Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank Deputy Adams for his kind words on the referendum and I acknowledge the commitment of Sinn Féin, and especially Deputies O'Reilly and McDonald, on the issue.

I very much welcome the opportunity to address the House on this important issue. Reducing waiting times for patients is a key priority for me as the Minister for Health and for my Government colleagues.

I acknowledge that waiting times for hospital procedures and appointments are often unacceptably long. Many areas in our health service lack sufficient capacity to meet the ever-increasing demand for services and the needs of patients. The evidence of this can be seen not only in the waiting lists but also in my Department’s health service capacity review. Therefore, maximising the use of existing capacity in the short term and seeking to build new capacity through the national development plan is central to improving waiting times. I will outline the approach the Government is taking in this regard in the course of my address.

Increasing capacity alone will not position our system to provide the services and access that our citizens demand. The Irish health service is undergoing a major transformation. The Sláintecare report, and the cross-party support that it enjoys, presents a unique opportunity to embed long-lasting reform in our health system. It is against this background that the Government will not be opposing this motion. It is clear to me that all of the Deputies here today have the same objective in mind, which is to improve access for patients. I would like to approach this debate in the spirit of solutions, and I am here to listen and consider ideas from all Deputies for sustainable solutions to improve access for patients. I hope that, in that spirit, it is also possible to acknowledge some of the progress and to accept the factual context that our health service will treat 3.3 million patients as outpatients this year and deliver 1.7 million hospital operations or procedures outside of the additional work undertaken by the National Treatment Purchase Fund, NTPF.

The NTPF is responsible for collecting and validating all waiting lists for public hospitals. The most recently published NTPF figures for the end of May confirm that just under 78,600 patients are waiting for a hospital inpatient or day case procedure. In July 2017, the number of patients waiting for an inpatient or day case procedure stood at 86,100. This represents a fall of more than 7,500 patients, or almost 9%, in just ten months. The NTPF figures for the end of May this year also show that 56% of patients who are on the waiting list for a hospital operation or a day case procedure were waiting less than six months. In much of the coverage on waiting lists, one never gets the impression that 56% of patients wait less than six months for a hospital operation and 82% were waiting less than 12 months for their procedure. In the area of day case procedures, operations and procedures, we are making good progress as a result of the investment being made and we have much more to do in that regard. This progress in reducing the time patients are waiting for a hospital procedure is a result of the focus and investment by Government in this area. In budget 2018, for example, €50 million was provided to the NTPF to provide treatment for public patients this year, which more than doubled its 2017 total allocation.

I published the inpatient and day case action plan in April, which marked a very important milestone in delivering on the Government’s objective to tackle waiting lists. The action plan is a joint initiative between my Department, the NTPF and the HSE with the aim of reducing the overall number of patients waiting for treatment. One of the central goals set out in the action plan is that by the end of 2018, the number of patients waiting for treatment will fall below 70,000, down from that historic peak figure of 86,100 in July 2017, and that the number of patients waiting longer than nine months will also fall dramatically.

To the end of May the NTPF has organised treatment for almost 7,600 patients. The total number treated in 2017 through the NTPF was just over 6,600, so already this year we have treated more patients through the NTPF than were treated in the entirety of 2017.

There are seven high-volume procedures that are the focus of the action plan, specifically, cataracts, hip or knee replacements, tonsils, angiograms, cystoscopies, skin lesions and varicose veins. All patients who are waiting more than nine months and are clinically suitable for treatment in an outsourced facility will be offered treatment in 2018 for these seven high-volume procedures. I hear a lot from Members about waiting times for cataracts and hip and knee replacements. If a Member's constituent is waiting for longer than nine months for any of those seven high-volume procedures and he or she is clinically suitable to have the procedure carried out, then he or she will have it carried out by the end of the year. For patients who are waiting longest for other procedures, the NTPF and the HSE will work together to identify their requirements, develop treatment plans and, where possible, offer treatments from within existing HSE or NTPF resources.

The cancellations of elective treatment and the increase of emergency procedures arising from significant emergency department pressures have resulted in some difficulties in tackling waiting lists. In the action plan the NTPF has committed to provide 20,000 procedures for patients. This activity is being actively monitored by my Department.

The NTPF will provide all the treatment for patients in both public and private hospitals. This is an important point because it is not always about private hospitals and the NTPF is also investing resources in public hospitals. The NTPF has invited all hospital groups to develop proposals for its consideration to maximise the use of existing facilities. Through the University of Limerick hospital group, for example, a dedicated cataract theatre is being opened in Nenagh Hospital and the NTPF will fund treatment for patients in this new facility in 2018. I look forward to opening that facility in the coming weeks. In addition, my Department, the HSE and the NTPF recently met representatives from the Royal Victoria Eye and Ear Hospital, and we have asked them to put forward a new proposal for priority consideration. These are two practical examples of where we work with the public sector to invest in more capacity.

While positive results have been witnessed through the work of the inpatient day case action plan, and while we are making progress in reducing the numbers of patients on the lists and in reducing the length of time people wait for a hospital operation or procedure, I acknowledge that the outpatient waiting list remains a significant challenge, with 511,000 people waiting for an outpatient appointment. This figure, however, needs to be seen in the context of the 3.3 million patients attending hospital outpatient clinics for appointments every year. It is important to say that more than 70% wait less than 12 months, 60% wait less than nine months and just under half wait less than six months. Sometimes in this House we get the impression from some Members that everybody waits for 18 months or two years on the waiting lists. It is unacceptable for anybody to wait that length of time but the statistics do not back up the idea that this is the norm. We see that a majority of patients are being treated in less than nine months. This does not in any way down play the very serious situation for those people who are waiting too long, which we are determined address. We have made progress with inpatient and day case procedures and we have worked with Opposition parties to re-establish the NTPF to do work on this. We now need to apply the same level of focus to our outpatient waiting lists. This is why I have asked the HSE and the NTPF to develop and outpatient waiting list plan, to provide the same degree of targeted focus to the lists.

In 2017 some 477,000 outpatients did not attend their appointment. This shows the importance of validating hospital waiting lists, given there are 477,000 missed outpatient appointments. Deputy Mitchell raised this issue, and I have had a private word with the Deputy. I will take the details of that case. It shows the importance of having accurate lists when 477,000 people last year were offered outpatient appointments and did not take up the appointments. This week I approved the establishment of a central validation office in the National Treatment Purchase Fund to centralise the validation of all waiting lists across the HSE. Our citizens deserve to have accurate lists so we can target the resources to where they are most needed and so we do not have almost half a million outpatient appointment slots missed each and every year.

I note and share the concern expressed in the motion about the monitoring of private practice in public hospitals. Under the consultant settlement agreement, all parties acknowledge that they are committed to providing a high-quality public health service and recognise that the consultant contract is fundamental to that provision. A central concern of mine and of this Government is the monitoring of the private practices in public hospitals, and my Department and the HSE have recently agreed a robust framework at national and local level to ensure compliance. I heard some stereotypes and labels thrown at me, at Fine Gael and at the Government. It might be useful politics to try to label one's opponents, but let me be very clear that I want to see the ending of private practice in public hospitals. This is why I have signed up to the commitment in Sláintecare and why I have established the Donal de Buitléir working group, which is under way. I hope that all other parties will make their views clear on this issue also. I want to see private practice removed from public hospitals, but done in an organised, intelligent and logical way as envisaged in the Sláintecare report.

I turn now to Sláintecare. It presents the opportunity to reform our health service and the implementation of this report is central to the development of sustainable solutions to reduce waiting lists significantly. In the 12 months since the publication of the Sláintecare report, the Government has taken significant steps to commence the programme of reform, including a commitment to the establishment of a Sláintecare programme office, the establishment of an independent review group to consider how best to remove private practice from public hospitals, and the completion of a consultation on the geographical alignment of hospital groups and community healthcare organisations.

The development of an integrated waiting list solution tailored specifically to meet the needs of our complex health system is being considered as part of this major reform programme. I fully support the view that there is a need for a more integrated approach to waiting list management at hospital group level. At my request, the NTPF has examined the feasibility of progressing to an integrated system. The report which includes a review of models used in jurisdictions such as Portugal is being considered by my Department.

The national development plan provides for a major increase in capacity across the health system. It is an exciting development that we can build three new dedicated elective-only hospitals to drive down waiting lists - one in Dublin, one in Galway and one in Cork. When the same was done in Scotland, waiting lists were reduced dramatically. We now have the funding to develop the three hospitals. They will not have emergency departments to provide emergency care; rather, they will just drive down waiting lists. This was a key Sláintecare recommendation, for which I have received full funding under the recent development plan.

I welcome this debate. I am committed to working collaboratively with all Deputies to find solutions. We can report some progress on the issue of hospital operations and procedures, as shown by the independent figures from the NTPF. However, we still have a large amount of work to do, particularly in outpatient services and ensuring we have accurate lists in order that 500,000 patients will not take up outpatient slots, which indicates a difficulty with the waiting lists. We must work together to increase capacity.

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