I rarely post things that are political in the blog, but I do occasionally discuss matters relating to dental politics and HSE Orthodontic Waiting lists. I see on the website Kildarestreet.com (where this is taken from, I freely acknowledge and would advise anyone wanting to track the treatment of various topics in the Dáil to look there) that there was this exchange recently on HSE waiting lists.
David Cullinane, a TD for Waterford said in Dáil on Wendesday June 26th, 2019
“I will give the Taoiseach the breakdown of public waiting times for orthodontic treatment in the south east as of today. It is 59 months in Carlow-Kilkenny and Wexford and 60 months in south Tipperary and Waterford, meaning the average waiting time is five years to have orthodontic treatment carried out. Within those classifications of waiting times, the Health Service Executive has had to prioritise crisis cases. The waiting times in that respect are 20 months in Carlow-Kilkenny and south Tipperary, 18 months in Waterford and 16 months in Wexford. How can that be the case? The capacity is not there and we do not have enough orthodontists.
This is a programme for Government commitment that has not been met as waiting times have increased. They have doubled in the past five years rather than going down. Will the Taoiseach outline to the House the extra capacity and resources that will be provided for orthodontic care and treatment to ensure people do not have to wait five years in some parts of this country for orthodontic treatment?
An Taoiseach, Leo Varadkar responded:
“On orthodontics, it is fair to say that we all agree that the current system is not satisfactory. The new oral health policy points out a pathway by which we can adopt a different approach to oral health. That is entitled Smile Agus Sláinte, and I would encourage Deputies to familiarise themselves with that.”
A few things arise from this...
Firstly the long waiting times for HSE Orthodontic treatment.
This is not the same throughout the country. Depending on where you live, HSE Orthodontics might well attend to your treatment a lot sooner than this. There is wide variation in the different regions – which are organised sort of independently rather than nationally – as to how many orthodontists are available at any given time to treat people. And when their books are filled up, then they can’t take on any more patients until they finish treating some other patients that were started long ago.
Orthodontics isn’t like other forms of surgery where – for example, you see a guy who needs his appendix out or a hip replaced, you take out the appendix or replace the hip, you follow up the patient to see how successful the operation was, and then you discharge the patient and this entire process might take a few days or a few months, but the surgical procedure is in the middle and takes a few hours in one episode and then it’s done. With orthodontics, the treatment takes a few hours too, but it’s done in 15 minute chunks, spread out over several years. To make things efficient you do the same thing for hundreds of other patients at the same time. When a new orthodontist starts in the HSE, roughly speaking, they take on a few hundred patients, then can’t take on any more for a few years when they start completing the patients they took on at the start.
So…..this leads to a bit of confusion on orthodontic waiting lists that we need more clarity on. When someone reports that “there is a 5-year waiting list”,
- do they actually think that someone going on the waiting list today will be treated in 5 years?
OR
- do they mean that someone coming off that waiting list and starting their treatment today was put on that list 5 years ago?
There’s a big difference.
The second scenario reflects all the problems that have occurred in the last 5 years, and the first is usually based on all the problems of the past, but oblivious to all the problems or solutions that might happen in the future.
As for Leo Varadkar’s reply….
You might think he’s clearly displaying a well-informed insight if he concludes that the HSE orthodontic system is unsatisfactory with waiting lists of 5 years, but in the quote as reported on Kildare Street, he makes the more sweeping statement that “we all agree that the current system is unsatisfactory”. I don’t think there is any evidence of abnormal waiting times or poor outcomes or any other unsatisfactory element of delivery of service in orthodontics delivered outside the HSE by similarly qualified orthodontists as the ones that work inside the HSE. I don’t know why he said that, and can only presume;
- He meant that the HSE orthodontic system is unsatisfactory, and simply made a mistake in the heat of the moment, or
- He knows something we don’t know
Mr Varadkar then advises Deputies to familiarise themselves with Smile Agus Sláinte, the new National Oral Health Policy.
The Orthodontic Society of Ireland and Irish Dental Association weren’t asked to play any significant role in forming this policy, even though their members will presumably be the ones expected to implement it. Both these organisations have tried to familiarise themselves with the policy and work out what it means but really at this stage the details are unclear about how the government intends to provide HSE-calibre orthodontic treatment in any different way.
You can read more about Smile Agus Sláinte and the National Oral Health Policy at this website (you may need to copy and paste it into your browser, I’m not hyperlinking it):
https://health.gov.ie/wp-content/uploads/2019/04/NOHP-Main-FINAL.pdf