Billy Kelleher (Cork North Central, Fianna Fail)
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To ask the Minister for Health the date on which he received the July performance report from the Health Service Executive; his views on the fact that the number of patients waiting to be seen at an outpatient clinic for the first time has almost doubled to 340,000 compared with figures released in April; if he will provide information on the true extent of the outpatient figures with some hospital deficits having doubled since April; and if he will make a statement on the matter. [41083/12]

James Reilly (Dublin North, Fine Gael)
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The draft HSE July performance report was received in my Department on 7 September. The figure reported therein of 339,441 patients waiting for an outpatient appointment is not new. The HSE's May performance report indicated that 342,665 patients were waiting for outpatient appointments, while the June report showed that 361,000 were waiting for appointments. Representatives from the SDU held a media briefing for health correspondents on 21 June, at which they outlined the new approach to the collection of outpatient waiting time data. They also indicated that, when up and running, the new system would be likely to show approximately 350,000 patients waiting for appointments. This is broadly in line with the figures being reported by the HSE.

While the figures are unacceptably high, it is important to emphasise that the reported increase since April is not due to a sudden large increase in the numbers waiting but rather to more accurate data which present a more comprehensive picture of the problem. The problem of outpatient waiting lists is not new. What has changed is the level of information we are collecting and putting into the public domain on these lists. Under the previous Government, the scale of outpatient waiting lists was not measured. I am quite prepared to state we do not have a definitive figure in this regard. The final figure may be in and around the 360,000 mark.

The is the first time the position has been measured and from now on it is going to be monitored on a weekly basis. As is the case with the inpatient waiting list, those who have been waiting longest will be seen first. It is utterly disgraceful and unacceptable that some 16,000 people have been waiting more than four years for appointments. I have given an undertaking - this is not detailed in my written reply - to the effect that by the end of next year, no one will be obliged to wait more than one year for an outpatient appointment. I will do everything in my power to make this happen.

Together with the National Treatment Purchase Fund, the special delivery unit in my Department will shortly begin the systematic collection of waiting time data at an individual patient level in a standardised format from all hospitals providing a consultant-led hospital outpatient service. Also, it will shortly assume responsibility for the reporting of outpatient waiting time data from the HSE

Billy Kelleher (Cork North Central, Fianna Fail)
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I thank the Minister for his reply. The figure to which he referred is alarming. He has stated the data are being collated in order to ensure efficiencies can be achieved and that pinch areas relating to waiting lists for outpatient appointments can be identified. It is disturbing that 360,000 people are waiting for outpatient appointments. I am not trying to pin the blame on the Minister for this. I welcome the fact that the relevant data are being collated and that resources will be allocated to address the issue. However, some 16,000 people have been waiting four years or more for outpatient appointments. It is clear, therefore, that there is a problem. It has been stated the numbers on the inpatient list are decreasing, which may be a result of the activities of the special delivery unit and further efficiencies in the system. If there is not, however, a throughput from the outpatient to the inpatient list, the numbers waiting will decrease. I am concerned that the numbers on the inpatient list are falling by virtue of the fact that outpatient assessments are being delayed. We want to reach a stage where we will know the exact numbers awaiting outpatient appointments. We also want the necessary resources to be allocated to ensure the numbers on the outpatient list will be brought down as soon as possible.

Does the Minister agree that the overriding problem facing the health service is the massive budget deficit and the huge overruns occurring in hospitals?

This was identified in the July performance report and in other reports and was highlighted on numerous occasions. Will the Minister agree that because of a lack of progress in addressing the budget deficit issues arising from as early as March 2012 there could be significant cutbacks in services in the last quarter to address the budget overruns in hospitals?

James Reilly (Dublin North, Fine Gael)
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We had a good debate in the other House yesterday and this area was touched on. I will rehearse some of the issues which were mentioned with regard to outpatient statistics. A total of 360,000 may seem an extraordinary figure and a daunting prospect but it should be put in context. Approximately 200,000 patients are treated in outpatient departments every month. Some of the issues are disturbing and unacceptable. There needs to be a change in practices and I have already spoken to the acting chief executive officer of the HSE. I refer to the practice of calling 35 people to attend at the same appointment time. This is to suit the system rather than to suit the client - the patient. In my view, this shows tremendous disdain and disrespect for citizens that their time is of no consequence. I wonder if we were to compute the cost in time lost from work for people, the figures could be quite staggering. I want appointments to be arranged in a more structured way that is respectful of people. Equally, this is a two-way street. I see no reason all hospitals cannot institute a system which is used in some hospitals, a system for texting the people on the list a couple of days before the appointment date to ascertain if they will be attending. If a person does not attend, having confirmed the appointment, I am prepared to discuss the prospect - even in the House - of a €20 charge for the next appointment.

The situation can be improved by ensuring that the right person is seen by the right professional. A survey carried out in England was also done in Cork - in Deputy Kelleher's constituency. The physiotherapists screened the orthopaedic referrals from general practitioners and they found that in nearly 50% of cases the physiotherapist was able to deal with the complaint. In fairness to GPs, that could mean a couple of things. It is also the case with regard to psychiatry. The GPs cannot access the service of a physiotherapist for their public patients and the only way to access the service is by sending the patient to the orthopaedic clinic, which seems a very fruitless waste of everyone's time, including the patient's time. Similarly, a depressed person may require counselling but this is not available for a GP's public patients so they are referred to the psychiatric clinic. This is very inconvenient for patients and very costly for the system.

There are many actions we intend to take to address this problem. While I am deeply unhappy with the level, for the first time now - as I said in the Seanad yesterday - we are now driving with headlights and we can see where we are going. We can see the size of the problem and we can start to address it. I will undertake to the House and to my colleague opposite that we will keep everyone informed as to progress. We will not be afraid to talk about this. We will make a target and I will expect to meet it. I will expect Deputy Kelleher to castigate me if I do not meet it but it is better to have a target which is open and transparent so that everyone can aspire to it as opposed to not knowing what is the problem and therefore not know how to deal with it.

Michael Kitt (Galway East, Fianna Fail)
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A brief supplementary, Deputy Kelleher.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister will agree that I do not castigate but I hold him to account. I welcome his reply. He referred to physiotherapy services being used in the assessment of patients in Cork and this scheme has worked quite effectively. I welcome the Minister's commitment in this area and I hope to see some movement in this regard. The key issue is whether services can be maintained in the next number of months or whether there will be a build-up of a backlog because of hospitals having to reduce services. The key issue of concern is that the backlog would be very difficult to address in the year ahead. I do not expect the Minister to work miracles and there will be challenges for the budget in the foreseeable future. It was different in the past when money could resolve the issue of backlogs but now it is a case of getting better results from existing resources.

James Reilly (Dublin North, Fine Gael)
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We have shown that we can work differently. If an analysis shows up the root cause of a problem we can deal with it. I think this has been achieved in the accident and emergency departments. We are not finished yet by any means and similarly with inpatient treatments. The Deputy is correct that we face a serious challenge with this year's budget although our activity levels are ahead of budget forecasts. I wish to reassure the House that activity will need to slow down in the areas where they have exceeded their levels. However, that does not mean that anyone who is acutely ill or who has cancer or needs urgent treatment, will not get it. We have been making progress on the waiting lists. I pointed this out to the House last week and to the Seanad yesterday that we have reduced the inpatient waiting list by 85% of people waiting one year or longer. We have reduced the waiting list of people waiting six months or longer by 63% and we have reduced the waiting list of those waiting for inpatient procedures for three months or longer by 18%. We are making progress and I ask people to bear with us.

Deputy Kelleher referred to the special delivery unit which has had a very beneficial effect. It is in the main due to the clinical programmes but mostly it is down to the excellence of the men and women working in our health service who have delivered this change and I thank them for it.