Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I welcome the opportunity to address the issues raised in the harrowing "RTÉ Investigates" programme, "Living on the List". People all over Ireland watching the programme found it hard to bear the pain and anxiety etched on the faces of the men, women and especially children who very bravely told their stories, and the shattering impact on those who love and care for them. I was genuine and truthful about my feelings on watching the programme. I will not defend the indefensible or excuse the inexcusable. Offering my honest response should not, however, be portrayed as being the only response I have offered. Today, I want to outline to the House the actions that were and are being taken, both before and after the programme, to address the long waiting lists that so traumatically affect patients.

When I became Minister for Health I was aware that I would receive increased funding for waiting list initiatives in the budget. However, I did not want to wait until then as the numbers were growing and the trajectory being forecast by my Department and the Health Service Executive was frightening. Something had to be done, even with limited additional resources and a short timeframe, to try to make a difference and I knew where I wanted to start. I unapologetically targeted resources at specialties with particularly long waiting lists, such as scoliosis and orthopaedics, through the winter initiative, and treating those patients waiting the longest by requesting the HSE to put in place an action plan to halve the number of patients waiting for 18 months or more for inpatient or day case procedures. Through this action plan, more than 11,500 patients came off the inpatient day case waiting list between August and December 2016, reducing the number of patients waiting more than 18 months for treatment by more than 50%.

While there are obviously still too many people waiting, the priority in 2016 was to reduce the number of long-waiting patients and the HSE, through its efforts, made considerable strides in this regard. Public hospitals showed they could deliver on sharing capacity and working together across hospital groups and the country. For example, 24 orthopaedic cases from Tullamore hospital were undertaken in Kilkenny hospital, 150 orthopaedic cases received treatment in Cappagh hospital on behalf of St. James's, Tullamore, Beaumont, Tallaght and Crumlin hospitals, and 34 adolescent scoliosis cases took place in the Mater hospital on behalf of Tallaght hospital.

Also in 2016, the National Treatment Purchase Fund, NTPF, undertook an endoscopy waiting list initiative to arrange for the provision of endoscopy procedures to patients waiting for longer than 12 months. By the end of December, more than 5,500 people had come off the waiting list and the NTPF had managed to clear more than 99% of those waiting longest on the list.

I want to do more in 2017 and we will do more. This is a priority for me, the Government and the people of this country. The NTPF allocation for 2017 will utilise capacity in the private acute hospital sector to provide treatment for our longest waiting patients on the inpatient-day case waiting list. The HSE will also submit an action plan to improve waiting lists in the public acute hospital sector for inpatients and day cases, as well as outpatients. Starting with the National Treatment Purchase Fund, in budget 2017 an allocation of €20 million was made to the fund and an additional allocation of €55 million has been made for 2018. In December 2016, I granted approval to the NTPF to dedicate €5 million to a day case waiting list initiative, with the aim of ensuring that no patient will be waiting more than 18 months for a day case procedure by 30 June 2017. It is expected that in excess of 2,000 patients will receive treatment through this process, commencing in March. The main areas of focus will be on lists with large numbers of long-waiting patients, namely, ear, nose and throat or ENT, ophthalmology, general surgery, dental, urology and vascular surgery.

The HSE will also submit a waiting list action plan for 2017 by the end of this month. The plan will concentrate on reducing the length of time patients wait for an inpatient, day case or outpatient appointment, with the aim of having no patient waiting longer than 15 months by the end of October. While I consider this is still much too long, it would mark a significant reduction in waiting times, with the aim of reducing waiting lists further. To ensure the best outcome for patients who are waiting, the HSE and NTPF will and must work together to utilise capacity in the public and private sectors. The plan will also be supported by the NTPF's proposal for a further €10 million of funding for patient treatment in 2017. In addition, I have requested that the HSE produce an action plan for scoliosis, which will be a targeted initiative prioritising scoliosis patients, and to focus on gynaecology, an issue discussed in the House many times, and cardiology.

Before I address other issues raised by the documentary broadcast on Monday night, I am sure we all agree that it was particularly difficult to watch the plight of Megan, Kira and Darragh who are waiting for scoliosis treatment. I was humbled by their courage and that of their parents. I am keenly aware of their burden and I stress my commitment to addressing the service problems they face.

Additional funding has been provided in recent years to develop paediatric orthopaedic services, including scoliosis services. I made available €2 million under the winter initiative in 2016 and more than 50 additional patients - children and teenagers - have been treated under this initiative to date. As a result, while we have made some progress, there is much more to do to provide the level of service needed.

On Tuesday, I met the chief executive officers of the children’s hospital group and Our Lady’s Children’s Hospital in Crumlin to discuss immediate action they can take to reduce wailing lists for children and adolescents with scoliosis. Although the new theatre in Crumlin was commissioned in 2016, it is only now being opened due to challenges with recruiting nurses. The hospital has undertaken an aggressive recruitment drive to attract new theatre nurses and I commend it on doing so. As a result of this drive, four new nurses will be in place by April and a further 16 international nurses have been offered posts and have commenced the registration process in Ireland.

The recruitment of these nurses means that the new theatre will provide the additional capacity for scoliosis procedures from April, as the nurses take up post. In addition, an orthopaedic surgeon post in Crumlin hospital will be filled in June, which will provide further capacity in that hospital and theatre this summer. As a result, Crumlin hospital expects to undertake 194 spinal procedures by the end of 2017, which is considerably more than last year, and this is expected to achieve significant reductions in waiting lists for scoliosis procedures and, most importantly, waiting times. Furthermore, bearing in mind the serious long-term health consequences for children with scoliosis, a specific action plan on scoliosis will be submitted to me by the end of the month. This plan will take on board the concerns of the advocacy groups in respect of scoliosis. My absolute commitment to families with children with scoliosis and to those with scoliosis is that this will be an absolute priority in 2017.

As Deputies will know, I have asked the NTPF to audit the practices in the hospitals highlighted by the individual cases featured in the programme on RTE. This means going in and auditing how waiting lists were addressed in each of the hospitals referred to in the programme. I wish to clarify an issue about NTPF data and waiting lists that was raised in the documentary. Since its establishment and in line with international protocols, NTPF published waiting list data has consistently excluded patients classified as pre-admit and planned procedure. Contrary to some political charges, this was not a decision made by me but one that has been in place since 2002. However, the NTPF is undertaking a project in conjunction with Trinity College Dublin to examine updated international best practice around waiting list data publication models. I will adopt its findings in full. Deputy Louise O'Reilly has made a good suggestion on integrated waiting lists and I will meet her next week about it. There is a lot of merit in what she says. She has been pursuing this with me for some time, which I acknowledge.

Before I conclude, I acknowledge that waiting list figures for January were published yesterday and, obviously, I am disappointed to see the figures go up, but I cannot be surprised. I knew the figures would increase because they tend to increase every January with the pressures on our emergency departments and as the action plan for the last year comes to an end. Due to the ongoing demands on our emergency departments and in order for the measures in train and those planned for the coming months to start having an impact, I am aware that it will take some time this year for our waiting list figures to start to go down. However, we will ensure that every patient in the country is waiting a shorter time for a hospital procedure or appointment by the end of this year.

I believe that we can do better for our patients. I do not believe that the challenges facing our health service will be solved purely by resources alone. Yes, resources are an issue, but if it was all about resources we would not have had any problems in the health service during Celtic Tiger Ireland. This is not just about resources. It is about how money is spent, how budgets are implemented and how hospitals are managed. These are all factors. We are reinvesting in our health service after some extremely difficult years but we have to be careful and must underpin this increased funding with new and tougher accountability rules. I want to see the performance and accountability framework deliver for patients and taxpayers. It is designed to do both. I want to be clear: we have some really excellent managers in our health service. I meet them and I know them as do other Deputies. However, there is definitely room to do more. I reject any assertion that we are already doing all that we can and that there is not room for improvement in terms of how the health service is managed.

I think we all recognise as well that we face a complex and multidimensional challenge. We are living longer and healthier than ever before, which is something to be celebrated. However, it also means that there are more demands on our health service. Every year, our acute health system delivers more than 3.2 million outpatient attendances in our hospitals, 94,000 patients have elective inpatient procedures and 1 million have a planned day case procedure, and the demand continues to rise. This is down to the hard work of front-line staff throughout our health service. We all know that, if we want to break the vicious cycle, we need to take the fundamental reforms, to have our ten-year plan, to address bed capacity and recruitment and to not play party politics with our health service.

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