A new plan to charge for orthodontic treatment in Northern Ireland has been branded a “tax on children’s smiles”.

Children who require orthodontic treatment will soon have to meet strict new criteria to qualify for the treatment on the NHS under new government guidelines, the Belfast Telegraph can reveal.

According to the British Dental Association (BDA), the overhaul of the current system — under which NHS orthodontic treatment is free — will mean all but the more severe cases will have to pay for their care.

With a course of orthodontic treatment which includes upper and lower braces costing in excess of £2,000, the new regulations — which could be in place in a matter of weeks — will mean parents shelling out several thousands of pounds for treatment to fix their children's smiles.

There are fears many parents will be unable to cover the cost, effectively highlighting class division and increasing low self esteem among a generation.

The move has been branded a taxation on the smiles of children across Northern Ireland by DUP MLA and member of the Stormont health committee Alex Easton who said he was “flabbergasted” at the plans.

“I am outraged the health committee has not been informed of these changes and I would call on the health minister to explain why he has not consulted with us on this issue,” he said.

“I am deeply concerned about these plans which is effectively taxing people’s smiles. The point of the health service is that it is meant to be free and this is just another way of making money.

“It is going to mean people from a less privileged background will not be able to afford this treatment.”

The BDA said: “This change will effectively introduce rationing of health service orthodontic care. It will hit families who care about the state of their children's teeth and create anxieties around cost where they have not previously existed. The decision taken by the department will restrict the scope of health service dentistry.”

The BDA is concerned the changes are being rushed through without adequate time to inform patients and has called for any savings made from the new system to be re-invested in dental care in Northern Ireland.

Belfast orthodontist James Lundy said: ‘‘Orthodontists recognise the economic situation in which the department finds itself but in the interests of patients

and dental practices we think there needs to be time taken to manage the change.

“This is a new scenario for patients, where availability of orthodontic treatment on the health service will change almost instantly and patients and their families need the time to prepare if they now find they have to pay.

“There will be challenges for practices too, most clearly there is a need to provide training on using the new assessment criteria and allow time for dental practices to make the changes needed.

“Patients need to be able to understand the changes which the department are implementing. Our concern is that sufficient time should be set aside to manage this successfully.”

Between April last year and March this year, 19,405 orthodontic appliances were fitted under the NHS in Northern Ireland.

An orthodontic appliance includes a removable brace — 2,879 of these were fitted — or a fixed brace, of which 16,526 were fitted.

A spokeswoman from the Department of Health, Social Services and Public Safety said the plans aim to ensure orthodontic care delivered through general dental services is based on need rather than demand.

“This policy is consistent with that which exists in England and Wales and is supported by DHSSPS policy set out in the Primary Dental Care Strategy ( 2006) and the Oral Health Strategy (2007),” she said.

“Orthodontic need will be determined by criteria based on the Index of Orthodontic Treatment Need which is a standard widely accepted across the UK by orthodontists. It is hoped to introduce this change within the next two months. We currently have no plans to change our policy on patient fee charges.”

How the new scheme will operate

Currently, any patient is entitled to have orthodontic treatment on the NHS if they require it — whether it is to correct the mildest crowding or more severe problems where the jaws are poorly aligned and may be causing health problems.

Under the new scheme, cases will be measured against a scoring system called the Index of Orthodontic Treatment Needs (IOTN), which is used to assess the need and eligibility for orthodontic treatment on grounds of health, and only those with a score of 3.6 and above will get free treatment.

The change will mean many families having to pay for orthodontic treatments to correct their children’s smiles that are currently provided for free on the health service.

A course of orthodontic treatment can cost in excess of £2,000.

The changes represent a fundamental change to the way orthodontic treatment for Northern Ireland’s young people is delivered.

The Department of Health, Social Services has said it plans to implement the new criteria within the next two months but the British Dental Association (BDA) believes it could be in place as soon as next month.

Even children who have already been told they require orthodontic treatment but are waiting for their teeth to fully form will not escape the new criteria.

The BDA has warned that as cases are not currently measured against any index, it cannot be quantified accurately how many children will be denied orthodontic treatment on the NHS once the new regulations come into force.

However, with almost 20,000 people receiving orthodontic care in the past 12 months, the figures are likely to be high.

Analysis

Stark choices to be made as the health budget dwindles

The Health Service in Northern Ireland is in crisis. With shrinking budgets, an ageing population and ever increasing public demand of the health service, there has to come a point where it can no longer meet all expectations.

Health Minister Michael McGimpsey has issued this very stark warning on a number of occasions.

His department has been tasked with finding £700m of savings over the next three years and is waiting to find out whether it will have to cut a further £113m from its budget.

So, an overhaul to the way orthodontic treatment is delivered in Northern Ireland comes as no surprise.

Currently, any patient is entitled to have orthodontic treatment on the NHS if they require it, whether it is to correct the mildest crowding or more severe problems where the jaws are poorly aligned and may be causing health problems.

But under the new terms, the health service will only pay for providing orthodontic treatment to children where the severity of the case in question satisfies the new criteria.

The Department of Health, Social Services and Public Safety has said the service is to become driven by need — but ultimately it is a cost-cutting exercise.

So, are these changes a sign of things to come in the health service?

There is no doubt the health service is already coming under significant strain because of financial woes and the scope of NHS dentistry is certainly one area under threat.

Last month, the Belfast Telegraph revealed concerns of Northern Ireland dentists that the number of treatments available on the NHS could be slashed under the new contract which is due to be piloted later this year.

The move could see taxpayers being forced down the road of private treatment and facing massive bills for work which has traditionally been done on the NHS.

At the moment, everyone in Northern Ireland is entitled to NHS dental treatment, which includes a range of procedures from simple check-ups to more complicated treatment such as crown and bridge work but it is thought this work could be threatened under the new contract.

Mr McGimpsey has consistently called for his department to be made exempt from any further efficiency savings but his pleas have so far fallen on deaf ears. In the coming months he will have difficult choices about which services to protect and which to axe.