NEWS RELEASEPR4.00Embargo: 00.01 hours, Friday 17 March 2000 WAITING LISTS FOR ORTHODONTICS UP TO 4 YEARS LONG BDA survey reveals unequal access to orthodontic carePeople in some areas of the country can wait up to 4 years for orthodontic treatment¹ in hospital,according to a new survey carried out by the British Dental Association. Many patients can betreated outside hospitals by specialist orthodontic practitioners² – who either work in the highstreet like family dentists or in community dental clinics – but there are shortages of trainedorthodontists in some areas. The British Dental Association has asked for an urgent meetingwith the Department of Health to discuss how these problems might be addressed.In many hospitals, there were two waiting lists for orthodontics – one for initial assessment andadvice and a second one for any necessary subsequent treatment. The BDA survey found wideregional variations in waiting times. Those living in Chelsea and Westminster only had to wait 3weeks for an initial assessment – but people in another area of London, Barking and Havering,had to wait over a year (78 weeks). After this, the wait for subsequent treatment was, onaverage, 70 weeks. In 4 Health Authority (HA) areas, there was no wait at all, but in Oxfordshirepeople are waiting up to 4 years (200 weeks).People who can be treated in a specialist practice, rather than a hospital, may find waiting listsshorter, but there are wide regional variations in the availability of specialist practitioners.Nearly 4 in 10 are based in London and the South East – and there is a fourfold difference in theratio of specialists to 12 year olds between London and the West Midlands³. The average wait ina specialist practice was 21 weeks – with people in Somerset not having to wait at all, but peoplein both Northamptonshire and Rotherham waiting nearly 3 years (150 weeks). People beingtreated in specialist practices waited an average of 6 months (26 weeks) for subsequenttreatment after their initial appointment – although many did not have to wait at all.Warren Jones, Vice Chairman of the BDA’s Central Committee for Hospital Dental Services(CCHDS) and Consultant Orthodontist at Warrington Hospital NHS Trust says:“This Government came to power promising to tackle inequalities in health and provide betteraccess for patients to NHS services. Three years on, this survey paints a picture of long waitingtimes for orthodontic care in many parts of the UK. There is a shortage of specialists in hospitaland community services as well as in specialist practice and clearer guidelines on treatmentpriorities need to be agreed. We want constructive dialogue with the Government – and soon,because a solution is urgently needed.”
Notes to Editors1. Orthodontics is concerned with the development and management of irregularities of the teeth jaws and face. The most common problems are overcrowding, impacted teeth (where a tooth cannot erupt fully because it is partially blocked by another tooth), and protruding upper teeth. The perception is that orthodontic treatment is solely cosmetic. This is not true. The aim of orthodontic treatment is to produce a healthy bite, straight teeth and an attractive smile – which can help improve a person’s confidence.2. A general dental practitioner (family dentist) can provide initial advice, and may provide treatment or refer the patient to an orthodontist – a specialist either working in a practice or in a hospital. Hospital orthodontic departments normally concentrate on treatment of the most severe clinical problems and train future specialists.3. The ratio of specialist practitioners to the number of 12 year olds (the average age for orthodontic treatment) in the population is 1:1308 in London, and 1:4692 in the West Midlands.4. In the year ending March 1998, approximately 500,00 children and 20,000 adults had orthodontic treatment on the NHS in England and Wales. Most of this treatment is carried out in the General Dental Services by general dental practitioners (GDPs or family dentists) or specialist practitioners.5. The BDA’s Central Committee for Hospital Dental Services (CCHDS) compiled the survey results in December 1999. 127 Health Authorities were identified in 11 regions from a list obtained from the NHS Executive. A consultant was identified in every HA and asked to liaise with consultant colleagues and specialist practitioners to provide the information requested, taking an average where there was a discrepancy between different clinicians. Questions were aimed at determining the waiting list times for initial consultation and treatment, patient selection criteria and external influences on orthodontic referral patterns. Information regarding waiting times for local specialist orthodontic practitioners was also requested. A 100% response rate was achieved.6. A copy of the survey is attached.For press enquiries, please contact the Press and Parliamentary Department on 020 7563 4580,Kate Cinamon on 7563 4144, Anjuli Veall on 7563 4145.
THE AVAILABILITY OF NHS ORTHODONTIC CARE IN THE HOSPITAL AND SPECIALIST PRACTITIONER SERVICE IN THE UKThe survey shows up access problems for orthodontic care. There is a need to train more specialists to workin the hospital and community services as well as specialist practice and then try to ensure where possiblethey practice in the areas with the longest waiting lists.This Government came to power promising better access for patients to NHS services. A recent survey bythe BDAs Central Committee for Hospital Dental Services (CCHDS) paints a picture of long waitingtimes and inequality of access for orthodontic care in parts of the UK.The survey found that considerable variation exists between health authorities (HAs) and within regions in theavailability of NHS orthodontic care provided by both the hospital consultant service and the specialistpractitioner service. Highlighting these discrepancies may assist in future manpower planning by drawingattention to those health authorities where waiting lists are long and the number of specialist practitionersrelatively few. Other findings include the widespread use of the Index of Orthodontic Treatment Need (IOTN)by consultants and a restriction in the acceptance of adults for orthodontic treatment both within the hospitalservice and specialist practice.FINDINGSHOSPITAL CONSULTANT SERVICE1. WAITING TIME FOR INITIAL ASSESSMENT The average waiting time for an initial assessment in the hospital service was 20 weeks. (a) The shortest waiting times: Health Authority/ Initial Subsequent Health Board/ Regional Office Assessment Treatment Health & Social Services Board (weeks) (weeks) Chelsea & Westminster HA London 3 78 Ayrshire & Arran HB Scotland 4 82 Walsall HA West Midlands 4 70 Northern HSSB Northern Ireland 4 104 (b) The longest waiting times: Health Authority/ Initial Subsequent Health Board/ Regional Office Assessment Treatment Health & Social Services Board (weeks) (weeks) East Surrey HA South East 72 0 Wakefield HA Northern & Yorkshire 72 4 Scarborough HA Northern &Yorkshire 72 80 Western HSSB Northern Ireland 75 0 Calderdale & Kirklees HA Northern &Yorkshire 78 0 Barking & Havering HA London 78 1302. WAITING TIME FOR SUBSEQUENT TREATMENT The average waiting time for subsequent active orthodontic treatment in the hospital service was 70 weeks.
(a) The shortest waiting times: Health Authority/ Initial Subsequent Health Board/ Regional Office Assessment Treatment Health & Social Services Board (weeks) (weeks) Borders HB Scotland 12 0 East Surrey HA South East 72 0 Western HSSB Northern Ireland 75 0 Calderdale & Kirklees HA Northern & Yorkshire 78 0 (b) The longest waiting times: Health Authority/ Initial Subsequent Health Board/ Regional Office Assessment Treatment Health & Social Services Board (weeks) (weeks) Oldham HA North West 12 156 Redbridge & Waltham Forest HA London 26 156 South Derbyshire HA Trent 36 156 Barnsley HA Trent 53 182 Oxfordshire HA South East 20 2003. COMBINED WAITING TIME FOR INITIAL ASSESSMENT AND SUBSEQUENT TREATMENT The average combined waiting time in the hospital service was 88 weeks. (a) The shortest waiting times: Health Authority/ Regional Initial Subsequent Combined Health Board/ Office Assessment Treatment Wait Health & Social Services Board (weeks) (weeks) Borders HB Scotland 12 0 12 South Lancs HA North West 7 7 14 Cornwall/Isles of Scilly HA South West 12 4 16 Barnet HA London 8 12 20 St Helens & Knowsley HA North West 8 12 20 Hillingdon HA London 8 18 26 Swindon HA South West 20 7 27 (b) The longest waiting times: Health Authority/ Regional Initial Subsequent Combined Health Board/ Office Assessment Treatment Wait Health & Social Services Board (weeks) (weeks) Redbridge & Waltham Forest HA London 26 156 182 Hastings HA South East 52 130 182 Grampian HB Scotland 70 114 184 South Derbyshire HA Trent 36 156 192 Barking and Havering HA London 78 130 208 Oxfordshire HA South East 20 200 220 Barnsley HA Trent 53 182 235
4. In nearly three-quarters of HAs consultants used the Index of Orthodontic Treatment Need (IOTN) as the main method for selecting patients for treatment though treatment complexity was also taken into account.5. In 8 out of 10 HAs, consultants accepted IOTN grades 4 and 5 only, with some grade 3 if, for example, the case was suitable for teaching purposes.6. For those patients that did not meet the criteria for treatment in the department, in half of HAs consultants referred these patients back to the GDP for onward referral or treatment.7. In three-quarters of HAs the consultant orthodontists alone decided on the selection criteria for treatment within their department.8. In a quarter of HAs consultants did not treat adults unless they were multidisciplinary cases, (i.e. cases where integrated care was required with other specialties).SPECIALIST PRACTITIONER SERVICE9. There were large regional variations in the number of specialist practitioners providing NHS treatment. Nearly 4 out of 10 of these were based in London and the South East of England.10. There were over three times as many specialist practitioners to 12 year olds in the population in London than in the West Midlands.11. In 1 out of 10 HAs there were no specialist practitioners. (There is a more even distribution of hospital consultant posts throughout the UK, although 12 of these posts, which is equivalent to 1 in 20, are at present unfilled.)12. The average waiting time for initial assessment by specialist practitioners was 21 weeks, ranging from no wait in Somerset HA (South West) to a maximum of 150 weeks in both Northamptonshire HA (South East) and Rotherham HA (Trent).13. The average waiting time for subsequent treatment by specialist practitioners was 26 weeks. Many specialist practitioners did not have a subsequent treatment waiting list, accepting patients for immediate treatment if appropriate, once seen for initial assessment.14. One third of specialist practitioners did not treat adults.The Central Committee for Hospital Dental Services (CCHDS) carried out a survey on the availabilityof orthodontic care within the UK between April and December 1999. 127 Health Authorities wereidentified in 11 regions from a list obtained from the NHS Executive. A consultant was identified inevery HA and asked to liaise with consultant colleagues and specialist practitioners to provide theinformation requested, taking an average where there was a discrepancy between different clinicians.A 100% response rate was achieved. Questions were aimed at determining the waiting list times forinitial consultation and treatment, patient selection criteria and external influences on orthodonticreferral patterns. Information regarding waiting times for local specialist orthodontic practitioners wasalso requested.Warren Jones Vice Chairman CCHDS & Consultant in Orthodontics Warrington HospitalMohit Khurana Senior Registrar in Orthodontics Warrington Hospital