Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank Deputy O'Connell for her comments. I fully agree with her on the value for money issue. When I became Minister for Health, I found it somewhat astonishing that we do not have a structured programme to ensure that every euro counts in the health service. Just like the Deputy in her own business and anybody in family life seeks to make sure that they get good value for money, there are a number of initiatives throughout the HSE but we need a more concerted and structured approach. I hope we can act on that with regard to future service plans. We cannot just increase the budget for health every year. We have to see what we are getting in return for that budget. I acknowledge that some progress has been made in recent years. We saw, for example, the activity-based funding for our health service based on how many procedures were conducted by a facility. There has been a commencement of linking provider payment with clinical objectives. The Ministers, Deputies Regina Doherty and Richard Bruton, and I have addressed Healthy Ireland and paying money for school meals. We make sure that we only fund school meals that tie in with our Healthy Ireland agenda. We have much more to do and I would like to see a structured value for money drive in place. Often, these things are needed in times of recession but the time to do it is actually now when the economy is growing and we are reinvesting. We should not be complacent. I do not think there is a citizen who does not believe that we can get better value-for-money for the health service and I hope to be able to move on that shortly.

I thank Deputy O'Connell for her kind comments on the HPV vaccine.

I thank her and other members of the committee for their leadership. Her professional background as a pharmacist meant she was not afraid to call out the nonsense, myths and scaremongering that was going on. I have been attacked and vilified by many a keyboard warrior for my position on the HPV vaccine, as have many other people in this room and in the Houses of the Oireachtas generally, but the HPV vaccine campaign has been a very good example of collective clinical and political leadership. The HPV Vaccination Alliance, all of its constituent NGOs, many of which Deputy O'Connell listed, have been incredible in coming together, calling out the myths, demanding that people put the facts out there and not just accepting myths as fact, which is often a risk in political debate these days. It was never about lecturing or preaching to parents; it was about asking parents seeking to make the decision - and any decision for one's child is a very important decision one must make as a parent - to get the facts and telling them where they can get the facts. I refer to the new website, hpv.ie, which provides all the information for parents along with the basic advice that if one wants medical advice, one should go to a medical professional, be it a pharmacist, doctor or other appropriate individual. This concerted and co-ordinated effort has seen Ireland reverse what has been a global trend that when uptake of a vaccine decreases, it continues to do so. This year, thankfully, the number of girls who have been vaccinated on foot of decisions they and their parents made will be up by well over 10%. I instinctively agree with Deputy O'Connell's desire to see the vaccine extended to boys but, as always, I must continue to follow the medical evidence in this regard. HIQA is carrying out a health technology assessment at present, the results of which are due next year. If there is a positive recommendation there, we will absolutely act on it. We should not be in any way complacent about this because while we have seen an increase in uptake of the vaccine, we cannot let our foot off the pedal on this one. We must continue to be very vigilant and to provide factual medical information to our citizens and not to pat ourselves on the back for too long on this one because there is still a long way to go. Nonetheless, Deputy O'Connell is right: there are women, young girls, who got the vaccine this year who will be alive in the future as a result of the increased uptake. We need to see this trend continue, and I thank Deputy O'Connell for her work in this regard.

I appreciate the opportunity to provide some clarity on the issue of scoliosis because we have discussed it in this committee on many occasions. When the "RTÉ Investigates" programme was broadcast earlier this year, 312 children were waiting for spinal fusion or spinal procedures. As we all know, people are placed on waiting lists all the time. Waiting lists are not static; they grow as more children need procedures. As of 1 December, that number has decreased to 156 patients, so we have halved the number of people on the list overall. This is due to an incredible effort on the part of the most dedicated clinicians. I know there was a legitimate debate about consultants and public and private care previously in this committee, but this group of clinicians has gone above and beyond the call of duty with might and main and worked additional hours with nursing colleagues, management of the children's hospital and the CEO of the Children's Hospital Group, Eilish Hardiman. Huge work has been done.

Regarding the four-month target specifically, just over 60 children will be waiting over four months by the end of the year. Obviously, we must work into our calculations the fact that time moves on. It is still intended to meet the four-month target, but it is fair to say that some parents will have been offered treatment that for very good reasons they will not have been able to accept. Taking one's child abroad, for example, is not an easy decision; it does not always work for families. The assurance I am giving people today is that, whatever the number, children left waiting over the four-month period by the end of this year will have a date for early 2018 by the end of the year. I also wish to debunk a myth I have heard and read today about the "abandonment" of the four-month target. I will be very clear about this. The HSE and I have brought together a scoliosis co-design group. We have asked patient advocate groups and clinicians, the people actually carrying out the surgeries, to come into a room with a group chaired independently by Brian O'Mahony in order to come up with a sustainable plan for scoliosis. They are due to make recommendations which, I think, will be published in January. I will follow them to the letter. We will do absolutely everything that that group commits us to doing. The point about the four-month target is important because I have sat in rooms with clinicians, the people carrying out the scoliosis procedures, as recently as two weeks ago and they have told me that for some children the four-month target will not be appropriate, that some children will need the surgery much sooner and that other children, for a variety of other reasons, including growth spurts, may need in their medical interest to have the surgery done at another time. We must be clinician-led in this. I wish to be very clear: the scoliosis co-design group is a group of patient advocates and doctors who carry out scoliosis procedures. They will come up with recommendations. We will hire additional consultants, we will have the theatre in Crumlin open full-time and we will in 2018 have what we have never had before in this country: a sustainable scoliosis service. We will be able to end the process of having to outsource procedures abroad during the course of 2018 as well, and we are making huge progress on this. I am very eager that we do not have a little progress made in 2017 only for the problem to reoccur because this problem has been ongoing for years. We will put in place a sustainable service. I thank the clinicians for their leadership in working with the patient advocate groups. The idea of an abandonment of the four-month target is not accurate at all. Whatever target will be set will be set on the basis of the clinical advice of the scoliosis co-design group, and this is an appropriate way to act.

Deputy O'Connell is entirely correct to raise the important matter of waiting lists. We need to be very careful when we set policy in the interest of our citizens that we know the scale of the challenge, and there is absolutely a major waiting list challenge in this country. However, people on the M50 in the morning are not concerned about how many cars are on the M50 but about how long they will have to remain on the M50. Therefore, we must ask what are we measuring and what is a sign of success? That more and more people are using the health service and undergoing procedures in the health service, including procedures which were not available in some cases a number of years ago, particularly in the area of ophthalmology, is in and of itself not a problem; the problem is when people wait too long. When the RTÉ programme, which highlighted a number of very important issues, was broadcast, I said I would be fully transparent and that we would publish every list, including lists that have never before been published under any previous Minister for Health and put them all out there. The problem now is that some people are misrepresenting the reality. There are many different lists. There is the active list. This details the number of people who are actually waiting on a given day for a hospital operation or procedure. The numbers on this list have fallen for three months in a row. How many people are waiting for an outpatient appointment, an appointment with one's consultant? These are very important metrics. These are the people who are actually waiting today. How many people are waiting for a scope today? That is very important. However, there are three other lists. There is a list called two come in, TCI. In this case one has received one's appointment date and the appointment will take place within the next six weeks. In other cases, people's appointments have been suspended and they are on a suspended list. Perhaps they have seen a doctor, who told them they are not medically fit for a certain procedure on a given day. No Minister for Health can tell that doctor to go ahead and carry out that procedure. Is that patient waiting, or is he or she not medically available for a procedure he or she has been offered? Then there are planned procedures, which are the cases Deputy O'Connell raised, and which are perhaps the most important when it comes to people misrepresenting the lists. People use the service regularly. They need regular check-ups, perhaps regular procedures, and they might see a doctor today and the doctor might tell them to come back to him or her in three months time. They get an appointment date for three or six months time and they have that appointment in three or six months time. Are they waiting? According to some of the figures one sees in the media, they are, but according to that patient, I reckon, if one spoke to them or their family, they are not waiting in that sense. Rather, they will be seen at the time at which the clinician wants to see them.

Trinity, independent of me - the NTPF had asked it to do this - is looking at how other countries report and record waiting lists in order that we can have accuracy in this regard. Please do not get me wrong - we have huge challenges in this area. However, we need to know exactly where the challenge is and not try to fix a different challenge that may not actually exist in such an acute fashion. I hope Trinity will examine other countries and see how best we should record accurate waiting lists. This is the other thing. We hear people say there are X number hundred thousand people on waiting lists but they are not all individual people. Anyone might be on a list two or three times for two or three different procedures. We therefore need to be very clear what we are measuring because I can receive from the taxpayer a significant fund of money and I need to be able to direct that into the appropriate place. Getting the list accurate, recording the figures appropriately and showing our citizens what is going well and what is not going well and how we will fix it is very important. I hope the Trinity group will be in a position to provide us at least with some interim guidance very early in 2018 in order that we can have an informed debate about where the challenges are and what we will do to fix them.