Billy Kelleher (Cork North Central, Fianna Fail)
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Question 7: To ask the Minister for Health if his attention has been drawn to the emerging difficulties with the special delivery unit in Northern Ireland and rising waiting times there; in view of same, is he confident in the special delivery unit's capacity to reduce waiting times here [26254/11]

James Reilly (Dublin North, Fine Gael)
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Reducing patient waiting times is a central part of the Government's commitment to increase equity in the Irish health system. One of my first priorities, therefore, was to establish the special delivery unit in June under the leadership of Dr. Martin Connor.

I know that the SDU in Northern Ireland - in respect of which Deputy Kelleher raised issues yesterday, to which I was unable to reply - was very successful when established in reducing waiting times. I do not propose to enter into an analysis of the Northern Ireland health system or to comment on the issues there other than to say that there were other issues at play which may not have been addressed. There is a series of reasons the initial, impressive effect of the special delivery unit was not sustained. The Government here is engaged in thorough reform of our health service. As such, what occurred in Northern Ireland will not pertain here. Underlying reforms that did not take place in other jurisdictions will happen here.

In my view, we need to embed performance management in the system to sustain shorter waiting times. That is critical. A once-off improvement will not work. The change has to be sustained and ongoing. Regardless of how well one improves, one must always strive to do better and must always have assistance to help one do better. As I stated earlier, to do that, one needs real time information.

As the Deputy knows, this Government has an ambitious programme of reform which includes institutional reforms and economic incentives which will make health care providers truly accountable for delivering patient centred care. I can assure the Deputy that I have the commitment and determination to deliver this agenda. I am very impressed with the work already begun by Dr. Connor. Our problems did not arise overnight and will take time to resolve but they are being tackled in a systematic and relentless fashion through the SDU. I do not minimise the scale of the task before us but I am very confident that the special delivery unit will provide a real performance management function for the Irish hospital system and will drive down waiting times.

Billy Kelleher (Cork North Central, Fianna Fail)
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I wish Dr. Connor, head of the special delivery unit, well in trying to address the difficulties in the system. However, while the special delivery unit, in the context of Northern Ireland, did initially create a positive momentum that has, in recent times, slowed dramatically for a number of reasons. In putting the emphasis on increasing capacity in the public health system, the use of private care was reduced. This appears to be the reason for the increase in the number of patients waiting more than three months to be seen. The figure in respect of people in Northern Ireland waiting more than three months to be seen increased from 17,000 in 2009 to 26,000 in 2010. This means, in the context of the Republic, that we have performed better than has Northern Ireland, even with the establishment of the so-called special delivery unit.

Some €29 million was taken from the National Treatment Purchase Fund budget to assist in the establishment of the special delivery unit in the Republic. How will this shortfall of funding be addressed in the context of private care in the delivery of outcomes?

James Reilly (Dublin North, Fine Gael)
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There is no obligation on the Government to provide funding for private health care or private hospitals. The National Treatment Purchase Fund was established under Deputy Kelleher's Government to use the private sector as a stream for procedures. I never agreed with the ideology that only 10% of that work could be done in public hospitals. The Government is changing that. We will use the funding from the NTPF to get the best value for the taxpayer and the patient.

That does not mean just purchasing procedures. It means employing key personnel in different areas to increase productivity or purchasing from the public system on a money-follows-the-patient basis, as we have already done with orthopaedic procedures. In such a scenario, when a hospital puts in the bill for a patient, the Department will pay it. If it does not perform the procedure, the money will be docked and diverted elsewhere in the system where it can deliver.

Michael Kitt (Galway East, Fianna Fail)
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We must move on.

James Reilly (Dublin North, Fine Gael)
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This is about bringing accountability to the system. There is little point in having transparency if there is no accountability to go with it.

Billy Kelleher (Cork North Central, Fianna Fail)
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Will the Minister accept that in trying to increase capacity, 1,900 beds are actually closed in the public health system, as the previous question from Deputy Ó Caoláin showed? People who need treatment will need beds but the capacity is not available. With a reduction of €29 million in the NTPF, how will additional capacity be achieved to deal with the immediate issue of people waiting over three months for treatments?

James Reilly (Dublin North, Fine Gael)
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Earlier this year, I sent a message to hospitals to inform them no patient should be left waiting longer than 12 months for treatment. A patient left for longer than 12 months for an inpatient procedure in a hospital will be treated elsewhere while the hospital in question will be deducted the quantum required to treat the patient. We must wait and see what this yields by 1 January 2012. That is what I mean by transparency and consequence. There will be consequences for hospitals that do not perform.

Regarding the €29 million alluded to by the Deputy, much of that may still end up in some private hospitals or not. It is being used in different ways to achieve the best outcome. Some of our public hospitals are extremely efficient at delivering care and more cost-effective than the private sector. The revers situation is also the case.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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While one would wish the health service situation in the North to be better than it is, at least we are able to assess it from the data published by the health Department in the Six Counties. Is the Minister aware the Health Service Executive decided to suppress the publication of details on the length of time patients must wait for access to given services in this jurisdiction? This was reported in June by the website, www.ratemyhospital.ie, when the HSE admitted it suppressed the publication of vital information on how long average patients have to wait for outpatient appointments in public hospitals.

Michael Kitt (Galway East, Fianna Fail)
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Thank you, Deputy. I must call the Minister.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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We are not able to make comparisons here because the HSE does not want the information to be made available.

James Reilly (Dublin North, Fine Gael)
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The Deputy has made a statement over which I cannot stand. I know there is not sufficient information around outpatients due to double-counting and other problems. These are, however, being addressed.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I do not want the Minister to stand over my statement. I want him to have these reversed.

James Reilly (Dublin North, Fine Gael)
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I am sure there are many things that Deputy Ó Caoláin may want but not all of them are achievable or desirable even.

We have acknowledged we are still gathering outpatient figures while we have got more information on inpatients and real-time waiting in accident and emergency departments. I cannot wave a magic wand and get it all done in one go. Six months into our tenure, however, we have made major strides in information gathering which allows us to analyse and plan how to tackle problems.

The spikes that occur in numbers at Limerick regional hospital have nothing to do with the number of attendees and admissions but other factors at the hospital. We cannot address any of these issues because they are not funding issues. We need co-operation from all members of staff to address these which I hope we will get from the Irish Nurses and Midwives Organisation, INMO, and others.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The spike is also attributable to the closure of certain hospital services at Ennis and Nenagh hospitals and the displacement of countless numbers of patients.