Pat Gallagher (Donegal, Fianna Fail)
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We have no choice but to suspend.

Regina Doherty (Meath East, Fine Gael)
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I can stay. If I am not able to provide an answer, I will revert to Deputy Burke. Will that be sufficient?

Peter Burke (Longford-Westmeath, Fine Gael)
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Yes.

Pat Gallagher (Donegal, Fianna Fail)
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The purpose of this debate is to make the Deputy's case to the Minister for Health. It is not the Deputy's fault. As we have been waiting for approximately four minutes, I recommend that we suspend for ten minutes. No one will lose out.

Regina Doherty (Meath East, Fine Gael)
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I am quite happy to take this Topical Issue debate instead of suspending, which would just waste everyone's time.

Pat Gallagher (Donegal, Fianna Fail)
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Is that agreed? Agreed.

Peter Burke (Longford-Westmeath, Fine Gael)
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I thank the Ceann Comhairle's office for selecting for debate the critical issue of the shortage of orthodontic consultants in the midlands. We are at crisis point as regards interventions for young children. I met a number of parents at one of my recent weekly clinics in my constituency office who had been affected by this situation. One was a lady whose son had been on the waiting list for in excess of 18 months. Cousins of his in another part of the country and who are much younger than him have already received treatment. Despite having waited longer than 18 months, there is still no timeframe for his treatment.

In another case, a young boy spent nine years on the waiting list. After seven years, he was referred to Carlow for private treatment under the national waiting list initiative that was rolled out at the time. His problem had advanced significantly during those seven years, which meant that he was referred back to the Midlands Regional Hospital at Mullingar, where he has spent a further two years on the waiting list. That is nine years in total. He will turn 22 in July.

These are young and vulnerable children and this issue is critical in terms of their self-confidence, body image and pressure from peers. Prevention is better than cure. After a prolonged period, problems like these grow much worse and require surgical intervention, which is more expensive for the State and comes at a significant cost to the well-being of the young people in question.

Currently, there are 2.5 whole-time equivalent consultants in the midlands covering Tullamore, Portlaoise, Athlone, Longford and Mullingar. An advertisement was placed to recruit another orthodontist. Why did that not succeed? It is unacceptable that young and vulnerable people have spent as much as nine years on a waiting list for the treatment they need. The Department and we as a State and a people cannot stand over cases being allowed to worsen to the point of requiring surgical intervention. I would like answers for those involved.

Our resources are improving, but we need to show that on the ground. For how long has the position been vacant? What are the details of the recruitment campaigns that were run? Where were they advertised and why did they not work? What remuneration was offered and was it competitive with other jurisdictions? If services are stressed right now with 2.5 whole-time equivalents, what were the new contract's terms of employment? How many children in the midlands are on the waiting list for orthodontic services? We need to know that. As far as I can ascertain from working on the ground with my constituents, the number is significant. What efforts have been made since the HSE's last recruitment campaign?

The examples I have provided are snapshots of two vulnerable children, neither of whom has yet received a date for surgery. They are still waiting in the unknown. One will turn 22 years of age in July and requires surgical treatment now. Under the waiting list initiative, he has been passed from the private sector back into the public sector and has still not received answers.

Regina Doherty (Meath East, Fine Gael)
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I thank the Deputy for raising this issue. From personal experience with my own little lady at home, I can speak about the length of and variations in the waiting lists.

In line with the commitment in A Programme for a Partnership Government to provide more timely access to orthodontic care, the HSE has undertaken a procurement of orthodontic services with a number of private service providers. Since commencing in 2016, this has enabled treatment for an additional 1,180 of the longest waiting patients. Approximately 400 of them were from the midlands.

Another measure being introduced to achieve this aim involves upskilling staff - dental hygienists or dental nurses - to become orthodontic therapists. Orthodontic therapists carry out a certain range of orthodontic treatments under the prescription and direct supervision of a specialist or consultant orthodontist. This facilitates a greater throughput of patients. Four orthodontic therapists are now in place. For each therapist, approximately 150 extra patients are removed from waiting lists annually.

Under Directive 201/24/EU, now commonly referred to as the cross-border directive, which I believe the Deputy alluded to, it is open to persons entitled to public patient health care in Ireland to choose to avail of that health care in another EU or EEA country or Switzerland. Assistance is provided by the cross-border health care directive department of the HSE. Access to treatment under the directive is based on the referral of the treating clinician.

The issue raised by the Deputy is an operational matter for the HSE. The orthodontic service for Longford and Westmeath is part of the midlands orthodontic service. The HSE advises that there is a centralised waiting list in the four counties of Laois, Offaly, Longford and Westmeath. This is to ensure equity of access within those counties and prioritisation of greatest clinical need. Currently, 1,896 service users are on that waiting list.

I am informed by the HSE that there have been three recruitment campaigns to fill the vacant post of consultant orthodontist in the area but that, unfortunately, they have not been successful. There are 2.6 whole-time equivalent specialist orthodontists, supported by dental nurses and clerical staff, covering clinics in Tullamore, Portlaoise, Athlone and Longford. The HSE is actively seeking ways to increase the number of children being seen and to reduce the waiting times for orthodontics. The post will be re-advertised and the HSE will continue to seek local cover.

The HSE will continue to seek to fill the vacant post to provide orthodontic services in a more timely manner than is being done at the moment. Other means will also be used to tackle the waiting lists. The Department of Health is at an advanced stage of developing a new national oral health policy. Future provision of oral health services, including orthodontics, will be informed by the new policy, which is being led by the Chief Dental Officer.

The aim is to develop a model of care that will enable preventative approaches to be prioritised, improve access, which is what we are here to talk about today, and support interventions appropriate to the current needs.

Peter Burke (Longford-Westmeath, Fine Gael)
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I thank the Minister for her response. She spoke about equality of access but it is very hard for me to go back and explain that to the parents of a nine year old who has been waiting over 18 months or to the 21 year old who has been waiting nine years. It does not ring true. The cross-border initiative is used by a lot of people in the State. Unfortunately, it does not suit everyone because payment has to be made upfront. There are people whose economic circumstances mean they cannot afford to do it so it is beyond their control. We have to be very clear on this. If the State is offering orthodontic treatment to people who are in vulnerable positions and we are spending a huge amount of money, at record levels, in the health service, we need to say we can treat them within a reasonable timeframe. We have taken 180 of the longest waiting patients off the list but if a 22 year old has been waiting nine years, I shudder to think how long some of the 180 people have been waiting. Where is the equality of access which should be its cornerstone? I cannot emphasise it enough. We get frustrated as public representatives when we see vulnerable people and children like this in our clinics who need this treatment. It frustrates politicians when a small bit of early intervention can save them invasive surgery years down the line. The HSE is getting money and the Government should recognise that having three recruitment campaigns represents a failure in the HSE. It has had three recruitment campaigns but has not secured a consultant when there are lots of them in the private sector. We cannot access them under the NPF because the conditions do not allow for it. We really need to get on top of it before it gets out of control.

Regina Doherty (Meath East, Fine Gael)
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I appreciate everything the Deputy has said. The only thing I will say again in the HSE's defence is that it is actively trying. It is not as if we do not acknowledge there are waiting times we are not happy with. That is why there are specific objectives in the Programme for a Partnership Government to address those. The national dental care policy is being devised. We have been waiting for a while but it is definitely coming this year. If the recruitment programme was successful we might be having a different conversation with regard to the waiting times in the four counties I have described today. Every objective is being looked at to make sure we improve it in a timely manner. It is not only politicians who are frustrated. The mammies of the young girls and young fellows who have an over-bite that needs to be corrected are also frustrated. I am not even talking about the level of surgery the Deputy talked about the 22 year old young man needing. They are formative years. They are the years in which they get goofy and get slagged in school. Our main objective, apart from giving the best health care we can, is to do it in a timely manner. Those objectives are being looked at to try to achieve the programme for Government initiatives this year.