Tom Neville (Limerick County, Fine Gael) | Oireachtas source

This issue arises from a reply received to a question about waiting lists in University Hospital Limerick and non-attendees. Some of the figures I have been presented with are quite startling. The answer I received outlined outpatient department attendance in 2015. The number of new appointments was 34,900; of these, 5,633 did not attend.

Outpatient department review appointments totalled 115,649, with 18,701 non-attendances, representing 16% of the total. In 2016 new appointments totalled 35,536, an increase of approximately 600. There was also an increase in the number of no-shows which was up by between 400 and 500. That figure was creeping up to 17%, at 6,029. Review appointments in that year totalled 120,875, with 21,294 non-attendances, representing 17.6% of the total. We need to quantify the exact percentage each year. If one takes the cataract waiting list in University Hospital Limerick, for example, reducing the 16% no-show figure could increase the number of patients seen by between 130 and 140 per year.

Even from a standing still position, this would be a way of combating long waiting lists and increasing efficiency. The HSE has pointed out that the statistics to which I have just referred represent the total numbers of new and review outpatient clinic attendances between 2015 and 2016. The data include patients who do not attend. However, since the launch of the new iPMS patient administration system in 2016, the HSE has reintroduced text reminders for patients. This measure is being rolled out on a phased basis. The HSE will be assessing the benefits of the system and adding additional functionality throughout 2017. The word "reintroduced" was used in the context of text reminders. Were they used previously? If so, why were they not maintained? In the private sector text reminders are used by utility companies, telephone service providers, alarm companies and so forth. Everything is connected to the customer's mobile phone. Mobile phone operators alert their customers to the fact that their bills have been issued; waste companies remind customers to put out their bins in two or three day's time and so forth. Reminders are issued regularly. Such customer-focused, interactive systems are needed in the health service, particularly in the context of reducing waiting lists, because such systems would allow us to combat the challenges presented by such lists. We must identify efficiencies that can be made. In the context of the HSE assessing the benefits of the system, what criteria will be used? I also want to know what additional functionality will be added in 2017.

I am sure there is a lot more knowledge within the HSE than I have of technology that could be utilised. I should not even be raising the matter in the House. It should just be a fait accompli; it should be done. I want to know if a text reminder system was in place previously and, if so, why it was not maintained. I would also like to see the statistics for the rest of the country, given that we are looking at a 17% no-show rate in Limerick. The reminder system should be rolled out across the country as soon as possible.

Minister of State at the Department of Health (Deputy Catherine Byrne):On behalf of the Minister for Health, Deputy Simon Harris, I thank the Deputy for raising this issue. I agree with him on the need to reduce non-attendance for hospital appointments. According to the latest published HSE data, in 2016 there were over 135,000 patients who did not attend new appointments and over 343,000 patients who did not attend review appointments, comprising a general non-attendance rate of approximately 13%. The cost of these non-attendances is difficult to ascertain. In order to ensure outpatient clinics and the time of clinical staff are used to best effect, hospitals usually schedule a greater number of patients in order that clinics are fully utilised in the event that some patients fail to attend. The administrative cost associated with non-attendance is approximately €25 per patient visit. Even more significant, however, is the loss of allocated clinical time which could have benefited another patient. In that context, it is important that the HSE progress initiatives to reduce the numbers of people not presenting for outpatient appointments.

Technology has its part to play in a modern, efficient health care service. The Department of Health has asked the HSE to identify quick, practical solutions to resolve some of the challenges that face the health service on a daily basis. One of these challenges is to provide digital solutions in the area of non-attendance by patients for appointments. One of the solutions eHealth Ireland has proposed is to provide a standardised national patient reminder service using SMS or email. This solution has the potential to reduce the numbers who do not show up for appointments and, in addition, to allow current processes to be adapted and new procedures built to reallocate appointments slots to other patients. This standardised national text reminder service project has been initiated.

Some hospitals such as those in the University of Limerick hospital group have a text messaging reminder service which is integrated with the patient administration system and allows a texting reminder service to operate. This tailored solution will be evaluated when the project is in a later stage to determine if it would be appropriate as a standard approach across the system. In addition, under the new outpatient reform programme, the hospital system will be moving to advanced booking systems which will give patients two choices of appointment time. This has been shown internationally to dramatically reduce patient failure to attend. There is also a further proposal to validate waiting lists using SMS reminder messages which would quicken the validation process, reduce workloads and increase efficiencies. A pilot scheme is to be initiated shortly for both inpatient and outpatient services using SMS reminders for appointment validation purposes. These initiatives are being progressed in conjunction with the HSE’s outpatient waiting list action plan for 2017. The Minister for Health will be communicating the details of these plans shortly.

Before I finish, I highlight the fact that the University of Limerick hospital group has been identified as a good performer in scheduled care. For instance, as reported in the waiting list figures published by the National Treatment Purchase Fund, NTPF, in the month of March, it was the hospital group with the lowest total number of patients waiting for an outpatient appointment.

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