Orthodontic changes planned across Lancashire

NHS bosses are planning a major overhaul of orthodontic services in Lancashire in an attempt to reduce waiting times of more than a year in some parts of the county.

The changes would mean that the specialist dental treatment is delivered at fewer hospitals – and only weekly clinics would be held at one of the remaining sites.

However, an influential group of councillors have said the revamp would be such a major change for patients – many of whom are under 18 – that a full public and local authority consultation should be carried out before it is implemented.

Currently, so-called ‘secondary’ orthodontic care – which deals with the most complex cases of teeth straightening and jaw and bite issues – is provided at eight hospitals across Lancashire and South Cumbria.

Under the proposed redesign, it would no longer be offered at the Royal Lancaster Infirmary, Queen Victoria Hospital in Morecambe or the Royal Preston Hospital. Patients who are – or would be – under the care of those three facilities would instead travel to Chorley Hospital.

However, those currently treated at Lancaster and Morecambe would also have the option to attend what would become a weekly clinic at Furness General Hospital over the South Cumbria border in Barrow – albeit a further distance than the trip to Chorley. At the moment, the Barrow service is fortnightly, but often has to be cancelled.

Meanwhile, Blackpool Victoria Hospital would also become a ‘satellite’ centre, at which clinics were held only once a week.  That service is currently closed to new patients, with locals having to travel elsewhere if they are newly referred.

‘High street’ orthodontic facilities – also provided by the NHS – would be unaffected by any change to the hospital-based provision.

A recent meeting of Lancashire County Council’s health scrutiny committee heard that the current secondary orthodontic set-up in the area was beset with staff shortages and had become “financially unaffordable”.

Members were told that patients were “often” waiting more than 65 weeks to begin treatment, but that “inequalities” in the service across the patch meant that there were variations of 30 weeks between the longest and shortest waits.   Follow-up appointments are also being delayed beyond the standard 6-8 weeks.

The problems – which a presentation to the committee said made for a “poorer patient experience” – are particularly acute in North Lancashire and the Fylde coast, with neither University Hospitals of Morecambe Bay NHS Foundation Trust nor Blackpool Teaching Hospitals NHS Foundation Trust currently having any permanent consultants – in spite of the former having advertised a vacancy for the past two years.

However, the service in East Lancashire was said to be “stable and functioning well” – and so will continue to operate out of both the Royal Blackburn and Burnley General hospitals.   For that reason, East Lancashire Hospitals NHS Trust would also become the “lead provider” as part of the changes – responsible for secondary orthodontic services throughout Lancashire and South Cumbria.

But committee member County Cllr Shaun Crimmins, who represents the Lancaster Rural East division, questioned the rationale for the proposed new arrangements.

“Blackburn and Burnley [are]10 miles apart, but they can have a service at both sites – and yet North Lancashire and East Cumbria can’t have anybody. It just doesn’t seem fair to me,” he said.

Amy Lepiorz, an associate director of primary care at the Lancashire and South Cumbria Integrated Care Board (ICB), said feedback from recently-completed public engagement on the plans had included appeals for help with travel costs should any of the existing services cease. She said the ICB was looking at whether it was possible to “reimburse” travel and parking expenses, but that no conclusion had yet been reached.

However, Ms. Lepiorz stressed that the proposed new lead provider model should make the Lancashire and South Cumbria area a more attractive place to work – because of the collaboration opportunities it will offer.

“East Lancashire [NHS] Trust is very well respected nationally for the quality of its orthodontic care – and quite often…consultants don’t want to work on their own outside of that wider multi-disciplinary team,” she explained.

There are just 3.8 full-time equivalent ‘substantive consultants’ working in secondary orthodontics across Lancashire and South Cumbria at the moment, seeing around 1,400 patients per year.

Committee member County Cllr Mohammed Iqbal said that without an “undertaking” that travel costs would definitely be covered for those affected by the restructure, he considered it to be “a significant change that will affect, adversely, parts of the county” – and his fellow members agreed.

If a change to NHS services is deemed a “substantial development or variation”, a formal public consultation would be required.   That is ultimately a decision for the NHS itself.

After the committee meeting, the ICB told the Local Democracy Reporting Service that the next stages of the process include meetings with NHS England and the ICB board – as well as the production of a business case.

The timeline for any changes, should they be agreed, has not yet been determined.