Complainants pointed out the problems in accessing dental services under general anaesthesia for persons with special needs. These persons, especially children, do not usually cooperate with dentists. They are scared, restless and anxious, which is why dental care is only possible with the application of general anaesthesia in these cases. Access to such dental care is difficult due to the unacceptably long waiting periods (six months and more). Persons with special needs must thus take a number of medications to ease their pain, which is unacceptable, especially in the case of children. The Ombudsman agrees with the opinion of the Health Council that the matter should be treated as a priority in all fields, especially in regard to children who, due to long waiting times, have to take painkillers. The Ombudsman believes that this is unacceptable and contrary to Article 24 of the Convention on the Rights of the Child in accordance with which State Parties recognise the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health.

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The Human Rights Ombudsman of the Republic of Slovenia (Ombudsman) received a complaint in which the complainants highlighted problems in accessing dental services under general anaesthesia for persons with special needs. They informed us that persons with special needs have sensory, behavioural and other problems that make dental care difficult. Persons with special needs, particularly children, do not usually cooperate with dentists. They are scared, restless and anxious, which only makes dental care possible with the application of general anaesthesia. Access to such dental care is difficult due to the unacceptably long waiting periods (six months and more) that are the result of the lack of sufficiently qualified anaesthesiologists and limited financing of dental care under general anaesthesia. These problems are even greater outside urban centres, where such care is practically non-existent. Due to long waiting times, persons with special needs are forced to take a number of medications to relieve their pain. The complainants particularly highlighted the cases of children who, while waiting for treatment, are taking strong pain relief medications (e.g. suppositories) every few hours.

To obtain answers and the position about how to resolve the relevant problem, the Ombudsman contacted the National Institute of Public Health (NIJZ), the Ministry of Health (MZ) and the Health Insurance Institute of Slovenia (ZZZS).

The ZZZS informed us that the lack of staff is evident in numerous fields. To resolve the current situation, it is necessary to realistically assess it and draft a comprehensive and systemic approach that includes an increase in the enrolment in the Faculty of Medicine, targeted specialisations and measures to retain staff in the public healthcare network. The ZZZS stated that the MZ was responsible for the secondary healthcare network, and it thus expected the MZ to present a plan for further activities in this field. The ZZZS would provide the financing once the network is established, and it also stated that all providers can charge 30 per cent more for the care of persons with special needs, which was assessed as a suitable price and sufficiently stimulative from the financial aspect.

The NIJZ informed us that it monitors the staffing situation and the number of services performed by general dentists and dentist specialists. In doing so, it determined that the number of dentists in the eastern cohesion region is lower than in the western cohesion region. This difference is also noted in the use of services, which is particularly low in the Pomurje and South-eastern regions. The NIJZ has no data on the accessibility and competence of dental teams which carry out dental services under general anaesthesia, as would be suitable in the case of persons with special needs. The NIJZ is aware of the problem, but its regulation supposedly exceeds its competence. Among other things, the NIJZ also determined that the code list of dental services at the ZZZS should be supplemented regarding the implementation of dental procedures under general anaesthesia.

The MZ responded that it was adopting measures aimed at the improvement of accessibility of healthcare services, and its activities were directed towards drafting the human resources strategy. The Ministry believed that it was crucial to ensure a sufficient number of staff to implement healthcare services, including for the dental care of children with special needs under general anaesthesia. The Ombudsman was not satisfied with the response of the MZ, and we submitted additional inquiries to the Ministry. The MZ responded to our letters and informed us that it was aware of the urgent need to ensure a sufficient number of teams to provide necessary dental services under general anaesthesia for persons with special needs. This need will be addressed within the procedure of drafting and adopting the Annex to the General Agreement for 2022.

The complainants also informed the Health Council about this problem. The Council decided to draft letters for stomatology divisions in Ljubljana and Maribor to ask them to set up organisational provisions (time, location and phone number) for the patients or parents of children with special needs in the event of emergencies. The Health Council also proposed that the outpatient clinic for persons with special needs be available at least once a week and asked to submit an appeal to the Extended Professional Board of Paediatrics and Dentistry to prepare clinical pathways and define a population that would be entitled to a procedure under general anaesthesia without a waiting period. The Health Council believed that this issue must be discussed with priority until the adoption of the oral health strategy and also proposed to prepare a clinical pathway, in which patients requiring general anaesthesia would be defined separately.

The Ombudsman agrees with the position of the Health Council that the issue be granted priority in all fields, especially in the case of children who must take painkillers due to long waiting periods. The Ombudsman finds this unacceptable and contrary to Article 24 of the Convention on the Rights of the Child in accordance with which State Parties recognise the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.

Based on the issue of waiting periods already discussed, the Ombudsman is aware that the increase in financial resources can increase the number of procedures, but it does not resolve the issue of the lack of staff. Long-term planning is required to address this issue, which is linked to the education system, the motivation of doctors to choose certain specialisations that are in demand, and all of the above is also connected with financing. The Ombudsman will wait on further processing of the complaint, i.e. until the adoption of the Annex to the General Agreement for 2022, from which it will be evident whether and to what extent the guarantees of the Ministry of Health will be realised. On that basis, we will be able to assess together with the complainants whether it is possible to expect that conditions in this field will actually improve. 9.4 - 22 / 2021