Joe Higgins (Dublin West, Socialist Party)
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I thank the Ceann Comhairle for selecting this vital issue for discussion. Some days ago we heard the shocking revelation that the number of people waiting longer than three months for a colonoscopy has more than doubled in the past year. Colonoscopies are used in the early detection of bowel cancer and are therefore a crucial life-saving measure. It is shocking that the waiting list now stands at more than 2,400, according to the National Treatment Purchase Fund. The Irish Cancer Society has stated that more people than ever before are now waiting longer than three months for this crucial test, with an additional 1,400 joining the list in the past year. Beaumont Hospital in Dublin has the largest waiting list at 662.

The waiting list at St. Luke's General Hospital in Kilkenny is also very large. This should strike a particular chord because it was there that a young mother, Susie Long's, diagnosis of bowel cancer was delayed by a catastrophic seven months in 2005 to 2006, which cost her life and deprived her family of a devoted partner and mother. She died because she was on a public waiting list. Had she been wealthy or covered by private health insurance, it is most likely this tragedy would have been averted. The then Minister for Health admitted that the health service nationally had failed Susie Long and many others in her position.

Five years later, it is shameful in the extreme that waiting lists are lengthening. It is little wonder that Conor MacLiam, husband of Susie Long, has expressed his anger that after the tragedy he and his family endured, a situation could continue where other people might suffer the same fate. That is a betrayal of the serious, solemn promise made following Susie Long's death that nobody would have to wait longer than a month for a colonoscopy. No doubt the waiting times have been badly affected by the savage cuts in hospital funding being ruthlessly implemented by the HSE. For example, Blanchardstown hospital, which has a long list, has endured a savage reduction of 19% in its funding in the last two years. Colleagues and I have received correspondence from 23 doctors there describing the catastrophe this is causing.

These life-threatening cuts are being made while the Government continues to spend tens of billions of taxpayers' funds to salvage the European financial institutions and Irish speculators who gambled recklessly in Irish property. The EU-IMF-ECB strictures on austerity are placing people's lives under threat. The HSE claims that almost all patients who require colonoscopies and who are deemed urgent cases are tested within 28 days. This is disingenuous and highly misleading. The Irish Cancer Society points out that there is no clinical way of identifying all urgent cases since bowel cancer can be well advanced in some cases before severe symptoms are detected. The delays in providing colonoscopies are condemning to death people who depend on our public health service and cannot afford private care.

Why has the promise that nobody would wait longer than one month for a test for bowel cancer not been implemented? What is the Minister's timeframe to effect that promise? Will he give us the precise and immediate schedule showing what resources will be made available to honour the pledge made to the memory of Susie Long and in memory of all those who have tragically suffered, including many who have died, from bowel cancer?

James Reilly (Dublin North, Fine Gael)
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I welcome the opportunity to speak about the issue of colonoscopy waiting times. As has been widely reported, the most recent waiting list figures provided by the National Treatment Purchase Fund to the Irish Cancer Society show 2,418 people are waiting longer than three months for colonoscopy tests. I have no hesitation in saying that both the numbers waiting and the longer waiting times are unacceptable.

That is the reason the HSE has put in place a specific waiting list initiative to address this issue.

It is important to point out that colonoscopy tests are carried out to monitor a range of other conditions besides cancer, including bowel disorders such as Crohn's disease and inflammatory bowel disease. I would like to clarify that while more than 50,000 colonoscopies a year are carried out in our public hospital system, the vast majority of patients are diagnosed as not having cancer. In 2009, the HSE provided hospitals with national guidelines on managing colonoscopies. This included a definition to prioritise patients referred for colonoscopy services into two groups, urgent and non-urgent.

The target timeframe within which urgent cases must be seen is four weeks. I accept, as Deputy Higgins said, that there is no exact science in terms of identifying all urgent and non-urgent cases. The symptoms which make a situation urgent are well known and these should receive priority. That is the way it has to be. However, I do not accept this number of people should be on a waiting list for a colonoscopy, urgent or non-urgent. I will deal in a moment with how we are going to address that. The target timeframe within which urgent cases must be seen is four weeks.

Data on waiting times for urgent colonoscopies has been collected. The monthly performance reports from the HSE show that the vast majority of people requiring an urgent colonoscopy receive the procedure within the 28 day target. In the month of June, 98.1% of patients waiting for an urgent colonoscopy had the procedure within the 28 day target. Nationally, five patients were outside the 28 day target. This is a slight improvement on the May figure, when the rate was 97.8%, with 20 people outside the 28 day target. It is important to stress that the NTPF waiting list referred to by the Deputy does notinclude urgent cases which are assessed and deemed by a doctor as being at risk from cancer.

With regard to HSE waiting lists initiatives for routine colonoscopies, the figures from the NTPF show that more than 1,600 people are waiting three to six months and a total of 2,418 are waiting up to 12 months and longer for the procedure. As I mentioned earlier, the HSE has put in place a specific waiting list initiative which will see at least an additional 3,000 endoscopies, namely, colonoscopies and upper GI endoscopies, take place by the end of the year in hospitals where there are waiting lists. The aim of this initiative is to increase access to routine colonoscopies for patients. A second phase of this initiative will bring the total additional number of endoscopies to be undertaken to 7,000.

The initiative involves providing funding to around 20 hospitals which will allow additional procedures to be undertaken within a strict timeframe during 2011 in order to address current problems. It may involve referral of patients to a different HSE hospital in line with the NTPF approach. This approach has a number of benefits, including increased access for patients, reductions in waiting lists for hospitals and assisting candidate screening colonoscopy units in their preparation for participating in the national colorectal screening programme which is scheduled to commence in 2012.

HSE monthly performance data show that practically all of those referred for urgent colonoscopy are being seen with a 28-day time frame. In addition, in regard to waiting times for non-urgent colonoscopy, I welcome the HSE's specific targeted initiative to address these and to ensure that those referred are seen in a timely manner.

Joe Higgins (Dublin West, Socialist Party)
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The Minister agreed with the Irish Cancer Society that it is not possible to clinically identify urgent cases. The response prepared for him by the HSE relies on the fact that so-called urgent cases are seen within 28 days. However, many cases of cancer, which could be advancing with detection, will not, therefore, fall within the urgent case cohort. That issue has not been dealt with. The only way this can be dealt with comprehensively is if the one month maximum waiting time is absolute in every hospital in every part of the country.

The Minister has, with respect, contradicted himself in his reply. I ask that he be more precise. Within which timeframe will every person needing a colonoscopy be given the procedure? Does the Minister accept that the pressure which hospitals are under in terms of resources militates against that type of service being available and that it is an urgent issue which must also be addressed by him?

In reality, this is a cancer waiting list. Poor people, those on modest incomes and affected by the recession and the tens of thousands forced out of private insurance are now potential victims in this scenario.

James Reilly (Dublin North, Fine Gael)
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I will try to address both of the Deputy's questions in the short time available to me. I have not contradicted myself. We know with certainty the cases that are urgent. We do not know with certainty the cases that might be urgent. That is the way cases are categorised. In other words, we know the symptoms which cause concern and should be seeking to identify. Doctors know such cases are urgent. That is not to suggest that people with innocuous symptoms will not also transpire to have cancer. Let us face it, in some jurisdictions which carry out routine colonoscopies cancer is identified despite the patient having no other symptoms.

Given the current climate, we are focussing on urgent cases. It is our intention, through the additional resources we are putting in place, to tender to have the backlog of colonoscopies in hospitals cleared. I cannot, however, tell the House today how much funding is being put aside as to do so would render the tender expensive. In other words, if people know how much money we have that is the amount at which they will pitch their tender. I will not share that information with the House as I want to get best value for the taxpayer and the best service for the patient.

The Deputy is correct that hospitals are under pressure. It is a legacy of the previous Government that hospitals were €70 million in the red at the commencement of this year. The previous Government allowed a huge overrun in activity in the first three months. We must also meet our commitments under the EU-IMF arrangement.

Timmy Dooley (Clare, Fianna Fail)
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We treated the patient. That is the problem.

James Reilly (Dublin North, Fine Gael)
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We are faced with a cut of almost €1 billion this year and a further €500 million next year.

Timmy Dooley (Clare, Fianna Fail)
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Our mistake was to treat the people.

James Reilly (Dublin North, Fine Gael)
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No roaring, shouting, giggling or laughing from Deputy Dooley or others on the opposite side of the Chamber will change those facts. That is the reality.

Timmy Dooley (Clare, Fianna Fail)
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The Minister is accusing us of treating patients.

James Reilly (Dublin North, Fine Gael)
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I would like the message to go out that we have a strategy to address this backlog. We are putting in place additional funds to make that happen and are addressing the issue in a manner which we hope will yield maximum result for patients who need this service.

Willie O'Dea (Limerick City, Fianna Fail)
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The same strategy as applies to the hospitals.