Dessie Ellis (Dublin North West, Sinn Fein)
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Cappagh hospital is a fantastic facility, with the best of staff, including nurses and surgeons. People who have availed of its services have nothing but praise for it, although there has been a 40% increase in the number of patients, coupled with a reduction in funding because of recent budgets, as well as a cessation of the funding from the National Treatment Purchase Fund. Increased funding in 2015 has been promised by the Minister, which should allow for more inpatient procedures. The opening of closed and under-utilised facilities should result in additional theatres, with approximately four theatres operating on a daily basis. That is urgently needed.

Recently, an orthopaedic surgeon told my colleague, Deputy Ó Caoláin, that the level of funding for the hospital has been nowhere near sufficient to look after people in a timely way. This lack of funding prevented a person from having a hip replacement that is urgently required. In response to a parliamentary question, the Minister for Health, Deputy Varadkar, indicated that the HSE has been engaging with Cappagh hospital and trying to identify ways to cut waiting lists and increase resources. He stated that additional funds would be made available in 2015 to open an additional 1.5 theatres per day. I would love to know the progress of this and if waiting lists will demonstrate a real decrease with this funding.

At the end of January 686 patients were awaiting knee surgery, with 100 waiting between nine and 12 months and a further 70 more than a year. I have some examples from my own area, although I am sure there are a myriad of examples throughout the country. A 76 year old constituent lives with her husband, who has Parkinson's disease and dementia, and she has been waiting two years for a back operation. It has been on an urgent list since 18 March 2014. On 5 September, the person was brought in for the pre-operation process. This woman is confined to her home and has the added problem of caring for her husband, who is reliant on her support.

There is a second case of a 50 year old man, married with three children, who has psoriatic arthritis, a chronic disease characterised by a form of inflammation of the skin and joints which can cause inflammation of the spine as well as tendons, cartilage, eyes, lung lining and, rarely, the aorta. He was referred to Cappagh hospital from Blanchardstown in February 2014, one year ago. He had his tendons done in Blanchardstown more than 18 months ago and he needs his hands straightened and fused. This should have been done shortly after his tendons had been done. An assessment form was sent to him only a month ago and he still has no indication of when this procedure will be carried out. His quality of life has been destroyed, as well as his ability to work or even play with his children.

I have a third case of a 79 year old woman who has been housebound because she needs a replacement knee. She has been waiting for three years in total, with no quality of life. A recent response to a parliamentary question on 16 December was sent to her family. It indicated that Cappagh hospital has confirmed that the woman was referred to the Mater and placed on the inpatient waiting list for Cappagh hospital for 2 April. This means she is eight months on the inpatient waiting list, and only patients waiting 14 months or longer are being treated. Cappagh hospital further stated that urgent patients continue to be prioritised, and it has advised that due to a strict chronological booking policy, all patients attending the hospital are being offered dates for a waiting time for surgery, with due regard to clinical categorisation.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Deputy for raising this issue, which is not unique to Cappagh hospital or the Dublin area. I am taking this matter on behalf of the Minister for Health who, unfortunately, is out of the country.

The Minister for Health briefed the House on Cappagh hospital's operating theatres in November last year. Cappagh National Orthopaedic Hospital is one of the major elective orthopaedic facilities in Ireland, providing a national secondary and tertiary referral service for orthopaedic care for both adults and children. The Minister met representatives from Cappagh late last year to discuss the issues faced by the hospital. As a result of the increase in the number of overall patient referrals, a reduced budget, cessation of funding from the National Treatment Purchase Fund and a reduction in private income, there was a reduction in the surgical capability of the hospital. Although Cappagh hospital has a total of seven operating theatres and there were sufficient consultant staff available to provide services to meet demand requirements, not all theatres were in use in 2014.

It is of note that, at the end of 2014, overall staffing levels at Cappagh hospital were not significantly less than they were in 2008. There were approximately 330 whole-time equivalents, WTEs, in 2014 compared with 328 WTEs in 2008. The number of nursing WTEs fell slightly between 2008 and 2014, from approximately 124 to 123, the number of medical and dental WTEs increased from 36 to approximately 43 and is at its highest level since 2008.

However, in 2014, Cappagh hospital experienced an unprecedented increase of approximately 40% in demand for inpatient treatment, a level of increase that was not observed in other sites.

I am pleased to inform the Deputy that further funding of €800,000 was provided in late 2014, which allowed Cappagh National Orthopaedic Hospital to undertake additional workload. Furthermore, the HSE, through its 2015 budget allocation process, has also provided Cappagh hospital with additional resources of €4 million over its 2014 allocation to allow for an increase in inpatient procedures. The 2015 budget allocation process has also provided for the opening of closed and under-utilised capacity at Cappagh hospital. This will enable the opening of an additional 1.5 theatres per day, bringing the total number of theatres open to four, which will allow Cappagh to increase activity levels and to address significantly its current waiting list breach volumes.

In 2015, the HSE will continue to engage with the hospital regarding its budget and to explore mechanisms to ensure optimal use of resources, including theatre capacity, at the hospital within the overall resources available to the acute sector. The Deputy will also be aware that Cappagh hospital is part of the Ireland east hospital group, which includes Mater Misericordiae University Hospital, St. Vincent's University Hospital, Midland Regional Hospital Mullingar, St. Luke's General Hospital, Kilkenny, Wexford General Hospital, the National Maternity Hospital, Holles Street, Our Lady's Hospital, Navan, St. Colmcille's Hospital, St. Michael's Hospital, Dún Laoghaire, and the Royal Victoria Eye and Ear Hospital. I am also confident that there will be a structured integration of Cappagh hospital into the Ireland east hospital group in 2015 and that this will provide opportunities and support for Cappagh hospital in managing demand and delivering high-quality, safe patient care in a cost-effective manner.

Dessie Ellis (Dublin North West, Sinn Fein)
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Cappagh hospital is located not far from where I live and it has been an iconic facility for many years. Undoubtedly, there is an urgent need to address these waiting lists, as well as the under-staffing. Although the Minister of State said the staffing levels did not change much, there was a 40% increase in demand last year. In addition, a number of people are due to retire in the coming year, so both problems will have to be addressed. I hope the Minister will do that.

It is good to hear that extra funding is being provided, but the reality is that there will be four theatres operating when there should be seven. It is a shame on us that the capacity of seven theatres, or close to that, has not been reached. That is the reason 79 year old people are waiting for hip and other replacements. Many very elderly people are waiting 12 months for surgery. I do not know to what level this will cut the waiting list, but I hope it will be cut considerably.

We should be taking account of the age of these people. The woman I discussed earlier cannot even go outside the door. Her husband has dementia and she cannot walk, but she has been told she might have to wait another three or four months. It is outrageous. There must be humanity in how things are judged. People are put on a list and it is judged by the time on the list, but account is not taken of the fact that this woman is elderly or that she has to deal with external circumstances. I hope we can address this better.

I have been hearing that the nursing situation is far more serious than the Minister of State says. The number of staff must be addressed. Obviously, we could also do with more surgeons and physicians, but there is no indication that this will be dealt with as well.

Kathleen Lynch (Cork North Central, Labour)
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There is no doubt that the circumstances in which the country finds itself are not ideal. I realise somebody else got into trouble for saying this, but I believe we have made significant progress, even in terms of additional revenue being allocated to the health service. The things that happened should not have happened and the consequence is that we have developed waiting lists for people such as the lady the Deputy mentioned. I am sure that when orthopaedic surgeons, or any other surgeons, general practitioners or nurse managers, look at a person's circumstances, they do not just concentrate on the pain and that they take all other issues into account.

The Minister for Health and I have discussed this virtually every week and it is our intention that the long waiters, the people who have been waiting more than 12 months, must be catered for. I have met many surgeons in my area in Cork. They tell me that the circumstances are such that by the time they get to see eight new patients per week, that is a significant number in the context of the return visits, patients who must be managed, theatre time and so forth, six of them will be recommended for immediate surgery. There are issues with orthopaedics that we must confront and on which we must concentrate. The difficulty is, as the Deputy knows, that as soon as we get that area resolved, another area will emerge. It is always about the prioritisation.

The additional money for Cappagh hospital this year will help. I have never been one of those who say that consultant surgeons do not work hard enough. My personal experience is that they work extraordinarily hard and long hours. They generally are not people who shy away from work. With the extra theatres open and the additional money, I am very hopeful that the Deputy will see an improvement in the waiting times experienced by the people he represents.