Frank O'Rourke (Kildare North, Fianna Fail)
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This Topical Issue matter is about the long, outstanding waiting lists for orthodontic treatment. It is regrettable that each time I face somebody from the Department of Health, it is on an issue of long, outstanding waiting lists or on difficulty with the service in general, which is a shame. We know that this subject was very well captured in the recent documentary on RTE, especially around the waiting lists. I spoke in the Chamber a few months ago about the waiting lists for adult spinal surgery being completely unacceptable, as are the associate problems for persons whose treatment is regarded as urgent. After 18 months they are still waiting for their procedure. The disappointing element is that a number of months on there is no change in that situation, despite the promises and commitment given in the House on that occasion a number of months ago. We must get real about bringing solutions to deliver where there are recognised problems.

I have a number of cases from my constituency of Kildare North and from speaking with my colleagues in other constituencies where the orthodontic waiting lists are going out of control. I have examples with me of cases of people who were seen back in 2013 and 2014. They were recognised at that stage as being very urgent. Here we are three years on, and in some cases four years on, and these people are still on a waiting list with no date for treatment or surgery for whatever work needs to be carried out regarding their orthodontic problems. That is completely unacceptable.

I know the Minister of State will probably agree with me, and the Department and Ministers do agree with me and my colleagues in the House when we say it is unacceptable. The Minister for Health said after the "RTE Investigates" documentary programme that he was "ashamed" and "heartbroken", and I am sure he does feel that, but those words are of little use or of any assistance to the people on these waiting lists. There are teenagers on the waiting lists, adolescents who may be in the middle of State mock exams and heading into their leaving certificate or junior certificate exams. They may be trying to plan to go away and work for the summer but their lives are on hold because they do not know if and when they are going to get this important and very necessary treatment that has been suggested after a diagnosis by professionals. That is wrong. It leads to all sorts of problems such as social issues, and in some cases bullying. In one case, one of my constituents is reluctant to go to school because of the difficulties and problems they face. It is completely unacceptable three and four years on from when they were first diagnosed in a consultation and treatment was prescribed that it has not been carried out.

I note that from the same documentary programme the HSE has acknowledged that it hopes to have waiting lists down to a maximum of 18 months by the end of June 2017. Given that this is just four and a half months away, how realistic is this hope? I have a number of cases with me right now that have not yet received a date for treatment. Is that an opportune response by the HSE or is it a real response to the waiting lists? Can I tell my constituents and their families that they are going to have an appointment and their treatment will be carried out before the end of June 2017? That is what it comes down to. We must see results and we have to get outcomes. We can no longer speak about the issues. We must see delivery and the public has to see an improvement and a better service. Four years is not acceptable to be on a waiting list for any treatment.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank the Leas-Cheann Comhairle. I also thank Deputy O'Rourke for raising this matter and for giving me an opportunity to update the House on the position on orthognathic surgery in St. James's Hospital as advised to me by the HSE.

Orthognathic surgery, or corrective jaw surgery, is performed by an oral and maxillofacial surgeon to correct a wide range of minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth. The HSE has advised that joint orthodontic surgical clinics were provided previously in St. Columcille’s Hospital, Loughlinstown and in St. James's oral and maxillofacial surgery unit each month. Due to the resignation of the consultant orthodontist at St. Columcille’s Hospital, Loughlinstown in 2014, however, it is regrettable that it has not been possible to continue the joint clinics between the two hospitals as before. The HSE has advised me that all patients under treatment in St. Columcille’s Hospital prior to 2014 have continued their surgical and orthodontic treatment in St. James’s Hospital. The HSE has also advised that, while consultant manpower, theatre and bed capacity issues have also arisen in the St. James's oral and maxillofacial surgery unit over this period, the hospital has maintained its levels of orthognathic surgery over the past 12 months.

The HSE has advised that it is working to progress the recruitment and appointment of a replacement consultant orthodontist at St. Columcille’s Hospital. The HSE has further advised that St. James’s Hospital has been working with the national clinical adviser to the HSE acute hospital division and with the HSE primary care division to agree a pathway of care to allow increased access to orthognathic surgery to meet demand. As part of these discussions, the recruitment of two oral and maxillofacial surgery consultant posts with a specific remit for orthognathic surgery has been identified as a priority. The HSE has advised that a decision on the first of these posts is expected in the near future.

St. James’s Hospital is part of the Dublin Midlands hospital group. Any proposals for St. James’s to develop the orthognathic surgery service further will need to be considered in the context of how the role of the hospital can best contribute as part of the Dublin Midlands hospital group and with regard to resources available.

On the waiting list for orthognathic surgery in St. James’s, as the Deputy is aware, reducing waiting times for the longest waiting patients is one of this Government's key priorities. Consequently, budget 2017 allocated €20 million to the National Treatment Purchase Fund, NTPF, rising to €55 million in 2018. Among other things, the HSE is developing a 2017 waiting list action plan for inpatient day case procedures to ensure no patient is waiting more than 15 months by the end of October, as the Deputy said. A similar plan is being developed for outpatient appointments. I expect that the details of both plans will be available in the coming weeks.

Frank O'Rourke (Kildare North, Fianna Fail)
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I thank the Minister of State. An area of concern in dealing with the waiting lists is the lack of resources and the infrastructure or supports not being in place. When we see that a consultant resigned and took up a post outside the country nearly three years ago and this position has not been filled, I believe we could all accept that this situation is not good enough. One must query the commitment to the process and the seriousness of dealing with these unacceptable waiting times and waiting lists. A waiting time of 18 months is borderline but three and four years is completely unacceptable for people to wait for much-needed prescribed treatment. These are not recommendations by me or others. These are made by consultants who are trained and qualified in this area. They recommend these treatments be carried out under the heading "urgent".

I am concerned that the Minister of State in her reply did not give definite timelines or commitments as to when these waiting lists will be reduced. When will the three or four cases that I have with me today be adequately and fully dealt with? It is very important for these families and for the people involved. We need to get real commitments. I am quite happy to give details of these cases to the Minister of State after this engagement, if she wishes, to try to have the cases prioritised, because the wait is not at all good enough. I accept there is the National Treatment Purchase Fund. Are we going to say that the fund should deal with these lists? Are the people in my constituency who have been waiting three or four years going to be dealt with in the next couple of months? That is what they need to hear. I hope the Minister of State can come back to me with real commitments and timelines to give these people some hope.

Before I conclude, if the Leas-Cheann Comhairle could indulge me for a moment, today has been a very poor day in my constituency of Kildare North. I know this topic is not related to my Topical Issue matter but there are around 500 job losses.

Pat Gallagher (Donegal, Fianna Fail)
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That is off subject Deputy.

Frank O'Rourke (Kildare North, Fianna Fail)
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It is important we acknowledge the staff and their families who have lost their jobs. We urge that the Government engage as quickly as possible to ensure-----

Pat Gallagher (Donegal, Fianna Fail)
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Deputy, please.

Frank O'Rourke (Kildare North, Fianna Fail)
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-----that they are retrained in order that they can be re-employed as quickly as possible.

Pat Gallagher (Donegal, Fianna Fail)
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The Deputy is taking advantage.

Frank O'Rourke (Kildare North, Fianna Fail)
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I thank the Minister for Jobs, Enterprise and Innovation, Deputy Mary Mitchell O'Connor, for agreeing to meet me and my Dáil colleagues in the constituency to discuss the issue.

Pat Gallagher (Donegal, Fianna Fail)
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The Deputy must allow the Minister of State to respond to the issue we are discussing.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I assure the Deputy there is no question but that the requirement to reduce waiting lists is a priority for the Government. As he outlined, patients waiting three to four years is unacceptable. There is no denying it. I look forward to the HSE's waiting list action plan and welcome its commitment that no patient will be waiting longer than 15 months by the end of October. That is what we expect it to deliver. I cannot comment on the individual patients to whom the Deputy referred. It would be helpful if he could provide me with details and I will ask the HSE what is causing the delay and what might be done to address it.