Dr. Anne O'Neill:

I will. The easiest way to consider this matter is by mapping the patient journey. While I can appreciate the numbers of practitioners within the dental treatment services, DTS, scheme is one of the trends to consider, a second trend is the amount of resources that are available in the geographical areas. While someone may have a contract, we have staff who have not yet been able to resume services because of Covid and there are additional difficulties with pregnant women past certain ages participating in care. People are also more mindful of their own general health in light of the impact of Covid, but the problems with the DTS scheme do not have their origins in Covid. Covid could be called the nail in the coffin, though.

Consider the journey a patient now takes. We will talk about the child, given the need for general anaesthetic care was referenced. Unfortunately, general anaesthetic care requires hospital facilities, meaning the dental patient is automatically in competition for access to the same resources that provide treatment to scoliosis and cardiac care patients. The dental patients are coming from the underfunded child service and hit the DTS service at the age of 16. They are not able to access the number of fillings that will allow them to reach what a dentist would consider a state of health. While the preference would of course be not to need fillings, if patients cannot access the number of fillings they require to bring them to a stable oral health status, they will end up losing those teeth earlier than is desirable. One of the differences between our current policy and the previous policy, which was the dental health action plan, was that the latter set health targets for people whereas the new policy talks about access to care. Access is an issue, but without having both in the same concept, it will be difficult to ensure there is sufficient resourcing for patients to be able to get the level of care they need.

The appointment numbers during the pandemic the Deputy mentioned fit into our general understanding of the resource difficulties the entire system is facing.

There is no doubt about it; orthodontic waiting lists have historically always been long, and because the treatment plans are long, orthodontists tend to take batches of patients from the waiting list from time to time. It is a two-year treatment plan. More patients are interested in having orthodontic treatment than ever before so they are more interested in being put on a waiting list and will wait for their treatment time because it is an expensive treatment. The orthodontic waiting list is not limited to those with or without resources. It is made up of children of clinical need and it covers all of our child population. The difficulty Covid has put on us is on top of an already under-resourced system. We are at crisis point with the entire range but our issue with the DTSS in particular is that the activity required to start mediating the problems that exist rests with the Department.