Dan Neville (Limerick West, Fine Gael)
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Question 15: To ask the Minister for Health and Children her views on the fact that more than 46,000 patients are on hospital waiting lists here; if she will provide a breakdown of the numbers of patients on waiting lists per hospital; and if she will make a statement on the matter. [34759/10]

Brian O'Shea (Waterford, Labour)
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Question 17: To ask the Minister for Health and Children the current numbers treated under the National Treatment Purchase Fund between 2009 and 2010; the cost to date spent on administering this fund; and if she will make a statement on the matter. [34685/10]

Mary Harney (Dublin Mid West, Independent)
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I propose to take Questions Nos. 15 and 17 together.

Since its establishment in 2002, the National Treatment Purchase Fund has provided over 200,000 public patients with inpatient treatment, diagnostic procedures and outpatient appointments. The median waiting time for medical and surgical patients is now 2.6 months. This is a very significant reduction from an average of between two and five years when the fund was established in 2002. The cumulative amount allocated to the fund from 2002 to 2010 is almost €598 million. Of this amount, €30.7 million has been allocated to costs related to administration of the fund. This is approximately 5% of the NTPF's total funding in that period.

In 2009, the NTPF facilitated almost 29,000 patients - 20,000 for elective surgery, 2,500 MRIs and 6,400 outpatient appointment - at a cost of €90 million, including administrative costs of €4 million. The fund's allocation for 2010 is €90.092 million. The activity targets agreed involve facilitating 31,000 patients, consisting of 20,000 inpatients, providing 3,000 MRIs and 8,000 outpatient appointments. The NTPF anticipates meeting these targets. I have emphasised to the fund the need for maximum cost-effectiveness, consistent with safe and effective care. I have asked it to seek even better value from private hospitals and the fund has successfully negotiated price reductions for certain high-volume procedures. In addition, it will not purchase services where the price is not acceptable.

The NTPF is responsible for the collation and reporting of national waiting list data and patients are placed on the national list only after they have been waiting three months. This is because many people receive their treatment within three months and, in some cases, with little or no waiting. It is not appropriate to classify these patients as "awaiting treatment" in the same way as those who have been waiting for several months. It is not, therefore, correct to conclude that there are over 46,000 patients on waiting lists.

The most recent figures relate to September 2010 and indicate that the number of patients waiting for over three months was 19,865. I would emphasise that it is more relevant to measure waiting times rather than the numbers of patients involved and, as I have already indicated, significant progress has been made in recent years in reducing average waiting times. There remains a relatively small number of patients who have been waiting for longer than 12 months for treatment and I have emphasised to both the HSE and the NTPF that they must continue to work together to ensure that these patients are afforded treatment without further delay. The detailed data on individual hospitals requested by the Deputy will be circulated in the Official Report.

James Reilly (Dublin North, Fine Gael)
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It may be all well in the Minister's mind to say that we will only talk about those waiting more than three months, but the reality is that there are 46,000 people waiting for treatment. The NTPF figures are extremely misleading because they do not include those people waiting up to three months. Many people are now finding that they are not getting onto the NTPF waiting list until they have been waiting six months.

How many people are believed to be on outpatient waiting lists? Does the Minister have any system to measure the number of patients and the length of time from the day a patient is referred from primary care to a hospital? Following our discussion on what happened at Tallaght, surely this is an issue of serious concern.

Mary Harney (Dublin Mid West, Independent)
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We never measured the lists in that manner, so we must compare like with like. When the NTPF was established a few years ago, there were over 30,000 people waiting over three months and now that list is below 20,000.

Clinical leads have recently been appointed by Dr. White to devise appropriate clinical pathways for patients, particularly in respect of access to appropriate outpatient appointments. Many of these patients end up being admitted to hospital through accident and emergency more ill than they otherwise might be, due to delays or inappropriate referrals. A great deal of work - I understand the Deputy has been briefed on many of these initiatives - has been under way in the HSE over recent months. Some highly respected clinical leaders have been appointed and they are making substantial progress. I expect to see the fruits of their new work early next year in regard to waiting times for outpatient and other appointments.

Jan O'Sullivan (Limerick East, Labour)
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I, too, would like to refer back to the previous question in the context of this one because that is what I meant when I said it was a policy issue in regard to the GP referral letters. As the Minister said, pathways of care are crucial to ensure we have proper relationships between the primary care system and the acute hospitals.

I would like to know when we will get information, and I do not believe the Minister answered that in response to Deputy Reilly's question. I gather it is planned to have information on the number of people with referrals from GPs and who await outpatient appointments. From my experience, more people are waiting a very long time before they even get to the outpatient department and on to the waiting lists. Will the Minister clarify when that information will be made available?

My second question relates to orthopaedics, which would be one of the large specialties in the work of the National Treatment Purchase Fund. Orthopaedic beds and orthopaedic theatres in a number of hospitals, in particular in the western area, are being closed. As a result, highly specialised orthopaedic surgeons cannot do the full quantum of work they used to be able to do. Will the Minister examine this in the context of value for money and the fact that many patients are going on to longer waiting lists and to the National Treatment Purchase Fund list? Public hospitals cannot do the work because beds and theatres are being closed and people are being sent to private hospitals, in some cases far from their homes, to have the work done.

Mary Harney (Dublin Mid West, Independent)
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For next year, we are examining the strong possibility of procuring, for example, orthopaedics from the hospitals because there is a substantial variation between the cost of procedures from one hospital to another.

Jan O'Sullivan (Limerick East, Labour)
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Is that from public hospitals?

Mary Harney (Dublin Mid West, Independent)
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Yes. In other words, we will ring-fence the money for orthopaedics, because it is very measurable, and procure that service based on value for money. Clearly, there is a substantial variation throughout the country in the context of what one can receive for a specific amount of money. That is evident from the case mix. The money taxpayers make available must be used as productively as possible. I am having discussions with the National Treatment Purchase Fund and the HSE on the procurement of that service for 2011. As Deputy Jan O'Sullivan acknowledged, the resource group recommended that we would move in this direction in the future and it might be good to start along this road during 2011 in order that we are clear what we can get and that we can make appropriate use of our public capacity.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister may or may not be aware that the number of patients on trolleys and chairs in hospitals today is 420. That figure was only 290 on the same date in 2005 when she committed to doing away with it entirely. Between August 2009 and August 2010 there has been an increase of 1,000 in the number of patients waiting more than three months for inpatient and day care treatments. Over the same period, there has been an increase of 5,000 patients waiting for up to three months for similar procedures. These statistics are shocking but they translate into real people.

How do I deal with a parent whose young child has constant issues in regard to a tonsillectomy which she has been told is not likely be performed for up to four years? That is the situation with which we are dealing. That is the advice being given by hospital sites to patients presenting today. It is not acceptable.

Damien English (Meath West, Fine Gael)
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There are hundreds of people on the waiting lists for elective surgery in Our Lady's Hospital, Navan. They now have to go into the system. Where will they get their operations? Will that not add to the Minister's woes and increase these waiting lists? There is, effectively, a full surgical unit which could operate on people but cannot do so because it has been closed. The waiting lists will increase and people will be left waiting. We are talking about hundreds of people.

Mary Harney (Dublin Mid West, Independent)
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All hospitals, including Our Lady's Hospital, Navan, and all regions of the HSE must live within their budgets. No additional money can be made available. There is much scope within hospitals for greater efficiency. University College Hospital, Galway is in the news currently. It has an absentee rate of 7%.

Mary Harney (Dublin Mid West, Independent)
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I am telling Deputies the measures hospitals must take and we are working to ensure they take them. The Croke Park agreement has a crucial role to play in this regard. University College Hospital, Galway loses 25,500 hours per month through absenteeism. It is being asked to reduce it by 28,000 hours per month. All the problem does not rest with the HSE nationally or with the Department. There must be a greater emphasis on efficiency and effectiveness in each hospital to reduce absenteeism rates.

In response to Deputy Ó Caoláin, there is no suggestion that anyone would have to wait four years for that procedure. The National Treatment Purchase Fund is there in the event of a person having to wait three months. If it is an emergency procedure, it will be done immediately.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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That is not what the hospitals are saying.

Mary Harney (Dublin Mid West, Independent)
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Will Deputy Ó Caoláin please give me the details? When I look for the details, I never get them.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I always give them.