Thursday, 1 April 2021
Saincheisteanna Tráthúla - Topical Issue Debate
I thank the Ceann Comhairle for allowing me the opportunity to raise this issue with the Minister. Dentistry and orthodontics, obviously, play important roles in keeping people healthy. People who have problems with their teeth and gums can find they leads to other, associated physical problems but they can also lead to psychological and esteem issues, particularly for young people. From the point of view of physical health, we know the importance of looking after our teeth. We must also remember the cosmetic reasons why people want to have a good-looking smile. It helps with self-esteem. It helps people to feel more confident in themselves and, naturally, that means they are happier.
My Topic Issue matter refers to the orthodontic care system. The HSE states that:
A patient may be referred by a primary care clinician for initial orthodontic assessment. In general, this referral takes place around the ages of 11-13 years of age ... but can be provided anytime up to 16 years of age.
Based on that, it would be safe to assume that between the ages of 11 and 13 and up to the age of 16 are the best times for these assessments and interventions to begin. No such assumption should be made. I will give some examples of the correspondence I am receiving on the topic. I will be referring to the parents of a constituent of mine whose details I have also emailed to the Minister's office. A parent told me about receiving the very good news that their 15-year-old daughter qualifies for free dental braces as her teeth are deemed bad enough to qualify for free dental assistance. She has already waited three extra years from her sixth class appointment with an orthodontist; such a consultation usually takes place when a child is aged 12. The parent went on to say that one could imagine how horrified they were to be told that it will be an extra six years before they hear about her next appointment in County Wexford. The girl in question is now 15 and will have to wait until she is 21 years old to have braces fitted. She is distraught, as are her parents.
A letter from another parent stated that their child was assessed by a HSE orthodontist in Enniscorthy on 8 June 2018. The parent was informed that the child would definitely qualify for dental treatment through the HSE as he is an extreme case but there is a four-year waiting list. The parent was extremely shocked by this but reassured by the orthodontist as she explained that this would be the optimal time for the child. The parent rang the orthodontist's department during the first lockdown but the phone was not answered and no one responded to the parent's voicemail. The parent finally managed to get through last week and was horrified, upset and frustrated to be told by the secretary that the child, Robbie, will have to wait for another three years. That waiting list has now gone from four years to six years.
This is the reality for many parents and patients. I wrote to the Minister of State's Department a couple of weeks ago. I received a response to the effect that the waiting list is now approximately 72 months' duration. Due to the Covid-19 pandemic and the additional measures in place, the orthodontic department has reduced capacity and has been unable to take any new patients off the treatment waiting list since March 2020.
With all of that information in mind, and given how important the scheme is, will the Minister of State outline when the system will resume taking new patients from the treatment waiting list which has now been suspended since March 2020? What steps are being taken to reduce and speed up waiting list times? A six-year waiting list clearly means that there are major problems in the system and something has to be done urgently. These issues also come on the back of Wexford General Hospital having an increase of 69%, accumulating now to almost 5,300 patients on a waiting list. We have had no psychologist or dietician in the children and adolescent mental health service, CAMHS, for nearly three years. There is now also no podiatrist at Wexford General Hospital.
I thank the Deputy for the opportunity to address the issue of waiting lists for orthodontic services on behalf of the Minister, Deputy Stephen Donnelly. The HSE provides orthodontic treatment to those who have the greatest level of need and have been assessed and referred for treatment before their 16th birthday. An orthodontic assessment determines if the referral meets the criteria for the service and, if so, what priority the patient is given. Those with the greatest clinical need are prioritised.
Orthodontic services are generally provided by orthodontic consultants and specialist orthodontists who are based in the HSE orthodontic clinics throughout the country and, in addition, orthodontic therapists assist in providing services in some areas.
The Minister and I accept that there are significant delays in accessing some services provided by the HSE, caused in part by the necessary concentration of resources on managing the current Covid-19 pandemic. I also acknowledge that prior to the pandemic, there were already ongoing difficulties which led to lengthy waiting periods in accessing orthodontic services. Waiting lists vary regionally and according to the complexity of the condition. There are generally longer waiting lists for the least complex care. At the end of 2019, more than 10,000 children were awaiting assessment, while 19,000 were awaiting treatment. However, a further 17,000 children were in active treatment. I do not have total waiting figures for 2020 because the staff involved have been redeployed. However, I am aware that the service has experienced 12 months of continual disruption because of the pandemic. The Minister is informed by the HSE that during 2020, more than 9,200 orthodontic patients were seen for assessment and 1,466 patients commenced active treatment.
Elective orthodontic services have gradually resumed. Social distancing and other organisational measures, as well as infection prevention and control guidance, mean that the usual throughput of patients is currently reduced but this is expected to improve over time. Difficulties in recruiting consultant and specialist orthodontists in some parts of the country have added to this problem. The HSE is putting in place a number of measures to address waiting times. The filling of permanent vacancies is being prioritised, with recruitment to fill two consultant posts ongoing. A treatment waiting list initiative between 2016 and 2020 resulted in 1,996 patients being placed in treatment with service providers at a total cost of €5.8 million. A new initiative to outsource treatment for patients with less complex orthodontic needs who have been waiting for more than four years is now at invitation to tender stage. This will provide treatment for approximately 300 patients annually at a cost of €1 million. It is anticipated that the first group of patients will be allocated to service providers in the second half of 2021.
The HSE is also developing a standardised approach to assessment with consultant and specialist orthodontists and annual training for referring dentists. The purpose of this is to ensure that all referrals will receive an orthodontic assessment within six months and that the number of inappropriate referrals will be reduced. Access to orthodontic treatment in another EU jurisdiction is available under the EU cross-border healthcare directive for patients who are already on an orthodontic treatment waiting list. Many patients in Border areas accessed care in Northern Ireland through this route pre-Brexit. A total of 342 patients accessed cross-Border care in 2020. This is being continued through the Northern Ireland planned healthcare scheme.
I reiterate that the Minister, Deputy Stephen Donnelly, and I fully acknowledge that the waiting lists for essential orthodontic treatment are unacceptable and we want to see real improvement this year with the significant funding that the Government has made available for enhanced community care.
I am very disappointed that somebody at the Minister of State's level would come into this House and restate what we can read on a website. These parents want to know when their children will receive treatment. As the Minister of State knows perfectly well, waiting lists have not fallen in years, so I do not know where the expectation comes from that they will definitely come down. I have information that was revealed in 2019 in a parliamentary question tabled by the current Minister for Health, Deputy Donnelly, to the then Minister for Health. At that stage, the number on the waiting list in County Wexford stood at 10,586. I cannot imagine the size of the waiting list at this stage because ,like the Minister of State, Deputy Feighan, I am unable to get the current figures. With due respect to the people of Wexford, waiting lists in every area of health in the county are growing.
I am sick of telling people there is a cross-Border initiative. We are talking about children. Orthodontics is a very specialised area and nobody wants to have to travel for four or five hours to get treatment. The process is not the same in that one must pay for the treatment and then apply for a rebate. The system is not simple and it does not work. It certainly does not serve to reduce the waiting lists. I am very disappointed that in spite of the notification of the question, the Minister of State has literally read out in the Dáil the first three paragraphs of a 21-page reply provided by the HSE in 2019. People require an answer and he has not provided one. They need the waiting lists to come down. The necessary orthodontic services should be in place. The pain and anguish orthodontic problems are causing children have increased their anxiety levels and this is causing gross mental health issues. I urge the Minister of State to address the issue in a fair-minded manner. It is not just that we do not have an orthodontist. We do not have our fair share and we have the highest waiting list in the country.
I am aware of the difficulties experienced by young people, especially in Wexford, as Deputy Murphy articulated, who have been waiting a long time for orthodontic treatment. As I outlined to the House, the Department and the HSE will undertake a number of initiatives to address waiting lists for orthodontic care.
Work is ongoing with Sláintecare, in conjunction with the HSE and the National Treatment Purchase Fund, and community waiting lists will be included in the plan. The Government is committed in the coming years to the transformation of oral healthcare services in accordance with the guiding principles set out in Smile agus Sláinte, the national oral health policy, which was published in 2019. With regard to orthodontic services, this policy supports the delivery of some orthodontic procedures in primary care dental practices, supported by clinical care pathways.
I acknowledge that there are issues and I thank the Deputy for raising them. I will convey the points she has made to the Minister and ask if he can provide her with further figures. The groundwork is being laid for the transformation of oral health services. The Deputy knows that from her involvement with Sláintecare. We will try to work within the Sláintecare agenda to deliver for the needs of people and make the provision of local services paramount.
I accept that issues arise in terms of people having to pay upfront for services provided through the cross-Border initiative. I will speak to the Minister and see if there is any way we can resolve the issue.