Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I raise this issue on foot of the grave disquiet earlier in the year when the "Prime Time" programme, "Living on the List" unearthed the fact that the information on which we depend to know about the varying degrees of lists, the number of people on them and for how long they are waiting is not always collated correctly, efficiently or accurately. I have always said that we are especially good at waiting lists. We have 685,000 people on some list or other in our health services. This cohort is from one half of the population, as the other half has private health insurance. In effect, it is 685,000 people out of approximately 2.3 million or 2.4 million people who depend on the public health system. Clearly, there is a huge difficulty in dealing with patients on waiting lists in a timely, effective and clinically sound manner. On top of that, we are not collating the information correctly.

On foot of the "Prime Time Investigates" programme, the National Treatment Purchase Fund was requested to audit waiting lists and come up with recommendations. The key findings of the audit were exceptional and extraordinary. The hospitals audited did not comply with national protocols on date capture. The audit team found evidence of a combination of non-compliance and inconsistent practices in how date captures were being recorded across all hospitals for outpatient, inpatient, day-case and planned procedure pathways. In some cases, the audit team found evidence of long delays in wait-listing patients, as well as retrospective wait-listing of patients. As a consequence, there were implications for overall waiting list management, including incomplete tracking of patient journeys and incorrect waiting times. All of this resulted in inaccurate reporting of patient waiting times at local and national level.

The audit team observed a number of patients across all hospitals who had been directly listed on an inpatient or day-case waiting lists. The findings are extraordinary in view of the fact that we at least assumed the information we were getting in the Dáil was always accurate as to the number of people on waiting lists and how long they were waiting. It was also assumed that information as to when they were transferred from one consultant to another was accurate. Interestingly, the audit team found evidence that direct listed patients were either referred to the listing consultant by another hospital consultant or community physician, for example a community ophthalmologist, or seen by the listing consultant in another hospital. The audit team observed variation in the management of referrals to ophthalmology services, in particular for cataract surgery.

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"Some referrals from community ophthalmologists were accepted onto an inpatient and day case waiting list, by-passing the outpatient service, whilst other patients referred from community ophthalmologists were placed on an outpatient waiting list to be seen prior to listing for their surgery." In that case it was wholly inaccurate:

The Audit Team found evidence of significant variance in the 'date placed on waiting list' as a result of the length of time between receipt of referral and the clinical decision to 'direct' list patients for cardiology and ophthalmology. As a result, there were inconsistencies in how patient wait times were recorded.

This is highlighting the problems. We need to ensure that the recommendations of the audit and quality assurance report presented to the Minister at the end of September, and carried out on behalf of the National Treatment Purchase Fund, NTPF, are implemented and that we can now depend on wholly accurate information when we raise these issues in the Dáil.

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