Liam Twomey (Wexford, Fine Gael)
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Question 1: To ask the Tánaiste and Minister for Health and Children if the national treatment purchase fund is in a position to take responsibility for outpatients department waiting lists for individual hospitals to streamline access to secondary care for patients in primary care. [4415/05]

Mary Harney (Dublin Mid West, Progressive Democrats)
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In accordance with the health strategy, the immediate focus has been on the reduction of waiting lists and waiting times for inpatient and day-case treatments in acute hospitals.

The national treatment purchase fund has been successful in arranging treatments for 23,379 patients to the end of 2004. The allocation to the fund for 2005 is €64 million, which represents an increase on the allocation of €44 million for 2004. The NTPF is expected to arrange treatment for a further 16,000 patients in 2005. It is now the case that, in most instances, any public patient waiting more than three months will be facilitated by the fund.

While our immediate focus has been on reducing waiting lists for admission to hospital for treatment, I am obviously very concerned about the long waiting times being reported in respect of obtaining outpatient appointments in certain specialties. There appear to be difficulties in particular areas and the problem also appears to be spread throughout the country. The management of outpatient waiting lists requires the attention of both the newly established Health Service Executive and the NTPF. At a recent meeting with the NTPF, I raised the question of the fund playing a part in expediting outpatient appointments. The NTPF is examining its position with a view to further assessing the needs of patients on waiting lists and the most appropriate clinical pathways and protocols required for their care. Details regarding this exercise are being finalised by the fund and I expect to receive them shortly.

Liam Twomey (Wexford, Fine Gael)
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The circumstances that obtain when trying to see a consultant are a mess. Is there any role for the NTPF in reducing the size of waiting lists? Could it take letters of referral from GPs and give patients a realistic idea as to when they will be seen by a consultant? There is a number of problems in this area. Sometimes when one refers patients to orthopaedic or ENT units in the south east, one does not get a letter back stating when those patients will be seen, at least not until two or three months before their appointments are due. This, however, could be two or three years after the original letter is sent. This is totally unsatisfactory to patients and the GPs who are trying to manage them in a proper way.

If we believe GPs are the gatekeepers of the acute hospital sector, which is slowly crumbling in front of us, we should give patients a realistic time at which they can be seen by a consultant and inform their GPs accordingly. The NTPF seems to be in a position to take over this role and look after the list for the whole country, possibly for all 37 acute hospitals. Perhaps there is no need for each hospital to have an outpatients' appointments administrative centre.

The validation of the current lists represents an annoyance and a hindrance and consequently care is not being given to patients when they need it. The waiting list trends are published every year in the media but the patients are not being seen any sooner. I would like to hear a radical proposal from the Tánaiste so patients will know when they will be seen. It is quite strange that in some other jurisdictions, the populations of which believe they have a good health care system, patients often wait no more than 12 weeks for an operation after the sending of the original letter of referral by their GPs. In Ireland, patients often have to wait 12 weeks just to get on to the waiting list. We are falling way behind.

I know the Minister has to deal with the crisis in accident and emergency units.

Séamus Pattison (Carlow-Kilkenny, Labour)
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The Deputy is making a long statement. This is Question Time.

Liam Twomey (Wexford, Fine Gael)
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Will the Tánaiste answer some of my questions?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I largely share Deputy Twomey's perspective. The NTPF was established as a universal insurer for those waiting a long time for appointments. The idea was that the fund would have a very focused, targeted approach to using private capacity that exists within or outside the State to deal with those badly in need of surgical procedures. It has worked extraordinarily well.

Awareness of the fund needs to be increased. Almost every week in my office, I deal with five or six cases concerning people entitled to use the fund but who have not been told about it. Later this month and in early March, the NTPF will engage in an extensive advertising campaign to ensure patients know they are entitled to obtain the treatment they require through the fund. The NTPF suggested that we have a patient register so the power would be with the patient and so the patient would be given details on the time of his or her outpatient appointment. The idea was that the patient could make direct contact himself or herself. The NTPF also felt the waiting lists were very inaccurate and that there was considerable duplication.

Given the long waiting times associated with some specialties, I must examine the issue of outpatient appointments. We need to increase substantially the number of consultant posts. We have approximately 1,940 consultants at present but we need to have 3,600. This is why it is so important that we negotiate with the hospital consultants regarding a new, more modern and flexible contract for consultants. Patients have to wait for so long because we obviously do not have enough consultants. In light of this, I have asked the NTPF to make proposals on how it could deal with patients who are waiting longest for outpatient appointments. The Deputy is correct that some have to wait for incredibly long periods. If there is capacity in the State to deal with these patients in a different way while we await the appointment of more consultants, it should be used.

Liam Twomey (Wexford, Fine Gael)
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Is the Minister saying we can tell patients that if they have seen a consultant, they will have to wait no more than three months from that date before they can approach the NTPF?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Yes.

Liam Twomey (Wexford, Fine Gael)
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What does the Minister feel about the fact that some hospitals are asking patients to attend accident and emergency units because they know they will not be seen in a respectable time?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy is correct in what he is implying. Not only doctors say that. Sometimes going to an accident and emergency unit is the only way people can get to see a consultant. However, it is adding to the pressure on these units. Every day, 3,300 people present at accident and emergency units. Accident and emergency units are supposed to deal only with accidents and emergencies. We do not have 3,300 accident and emergency cases per day but, due to the lack of out-of-hours GP services in many areas and the failure to secure outpatients' appointments, people are using accident and emergency units. It is important, therefore, that we use the fund when we can without detracting from its focused nature and that we increase the number of consultant appointments, particularly but not exclusively outside Dublin. Some regions have no rheumatologist or plastic surgeon and only one specialist in areas of considerable activity. Nobody can provide a service on that basis.