Ms Susan Clyne:

In response to Deputy Bernard J. Durkan on the waiting list problem, yes it has been ongoing for several years. However, it is becoming significantly worse and is a multi-factoral problem involving demographics, our ageing population and people living longer and the incidence of chronic disease. Many patients are referred into the acute system because services in the community are so poor. Some of those patients could be dealt with in the community, which would require funding of GP contract and other community services.

Additionally, the lack of consultant posts and our inability to recruit consultants will continue to have a detrimental and negative impact on waiting lists. It is unsustainable to have increased demand and fewer and fewer doctors operating in the system. We earlier touched on recruitment problems and I wish to make the additional point that the recruitment issue not only affects the current cohort of consultants but also our trainees and non-consultant hospital doctors, NCHDs, who are looking at this and deciding to go away, not for training or fellowships as has been the case in the past and as our colleagues in the IHCA outlined, but permanently, with no plans to come back to work in the system.

Shortage of bed capacity is a fact. We have lost 1,400 beds in our acute hospitals at a time when more beds are needed. I have mentioned that GP services and the lack of community care facilities also contribute to the long waiting lists.

While people accepted that there was a waiting list problem, the idea was that we would try to sort out that problem. Instead we have a situation where the population demographics have caught up with us and we have not sorted out the problem. All the other issues that have happened in the health service have made it worse. That is what is happening.

On the Chairman's comments on value for money, there are very few medical professionals working in the system and they provide value for money, given the work that they do. People have accepted that consultants work over and above their contractual duties. An IMO survey of its consultant members has shown that, on average, a consultant will work up to 20 additional hours per week. It is not unusual and is in fact the norm to see consultants doing rounds on Saturdays and Sundays in hospitals. The HSE hospital activity shows that private patients are not displacing public patients on waiting lists. The waiting list issue is one of funding and capacity. On the issue of theatres, it is all very well to have a physical room but if there are not staff and the resources to fund the staffing required for that room, the medical professionals and the bed or ICU bed that will be required for that patient afterwards, these physical rooms will not change anything. The Chairman is right that wards were closed down and there are physical rooms and wards present. In some hospitals, some of the closed wards have been turned into offices.