Thursday, 15 July 2021
Saincheisteanna Tráthúla - Topical Issue Debate
Our third matter is in the name of Deputy Verona Murphy, who wishes to discuss the three-year wait time for disability dental services in County Wexford alongside many difficulties family carers experience in securing essential medical appointments.
I will read into the record two representations made to me.
You will be aware from previous correspondence that I am a full time family carer to my sons Evan (21), who is non verbal and has diagnosis [of] ASD, ID, ADHD, Keracatonus and complex medical needs, and Daniel (17), who has a diagnosis of ASD.
Like so many family carers across Wexford and the entire country, Covid and the necessary restrictions imposed during lockdowns were...[a] challenging time for families like mine. The challenge was no greater than when adult disability day services and special [needs] schools closed and the small amount of home support we had came to a sudden halt and our doors were closed behind us leaving us caring alone often with loved ones who did not have the capacity to understand Covid and suffered greatly from the absence of their much needed routines. Family Carers played a vital role in protecting our most vulnerable citizens and in suppressing the virus by caring for our loved ones in their own homes while keeping them safe and well at enormous personal sacrifice as there was no end to our shifts, there were no days off and for many of us there was rarely a night's sleep....
I am writing to you to bring to your attention the many difficulties I am currently experiencing in securing essential medical appointments for my son Evan. Evan has multiple profound disability and the pandemic and particularly the changes it brought to his life had a profound impact on him in terms of consistent disruptive sleep, serious hypertension and an increased obsession with food. In consultation with Psychiatry, Primary Care, HSE Disability Services and Wexford General Hospital, Evan was referred for urgent review to a Dublin Hospital for assessment of a possible additional diagnosis. His symptoms are persistent and I am therefore anxious for him to be assessed as a matter of urgency as [that] is also the medical advice. Following the Cyber attack experienced by the HSE, I was unable to make any contact with the hospital department to which Evan was referred. Having left multiple voice messages detailing my concern, my calls were not returned...
Evan also has a degenerative eye condition which has seriously impaired his vision and in the absence of care could result with further loss of vision. The medical advice is that Evan's vision is to be reviewed every six months to monitor any changes to his condition and as Evan is non verbal he is unable to tell us if he experiences further sight loss making it imperative that he is reviewed on a six monthly basis... Evan received his vaccine. As soon as he was vaccinated I requested an appointment for him. The appointment was offered for the week in which the cyber attack took place and I then received a phone call to say that it had been cancelled... I have attempted to contact the Dept... the voicemail box was full and no longer recording messages. There is no available email address in which to contact the office so I called the hospital switch where I was put through to an alternative extension and advised that the Secretary responsible for Evan's appointments was on leave and there was no information with regard to when she might return and no solutions offered as to how I might resolve the issue in the interim [to] provide Evan with the care he needs. ... it is not acceptable in my view to compromise the health and well being of our most vulnerable citizens by making it next to impossible to communicate with hospital outpatient departments...
I will move on to my next representation:
Peter is non verbal and has a number of complex medical issues. He attends St. Vincents Hospital for regular check ups. Peter presented at the Primary Health Care Centre in Grogans Road Wexford as an emergency with...[his mother] last week as he was experiencing difficulty with an abscess on his gums. It was determined by the dentist on the day that Peter was in need of an extraction and further treatment but his mother was informed they would have a 3 year wait...
Peter had previously visited the dental clinic in Grogans Road a number of years ago...[with] his mother [and he] was told he would be in receipt of a follow up treatment appointment. This appointment never came. To the best of my memory this visit was perhaps 3 or 4 years ago but she could not recall the exact date.
The issue is as the Ceann Comhairle put it to the Minister.
I thank Deputy Murphy for her Topical Issue matter. The Minister of State, Deputy Rabbitte, has asked me to take it as she could not be here herself and I am glad to do so. The matter Deputy Murphy has submitted refers in particular to addressing the three-year wait time for disability dental services across County Wexford. She has raised specific cases in her contribution. I will relay those directly to the Minister of State, Deputy Rabbitte, as well as the experience Deputy Murphy has had.
I will update the Deputy on the overall question of wait times for dental services and other difficulties that family carers are experiencing in securing essential medical appointments for people with a disability in County Wexford. Dental services for children up to 16 years of age and persons of all ages with special needs, including patients with a disability, are provided by the public dental service of the HSE through its dental clinics. Emergency care is also available daily. Previous surveys and research in Ireland have shown that dental care for many people with a disability can be provided in primary care and community settings by a dental workforce with the relevant skills and competencies. There are waiting lists for those for whom provision of care requires the use of either sedation or dental general anaesthesia. This treatment requires special facilities and staff with specific expertise. Furthermore, treatment under general anaesthesia requires hospitalisation. Treatment in hospital requires a referral from a primary care dentist and the HSE dental service and acute hospitals collaborate in this regard.
In line with other services, dental treatment, including treatment under general anaesthetic, has been curtailed during the pandemic and when provided has been at a reduced capacity. There is some capacity for dental surgery at Wexford General Hospital on Friday mornings. This is used mostly for paediatric dental extractions but, when possible, can be utilised for disability services clients. The HSE anticipates that the filling of vacancies - one full-time in special needs and one part-time in the public dental services in Wexford - and the gradual resumption of services phased down during Covid-19 will help to reduce waiting lists during 2021. The Minister of State, Deputy Rabbitte, has been informed by the HSE that most community health services such as disability services are operating as normal. The HSE's advice for families is to attend any appointments scheduled with disability services.
The Minister of State stresses the importance of mainstreaming. People with disabilities, like all of us, just want to live normal lives, in normal places, as much as possible. There is an obligation on all of us to ensure that the needs of people with disabilities are understood and vindicated in every policy. People with disabilities should have the same access to healthcare as everybody else in society. Their needs should be factored in as we design and deliver our health services to provide the best outcomes for all the people of this country.
Smile agus Sláinte, the national oral health policy published in 2019, provides a new framework for the delivery of oral health services. The ethos of the policy is to maximise the services available in primary oral healthcare settings, with care provided by local family dentists and their teams. This means that children, adults and vulnerable people, including people with a disability, will be able to access oral healthcare in the local dental practice of the individual's choosing. To support the mainstreaming ethos, additional support, technology and time required to treat more vulnerable patients will be provided by the salaried service of the HSE. The HSE will also have a role in assessing the oral health status and needs of vulnerable people, particularly those in residential care.
I mean no disrespect to the Minister, whom I thank for coming to the Chamber to respond to the matter I have raised, but we all have to work towards something that is better. Nothing he said fills me with hope and it most certainly will not fill with hope those I am representing. It is unacceptable for someone with complex medical needs, who is non-verbal and has been taken in on an emergency appointment basis, to be told the waiting time is three years.
Nothing is improving in this regard. I appreciate everything the Minister had to say but it has been said for a long time and nothing is improving. The people I am representing with this matter are only two, but I know of about 42 others I could mention for the record. I am becoming very disillusioned because we are leaving vulnerable adults and vulnerable young children, with complicated medical needs, at the end of the queue just because they are in the minority and marginalised.
I appreciate that the Minister of State is doing her best - I know she is because we communicate regularly - but we have to start to walk the walk and not just talk the talk. If I were to take a non-verbal child into an emergency appointment such as this and walk out with the only answer being that we should wait for a further three years, I do not know how I would mentally cope with that. I do not know how the carers and parents cope with that, seeing their child in pain, unable to express it, and just seeming to get the same answers all the time. That is primarily why I raised this matter. I am not trying to harangue any Minister or to blame anybody, but something is wrong and the system is not working. We all need to work hard together to change this. All I have seen in the 17 months I have been a Deputy are longer and longer waiting lists. No matter what we do, it is not getting any better.
I will relay to the Minister of State, who is working to address this and make genuine progress, the Deputy's representations and the points she has made. Nationally, the public dental health service staff of the HSE comprise 260 dentists, 60 dental hygienists and 510 dental nurses and dental surgery assistants. Over the course of the pandemic, the number of available staff has reduced by 23% on an annualised basis due to staff redeployment for Covid-19-related work such as testing and tracing and vaccination, and that has had an impact.
As for Wexford, there are currently vacant posts in dental services. As I mentioned, the one whole-time equivalent special needs surgeon post was sent to the national recruitment service in February and it has advertised the post to be filled. The same is true of the part-time dental surgeon post, for which a recruitment campaign commenced last month. It is anticipated that when those posts have been filled, it will have an impact on addressing the waiting lists there for dental services. In Wexford, 150 persons, that is, 65 adults and 85 children, with special needs require dental treatment under general anaesthesia. Waiting times, as the Deputy pointed out, can range from six to 36 months, with a small number in excess of 36 months, which is obviously much too long and not acceptable.
The issue is recognised. The two posts are being pursued with a view to having them filled. Undoubtedly, it has to be a priority because, as the Deputy outlined, it is not acceptable for all the families and children. I will convey the Deputy's points to the Minister of State for a further follow-up.