Michael McGrath (Cork South Central, Fianna Fail)
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I thank the Ceann Comhairle for selecting this important matter for the Adjournment debate, which concerns waiting times for people wishing to see an orthopaedic consultant in the Cork area. Having researched the matter, it is not unique to Cork but appears to be particularly acute there. Before a person is added to a waiting list for orthopaedic surgery, he or she must see an orthopaedic consultant. That is where the bottleneck exists. The outpatient waiting list for those waiting to see an orthopaedic consultant is 3,356, according to the latest figures from the HSE for Cork University Hospital, CUH. Only 248 people were on the waiting list for orthopaedic surgery. Even a cursory analysis shows the bottleneck in the system is the outpatient appointment system. Looking closer at the figures, some 1,500 of the 3,356 people are waiting for at least 12 months. It is a very long time for someone in need of a hip operation or knee replacement surgery. Of those people, almost 350 are waiting to see an orthopaedic consultant for two years or more. This is a real problem in Cork that must be grappled with as an urgent priority. I am aware the problem exists elsewhere as well.

What is the root cause of the problem? Is it the lack of orthopaedic consultants in Cork? Do consultants spend too much time on private patients rather than public patients? Are they not complying in full with the new consultant contract? A constituent contacted me and told me he will almost certainly need a hip replacement. He has been told by the CUH that it will be at least two years before he sees an orthopaedic consultant. It is only at that point that he can join the waiting list for surgery. The National Treatment Purchase Fund cannot help him because it deals only with those on waiting lists for surgery for at least three months. While there is an outpatient initiative in place, it does not help those waiting to see an orthopaedic consultant in Cork this year. If he has money and is able to go to a private hospital and pay for the procedure, he can get it done quickly. Otherwise, he must wait at least two years before he sees a consultant and joins the waiting list for surgery. There is not equality of access in respect of treatment for that man or thousands like him. We must address the issue of orthopaedics urgently.

I ask the Minister to consider extending the role of the National Treatment Purchase Fund to take on outpatient cases. From my work on the Committee of Public Accounts, it is clear the quality of the outpatient waiting list data is very poor. When representatives of the National Treatment Purchase Fund appeared before the Committee of Public Accounts some months ago, they gave evidence that when they probed the data it was of poor quality. Many people on the outpatient waiting list data provided by the hospitals were deceased. Many had treatment carried out elsewhere and others did not need the treatment anymore. In many cases, the contact information was out of date. There must be a national audit of waiting lists and waiting list data must be validated. Waiting lists will not be as long if we establish the true picture in that regard.

A recent article in the Sunday Business Post stated we have a ratio of one orthopaedic surgeon for 54,000 people, the lowest ratio in western Europe. Many countries have a ratio of one surgeon to 15,000 people. There is an issue in CUH but also other areas of the country. It is not fair or reasonable to expect someone who urgently needs to see a consultant and subsequently needs to have surgery carried out to wait at least two years before going on the waiting list for surgery. I hope the Minister of State can shed some light on the situation and give people in Cork hope that they will not be waiting so long to see a consultant and gain access to the surgery they so badly need.

John Moloney (Laois-Offaly, Fianna Fail)
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I am replying this Adjournment matter on behalf of the Minister for Health and Children. The division of trauma and orthopaedics at CUH is responsible for providing trauma and elective orthopaedic services in Cork. Trauma services are delivered in CUH, while elective orthopaedic services are currently provided at St. Mary's Orthopaedic Hospital. Currently, there are five permanent consultant orthopaedic surgeons engaged in the trauma and elective service, with two locum consultants engaged in the trauma service only.

At present, just over 300 are people waiting for elective orthopaedic treatment in the CUH, the majority of whom are waiting for less than three months. The HSE estimates that 97% of elective orthopaedic cases are treated within six months. For most of the remaining patients, there are specific individual reasons why surgery has not been completed. The HSE indicates that approximately 3,500 people are on the waiting list for orthopaedic outpatient appointments in CUH. Work is in progress to validate the waiting list to establish whether all of the people concerned still require an appointment.

The HSE is working to reduce orthopaedic waiting lists and a recent initiative is the establishment of a physiotherapist-led assessment clinic to triage patients waiting longest to be seen. Evidence shows that many patients on outpatient waiting lists can have their needs addressed by a physiotherapist working in a team led by a consultant orthopaedic surgeon. The HSE is optimistic this initiative will result in an appreciable reduction in the number of patients still awaiting treatment and in the waiting period involved. The HSE is also making arrangements with the National Treatment Purchase Fund for orthopaedic outpatient appointments to be offered by the fund to approximately 400 people who have been waiting longest to be seen at the CUH.

The business plan of the HSE south for 2010 prioritises the reconfiguration of acute hospital services in the region. This plan involves the creation of a single acute hospital system across the region, to achieve the best possible health outcomes for the people of Cork and Kerry. As part of this process, the HSE will reorganise some services across the six acute hospitals in the region. While complex care will tend to be centralised, the roles of local hospitals in the areas of day surgery, diagnostics and outpatient care will be expanded.

In May 2010, the HSE announced its intention to relocate orthopaedic services, including elective inpatient, rehabilitation trauma and day surgery, from St. Mary's Orthopaedic Hospital to the South Infirmary Victoria University Hospital, Cork. This change, which is planned to take place in 2011, will result in all orthopaedic services being provided in an acute hospital setting, with related specialties, including rheumatology, on site. Patients from Cork, Kerry and the wider Munster area will benefit from improved treatment and surgery for conditions including spinal and skeletal injuries and deformities, in addition to rehabilitation for damaged joints and muscles. The redeveloped facility will have three dedicated orthopaedic theatres, compared to two in St. Mary's Orthopaedic Hospital. It is also intended, following the move, to recommence orthopaedic surgery for children, for which HSE south patients must currently attend Our Lady's Children's Hospital in Crumlin. Trauma and emergency orthopaedic surgery will continue to be delivered in CUH, as is the current practice.

The HSE is working to develop national quality and clinical care standards across a range of hospital services and specialties and to improve the performance of outpatient services generally. The measures I have outlined represent a structured approach to improving access to orthopaedic services in the Cork area and to the longer-term organisation of services in this key specialty on a safe and sustainable basis.