Dáil debates

Tuesday, 28 June 2022

Saincheisteanna Tráthúla - Topical Issue Debate

Dental Services

11:30 pm

Photo of Martin BrowneMartin Browne (Tipperary, Sinn Fein)
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I previously raised the case of a 13-year-old boy who was referred to an orthodontics department on 8 August 2019 and not offered an assessment until 3 March 2022. His family was also informed that if he needed treatment, he would have to wait five years for it. When I inquired about this, the HSE also confirmed that the consultant orthodontist for south-east community healthcare carries out all assessments in Clonmel clinic and that the consultant is available one day every fortnight. Leaving aside the fact that a child can be expected to be on a waiting list for five years, the fact that it took more than two and a half years for him to be assessed by a consultant who is available in Clonmel for one day every two weeks is a complete failure. I understand that Covid had an impact but that is no excuse for how long children have to wait, either for assessments or the procedures they need.

I was recently contacted by the parents of another 13-year-old in Tipperary. This girl was assessed by the consultant orthodontist on 23 December 2021 and was added to the waiting list for treatment. The family was told that she can expect to wait approximately 48 months before being offered an appointment. The family was then told that if their daughter was found to require surgery to correct jaw-size discrepancy and so on, she can expect to wait another 36 months for an initial assessment with a consultant oral and maxillofacial surgeon. This means that the girl could have to wait until she is 20 years of age. This young lady's father was told by the orthodontist that while she would have liked to deal with this immediately, her hands were tied because of understaffing and underfunding, and hence the length of the waiting list.

The orthodontist said that she would like to see the girl given a block brace. Doing this could avoid any need for surgery in the future. It will only be effective if the brace is administered in the very near future, while the girl is still young. If she has to wait until she is in her late teens or even in her early 20s, as she has been told, then surgery is more likely.

It is a problem because it would be more invasive and it would ultimately cost the HSE and the State even more.

There is another complication facing the family. If they went a private route now and got the brace that way, they are concerned that if their daughter needed some form of surgery in future, they would have to continue to rely on the private system. They cannot get the services they need in the required timeframe and if they go private, it would make things very tight for them, although it would address their daughter's needs. They would be disqualified from follow-up treatment, however. They are precluded from being able to avail of the treatment their daughter deserves from the State. They are in a lose-lose position.

This family has an immediate need. Is the Department going to fail this young lady or can something be done to ensure she gets the treatment she needs when she needs it?

11:40 pm

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Deputy for giving me the opportunity, on behalf of the Minister for Health, Deputy Stephen Donnelly, to address the question of waiting lists for orthodontic services. He mentioned the case of a young lady awaiting treatment and if he sends me the details, I will pass them to the Minister as well.

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 greatest clinical need are prioritised. Orthodontic services are generally provided by orthodontic consultants and specialist orthodontists, who are based in HSE orthodontic clinics throughout the country. In addition, orthodontic therapists assist in providing services in some areas.

The Minister accepts there are significant delays in accessing some services provided by the HSE, caused in part by the necessary concentration of resources at managing the Covid-19 pandemic, the cyberattack and challenges in recruitment of staff in some areas of the country. 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 the first quarter of 2022, over 10,000 people were awaiting treatment. However, a further 12,000 children were in active treatment. The HSE has put in place a number of measures to address waiting times and these include the prioritisation of the filling of permanent vacancies. The HSE is prioritising the filling of these permanent vacancies and a consultant orthodontist has recently been recruited for community healthcare organisation, CHO, 6, in Loughlinstown, County Dublin. Competitions are ongoing to recruit additional consultant orthodontists in CHO 5 in the south east and in CHO 4 in Kerry.

In the third quarter of 2021, the HSE extended the orthodontic procurement programme that allows patients to have treatment with private specialist orthodontists. Under the updated framework, children and young people assessed as grade 4, whose care can be appropriately dealt with in a community practice setting and who have been waiting over four years, are offered treatment. To date, over 1,612 patients have accepted transfer and are currently in treatment. To support this procurement programme in 2022, the Minister made €4.1 million available for orthodontics as part of the waiting list action plan.

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 that are already on an orthodontic treatment waiting list. Many patients in Border areas have accessed care in Northern Ireland through this route pre-Brexit. This is being continued through the Northern Ireland planned healthcare scheme.

I reiterate that the Minister for Health fully acknowledges that the waiting lists for essential orthodontic treatment are unacceptable and the Minister wants to see real improvement this year with the significant funding that the Government has made available. I thank the Deputy for raising this matter. It is simply unacceptable that the waiting lists are far too long.

Photo of Martin BrowneMartin Browne (Tipperary, Sinn Fein)
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I accept the Minister of State's comments but the response does not even mention the four-year waiting list, which is shocking. This family does not need facts and figures and the girl needs treatment instead. That is the only thing that will help her. Her father has told us that this young girl is very good at sports and is a very bright child, with a good future ahead of her in school and college. The comments from others, however, are causing psychological harm and holding this girl back.

In 2015, the Department of Health approved the private treatment for waiting lists initiative, with an allocation of €1 million per year to target patients who had been waiting for over four years for treatment. The Department accepting that only those waiting for more than four years would have action taken is completely and desperately wrong, as the Minister of State would admit. It is my suspicion that delays being experienced across the country by children will result in two trends. The first is that the number of children waiting over four years will increase all the time, as we can see when they come to everybody's office. More children will have to be referred for private treatment as a result. The second issue is that some children are being forced to live with deterioration, so more will require more intensive surgery, adding to the number of children qualifying for the private treatment.

Children in this position need immediate treatment and not a fake promise of what will be done in years to come. Will the Minister of State ask the Minister, Deputy Stephen Donnelly, what is being done to improve access to treatment? Does he have plans to change criteria to allow more children to access private treatment in order to prevent their condition from getting worse? What can be done in this case and how can the family ensure the timely treatment of their child?

Towards the end of last year there were 1,123 patients waiting for HSE orthodontic service in my area of the south east, along with 506 in the mid west. I ask the Minister of State not to tell me this is all down to the pandemic because in 2019 the number of people waiting for four years or more for this service in the south east and mid-west had more than doubled from the previous year.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I have heard the Deputy's comments from across the Chamber and I assure him that the Minister and I appreciate the difficulties experienced by young people waiting for orthodontic care. As I outlined to the House, the Department and the HSE are undertaking a number of initiatives to address the question of waiting lists for orthodontic care. 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.

Under that policy, all children up to 16 years will receive eight oral healthcare packages, including examinations, assessments, advice, prevention interventions, emergency care and referrals as appropriate. The packages will be provided in a primary care setting by oral healthcare practitioners contracted by the HSE. With respect to orthodontic services, the policy supports the delivery of some orthodontic procedures in primary care dental practices, supported by clinical care pathways.

The policy recognises that in line with international evidence, some orthodontic care may be provided in different types of primary oral healthcare settings where the level of skill of the oral healthcare practitioner will match the complexity of care required. Orthodontic treatment involving inpatient surgical interventions and multi-specialty advanced care will be provided in advanced oral healthcare settings. Smile agus Sláinte provides the groundwork to transform oral health services and it embraces the same ideals as Sláintecare, with the needs of people at the core and the provision of services in the local community paramount.

Again, if the Deputy wishes to send the details of that young girl to me or the Minister, we will follow up with the HSE and see if there is any way the matter can be dealt with.