Ciarán Lynch (Cork South Central, Labour)
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There is a backlog of 4,478 orthopaedic outpatients on the waiting list at Cork University Hospital who have been waiting two years or longer. The patient longest on the list has been on it for three and a half years. Each week an average of 100 new patients are referred to the hospital. The average waiting time for what is described as a "routine" patient is 24 months. A routine patient is likely to be an elderly person who will suffer "routine" pain every single day of the two years he or she is waiting to be examined. During this time, pain management often has to be administered by the local general practitioner while the person awaits that initial appointment with the consultant. As a result, the quality of life for this person is greatly diminished while he or she is waiting for the procedure.

For administration purposes, pain may be described as "routine" but it is far from routine when examined in real human terms. Only this week on TV3, we saw an example of a woman on this waiting list, who, rather than go through the daily grind of dealing with the pain, went to her local credit union, borrowed €5,000 and got on an aeroplane to Poland to have her procedure carried out. To take another example, a 72 year old patient came to me last year who was also classed as a "routine" patient. He was advised that an urgent MRI scan was needed but that it could not be carried out until a hip examination had been completed. This makes no sense. Furthermore, patients classified as urgent wait an average of 18 months for an appointment at CUH. It is hard to conceive how a patient classed as "urgent" by a consultant can be expected to go on a waiting list for so long.

The national outpatient department, OPD, project has been established to improve the delivery of OPD services and I commend the medical staff who are making every effort to reduce the backlog. Nonetheless, waiting times are increasing. Comparisons must be made with the private sector where it is commonplace for a patient to be treated for hip replacement in about eight to ten weeks. That suggests there is a major organisational difficulty at the heart of the problem and this was seen to be the case for a great number of years before the creation of the national treatment purchase fund, NTPF. In CUH we saw that patients were seen within three or four months. They may have been waiting two years for a procedure but were seen within that short period. Since the NTPF was put in place those patients must now wait for two years before they can get a first appointment. If they are not treated by that time they are then seen within the NTPF. There is something very worrying going on in Cork University Hospital and this has been the case for several years at an administration level. This must be sorted out. Cork University Hospital has made improvements in processing other areas of outpatient treatment. The same skills must be employed to improve orthopaedic services in the Cork region.

I share the Minister's objective of renewing the health service as set out in the programme for Government but 4,478 mainly elderly patients must not be expected to suffer in silence during this period of renewal. I ask him to make these patients his priority.

Ciarán Cannon (Galway East, Fine Gael)
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I will take this matter on behalf of my colleague, the Minister for Health, Deputy James Reilly.

This Government finds the situation of waiting lists for orthopaedic services totally unacceptable. Patients need a service that is timely and effective. Statistics such as those given by the Deputy prompted the Minister to establish the special delivery unit as a priority. The SDU will focus in particular on those waiting for consultant appointments, as the Minister views the consultant appointment key to diagnosis and treatment of a patient.

Reducing waiting times for outpatient departments is a priority for 2011, especially in specialties, including orthopaedics, that have the highest waiting times and numbers. There are a number of encouraging initiatives under way to alleviate this problem, in addition to the SDU. In HSE South, these include: additional staffing; a physiotherapy initiative; validation of waiting lists; improved management of OPD processes, including reducing missed appointments; and increasing the numbers of new patients seen at clinics.

In HSE South, there are five permanent consultant orthopaedic surgeons in post in the trauma and elective service, with two locum consultants in the trauma service. There are currently 100 referrals per week. This has increased over the past 12 months, with two new permanent consultants providing revision surgery. HSE South has approval for three consultant orthopaedic surgeon posts at Cork University Hospital and South Infirmary Victoria University Hospital, namely, two new posts for orthopaedic surgeons with a special interest in paediatric orthopaedic surgery and one replacement post of orthopaedic general surgeon. Recruitment has been completed and it is anticipated that formal letters of appointment will issue soon.

Physiotherapist-led clinics were introduced in 2010 to address the waiting list for OPD appointments. The physiotherapists triage patients based on those waiting longest, patients primarily from the hip and knee lists. Some 35% of the patients seen at these clinics were referred to an orthopaedic consultant for surgical review. A review of this initiative has been completed, to continue to improve patient flows.

Approval for three additional physiotherapists under the outpatient programme for rheumatology and orthopaedics has been sanctioned. These posts will allow for more musculoskeletal physiotherapy led clinics. The recruitment process has begun.

At national level, an outpatients department performance improvement group has been established to improve OPD Services throughout the country. The project aims to address the significant numbers on waiting lists for some specialties and will standardise all aspects of OPD, including waiting lists validation, management of those who do not attend, DNAs, improvement in new to return ratios and improved triaging. Cork University Hospital and South Infirmary Victoria University Hospital have been selected to participate in the initial phase of this project. Cork University Hospital is undertaking a validation exercise on its OPD waiting lists. This exercise will link with the national OPD programme on the validation protocol, particularly for the clinical governance process for removing patients from waiting lists and for GP involvement in the process. It is expected that this exercise will reduce the numbers on the waiting list.

Under the reorganisation of acute hospital services in counties Cork and Kerry, electronic GP referral to acute hospitals is being piloted. This will enable more efficient processing of referrals and allow patients and GPs to see waiting times for individual consultants.

The implementation of these initiatives will greatly improve waiting list numbers. The Minister and his officials will closely monitor the situation to ensure that these statistics become a thing of the past.