Liam Twomey (Wexford, Fine Gael)
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I highlight this issue because it is ongoing in the south east. It is appropriate to focus on it because it gives us an indication of what is wrong with our health service from a medical and financial perspective. Patients in Dublin currently wait approximately two years to see an orthopaedic surgeon but a patient in the south east can be waiting up to four years for a routine appointment to attend an orthopaedic surgeon. If a general practitioner marks a patient's case as urgent it will often be a year before that urgent case is seen by an orthopaedic consultant. This problem has been ongoing for years and it is no longer acceptable. Patients and their general practitioners have no idea how long they will be waiting to see an orthopaedic consultant. This appears to be a problem across all specialties, and part of my question to the Minister is whether he will publish data from the special delivery unit on the number of people waiting for consultant appointments in all specialties in the south east. It might help doctors referring patients if they knew how long people would have to wait because a hospital or a consultant with a shorter waiting time could be identified and the patient referred directly to that hospital or consultant.

I am also concerned about what we are hearing about the reorganisation of the service in the south east, as it will not tackle the major problem. The retention of catchment areas will continue to support the inequality and inefficiencies in our health services. That inequality sees patients in one part of the country waiting two years to see an orthopaedic consultant while patients in another part wait four years. The problem was supposed to have been ironed out with the establishment of the HSE, yet there has been no significant change to the status quo. The stated policy of our Government that money should follow the patient would help to reduce that inequality, but I would like to know whether that forms part of the remit of Professor John Higgins in reorganising the health services not just in the south east but across the country. Will we see money following the patient, and will it have an impact on waiting times? If that was the case it would at least reduce the inequality and we would see people being treated equally across the country in the future. I ask the Minister of State to address those questions.

Paul Kehoe (Wexford, Fine Gael)
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I apologise for the non-attendance of the Minister, Deputy Reilly, and his two Ministers of State, who are detained at a press conference. They thought they would be here to take this Topical Issue matter, but I have been given that job.

I thank the Deputy for raising what I understand is a huge issue in the south east. Immediately following his appointment, the Minister for Health set about establishing the special delivery unit, SDU, whose aim is to unblock access to acute services, both emergency and elective, by improving the flow of patients through the system. The SDU's scheduled care team addressed access to elective care and initially focused on waiting times for inpatient and day case elective surgery. So far this year, overall waiting list numbers have fallen from 56,020 to 49,601, a decrease of 11%; the number of adults having to wait more than 12 months is down from 2,435 to 118, a decrease of 95%; the number of adults having to wait more than nine months is down from 5,676 to 415, a decrease of 93%; and the number of children having to wait 20 weeks is down from 1,712 to 276, a decrease of 84%.

The SDU is now beginning to focus on outpatient waiting times, building on work already undertaken by the HSE. A priority action for the HSE has been the development and implementation of standardised reporting for outpatient access through the HSE outpatient data quality programme, which has enabled reporting of outpatient waiting lists from January 2012. Waiting times have been published on www.hse.ie each month as part of the HSE performance reports. The latest HSE performance report for September 2012 shows that 25,643 patients are waiting for a consultant outpatient appointment in Waterford across all specialties, underlining the critical need to address outpatient waiting times.

Together with the National Treatment Purchase Fund, NTPF, the SDU is building on the work already done regarding outpatient waiting lists. The collation and analysis of outpatient waiting time data in a standardised format will reveal the distribution of long waiting times across all hospitals. In the first instance, this will allow the SDU and the NTPF to target their resources towards those patients who are waiting longest and ensure that they are seen and assessed.

Over the course of 2013 to 2015, the HSE, together with the SDU and the HSE clinical programmes, intends to radically reform the structure, organisation and delivery of outpatient services to ensure that the right patient is seen and assessed by the right health professional at the right time. Key elements of this large programme of reform will include ongoing validation of waiting lists, the systematic and standardised management of referrals from primary care, a reduction in unacceptably high did-not-attend rates, and discharging from outpatient services when clinically appropriate. Maximum waiting time targets of 12 months for a first-time outpatient appointment by 30 November 2013, 26 weeks by 30 November 2014 and 13 weeks by November 2015 are the goals for the HSE and the SDU.

In regard to orthopaedic outpatient waiting lists in Waterford, several initiatives are under way to address the issue. Up to 2,000 of the longest waiting patients from the south east have been transferred to Cappagh National Orthopaedic Hospital. The national musculoskeletal national clinical programme has commenced and aims to reduce the outpatient department, OPD, waiting list for both orthopaedics and rheumatology through physio-led clinics which will run alongside the consultant clinic.

Additional information not given on the floor of the House.

An arthoplasty clinical nurse specialist-led initiative relating to the care of patients after their surgery will result in an increased number of new patient slots in consultant clinics. Waiting lists are continually being validated and a programme of validating the longest waiters is currently under way. Waterford Regional Hospital continues to receive approximately 400 new referrals each month to the orthopaedic service. The initiatives I have outlined, along with the national outpatient improvement programme, are designed to ensure that those patients are seen in a timely manner and receive the care they need, when they need it.

Liam Twomey (Wexford, Fine Gael)
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I want to reiterate the need for us to get the information the special delivery unit is receiving about waiting times for each consultant in all hospitals in the south east. The gross figures are not much use to us when it comes to referring patients and examining the efficiency of each hospital. I know the special delivery unit and the Health Service Executive have the figures. It would be useful in channelling patients to the right consultant at which they will be seen the fastest. I also hope the initiatives outlined by the Minister of State will work, particularly in orthopaedic services because that has been stressful and unsatisfactory for patients over the past several years.

Paul Kehoe (Wexford, Fine Gael)
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I will ask the Minister for Health to supply the Deputy with the statistics he requested. Coming from the same county as the Deputy, I know this is a significant issue in the south east. Both of us have been approached by many patients who are in stress waiting for surgery. I will highlight to the Minister the issues raised by the Deputy.