2026-03-26

As if the crisis that exists in the provision of ophthalmology services across the south-east was not enough, we have an even greater crisis in the provision of orthodontic treatment for children across the region. I can only describe the state of orthodontic services in County Tipperary, in particular, as deeply worrying and shocking following new information that I received from the HSE. Figures reveal that 546 children are waiting for critical orthodontic treatment, some of whom have been waiting for up to 82 months, or almost seven years. There are another 312 children waiting for an initial assessment. Children in my constituency of Tipperary South are being left to wait for the best part of their childhood for essential orthodontic care. This is not a delay but a systems failure. The HSE has confirmed to me that there are no waiting list reduction targets for 2026 or 2027. The service is operating with just 0.1 whole-time equivalent consultant orthodontist cover for assessments in Clonmel. A specialist orthodontist post has effectively been reduced from full time to 0.6 whole time equivalent and vacancies remain unfilled dating back as far as 2021. It is extraordinary that in the face of such extreme waiting lists the HSE has set no targets whatsoever to reduce lists. This points to a lack of urgency and a lack of accountability. Even more concerning is the admission that waiting lists will continue to grow over the next two years. This means children who are now only being referred may not be treated until they are well into their teens. The HSE acknowledged to me that demand is exceeding capacity, with more patients joining the waiting list than can be treated. Urgent action is now required. We need immediate recruitment to fill long-standing vacancies, a clear recovery plan with measurable targets and additional capacity put in place without delay. I am sure the Minister of State will agree that no child should be left waiting years for care that is critical not just to their health but also their confidence and development. What we are looking at here is not just pressure on a service but the effective absence of a functioning orthodontic service across the south-east and particularly in my constituency. Seven years is not a waiting list but a denial of care. The most shocking element is not just the delays but that there are no targets at all to reduce them. The HSE has openly admitted that waiting lists will continue to grow over the next two years. We are talking about children missing the critical window for treatment that can have life-long impacts on their oral health and confidence. Parents are being left with an impossible choice: either pay privately or watch their children wait for years. By the time some of these children are seen, the clinical need may be more complex and, indeed, more costly. This is a classic example of a service where demand is known and predictable but not planned for. There is no credible explanation for having no reduction targets in the face of such a crisis and such extreme delays. If this were happening in any other part of the health service, it would be treated as an emergency.

I thank the Deputy for raising the important issue of the HSE's public dental and orthodontic service in south Tipperary. I am taking this matter on behalf of the Minister for Health. The HSE oral healthcare service aims to provide an oral examination and necessary treatment for children at ages approximating to second and sixth class and, in some cases, fourth class. Emergency care is provided for children of all ages up to 16 and for those with complex and additional needs. The HSE provides orthodontic treatment to patients with the most severe and complex treatment needs. The Minister for Health is aware that there are currently backlogs in the HSE's child oral health examination programme, which have meant that the sixth-class groups are being prioritised. In relation to orthodontic services, targeted investment is delivering meaningful improvement. On top of the €240 million that the Government invests annually in oral healthcare, over €20 million has been allocated to waiting list initiatives for contracted orthodontic care, resulting in more than 5,200 removals from waiting lists since 2020. This includes a dedicated orthodontic surgery programme that has delivered treatment for an additional 266 patients to date. This funding will continue in 2026 with a further €2.8 million being provided. The HSE has advised that there are staffing challenges in the public dental service in south Tipperary and that the healthcare area manager for south Tipperary is currently reviewing staffing levels and waiting list times to replace one specialist in orthodontics based in south Tipperary. To support capacity nationally, €2 million was awarded in 2025, increasing to €4 million in 2026 for an additional 15 HSE dental staff to deliver oral healthcare in the community. The HSE advises that Carlow, Kilkenny and south Tipperary have been allocated one of these posts, which have been difficult to fill. With regard to immediate and long-term reforms, the Minister acknowledges that the current system, which was developed in the 1990s in response to the identified oral healthcare needs at that time, must be modernised and aligned with current needs. The Government is committed to addressing the immediate difficulties that patients are experiencing in accessing oral healthcare services. The Department of Health is working with colleagues in the HSE and other relevant stakeholders to address the immediate backlogs in the public dental system while long-term reform is under way. The national oral healthcare policy sets out the vision for oral healthcare services in Ireland and has two key goals: to provide the supports to enable every individual to achieve their potential best oral health and to reduce oral health inequalities across the population by enabling vulnerable groups to access oral healthcare and improve their oral health. Reform of our services is vital and I thank the Deputy for raising this important matter to ensure that people of all ages can have access to modern, prevention-focused care.

I thank the Minister of State for the reply, but there was nothing in it to give any comfort whatsoever to those children on the waiting list across the south-east, and in particular south Tipperary. I am thinking of those children who have been waiting for up to 82 months for a critical intervention. The solution is not complicated. It is about filling those posts that have been vacant since 2021. We need a targeted recruitment drive for orthodontists in the south-east. We need them now. Relying on staff travelling from Waterford to Clonmel a few days a month is not a sustainable model of care. What is needed now is a clear recovery plan with timelines, targets and accountability. It is important that we look at interim measures, including outsourcing or additional clinics, accessing capacity that is in the private sector in the same way we are doing in the context of ophthalmology to bring waiting lists down quickly. This has to be treated as a priority within the regional health structure. The Department of Health needs to intervene. This is beyond a local staffing issue. I want to see a clear plan published for how we can bring down these waiting lists. We know there are pressures nationally, but the situation in south Tipperary is more than acute and cannot be normalised. Even in a stretched system, a seven-year waiting list for a young child awaiting critical orthodontic care is indefensible. No child should spend his or her time on a waiting list. That is the bottom line.

I have listened to the Deputy and taken on board the points he has made. I will bring them back to the Minister, Deputy Carroll MacNeill. The Deputy has advocated for his constituents to ensure they have better dental and orthodontic treatment services. I assure him that improving access to dental care for children is a priority. We need an accelerated response to the staffing deficit that Tipperary is experiencing. We must also ensure that waiting lists are reduced significantly over the time ahead. The Government is investing heavily in oral health policy. This is part of the modernisation of our health service. We need transformation in how we deliver the care at a regional level and not just at national level. Sometimes that is forgotten. There should not be inequality across the east, west and south. Everyone should be on this journey at the same time. We are committed to ensuring that patients who are experiencing real difficulties have access to services. I will take this issue back to the Minister and thank the Deputy for raising it.