Seán Kenny (Dublin North East, Labour)
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I thank the Minister for Health for coming into the Chamber to respond to this Topical Issue matter. The parents of children in my constituency who are on orthodontic waiting lists for treatment at the dental clinic at Ashtown Gate, Navan Road, have been notified recently that they can transfer to the waiting list at the orthodontic unit in Louth County Hospital in Dundalk. This would involve not only considerable travel costs, particularly as orthodontic treatment can involve several return visits to the dental clinic, but also consume considerable time for children and their parents. I will read a letter which one of my constituents received last week from the orthodontic service at Ashtown Gate, because it takes an interesting tone. The letter reads:

Dear Parent or Guardian,

We are now in a position to offer [Jack] an orthodontic treatment place in the Orthodontic Unit, Community Care Building, Louth County Hospital, Dundalk, County Louth if you are willing to travel to Dundalk for the duration of the treatment.

Please note that [Jack's] complete orthodontic treatment will take place in Dundalk and patients who commence their orthodontic treatment will not be able, under any circumstances, to transfer back to the orthodontic unit at Ashtown Gate. If you accept this treatment place [Jack's] record will be forwarded to the Orthodontic Unit in Louth County Hospital and the orthodontic staff in Dundalk will be in contact with an appointment by post within the next four to six weeks.

Please confirm if you wish to avail of this treatment place in Dundalk or remain on the waiting list in Ashtown Gate by completing the section below and returning it to the above address. I cannot give you the waiting time for orthodontic treatment in Ashtown Gate.

Please respond immediately on receipt of this later and no later than two weeks from the date at the top of this letter to indicate your preference for treatment.

Please note a complete orthodontic treatment typically equates to approximately 30 to 40 visits to the Orthodontic Unit in Dundalk over a period of two to four years. It is imperative that you attend all of these appointments punctually. Failure to do so may result in you being removed permanently from the orthodontic list.

As Jack's parents found this notification disturbing, I wrote to the director general of the HSE asking him to review the orthodontic clinic location for children in Dublin city north of the Liffey to find a more convenient location for a dental clinic. Today, I received a reply from Mr. O'Brien's office to tell me that my correspondence had been referred to the HSE's parliamentary affairs division. This response is not good enough, which is why I have sought to raise the matter in the House as a Topical Issue matter. I ask the Minister to intervene with the HSE as a matter of urgency to find a more accessible orthodontic health treatment clinic for the Dublin region north of the Liffey.

Leo Varadkar (Dublin West, Fine Gael)
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I wish to thank the Deputy for the opportunity to address the issue of orthodontic services. I am taking the debate on behalf of the Minister of State in my Department, Deputy Kathleen Lynch, who is attending to business elsewhere.

Orthodontic treatment is provided by the HSE to patients based on their level of clinical need. The HSE provides orthodontic treatment to those who have been assessed and referred for treatment before their 16th birthday. Patients are assessed by the HSE orthodontic service under the modified index of treatment need. Patients with the greatest level of need are provided with treatment first. The HSE endeavours to provide patients with services close to where they live. Occasionally, when there is capacity to provide this treatment sooner in another centre this option is offered to patients. In this way, patients on a waiting list who live in Dublin may be offered treatment in Louth County Hospital. Should they choose not to avail of this option, treatment will still be provided in Dublin. Most patients - approximately 75% - who are given this option choose to accept it. At the end of the second quarter of 2014, a total of 23,982 patients were in treatment, 6,658 were awaiting assessment and 16,518 were awaiting treatment. While patients with greatest need are given priority, long waiting times for orthodontic assessment and treatment are a matter of concern for my Department and the HSE.

The HSE commissioned an independent review of orthodontic services in 2012. The key issue highlighted by the review, which assessed services nationally, is that the orthodontic service should be fully integrated within the primary care service. This recommendation will be implemented as part of the HSE's wider reform programme. The HSE has also recently established a pilot scheme which will involve the use of orthodontic therapists. The HSE Dublin north east, or DNE, orthodontic service has been chosen as the pilot area for this new and innovative training programme. One member of the dental hygienist staff and one member of the dental nursing staff commenced this training in September 2014. During the course of their training, the students will work under the direct supervision of specialist orthodontists currently working in HSE units in the Dublin north east region in the treatment of a select number of children eligible for HSE funded orthodontic treatment. In addition, orthodontic treatment for certain categories of misalignment will be provided over the next three years by a panel of independent practitioners under contract to the HSE. A tender process is underway and provision is due to commence in 2015. It is expected that these changes will have a positive impact on waiting times and on the services available to patients.

I have a copy of the standard letter sent out to patients which Deputy Kenny's constituent would have received. The only thing that is wrong with its tone is that it does not give an indication as to where a person is on the waiting list for Ashtown Gate. If it did, parents could make an informed choice as to whether to wait it out at Ashtown or go to Dundalk. I am very familiar with Ashtown Gate as the service which serves my own constituents and is located in my own constituency. It is not practical or appropriate for me to start deciding where clinics should be located for reasons the Deputy will appreciate.

The reason the policy is pursued is a good one. In the HSE Dublin mid-Leinster area, there is only one person who has been waiting more than seven months for assessment yet there are 556 children in the Dublin north east area waiting between six and 12 months for assessment. If it is not possible or we do not have the resources to bring waiting lists down everywhere, does it not make sense and is it not fairer to allow people who live in an area where there is a very long waiting list to choose to transfer to an area where there is a low or no waiting list? That is why this is being done. It is an attempt to provide some equity across the regions so that people do not face excessive delays just because they happen to live in the wrong place.

Seán Kenny (Dublin North East, Labour)
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I thank the Minister for his response. The letter from the HSE does not tell the parents of Jack where he stands in regard to the Ashtown Gate waiting list and therefore, as the Minister says, they cannot make an informed decision. If they thought they could get treatment sooner by going to Dundalk perhaps that would change things. However, the problem is that Jack's father is in full-time employment while his mother is a person with Crohn's disease. It would be difficult for her to travel with her son to Dundalk for what we are told may be treatment requiring 30 to 40 visits. It is quite expensive to purchase a return train fare from Kilbarrack to Dundalk for a child and an adult and it would amount to a significant sum for 30 to 40 trips. There is also the question of the health of Jack's mother.

The policy of the HSE is not focused on the needs of the particular client and his or her family. As the Minister pointed out, there is no information in the letter as to whether they would be better off remaining on the Ashtown list. The implication of the letter is clearly that they will be seen more quickly if they go to Dundalk but it does not say that directly. In the absence of definite information, the family is in a quandary. To have to go to Dundalk for 30 or 40 visits would pose difficulties for the family. I am disappointed with the director general of the HSE who did not take up the points I made and simply referred the matter to someone else. I would appreciate it if someone could persuade the HSE to give more information to children like Jack as to whether they would be better off staying on the Ashtown Gate list or seen more quickly by going to Dundalk.

Leo Varadkar (Dublin West, Fine Gael)
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The figures I gave the Deputy earlier related to the time it takes to get assessed. In fact, HSE Dublin north east is better than Dublin mid-Leinster. One is assessed more quickly in the former but gets to the treatment stage more slowly. Of the 4,000 cases in HSE mid-Leinster, only 87 have been waiting more than two years whereas 748 of the 3,786 cases in HSE Dublin north east have been waiting for more than two years. However the Deputy's point is well made. It is right to give people the option to travel a certain distance to get better treatment but we should allow parents to make an informed choice as to how long they may have two weight if they do not accept the offer of going to another location. It is certainly something I will take up with the dental section of the HSE. That is a fair point.

I note, however, that no matter where one draws the boundaries, there will always be some issues. As politicians who deal with constituency boundaries, we know that well. There will be people who live in parts of Meath who are just as close to Dundalk as they are to Ashtown Gate. The offer to go to Dundalk may even be more convenient for them. That is just the nature of boundaries and catchment areas.

Joanna Tuffy (Dublin Mid West, Labour)
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As the fourth Topical Issue matter has also been deferred, the Dáil will adjourn.