Dr. Tony O'Connell:

With regard to the question on orthopaedic waiting times, the challenge across all outpatient settings is that there has been a 10% increase in referrals to clinics. We have been able to increase activity despite the budgetary restraints that apply. However, we have only been able to increase it by 8%. In other words, there is a gap between the levels of demand and supply, both of which are rising. This has been a challenge for us. Due to the effective squeezing out of scheduled elective activity in our hospitals as a result of the increases in emergency activity to which the director general referred, this year has seen a reduction in orthopaedic booked activity. I refer here to a 2.9% decrease in inpatient numbers and a 2.1% reduction in day cases.

Nevertheless, when one compares this year with the same time in 2010, there has been an overall increase in activity of 4.6%, which is extraordinary. This reflects the fact that despite the financial challenges we face, we are becoming more efficient through programmes such as the productive operating theatre programme utilising lean methodologies, as well as becoming more efficient in how we manage the overdues on the lists in order that we attempt not to have too many people waiting for too long. As for the questions about the cardiac catheterisation service at Waterford, I might just quote the exact words in the so-called Higgins report on this issue. It is referred to in only two sentences and states:

Waterford Regional Hospital will continue to provide invasive cardiology services for the South East population. Working in collaboration with the cardiology service in Cork the current service should be extended with new joint appointments of cardiologists.

The Higgins report is actually a description of the way in which hospitals should be arranged into groups as is not seen as a service planning exercise by the Department. Nevertheless-----