Directory of European Resources > Eurocleft Clinical Network > Registered Clinical Teams > Ireland

Clinical Teams in IRELAND

• Dublin (One Centre comprising Crumlin Children's Hospital, St. James' Hospital and Temple Street Children's Hospital)

Population
Approximately 3.6 million.

Health Service
The health system is primarily funded from general taxation and is publicly provided although private health care retains a considerable role. A high degree of emphasis is placed on preventive medicine and in particular, efforts are being made to address the main contributors to premature mortality such as smoking, alcohol abuse, poor nutrition and lack of exercise. At national level, the Department of Health sets the budget for services, plans their overall development and initiates regulatory and legislative change. The provision of health care at regional level is the responsibility of eight Health Boards. Voluntary hospitals, mainly run by religious orders, are an important and integral part of the health care system. They too report to the Department and receive their funding from it.

Individuals ordinarily resident in Ireland have either full or limited eligibility for public health services: the type of eligibility is determined by a means test. Approximately one third of the population has free access to the complete range of services and the remainder is entitled to consultant and hospital care subject to small charges. This group also obtain primary care services and prescribed drugs on a private basis. The Irish Society for Quality in Health Care co-ordinates activities in this area and serves as a clearing house for quality initiatives. A patient’s charter for hospital patients has recently been introduced.

Cleft Care Organisation
In Ireland each year around 85* new babies are born with clefts of the lip and/or palate. In the 1990s, existing cleft services were restructured and a single Dublin centre set up with two primary cleft surgeons, orthodontist, paediatric dental surgeon and speech and language therapists between Our Lady’s Hospital, Crumlin/St. James’s Hospital and The Children’s Hospital, Temple Street. In 1988 St James’ was designated the National Maxillofacial Centre including the orthodontic treatment centre for cleft lip and palate. A Cleft Co-ordinator was appointed in 2001 and a national Prosthodontist has been in post since 2002. The Dublin cleft centre cares for 80% of all babies born with clefts annually from all over the country. A centre also exists further south in Cork and a small number of patients with clefts are cared for in Galway. All of the members of the Dublin team have specialist training in cleft care. The orthodontic and maxillofacial components are based solely at St James’s with attachments to Crumlin and Temple Street. There is a very active parents group. All care is free and provided under the public health system since 1983.

Challenges to Attaining the Eurocleft Consensus Recommendations
With only 85 new patients per annum the present number of centres (one in Dublin and one in Cork) precludes the objective of 40 new patients per surgeon, orthodontist, speech and language therapist per year. There are no special training programmes for those individuals involved in cleft care. As yet there has been no participation in intercentre studies or clinical trials.

Future Plans
The UK’s CSAG report into cleft lip and palate services as well as the proposals of the Eurocleft BIOMED II and INCO network have helped to foster a significant change in the attitude of the Eastern Health Board towards organisation and particularly co-ordination of the service. A working party consisting of health officials and clinicians have recommended the appointment of a cleft services co-ordinator for the eastern area and have pledged a commitment to encouraging multidisciplinary team work, high volume operators and a national database registry of cleft patients. Approval has also been given for the appointment of a prosthodontist to treat cleft patients in the Dublin centre. Although these changes are being made at a regional level they are nonetheless far reaching and it is hoped that policies will be formulated on a national basis.

* Number of clefts per annum reported by national representative for Ireland