Billy Kelleher (Cork North Central, Fianna Fail)
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1. To ask the Minister for Health when the waiting lists and waiting times for inpatient and day case scheduled admissions will improve; and if he will make a statement on the matter. [2647/15]

Billy Kelleher (Cork North Central, Fianna Fail)
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When does the Minister envisage an improvement in waiting lists and waiting times for inpatient and day case scheduled admissions? The most recent figures are for October 2014, but the Minister may have more recent ones. At the time 59,463 were on inpatient day case lists, of whom 54,250 were adults and 5,205 were children. Those on the lists, who require some service from the health service, have been waiting an inordinate length of time. Things are moving in the wrong direction. Even though there has been an increase in funding for acute hospitals, when does the Minister envisage a decrease in waiting times?

Leo Varadkar (Dublin West, Fine Gael)
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Improving waiting lists for inpatient and day case treatment is a key priority for me and the Government. My Department is working with the HSE to put in place a plan to eliminate very long waiters by the end of the year. This will involve productivity improvement and rigorous waiting list management. Further increasing day case surgery rates for specific procedures will be important in improving elective access within available capacity. Priority will be given to adherence to the guidelines on the scheduling of patients for surgery, including chronological scheduling, which will be vigorously monitored by the HSE throughout the year.

The management of competing demands for emergency and scheduled care requires changes in how and where patients are treated. The movement of care and treatment from inpatient to day case and from day case to outpatients is most important, as is ensuring the appropriate ratio of new to return appointments, which reduces unnecessary return appointments. Limiting elective surgery in preparation for, or as a response to, increased emergency department attendances is intended to help to manage the need for immediate emergency or trauma care.

Where it is necessary to prioritise cancer and other complex cases, the HSE assures me that this is being done. This inevitably will affect waiting lists. The challenge is to minimise the need for cancellation at short notice and to manage the impact of such cancellations effectively, within the hospital and in collaboration with other hospitals. As I have stated publicly in the context of the significant emergency pressures being experienced by hospitals, realistically I do not envisage significant improvement in elective waiting times in the early part of the year. However, based on the high priority attached to this area in the HSE service plan and the first overall increase in the HSE budget in seven years, it is expected that improvement will occur later in the year.

Billy Kelleher (Cork North Central, Fianna Fail)
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The previous Minister for Health, now Minister for Children and Youth Affairs, Deputy James Reilly, said, "For people and patients, a key barometer of the success of our reform programme must be the performance of emergency departments and waiting lists." I cannot blame the Minister for Health for the previous Minister's failings, but I cannot absolve him because of the fact that he is a member of the Government which put a fierce emphasis on the pretence that it would address all of these issues. We are facing into the fifth year of the Fine Gael and Labour Party Government and things have got progressively worse. Even though the Minister changed the criteria for counting those on waiting lists and the time people were waiting, things are still getting progressively worse. The idea that the solution to overcrowding in emergency departments is the cancellation of elective surgery beggars belief. This is creating a major difficulty for individuals in terms of being told their elective surgery haas been cancelled and that they are back on waiting lists. If we could have clarity on what the Minister intends to do about this, we would appreciate it.

Leo Varadkar (Dublin West, Fine Gael)
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It is important to point out that all waiting lists are not the same. There are different waiting lists for different procedures, surgery, outpatient appointments, scans and other investigations. There are different waiting lists in different hospitals and for different consultants. Not all waiting lists are increasing; some are decreasing. For example, the waiting lists for physiotherapy and occupational therapy in the community are decreasing and there are very short wait times, if any, for palliative care. It is the case that the waiting lists for hospital-based investigations, procedures and appointments are rising. The figures for November which will be released tomorrow will show that they are rising and they will continue to rise for a number of months, not least because we have had to cancel so many elective surgeries this month. I agree that it is not a solution, but it is a necessary response to the overcrowding we are facing in emergency departments. We are doing three things. These involve transparency, greater efficiency around waiting lists such as adherence to chronological order, more new patients, fewer returns and other such things, and specific initiatives. Some 20,000 more day cases will be dealt with in 2015 as a result of the increase in the budget and there are specific initiatives in the case of scoliosis, endoscopy, ophthalmic services for children and orthodontics. We will see the impact of this but not until later in the year.

Billy Kelleher (Cork North Central, Fianna Fail)
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We welcome any commitment that there will be an improvement, but we would like to see an improvement in how we manage waiting lists. More importantly, we would like to see resources being put in place to streamline the assessment of patients and the lists on which they should be placed. What confounds people is the idea that we are consistently cancelling elective surgery in order to deal with crises in emergency departments. The idea that we put people on a waiting list while knowing that there is a chance that elective surgeries will be cancelled in January is something we need to examine. That policy exerts major stress and pressure on the many people preparing for operations throughout the Christmas period and in January who are then told that the response to the continuous emergency overcrowding in January is the cancellation of elective surgery. This has caused great distress for many, as the Minister knows from his other profession. People have major concerns when they are waiting for operations and procedures and that they are being cancelled as an emergency response is not good enough.

Leo Varadkar (Dublin West, Fine Gael)
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It is important to point out that roughly 80% of people are seen within the target time. We tend to focus on those for whom the target is not met. While non-urgent elective surgery is being cancelled, out-patient surgery is not and in most cases day surgery and investigations such as scopes, for example, are not being cancelled. It is not the case that everything is being cancelled or anything like that.

It is the case that emergency departments are much busier at this time of year every winter. What it might make sense to do would be to smooth out activities in hospitals so we do not plan as many elective procedures in January and instead plan to carry out more in the summer. At the moment, the surge happens in January and elective surgery is deferred but then wards are closed in the summer. It might make more sense from now on to plan to do fewer elective procedures in January and February and during the summer to keep the wards open and to do more elective procedures at that time. This would be a way of smoothing out the activity in hospitals. I am sure if it was that simple it would have been done long ago but it may be something that at the least may need to be attempted.