Mary Upton (Dublin South Central, Labour)
Link to this: Individually | In context

I thank the Ceann Comhairle for the opportunity to raise this matter. A number of constituents have contacted me about the unacceptable waiting times to get an appointment for assessment at St. James's Hospital following diagnosis of arthritis by their GPs. In one case, my constituent was given an appointment for 12 months later following referral by her GP. This lady waited for a few months in some considerable pain and then decided, at significant personal financial hardship, to get a private assessment in a different hospital.

Arising from the information provided by this lady and a number of others, I made inquiries with St. James's Hospital to establish the average waiting times and the number of patients awaiting assessment and treatment. There are approximately 500 patients on the waiting list. I understand the average waiting time for assessment is 15 to 18 months following referral by a GP. If the case is defined as urgent, it can take as long as four months to be seen by a consultant, unless the patient is admitted as an emergency case.

From my constituent's perspective, living in pain for 12 to 18 months was the immediate concern. However, what might not be obvious to her or other people suffering from arthritis is that many long-term effects are associated with delayed treatment. These include irreversible joint damage and internal organ damage. It is estimated that a delay in providing treatment for inflammatory arthritis can reduce life expectancy by ten years. Many related medical problems, including heart disease, osteoporosis and increased susceptibility to infections and cancer may also develop as a consequence of delayed treatment. Early diagnosis, assessment and treatment indicate a more positive outcome for patients.

What plans are in place to reduce waiting times for these patients? What resources will be provided to St. James's to allow waiting lists to be addressed and patients to be seen within a reasonable timeframe?

Preventative medicine is the Cinderella of the health service. Early intervention would make a huge difference to the quality of life of my constituent. In the case of the other 500 patients on the waiting list, it would also result in long-term savings to the State if the consequential illnesses were prevented. This debate is about quality of life, the avoidance of unnecessary pain and the right to access medical treatment when recommended by a GP. It is about life expectancy and the avoidance of other complications setting in later in life. It is also about wise investment and management of resources so that prevention becomes the priority.

We all know people suffering from arthritis. While it may not have a high profile medically because it is not seen as life threatening, the hidden consequences should give food for thought. I ask the Minister to put in place the personnel, services and facilities to reduce the suffering of the patients I have mentioned.

I visited St. James's Hospital because of the concerns raised by my constituent. I found the staff with responsibility for the care and management of patients with arthritis are doing their best to accommodate as many patients as possible in conditions that leave much to be desired. I urge the Minister to undertake to review the provision of facilities and staff resources for the delivery of arthritis related services. It is not good enough that up to 500 patients are left waiting and in pain for a service that could easily be enhanced and upgraded for a relatively modest investment.

Tim O'Malley (Limerick East, Progressive Democrats)
Link to this: Individually | In context

I thank Deputy Upton for raising this matter. I am responding to this on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

Operational responsibility for the management and delivery of health and personal social services is assigned to the Health Service Executive under the Health Act 2004, and funding for all health services has been provided as part of its overall Vote. The former Comhairle na nOspidéal undertook a review of rheumatology services and published its report in 2005. The report recommends the creation of additional consultant posts in rheumatology and recognises the need for the appropriate allied health professional staff, including physiotherapists, to work alongside consultants in a multidisciplinary team approach. Responsibility for the implementation of the report rests with the Health Service Executive.

The executive has advised that it established a working group on arthritis and related conditions earlier this year. The group reflects the range of stakeholder interests in this area including consultant medical, specialist nursing, GP and patient input. The group will undertake a comprehensive needs assessment, propose a model of care and make recommendations for the development and reconfiguration of services across the full spectrum of care. The HSE has also identified chronic disease management as a priority and arthritis is included within this category. To address chronic diseases, the HSE has this year established an innovative self-care management programme and hopes to develop this further in future years.

As the Deputy will be aware, the National Treatment Purchase Fund was established in 2002 to deal with those public patients who are longest on public hospital waiting lists. To date, more than 50,000 inpatients have been treated under this initiative. Happily, we are now at a stage where most public patients who have been waiting more than three months on a public hospital waiting list for a surgical procedure can access the NTPF.

The main referral pathway for arthritis sufferers is via a general practitioner to either an orthopaedic or a rheumatology outpatient clinic for assessment. At the Minister's request, the NTPF expanded its activity in 2006 to include working with public hospitals on outpatient waiting lists. The fund also undertook an outpatient initiative on a pilot basis on the rheumatology outpatient waiting lists in Galway and a further pilot is being undertaken in Dublin with St. James's Hospital.