More than 1700 Auckland children are stuck in a backlog for tooth extraction surgery, forcing them to live in pain and risking their wellbeing and education, after Covid-19 put more strain on an already overburdened health service, the Weekend Herald has learned.
An internal report by the Auckland and Northland district health boards, prepared late last year, said the waiting list amounted to "a classroom of children, aged mainly 3-6 years old, needing a surgical extraction under anaesthetic, every week for a year".
At the current rate of surgeries, it would take dentists at least a year to clear the backlog if there were no new referrals — and dozens more children are being sent for help every week.
Delays that were already lengthy were "exacerbated during the recent Covid lockdowns where routine oral health services were unable to operate," said the report, which was obtained under the Official Information Act.
Officials conceded that the backlog has grown since the report was prepared. Measures include hiring more staff, but their recovery plan is not expected to significantly reduce delays until later this year.
Inadequate oral care could have significant consequences for children's wellbeing, the report warned, affecting "multiple aspects of their lives", including nutrition, sleep, physical and mental development and ability to concentrate at school.
And it worsens inequity between Pākehā, and Māori and Pacific children, who have higher rates of dental decay and tooth extractions.
The report was submitted to the Ministry of Health before the latest cluster of coronavirus cases sent Auckland back into lockdown in February and again this week. The DHBs proposed to overhaul oral care across the northern region, with a "multi-year implementation plan" to be ready by June.
The crisis is a stark illustration of how weaknesses in New Zealand's health system have deteriorated in the past year, as attention and resources focused on stopping the deadly coronavirus.
Tens of thousands of surgeries and specialist appointments were delayed, along with health screening vital to catching and treating illnesses such as cancer and eye disease. The pandemic also slowed planned health reforms, including an overhaul of mental health.
Some services that were in decent shape before Covid-19, have bounced back but for others, the strain has been severe — to the detriment of patients who include some of the country's most vulnerable.
Children in Auckland receive free dental care up to school year 8 through the Auckland Regional Dental Service (ARDS), mostly in school clinics. Those needing hospital-based treatment, including extractions, are sent to a service run by Auckland DHB.
Performance across the system was already poor before Covid-19, with widespread "access issues" and "persistent inequity", according to DHB documents.
In 2019, only half of all 5-year-olds received a dental examination. Of those who did, 57 per cent of Māori and 70 per cent of Pacific children had dental decay, compared to only 38 per cent of non-Māori or Pacific youngsters.
The situation got even worse last year, when routine dental services were suspended during the Covid lockdowns because of the risk of infection to dentists and nurses. Urgent treatment was allowed if patients met certain criteria, including being in severe pain that couldn't be controlled with drugs, but only 27 children met that definition.
Services restarted when Auckland dropped back to lower alert levels but ongoing infection controls and pre-screening requirements cut the number of children who could be seen each day. By the end of August, almost 60 per cent of Auckland children were overdue for a routine check-up. DHBs aim to keep that number below 10 per cent.
More than 17,000 children hadn't had an examination since 2018.
About 180 to 200 children in greater Auckland are referred to the hospital service for dental surgery every month, but capacity is only about 135 surgeries.
Mike Shepherd, interim director of provider services for Auckland DHB, told the Weekend Herald the three Auckland health boards have allocated almost $2 million to address the hospital backlogs, and are planning to hire more staff, put on extra theatre sessions, and send some work to private clinics.
"It will take some time for these measures to have an impact but our goal is to substantially reduce waiting times and number of children on the waitlist for assessment and treatment by late 2021," Shepherd said.
"There's ongoing high demand for hospital-level dental care, which is partially due to Auckland's growing population. This demand, along with the impact of Covid-19 on dental services, means that children are waiting longer than they, their whānau, or we would like. We apologise to affected whānau and tamariki for this and are working to ensure that we do much better."
The estimate of 1700 children needing tooth extractions cited in the DHB report was done in July 2020, and was based on the actual surgical waiting list combined with an estimate of how many children waiting to be assessed would need surgery. Using the same calculation, that total is now thought to be around 1900.
Another $560,000 will be spent on redesigning services "end to end", including data analysis and interviews with families and frontline workers to understand what's going wrong and who is missing out.
There will be a particular focus on reducing inequities. Nearly half of referrals for hospital-level treatment are for Māori and Pacific children, mostly living in South and West Auckland.
Problems with oral health are closely linked to poverty, the DHB documents noted, and addressing them requires consistent prevention measures and wider government policies as well as service improvements. Some health boards have lobbied the Government to curb demand by introducing a tax on sugary drinks but those efforts have so far been unsuccessful.
'The service is always working with a backlog': Ōtara principal
Alan Lyth, the principal of Bairds Mainfreight Primary School in Ōtara, told the Weekend Herald the dental clinic time allocated to his 430 students was never enough.
That problem was made worse because the mobile clinic didn't have time to see all the kids from previous schools, so they'd be booked to be seen when the clinic turned up at Bairds Mainfreight.
His own students who weren't seen, were then rebooked at the schools the clinic had moved on to. However, Lyth said those appointments were
often missed, for reasons including parents unable to get out of work, or lack of transport.
"There are children who haven't been seen for long periods because, through no fault of their own, the service is always working with a backlog."
It was due to a lack of resourcing, Lyth said, and the situation hadn't improved in the 12 years he'd been at the school.
Recently he was called by a parent who was having to take her child to a dentist, after they weren't seen by the school clinic.
"That's crazy — there's a dental clinic sitting at the back of our school, but she's having to take the child to the dentist. And that's a child who is in pain."