Billy Kelleher (Cork North Central, Fianna Fail)
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76. To ask the Minister for Health the factors behind the big increases in inpatient, day-case and outpatient waiting lists between January and July of this year; and if he will make a statement on the matter. [36529/14]

Billy Kelleher (Cork North Central, Fianna Fail)
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What are the factors behind the large increases in inpatient, day-case and outpatient waiting lists in the period January to July of this year? The National Treatment Purchase Fund published statistics quite recently and some of the increases these show make Zimbabwean inflation figures appear modest. In some areas there has been a 968% increase in the number of people awaiting procedures. What are the key reasons behind the increases to which I refer?

Leo Varadkar (Dublin West, Fine Gael)
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The HSE is continuing to experience a significant increase in demand for its services, which is reflected in an upward trend reported in waiting lists for July 2014. The success of the outpatient initiative run by the HSE at the end of 2013, and further validation work in 2014, resulted in the facilitation of 33,000 extra outpatient appointments in 2013 and an additional 55,883 such appointments thus far in 2014. As the Deputy can see, there has been an increase in capacity. The success of the outpatient waiting list initiative last year in reducing the waiting list from over 100,000 in March 2013 to fewer than 5,000 in December 2013 has had the consequence of driving up inpatient and day-case waiting lists as patients are referred for appropriate treatment. In addition, other pressures such as almost 30,000 new cancer diagnoses each year are placing increasing demands - of the order of 3,000-6,000 additional referral requirements - on the system each month.

Almost half of the 7,727 patients waiting over eight months for inpatient and day-case treatment are accounted for by three hospitals, namely, Beaumont, the Mater and Galway. There are several potential strategies hospitals can use when planning their resources most effectively around the delivery of the national access targets for their patients. For example, improvements in chronological scheduling, consistent validation of waiting lists and active engagement with patients to reduce "did not attend", or DNA, rates are under way in order to address outpatient waiting list. Similar measures, as well as optimisation of theatre capacity and day of surgery admission, where possible, are being employed to improve management of inpatient and day-case waiting lists. All hospitals have been asked to provide action plans to address all waiting lists by the HSE's national director of acute hospital services. These individual hospital plans will be monitored by the special delivery unit's scheduled care team.

Billy Kelleher (Cork North Central, Fianna Fail)
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To the end of July more than 360,000 people were on outpatient waiting lists, an increase of almost 60,000 on the figure for last year. It is obvious, therefore, that something either is or is not happening, as the case may be. There comes a point where it is no longer possible to force that level of throughput through hospitals because they simply do not have the ability to deal with it as a result of a lack of theatre capacity, consultants and front-line staff. There is also an issue with regard to an inability to transfer people from acute hospitals to step-down facilities. The latter is because the Government, the Department and the HSE have simply not provided funding for such facilities in recent years. At any given time there can be between 600 and 700 people in our hospitals who should not be there and who should instead be being looked after in community settings - with access to home-care packages - or in step-down facilities. It is one thing to make statements but there is also a need to put sufficient funding in place in order to ensure that our hospitals have the necessary capacity.

Does the Minister agree that the special delivery unit appears to have run out of steam and that it also seems to be incapable of addressing outpatient and day-case waiting lists? Will he take action to ensure that adequate funding is put in place, primarily in respect of step-down facilities, in order that people will be removed from acute hospital settings when they no longer need to be there?

Leo Varadkar (Dublin West, Fine Gael)
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It is important to point out that even though there has been a significant increase in the number of those waiting more than eight months or a year, 89% of patients are waiting less than 12 months for access to outpatient treatment. The target is not being fully met but we have achieved a level of 89%.

There is obviously a deficit in the context of step-down facilities, nursing homes and home-care packages. We do not offer enough home care and people here go to nursing homes sooner than they should and sooner than do their counterparts in other countries which provide much better social and home care than Ireland. Whether the funding available will be adequate is a matter for discussion in the coming weeks. As matters stand, there are approximately 700 delayed discharges across the acute hospitals. There will always be some delayed discharges - perhaps 200 to 300 - but a figure of 700 is quite remarkable.

Were those patients in step-down facilities or nursing homes, we would not have the problems we have with overcrowding in emergency departments or delays in elective procedures. This is a major problem and it will cost a good deal of money to put right. I cannot say with any certainty whether that money will be available to me next year.

Billy Kelleher (Cork North Central, Fianna Fail)
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I do not expect the Minister to announce the budget in the House, although he may announce it or his efforts to secure adequate funding elsewhere from time to time. What we need in terms of policy is a stated commitment to ensure we will examine the issue in the acute hospital setting and the fact that we have up to 700 patients in beds on any one night who should be elsewhere. That is not only bad for hospitals but for patients also. They should be in step-down facilities or home care settings.

What we have seen in terms of prioritising from the special delivery unit in recent times amounts to fire brigade action to address the difficulties. What we need is a sustained policy of funding home care packages to bolster the associated social and clinical supports and step-down facilities. This should be a priority. Otherwise we will be back here next year talking about an increase in the numbers on outpatient waiting lists and waiting as day cases. We need a sustained and coherent strategy covering several years.

Leo Varadkar (Dublin West, Fine Gael)
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I quite agree with the Deputy. That there are 700 mostly elderly patients awaiting discharge in hospitals is not only bad for the health service but it is also bad for those individuals because they are more at risk of acquiring an infection in hospital and falls. It is bad all round.

It is frustrating that we have been talking about this issue for ten years. It is not something that has happened in recent weeks; it is not a sudden crisis. This is a chronic problem in the health service that has been ongoing since I was a medical student and I find it frustrating that we are still grappling with it. I will be working on the matter with the Minister of State, Deputy Kathleen Lynch, and we intend to put together an integrated plan to deal with it, starting with home care and moving all the way through the hospital system. This will have to be funded, which obviously will be a struggle.