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WQ.225/2018
WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES
BY CONNÉTABLE A.S. CROWCROFT OF ST. HELIER
ANSWER TO BE TABLED ON TUESDAY 23rd OCTOBER 2018
Question
What action, if any, is the Minister taking to address the 385-day wait for community dental services as reported by the Jersey Evening Post on 4th October 2018?
Answer Introduction
The Community Dental Service is significantly challenged by the increasing number of patients eligible for treatment. It offers all children in Jersey under the age of 11 free dental care, which, as a consequence, creates high demand for the service. The Health and Community Services Department (H&CS) constantly reviews community dental waiting lists and clinic utilisation to ensure every resource is optimised and has been pursuing different options to try and reduce these waits. Currently, one part-time consultant and three dentists (one of whom is full time) meet the current workload.
Any child considered to require an urgent appointment will be seen the same day or the next working day.
The number of referrals (new appointments) continues to rise (see table). On the 1 October 2018 there were 927 patients on the waiting list, of whom 627 (68%) had waited over 90 days. As a comparison, on 1 October 2017 there was a total of 1,013 patients on the waiting list of whom 737 (73%) had waited over 90 days.
Year | Total new referrals | Avg per month |
2016 | 1049 | 87 |
2017 | 1244 | 104 |
2018 (to Sept) | 1038 Projected 2018 (total) 1386 | 115 |
Actions taken
A number of measures have been taken in 2018 to reduce waiting lists and will continue to be taken to optimise resources.
- In January 2017 there was a small but permanent increase in community dental officer provision with the funding of an additional clinic per week. The impact of this has resulted in an additional 10-12 patients being seen per week.
- Between February and April 2018, an additional 10 clinics were held. This involved a local dentist on a bank contract within H&CS. Approximately 120 additional patients were seen as a result of this initiative to reduce waiting lists.
- Additional community dental clinics will be considered in 2019. These should help reduce waiting times further.
- Patient waiting times and the community dental department's administrative workload are adversely affected by the number of patient Was Not Brought' (WNB) appointments. In 2018 (to September), the Community Dental Department scheduled appointments for 8,646 (vs 8,815 in 2017) patients. Of these, 1,257 or 14.5% (vs 1,464 or 16.6% in 2017) were not brought. To put this in perspective, a 16% WNB rate is equivalent to one funded clinic session in six having no patients.
The impact of a high WNB rate is considerable as all patients have to be given another appointment, as H&CS policy is that it is not the child who is responsible for the failure to attend, but the parent or guardian who failed to bring them.
To help overcome these challenges, a Rapid Improvement Workshop was commissioned within H&CS in February 2018 to address inefficiencies, improve clinic utilisation and reduce the number of WNBs. The implementation of a new system for booking patients and sending an appointment 6 weeks in advance as opposed to 12 months is now having a positive impact. Whilst the WNB rate has fallen to 14.5%, the true impact of the changes won't be known until the end of the year.
At its peak in 2017, the WNB rate was 23%; in September 2018 this had been fallen to 10%. The net benefit across all clinics is the take up of 25 new patient appointments per week.
Future Plans
The H&CS Acute Service Strategy follows on from Proposition P82/2012 on the reform of healthcare in Jersey. The Strategy outlines that treatment in the General and Future Hospital will be focused on those patients for whom it is clinically necessary that such treatment is provided in an acute hospital. For dental patients this would include, among others, patients with facial trauma and those requiring anaesthesia (some patients with dementia or learning disabilities, and some children). Such considerations are informing planning for the development of Jersey's Future Hospital, and may mean that non-acute dental patients may be treated in a more appropriate primary care setting. As part of the Common Strategic Policy, the Council of Ministers is committed to improving access for children to primary care services, including dentistry, with an emphasis on prevention and early intervention.