Liam Twomey (Wexford, Fine Gael)
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Question 130: To ask the Tánaiste and Minister for Health and Children her plans to prevent the cancellation of elective operations and procedures; and if she will make a statement on the matter. [3279/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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It is regrettable that some patients have their operations postponed and I recognise that this can cause inconvenience and stress for them and their families. Every effort continues to be made by the HSE and hospitals to keep cancellations to a minimum. However, due to fluctuating demands on the acute hospital system, in some instances it is necessary to reschedule planned treatment, particularly when priority has to be given to emergency cases.

The Government has pursued a number of policy initiatives to increase throughput of the acute hospital system by way of improved infrastructure, providing additional acute beds, increasing the amount of day surgery, increasing the number of consultants and providing more step-down accommodation and home-care packages. For example, the number of patients treated on a day-case basis has doubled between 1997 and 2004. The number of approved consultant posts increased by 56%. The National Treatment Purchase Fund has also been successful in facilitating treatments for patients in private hospitals, here and abroad. To date more than 38,000 patients have had treatment arranged for them by the National Treatment Purchase Fund and waiting times for elective surgery have fallen significantly. It is now the case that, in general, anyone waiting more than three months for surgery will be facilitated by the National Treatment Purchase Fund.

As Deputy Twomey is aware, the Health Service Executive, through the National Hospitals Office, has lead responsibility to manage and deliver the services provided in acute hospitals. The Department of Health and Children will continue to work closely with the HSE in monitoring the delivery of acute hospital services to ensure that the postponement of elective operations and procedures is kept to a minimum.

Liam Twomey (Wexford, Fine Gael)
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Even today a great number of patients are having neurosurgical, cardiothoracic, orthopaedic and other major operations cancelled. Basic diagnostic procedures, such as colonoscopies for bowel cancer, are being cancelled on an all too regular basis. A report was published in the Sunday Independent on 22 January 2005 which highlighted seven faulty work practices within our hospitals. I am sure the Minister has seen the report. Why did none of these deficiencies in work practices turn up before the benchmarking process was implemented? Why were benchmarking payments awarded to all the professionals in the health service when the seven work-related issues we read about in the report, and which are obviously widely publicised, were not addressed? The Minister will have seen references to them. They have been known to every Member for at least ten years and many of them have been commented on in this House for a number of years.

When commenting on the work practices referred to in the report, the Minister used some very strong language. She was very critical and used phrases including "indefensible" and "highly inefficient". In light of this, why was nothing done about the work practices during the course of the past several years, during which period they were well known? Why did they not turn up when the benchmarking process was being considered? We expect the Minister to give us the answers because, apparently, all the background details on benchmarking have been destroyed and we will therefore not be able to find answers in the records.

Mary Harney (Dublin Mid West, Progressive Democrats)
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It is always unacceptable when somebody has elective surgery cancelled. To put the matter in perspective, the percentage of cancellations is between 2% and 3% per annum, although that is still too many. I was reading that in the United Kingdom 15% of elective work is done by the private sector for these kinds of reasons.

The HSE recently commissioned process mapping exercises of ten of our acute hospitals to examine their practices throughout the hospital. Those exercises are now to hand, I have had an opportunity to read them and they will be published shortly. They form the basis for the HSE's allocation of funds to those hospitals during this year.

The recommendations will require major internal reform of how hospitals operate. For example, in the Cork area the time a patient spends in hospital is on average one day shorter for every procedure than for the Dublin area — I do not know why this should be the case. Much of the difficulty clearly has to do with pressure, although I do not want to take from the fact that there are many pressure areas, such as issues concerning older patients and the speed at which they can be accommodated in more suitable accommodation when doctors medically discharge them. Issues also arise with regard to work practices, discharge policies, length of stay and so on. These matters form the main basis of the reform now underway, which, in particular, will this year take the route of the funding allocations.

I do not have information on the benchmarking exercise. I do not think it went into the kind of detail to which the Deputy refers, which was one of the flaws of the exercise.

Liam Twomey (Wexford, Fine Gael)
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Some €1 billion of taxpayers' money was invested in professionals working in the health services and benchmarking. Now it seems the Tánaiste is seeking to scapegoat many of those working in the health services with this sort of fast-tracking and some of the information coming out of it, some of which is ancient news. I am surprised the Tánaiste never tried to do anything about this in the past.

Mary Harney (Dublin Mid West, Progressive Democrats)
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These difficulties do not arise in the private system which, to be fair, does not deal with trauma and accident and emergency cases, which cause many of the difficulties in the public system. I acknowledge that the health care system is experiencing a major shortage of consultants, which is why it is extremely important to get a new contract of employment that suits the public health care system in particular. That would greatly add to the system. For example, currently only a consultant can discharge a patient. We are too heavily dependent on junior hospital doctors, of which there are 4,000 whereas there are 2,000 consultants. We need to reverse that balance, which would greatly help, particularly in the discharge area. Instead of services being led by consultants, they would be delivered by them. That process proves highly successful in other countries and I have no doubt it will do so here also.