Trevor Ó Clochartaigh (Sinn Fein)
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Cuirim míle fáilte roimh an Aire Stáit. Tá mé thar a bheith buíoch di as ucht an t-am a thógáil leis an cheist seo a ghlacadh. Tá cúrsaí ortódóntacha san iarthar ag déanamh imní do chuid mhaith tuismitheoirí ansin, go háirithe i gContae Mhaigh Eo agus i gContae na Gaillimhe.

In October 2013 it was reported that nearly 40,000 children were waiting for orthodontic treatments, with 462 patients waiting longer than four years. Spokespersons on behalf of dentistry groups, such as the president of the Orthodontic Society, argued that one can only treat so many patients at a time and the numbers then were in line with the recruitment moratorium within the HSE.Others were stronger in their statements.

We were told that the lifting of the moratorium on the recruitment of dentists and support staff, including nurses and radiographers, would improve services and reduce waiting lists, but the newly elected president of the HSE's dental surgeon group stated that the recruitment embargo was having a negative impact. She went on to state:

Waiting lists for treatment under general anaesthesia, orthodontics and oral surgery have soared due to the lack of resources. This is a reprehensible consequence of the circumstances which now prevail in our public dental service.

Kathleen Lynch (Cork North Central, Labour)
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I will read my script, but I can also discuss a different type of service that we hope to introduce and that has significant possibilities.

As we all know, the HSE provides orthodontic treatment to those who have been referred for treatment before their 16th birthdays. Patients are assessed by the HSE orthodontic service under the modified index of treatment need. The index has two components, those being, dental health and aesthetic. Under the modified index, the aesthetic component has three categories. The dental health component has five categories ranging from category 1, where there is no need for treatment, to category 5, where there is a great need. Grade 5 and some grade 4 cases are treated within the public health system.

A regional orthodontic service for Galway and Mayo is provided at Merlin Park University Hospital, with outreach clinics provided in both counties. Unfortunately, a breakdown of waiting lists by county and age is not available. Children are generally referred to the assessment waiting list in sixth class when they are 11 or 12 years of age. Currently, all are assessed within 12 months and all those in the categories eligible for treatment are treated within 36 months of assessment. The nature of orthodontic care means that immediate treatment is not always desirable. It is estimated that, in up to 5% of cases, it is preferable to wait for further growth to take place before treatment commences. We all understand this.

The latest data available for treatment waiting lists are from the end of December 2014. They show that 1,212 children were on the grade 5 waiting list in Galway and Mayo.Of these, 640 or almost 53% were waiting for less than 12 months; 462 or 38% were waiting for 12 to 24 months; and the remaining 110, 9%, were waiting for 25 to 36 months. The grade 4 treatment waiting list has a total of 2,088 children. Of these, 912 or almost 44% were waiting for less than 12 months; 832 or almost 40% were waiting for 13 to 24 months; and the remaining 344, 16%, were waiting for between 25 and 36 months.

The HSE has established a pilot scheme in Dublin north-east, which will involve the use of orthodontic therapists in the treatment of a number of eligible children. Consideration will be given to expanding this scheme to other HSE areas in the future. An initiative which will especially focus on those waiting for four years or longer, which I think was the concern of the Senator more than anything else, will be put in place later this year. A panel of independent practitioners under contract to the HSE will bein situfor three years to treat certain categories of misalignment. It is expected that this initiative will have a positive impact on the waiting lists. It is those waiting the longest we all have most concern about.

Trevor Ó Clochartaigh (Sinn Fein)
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I appreciate the information and statistics that have been given. There are still 1,500 children waiting up to a year for treatment, 1,294 or so waiting up to two years and 500 children waiting from two to three years, which is not a huge improvement on the figures we had a year and a half ago. Has the review that was talked about by the former Minister of State at the Department of Health and current Minister for Communications, Energy and Natural Resources, Deputy Alex White, been done? If so, has the moratorium made any difference? Will there be new permanent posts provided under the HSE? There can be service plans, independent practitioners and people brought in from agencies, etc., but what we need are more nurses, dentists and staff within the service. Are there plans to do that?

Kathleen Lynch (Cork North Central, Labour)
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I do not wish to dismiss what orthodontists and their assistants do in their clinics every day of the week, they do great work and are always juggling to get children in on time under the particular age set out and those with greatest severity as well. We all know that from our own personal if not constituency experience.

The review tells us what we need to do and we have now established an individual within the HSE who looks at how to develop a national programme for orthodontics. In the main, that applies to people under 16 years of age. Part of the review and national programme is telling us we should be looking at alternative methods of treatment, for example the orthodontic practitioners, who are highly trained nurses already nursing within the dental service and who have taken on additional training in how to fit braces. I am not certain yet and it is just a pilot programme but I must admit I was very impressed by the people who came in to talk to me about it. I am told that in other countries orthodontic practitioners are widely used, under the supervision of the orthodontist, of course. Other countries have managed to bring down waiting lists and deliver services in a far more timely fashion than we have in the past.

Private practitioners not normally working within the HSE will be assigned in order to ensure that long waiters will be dealt with as a priority. My worry is that those children who are waiting longer than four years will go over the age barrier of 16 before they are seen.These two initiatives should have a visible impact on waiting lists.