 1985 which ran for 14 years and was successful in reducing the waiting lists. His trainees were treating up to 500 patients at a time. Their salaries were in the mid-£30,000 range.
"Dentists became trained and, at the same time, thousands of patients were treated to a high standard." The training programmes ended in 1999 because the British-based Specialist and Advisory Committee (SAC) declined to approve them unless they were attached to one of the two dental schools in the State, at Dublin or Cork.
In his recent address to the Joint Committee, Mr Martin stated: "This informal training framework was inconsistent with the modernisation of dentistry under governing EU directives which led to the introduction of specialisation in dentistry in the 1990s." Mr McNamara said as the training programmes collapsed, dentist staff left regional units. "The case load for remaining staff was excessive. In some cases, the numbers were so great it was not possible to treat everybody to a safe standard.
"Our trainees saw there was no reward for hard work," Mr McNamara said.
In some cases, children who had been treated were worse off than before because extractions had been carried out. "Many were damaged by the lack of supervision and the long intervals, in some cases up to a year, between visits, instead of once a month.
"Hundreds of children in some parts of the country ended up with poor-quality treatment and results." He said the replacement training scheme, which is supported by the Department, is overly restrictive. It caps the number of patients treated by trainees at 120, similarly to programmes in Britain which run for a three-year period although the Irish ones ran for four to five years.
Now, with a Department budget for the Mid-Western Health Board of £350,000, he expects to get just over 350 patients treated at a Department-approved cost of £2,300 per patient. "Previously I would have expected to be able to treat considerably over 1,000 children for this amount of money and, in addition, my health board would have had extra qualified orthodontists at the end."
He said Mr Martin was not concerned about waiting lists. "He just wants to be seen to be spending money. We cannot spend it efficiently.
"I have been in the system for over 17 years. It improved every year until Brian Cowen took up office and that was the first time it started to deteriorate. It has continued to deteriorate since Micheβl Martin took up office." Neither Mr McNamara nor his counterpart in the Southern Health Board, Mr O'Dowling, is doing assessments at the moment because of what they describe as the confusion in the Department on guidelines.
While treatment waiting lists might be diminishing, they believe the number of people who should be receiving treatment is growing.
Mr O'Dowling said the ability to be able to deliver a service was the main issue. "We are being prevented from training people. Ted did it very successfully for a number of years and he was stopped.
"We want to train people to work in the public health service, not to train people to work in private practice."