Seanad debates

Thursday, 31 March 2022

Nithe i dtosach suíonna - Commencement Matters

Dental Services

10:30 am

Photo of Paul GavanPaul Gavan (Sinn Fein)
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It is always good to see the Minister of State. I need to bring him back to the 1990s, when a number of what were known as regional orthodontic units were set up around the country to treat children who needed dental work on public waiting lists. At the time, waiting lists were very long but, within a few years, the regional units proved very successful at reducing waiting times. In fact, in Dublin and the mid-Leinster area, we understand waiting lists were more than halved from 18,000 children to approximately 6,000 children. All of that changed when, in the late 1990s, support for the regional orthodontic units was withdrawn. As a result, the units ran into trouble and, in effect, began to collapse.

The regional orthodontic units in Dublin and the mid-Leinster area were particularly affected and the knock-on effect was that up to 9,000 children were left stranded mid-treatment. Many of them were still wearing orthodontic appliances, meaning some suffered irreversible damage. The situation deteriorated so much that some parents staged sit-ins in dental clinics as they desperately tried to get treatment for their children. In particular, an orthodontist, Ted McNamara, expressed serious concern in regard to what was happening. The HSE appointed two people to investigate - Professor Richmond from Cardiff and Professor Bearn from Dundee – and they reported back to the HSE in 2015. However, four years later the report had still not been published.In 2019, the issue was highlighted by an RTÉ "Prime Time" programme. We know the medical files of more than 7,500 children were reviewed as part of a large-scale audit by the HSE following these allegations.

When regional orthodontic units were practically abandoned back then, many children were left with orthodontic appliances in for far too long. They were left stranded and without care and, in some cases, were left with irreversible damage. Some of these children were left with pain, as well as distortion of the teeth much worse than they had before they started treatment.

However, the original damning report that was given to the HSE in 2015, seven years ago, has still not been published. We know the audit of these files has been completed but there is still no publication. Will the report be published soon, even in redacted form if necessary? In the seven years we have been awaiting publication of that report, what has changed to prevent further damage being done and to ensure the best standards of practice are being maintained by practitioners in the profession, particularly those in the public service? What changes to the orthodontic teaching, training and monitoring of practice are in place? Why might Ted McNamara and some of his orthodontist colleagues be feeling that they have been ignored and undermined?

Some orthodontists claimed the recruitment process was rife with nepotism and that some professionals lacked the proper postgraduate qualifications. It would be helpful to know what is being done to increase the availability of orthodontic treatment in the public sector for children who need these services, because it appears the system supports the private model of provision of orthodontic services rather than encouraging a better service for the public sector.

I cannot help but mention the crisis in wider dental care for children, especially those who rely on the public system. We need drastic changes to help stop dentists leaving the medical card scheme. I presume this has a direct effect on the orthodontist service as well. There has been a lot of concern for a long time in respect of the delivery of orthodontic services. Have lessons been learned from this scandal or is it just business as usual and let the report be buried?

I hope that when the Minister of State responds he will not try to defend the indefensible. This report should have been published. The public have a right to know. This was an outrageous scandal. It has been buried by the HSE for the past seven years. I look forward to a positive response.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I thank Senator Gavan for raising this issue and giving me the opportunity to address the orthodontic look-back review. As he stated, in 2015 a review report was commissioned by the HSE following receipt of a statement of concern relating to an orthodontic service serving the greater Dublin area between 1992 and 2002. This review was, in fact, a scoping report commissioned to advise the HSE on what action should be taken to determine if there was a risk of harm to patients in this case. The 2015 report did not include a review of patient records for the period and so, understandably, reliable conclusions could not be drawn at the time in respect of potential patient harm.

Following receipt of that report, the HSE initiated a comprehensive audit of more than 7,500 patient files available from that period. Due to the scale of the audit and the requirements for specialist staff and resources, the timeline was protracted. While the HSE regrets that this work has taken so long to progress, its priority all times has been for a robust audit on which to base any further action required. The audit and clinical review of relevant patient files from the period was completed in 2020.

As a result of this complex and large-scale audit, it was found that 16 of more than 7,500 records reviewed by clinicians did not include a documented endpoint to the patient's treatment with braces. The HSE has issued correspondence to all of the patients identified as requiring recall and the process of engagement with them is ongoing. The timeline for review prioritises affording patients time to engage with the HSE at their own pace and in the context of the overall Covid-19 restrictions. The HSE advises that a draft report has been submitted to the commissioner, the HSE national director of community operations. Once the commissioner has accepted the report and the patients have been engaged with and given a copy, the report will be made available to stakeholders.

The Senator referred to Ted McNamara in the context of the report. To me, seven years is far too long, Covid-19 notwithstanding. I hope the report will be made available to stakeholders as quickly as possible. I will follow this up within the Department but, to me, seven years is a simply unacceptable timeline.

Photo of Paul GavanPaul Gavan (Sinn Fein)
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I thank the Minister of State for putting on record that he will chase this up. That is very welcome because I understand that, as RTÉ confirmed in its report in 2019, the two UK experts who were engaged to do the report secured assurances that it would be published. Unfortunately, those assurances have been reneged on by the HSE. As the Minister of State noted, it is completely unacceptable. I am placing my faith in the Minister of State because the scripted response he was handed by his colleagues in the Department does not give me reassurance. I want to be clear on that. His scripted response states that the report will be made available to stakeholders. That is not the same as it being published. It does not give any timeline. As the Minister of State pointed out, a wait of seven years is outrageous. We are all accustomed to the fact that the HSE has a culture of burying bad news and not being open and transparent. That is what has led to so many problems within the health system. We need a commitment from the Minister of State that the report will be published, not at some distant point but in the coming months. I ask him to deliver on that.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Senator. I will raise the issue with the Minister, Deputy Stephen Donnelly, and will look for assurances and a commitment to a timeline. Once again, I assure the House that the HSE has conducted a thorough audit that involved the use of specialist staff over a protracted period and a review of more than 7,500 patient files. The focus of the HSE has been on reviewing patient safety in line with its policy, including its incident management framework 2020 and predecessor frameworks, as well as international patient safety practice. While it is regrettable that this work has taken so long to progress, the priority of the HSE at all times has been for a robust audit on which to base any further action required. I look forward to the completion of the report, which will be provided to patients and stakeholders. It is regrettable that it has taken so long. To me, seven years is quite a long time for people to wait, particularly in the context of assurances to those who carried out the report that it would be finalised. I will raise the issue with the Minister and try to get a response for the Senator.