Patients up to their 16th birthday are referred for secondary care orthodontic treatment under the modified Index of Treatment Need. Those with the greatest clinical need i.e. Grade 5 or Grade 4 are provided with treatment by the HSE. It should be noted that 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 necessary to wait for further growth to take place before treatment commences.
In line with a commitment in the Programme for Partnership Government to provide timely access to orthodontic care, the HSE has undertaken a procurement of orthodontic services with a number of private service providers. Those patients who have been waiting over four years have been contacted first, followed by those waiting three years or more. This initiative commenced in April 2016. By the end of 2016, 1,889 patients had been contacted and 1,238 accepted transfer from HSE to a private orthodontic provider. By virtue of this outsourcing initiative, it is not envisaged that the Waiting List initiatives due to be implemented by the NTPF and the HSE under its Waiting List Action Plans will include orthodontic care.
The HSE is also considering changes in skills mix to assist in providing timely access for patients. This involves using orthodontic therapists working under the supervision of specialist orthodontists. Two orthodontic therapists are in place and a further two are in training and the HSE plan to extend this initiative.
Orthodontic treatment is included in the list of treatments available under the Cross Border Directive. Patients may access orthodontic treatment outside the state, and can be reimbursed by the HSE. Further information on this is available on the HSE website.