Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

I welcome the Minister and I welcome the introduction of the Supplementary Estimate. It encompasses many of the sensitive areas to which we have brought attention in the course of this year and for a number of years. It is to be hoped that the detail provided and the specific target areas will result in a clearly identifiable result at the end of the spring. We can talk about these matters ad infinitum, but putting in place the measures to deal with the issues as they present themselves is very important. It is also a litmus test of the health services. This challenge of waiting lists and access to accident and emergency services and elective procedures and so on has become an annual challenge.

If we do not get to a position where we can identify precisely a smooth flowing and seamless delivery of services, questions will always be asked. What the Minister has pointed out is very important. Who is on the waiting list? Have they been approved for a procedure or are they awaiting diagnosis? Is a delay required? Unless and until these people are diagnosed and have a specific requirement, there is no use counting them anywhere. I remember dealing with a patient years ago who was allegedly on a waiting list but he would never be put on a waiting list because he was not medically fit to go through with the procedure. That was not said.

There are a number of matters about which I have become a little worried over the years. It is well known that there are professionals in the system who can identify at an early date areas likely to cause problems. In other words, they will be overly stressed or overloaded etc. The people in those areas must be more active and let the Minister know about it at an earlier date. It should not fall to any investigative body, including RTÉ or the Committee of Public Accounts, which deals with issues retrospectively. It should be known and identified within the system and measures should be put in place to deal with the matter. This is instead of it dragging the system down, along with the reputation of many people within the system who work extremely hard in a very demanding and challenging area.

The number of claims has caught my eye in recent times. Reference has been made to the claims agency and provision is being made in the area. It is €50 million. How many of those claims would be preventable? I know accidents happen but if accidents repeatedly happen in the same institutions, I would ask questions. Why would they happen repeatedly in the same institutions? For example, is there evidence indicating that in particular hospitals there seems to be continued risk of claims arising? Quite a number of claims in the media in the past few years have been in respect of maternity hospitals. I know accidents will happen but if due process was followed and all precautions were taken, there should not be a liability on the system. With the best will in the world, one cannot eliminate accidents and they will happen. There is a necessity to look again at the degree to which we see the same institutions named or involved with claims.

There is also the cost of claims. We hear about the award, with the included legal fees. Are we spending money wisely and could preventative measures be taken? In order to provide a good service, we need to address such matters at an early date. To what extent are measures or steps being taken within the health services to address those areas, with particular reference to the unfortunate hospitals that seem to be named repeatedly in respect of claims? I am not in any way attributing blame but if they appear again and again, there are issues. Is there a problem in the system or is the fact that it is a high-risk area the explanation? We need to know.

There is a figure of €30 million for acute general hospitals and it is good to have identified that specific area. I repeatedly made the point over the past year that in order to solve something, one must identify the precise area that requires attention, which is causing a problem or slowing the system. It is not rocket science and it is very simple but one needs to have the inside track and be able to identify precisely where the slow-down or shortfall is taking place. It is a question of identifying where the system is being snagged so the issues can be addressed. If issues must be addressed, that must be done. There is no point in saying we cannot do X, Y or Z because it would cause upset. Upset is caused to people who are victims of snags in the system as well. In the past couple of days I received a reply to a parliamentary question to the effect that a patient will be waiting another 12 to 15 months for an orthopaedic procedure. Having identified the issue and with diagnostics undergone, why is it taking 12 to 15 months for this to happen? There must be some movement along the lines. What if every procedure took 12 to 15 months? Perhaps a patient has a more acute need than another at a particular time, which is correct.

The patient suffers the pain. I am sure everybody here has come across cases where people have suffered intense pain for two or three years, and that is unacceptable. We must put ourselves in the shoes of patients. Having been worried and concerned about a condition and having received a diagnosis, he or she is then told to wait. It can seem like an awfully long time for somebody in severe pain. I will not repeat what I said at a previous meeting, which identified the extent to which patients are being recirculated through the system. That should not be happen. Patients are not getting treatment but are going to the accident and emergency departments. When they are discharged, they come back through the system, perhaps twice, or three, four, five or six times. There needs to be an examination to identify the areas with respect to which that is most prevalent. We are moving in the right direction but we spoke of the shortfall of income in acute general hospitals.

It is important to note that when patients are admitted to hospital, they have the option to be treated as private or public. This is moot. What are the implications in the event of a patient being admitted to a public hospital and having an option of going private or public? I would claim to know the answer but I would like to hear it more graphically described. It is very important. I am slowing as I come to the end.

I have referred to scheduled and unscheduled processes already and I will not go through it again only to say the unscheduled ultimately become scheduled. What was not urgent yesterday could well be urgent tomorrow. We need to be sure about such matters. The National Treatment Purchase Fund is the only way to my mind that lists can be cleared if there is a major backlog. I cannot see how it could be done otherwise. It is as simple as that. If a backlog has been developed for a particular reason and we have not identified the reasons for it in the first place, we must put in place emergency measures to clear it. It would not work any other way. There is no use in having one reason or another for not doing it and we must do it.