Micheál Martin (Cork South Central, Fianna Fail)

I did not interrupt speakers. We are in a House where the principle of free speech should be honoured and I would appreciate the opportunity to complete my speech.

It is important to put the provision of acute hospital services in context. Over the last two or three decades there have been numerous important advances in surgical technology and in anaesthesia. These advances have greatly improved the range, the safety and the effectiveness of the surgical procedures that can be offered by modern health systems. However, as a consequence there have been dramatic increases in the demand for surgical procedures, especially elective procedures. Day activity is now a significant component of hospital-based care in Ireland. Evidence shows that much of the growth is the result of technological and medical innovations, such as less invasive surgery and advances in anaesthetics. There has been a staggering increase of nearly 80%, from 249,472 to 440,817, between 1997 and 2003. This increase reflects the increasing ability of the hospital system to treat more patients on a day basis where they are admitted and discharged on the same day. The funding has gone to that 80% increase, but that is rarely acknowledged in the House.

The nature of any health care system is such that not all treatments can be made available to patients immediately. Acute services have to be provided in a way that uses hospital facilities to best effect. Patients who require elective treatment may have to wait because beds, staff and operating theatres are being used to treat emergency cases. The balance to be achieved is to ensure that the available resources are used efficiently and that treatment can be delivered to patients in a reasonable time.

From the beginning this Government wanted to focus clearly on reducing waiting times for public patients who required admission to hospital for elective treatment. In order to keep the focus on waiting times we set ourselves ambitious targets both in the health strategy and in the programme for Government. I make no apologies for the setting of these targets, as without targets we would have nothing to aim for. Those targets have allowed the Government to maintain a particular focus on those waiting longest for hospital treatment.

I was very pleased earlier today to announce significant progress in relation to identifying the true position of elective waiting lists in this country. This significant progress has in particular been achieved through the work of the national treatment purchase fund. The NTPF is a health strategy initiative with the task of achieving reductions in waiting times and particularly to offer treatment to those who have been waiting longest. I will set out for the benefit of the House some of the information reported by the NTPF today. The NTPF has reported that waiting times have fallen significantly in the last year, with 37% of patients now waiting between three and six months and 43% waiting between six and 12 months for surgery. Therefore 80% of patients now wait less than one year for surgical treatment. This represents a major reduction in the length of time patients have to wait.

The NTPF has a multidisciplinary team which has been working with individual hospitals to identify patients on waiting lists for surgical procedures. The NTPF has undertaken validation of those waiting longest for treatment and this suggests that the figures reported to the Department of Health and Children overstate the number of persons who are available for treatment. The Department, in consultation with the NTPF, has carried out a comparative analysis of the number of patients reported to be waiting for surgical treatments and it has become clear that the number of patients reported to the Department includes patients who are not actually waiting or available for treatment.

Having set up the NTPF on a statutory basis with effect for 15 May 2004 I have also decided to transfer responsibility for the recording and publishing of waiting list figures to the NTPF. The NTPF, in conjunction with the Department and health agencies, has undertaken a verification process which takes account of the constant movement of patients on and off lists — "the flow factor". The NTPF has taken account of such factors as patients not being available for treatment, patients not being medically suitable to undergo treatment, patients no longer requiring treatment and patients postponing treatment at their own request.

When those factors have been taken into account the NTPF has estimated that a large number of patients, approximately 4,500, can be removed from the Department's reported figure.

See this speech in context