Ms Angela Fitzgerald:

The Senator is quite correct. The effect of the decisions in March to curtail non-urgent elective care, which were appropriate because we were at a very early stage of understanding the disease, had a significant impact. While the system recovered, we have given ourselves a very big challenge. To put it into context, at the end of last year we had 66,000 patients waiting on our inpatient and day-case waiting list. At the peak in the middle of the summer, that rose to 85,000. That was largely because we were not able to schedule cases.

We are back down to 72,000, but 72,000 is obviously an unacceptable number. I mentioned earlier the access to care plan, but that is very challenged because, as the committee can see, alongside lockdown measures we also have to curtail elective care that is not time-dependent. It is important to say - and I think Dr. Hamilton will be able to come in on this - that we did, as far as possible, try to protect time-dependent care in two ways: not only in our public hospitals but also through the arrangement we had with private hospitals, which was intended to protect that care. While a lot has been said about the success or otherwise of the private hospital initiative, the committee will see in the pack and the opening statement we have provided the scale of work that was done in that time. Much of it was supporting cancer and other care. We did over 50,000 inpatient and day cases during that time. We also moved cancer care from public to private hospitals very successfully and moved the doctors with it. We saw that in St. Vincent's, in the Mater, in the Whitfield and in Cork. That will be an important part of surviving this current surge.

Regarding outpatients, which comprised a very challenging number to begin with, we had made significant inroads last year, although we were still at a very high figure. We went from a figure of about 565,000 at the end of last year up to more than 600,000 now. While typically none of these are patients waiting for cancer care, they are people who need to be seen and they pose a very significant challenge. One of the things we did successfully during the peak of the first surge was to shift some of our outpatient appointments to virtual appointments. At one point during the peak almost half our patients were being seen virtually. We would like to take that forward as part of the way we do our business but we also recognise that new patients need to be seen in person. At macro level the figures have deteriorated. Over the year we have seen them go, as I said, from 66,000 to 72,000 and from 560,000 to 610,000.

Regarding cancer, we have separate data coming through from the NCCP, and Dr. Hamilton may wish to comment on that, and our rapid access services, which are our early ways of detecting cancer, continued throughout. One of the challenges was that people were delayed in presenting because many people did not present. That is a challenge, and I think Mr. Woods made the point earlier that we see a direct relationship between attendance at ED and lockdown measures. People tend to stay away. It is a difficult message to get out. We are trying to prevent people from moving around unnecessarily but we still want people to present to their GPs and to the ED if they need to do so. The messaging that NPHET and others have got out on this is better and we are seeing better traction on it now. We are happy to share the detail of this with Senator Hoey if she so wishes.