Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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I thank the office of the Ceann Comhairle for selecting this matter which is an important one for the country as a whole and, in particular, for the health service. Since the start of 2014 we have seen an almost continuous increase in waiting lists both for outpatient consultations and for scheduled day case and inpatient procedures. The latest figures for April are remarkable because they show that for outpatients, there are now 412,422 on the waiting list. Of those, 83,347 are waiting more than a year while more than 11,000 are waiting more than two years. A total of 2,166 are waiting more than three years and a most unfortunate 778 people are on the outpatient waiting list for more than four years.

A total of 3,879 children are waiting more than a year in the children's hospital group alone, that is, Crumlin and Temple Street hospitals. That is a doubling of the number in the past year and obviously there are more children waiting to be seen in other hospitals across the country. The number of outpatients waiting more than a year is up 16,725, or 25.1%, since the start of 2015 alone. The year-on-year figures show a jump of 60,601, or 266.4%, for the numbers waiting more than a year.

For inpatient and day case procedures, there are now 67,165 on the list, with 27,260 waiting longer than the internationally accepted benchmark of six months. A total of 9,433 are waiting more than a year and 361 of these are in the children's hospital group.

The Government set a target for children of 20 weeks. Yesterday's HSE performance report for February showed that the target was being reached in a miserable 56.2% of cases, compared to 84% in February 2014. The following hospitals did not even get half way to the children's 20 week target in February - Beaumont Hospital at 48.1%, Cavan General Hospital at 34.1%, University Hospital Waterford at 48.9%, Our Lady of Lourdes Hospital, Drogheda, at 41.1% , the Royal Victoria Eye and Ear Hospital at 47.2%, Letterkenny General Hospital at 47.2% and Our Lady's Children's Hospital, Crumlin, at 47.8%. In fairness to the Minister, Deputy Varadkar, he said that things would get worse before they got better. Obviously, they have got much worse.

As a Kildare Deputy, I am relieved to see that Naas General Hospital's figures have not risen as much as many others, but many Kildare people go to Tallaght hospital and the figures for that hospital are truly appalling. There are 30,713 people waiting for an outpatient appointment in Tallaght hospital. It is not the worst in the country overall, but 9,825 of those people, almost one in three, are waiting more than a year. That is an increase of 1,303 since January and an increase of 5,235 in a year. It has more than doubled since April 2014.

When will things get better? All the Minister appears to have done is scrap his predecessor's target times. Obviously more resources are required. The Minister told us he had achieved a realistic budget last October but he has since required an additional €74 million in funding to confront the realities of overcrowding in emergency departments. Will the Minister be seeking a further Supplementary Estimate to his realistic budget, as he described it, to address these appalling waiting times and when can we expect it?

The difficulty is that real human beings are enduring real hardship and suffering as a result of the bogus budgets the Department of Health has brought before this House in each of the past two years.

Paul Kehoe (Wexford, Fine Gael)
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I thank Deputy Ó Fearghaíl for raising this issue. I am replying on behalf of my colleague, Deputy Varadkar, who sends his apologies for being unable to be in the House this afternoon. He is otherwise engaged on Government business.

Under the Future Health plan, significant structural changes are envisaged for the acute hospital sector, with the formation of hospital groups and the reconfiguration of services to improve both quality and access. These major structural changes will take some time to implement and there remain significant operating pressures on acute hospitals, including waiting lists for inpatient and day case treatments and outpatient appointments. Reducing these waiting lists is a key priority for Government. Taking into account current pressures on acute hospital services, the Minister has put in place a target that by mid-year nobody will wait more than 18 months for treatment or an outpatient appointment; by year-end, that target will be revised to a wait time of no more than 15 months. When these targets were announced in February, there were 4,996 patients to be treated by the end of June 2015. As of 1 May, there are 3,508 patients requiring treatment by the end of June 2015 if the 18 month target is to be achieved, a reduction of almost 1,500.

It is acknowledged that the volume of the outpatient waiting list is far greater, principally due to consultant shortages in particular specialties and resource pressures on a small number of hospitals. The HSE has put in place specific measures to manage waiting lists more efficiently, including observation of the national waiting list protocol, adherence to relevant HSE national clinical programme guidelines, prioritising day-of-surgery admission where clinically appropriate and validation of inpatient waiting lists to establish and maintain a precise current position regarding the volume of people awaiting care. The monthly publication of hospital and speciality level waiting list information on the National Treatment Purchase Fund website is a welcome development, as is the HSE service plan commitment to the publication of waiting lists at consultant and speciality level.

I am advised that the acute hospitals division is meeting weekly with the hospital groups to review performance against agreed clearance plans for all treatment waiting lists. A similar process is in place for outpatient appointments, with the assistance in particular of the national clinical programmes for orthopaedics, rheumatology and surgery. New pathways of care to improve patient flow through hospitals, such as medical assessment units, local injury units and urgent care centres, as well as care provision in non-hospital settings, can and must be used to provide a spectrum of care which supports the efficient use of hospital resources.

Waiting list performance will be assessed within the revised accountability framework for the HSE, which requires formal performance management for hospitals to include access, quality, outcomes and financial performance. The work of the special delivery unit indicates that there is still significant potential to improve performance in hospitals. The hospital redesign programme is working with the national clinical programmes to support local change and innovation and raise national standards through the use of internationally recognised redesign and improvement methodologies.

Based on the emergency department task force's action plan and in view of experience to date, the Government is providing additional funds of €74 million, in addition to the €25 million provided in 2014, to address delayed discharges and support initiatives which improve timeliness for admissions from emergency departments and waiting lists. The Department of Health will continue to work with the HSE to ensure that all issues relating to hospital waiting lists are resolved.

Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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The Minister has my sympathy. He is reading out a response from the Minister, Deputy Varadkar, that is effectively a non-response. He talks about programmes, protocols and delivery units, but the reality is that the Minister, Deputy Varadkar, was faced with a crisis in accident and emergency departments last winter. His response was to create a situation where it was addressed to some extent, although in Naas General Hospital, for example, over the past 12 months record numbers of people were treated on trolleys, which is absolutely unacceptable. However, as a result of the initiative taken by the Minister to address the crisis in emergency departments, there has been an exponential and phenomenal increase in the waiting lists for services throughout the health sector.

All of this comes back to one critical issue, the funding of the health services. Over the past two budgets this House was presented with figures for the health budget that were inaccurate, not based on fact, bogus and which have been described on a number of occasions by Members on this side of the House as fraudulent. The people who brought them before the House knew they were not figures that could sustain the health services for the period ahead. Now, we have a situation where incredible numbers of people continue to build up month after month on the various waiting lists of hospitals throughout the country. Furthermore, we do not know where we are going in terms of the funding of the health service or whether a Supplementary Estimate will be brought forward by the Department of Health.

Perhaps if the Minister could us an assurance today that there will be a Supplementary Estimate, we might have some expectation of seeing these incredible waiting lists addressed in the short term.

Paul Kehoe (Wexford, Fine Gael)
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I will share the Deputy's concerns with the Minister, Deputy Varadkar. Anything regarding a Supplementary Estimate would be an operational matter for the Department of Health and the Minister, and I am not privy to any information that there will be a Supplementary Estimate.

The Minister and I accept that, as the Deputy said, this is a hardship for families and for the human being. However, this has been a major issue over many years for every Minister with responsibility for health. There is no quick fix to ensure every patient is seen, but the Minister has put in place a target-----

Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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It is getting worse.

Paul Kehoe (Wexford, Fine Gael)
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-----that by mid-year nobody will have to wait more than 18 months for treatment or an outpatient appointment.

By the end of the year the target will be that nobody will have to wait more than 15 months.

I hope the plans the Minister has put in place will be implemented. There is a shortage of consultants in some hospitals across the country, but I am not saying that is the main problem. The Deputy recognised that we had a crisis in accident and emergency departments in January, which caused its own problems and had repercussions for outpatient appointments. I will bring to the attention of the Minister the concerns raised by the Deputy, and he will keep the Deputy and the House updated on how his targets are progressing. The Deputy is correct in saying it is up to Members to ensure they get a briefing and are kept up to date on the targets. I repeat that weekly meetings take place on the targets the Minister has put in place to ensure they can be achieved.

Michael Kitt (Galway East, Fianna Fail)
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Before I call Deputy Eamonn Maloney, I believe Deputy Shane Ross wishes to defer his Topical Issue.

Shane Ross (Dublin South, Independent)
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I thank the Leas-Cheann Comhairle. With the permission of the House, in the absence of the Minister for Finance, Deputy Michael Noonan, and the Minister of State, Deputy Simon Harris, I wish to defer my Topical Issue.

Michael Kitt (Galway East, Fianna Fail)
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I thank the Deputy. That Topical Issue will be taken on another date.