Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I thank the Ceann Comhairle for selecting this important matter for discussion in the Topical Issue Debate. Waterford Regional Hospital, now known as Waterford University Hospital, is the closest hospital to a large number of people in south County Kilkenny, many of whom are waiting for an outpatient appointment or inpatient day case treatment in the hospital. The number of people on waiting lists for treatment at Waterford University Hospital is shocking. In May 2015, some 26,553 people were waiting for outpatient treatment, an increase of 4,188, or 18.7%, in 12 months. It is especially appalling that 10,866 people have been waiting to see a consultant for more than a year. While the figure decreased slightly in April 2015, it increased by 1,744 between January and May and by 7,767, or almost 250%, in the 12 months preceding May 2015.

As such, 41% of those awaiting an outpatient appointment at Waterford have been waiting for more than one year, which is twice the national average of 20.5%. If one examines the figures further, matters get worse as there are 2,965 people who have been waiting for more than two years for an appointment. No other hospital in the country has so many people who have been waiting for more than two years and only Tallaght comes close with just over 2,000. Of the almost 3,000 people who have been waiting more than two years in Waterford, more than one third have been waiting for more than three years. That means 1,067 people have been waiting since May 2012. There are a further 452 people who went on the list in May 2011 and are still waiting.

It is not only outpatients who are suffering of course. The latest National Treatment Purchase Fund figures from May 2015 show that 4,210 people are on waiting lists for day case inpatient treatment at University Hospital Waterford. This compares to 3,773 in January 2015, 2,336 in May 2014, and 1,581 in May 2013. Of the 4,210 waiting in Waterford in May 2015, 624 have been waiting for more than 12 months, which compares to 64 in January 2015, 20 in May 2014 and none in May 2013. The numbers on the day-case inpatient list in Waterford have almost trebled in two years. No other hospital in the South/South West Hospitals Group has experienced this. Nationally, the waiting list has increased by 39.5% in over two years whereas in Waterford the increase has been of the order of 166.3%, which is appalling when Minister is seeking to have this addressed and substantially reversed. We all accept that health services are demand-driven, but to have so many people waiting for so long is a scandal.

I was in University Hospital Waterford at the weekend. The pressure front-line staff are under is enormous and something must be done about it. We must spend more money and appoint more front-line staff in Waterford because the hospital is unable to cope at present.

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy for the opportunity to outline the concerted actions being taken to reduce waiting times, nationally and in University Hospital Waterford. I recognise fully that too many patients are waiting too long for treatments and that this needs to change but reducing wait times is not that simple. If it was simple, it would have been done by now. As the Deputy will be aware, it is not long ago that his own party leader promised in office to abolish waiting times altogether, but that was not done.

However, I can assure the House that reducing waiting times is a key priority for this Government and much work is underway. Structural change in the organisation of our hospital sector, which is currently underway, will improve quality and access. Hospital groups will help us to better manage patient flow and patient demand. The reality is, however, that the major changes underway will take some time to implement and further time to show results. In the meantime, we must address the significant pressures on hospitals, including pressures on waiting times for inpatient and day-case treatments and for outpatient appointments. The HSE has specific measures in place to manage waiting lists more efficiently. These include the national waiting list protocol, the national clinical programme guidelines, prioritising day-of-surgery admission over inpatient surgery and the validating of inpatient waiting lists. Regarding this last measure, many waiting list entries are duplicates or relate to people who have since gone private.

I want to drive improvements in waiting times and ensure that we make maximum use of all available resources. Taking into account current pressures on acute hospitals, I have set a maximum permissible waiting time such that by the end of this month, nobody should wait more than 18 months for treatment or an outpatient appointment. By year end, that outer limit will be 15 months. This will be achieved in all but a small number of specialties in which there is a shortage of adequately trained staff which we cannot resolve. The HSE is focused on delivering this objective through maximising capacity across hospital groups. However, there are key limiting factors, primarily theatre nursing staff and consultant numbers in particular specialties. Consequently, some outsourcing to private hospitals is required, which is being managed through a public tendering process.

For my own part, I believe that new pathways to improve patient flow, such as medical assessment and local injury units, urgent care centres and non-hospital settings, can and must be used to provide a range of care to support the efficient use of hospital resources. There is significant potential to further improve hospital performance and efficiency. We must achieve the highest levels of efficiency ahead of providing new resources. The Irish hospital redesign programme is working with clinical programmes to support local change and innovation and raise national standards through internationally recognised redesign and improvement methods. I welcome this initiative. It is now advanced in Tallaght and Limerick is next on the list. At national level, the HSE's acute hospitals division is responsible for and manages hospital performance. Weekly meetings are held with the hospital groups to review performance against agreed clearance plans for treatment waiting lists and for outpatient appointments.

University Hospital Waterford is contributing to the South/South West Hospitals Group plan to reduce waiting times through additional outpatient clinics in all specialties. I am also advised that evening or weekend clinics are being held for ENT, orthopaedics, general surgery, vascular, neurology and urology. In terms of staffing, two consultant urologists have taken up posts this year and a temporary part time ENT consultant will begin at the end of June. Two much-needed consultant dermatologists are also expected to start in 2015 and a replacement consultant orthopaedic surgeon post is awaiting approval. My Department will continue to work with the HSE and hospital groups to ensure an appropriate focus and drive to improve hospital waiting times, including that in Waterford.

Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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The figures I have quoted today give the lie to the December 2013 outpatient figures, which claimed that no one was waiting more than one year at Waterford. On a national basis, the figures were much trumpeted by the then Minister, Deputy James Reilly, to show how well he was doing. To say the least, the figures from December 2013 are inconsistent with the figures for last month which I quoted in my initial remarks. The May 2015 figures indicate that 1,067 people have been waiting for an outpatient appointment since before May 2012, 452 of whom went on the list in May 2011 or earlier. Nevertheless, the published figures for December 2013 told us no one had been waiting more than one year in Waterford; a complete fabrication. The published figures for May 2014 indicated that just nine people had been waiting since before May 2012 with just two waiting since May 2011. How does the Minister explain a hospital waiting list in 2013 which said no one had been waiting since 2012 when the waiting list from 2014 indicated that nine had been waiting since the middle of 2012 and the recent figures show that more than 1,000 have been waiting since the middle of 2012, almost half of whom have been waiting since 2011? The figures do not add up. The Minister has given me an assurance in his reply, but this is not going to do anything in University Hospital Waterford where waiting lists are double the average of those in every other hospital in the country. There are over 3,000 people waiting. The Minister must give a reply and explain how the list will be brought down and into line with the rest of the country.

Leo Varadkar (Dublin West, Fine Gael)
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Obviously, operational responsibility for the hospital lies with the hospital management and the South/South West Hospitals Group board. I do not individually manage 50 hospitals. That is not something any health Minister has ever done or could ever do. However, I can discuss the issue in general. I find it hard to get my head around the figures also.

Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I can give them to the Minister.

Leo Varadkar (Dublin West, Fine Gael)
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I have them and I find them anomalous.

Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I can hand them over to the Minister.

Leo Varadkar (Dublin West, Fine Gael)
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No, I have them. In pointing to the anomalies, the Deputy makes a valid point. I wonder if the major increase we have seen in people waiting in the last couple of months is a reflection of the fact that the numbers were not accurate before rather than anything else.

Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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This is May 2015.

Leo Varadkar (Dublin West, Fine Gael)
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The Deputy does not understand what I am saying but if he reads back over what he said, he might. It is important that when the Deputy uses the figures, he understands them. There may well be 400,000 people awaiting an appointment of some sort in our health service. Some of those people are waiting a few days or a few weeks. What matters to most people is how long they are waiting not what number they are on a waiting list. If one is No. 120 on a general surgery waiting list, one may be seen in a couple of weeks, whereas if one is No. 60 on a particular surgery list, one might be waiting years. What is most important in my view is ensuring that we reduce waiting times. One must bear in mind that every time we establish a new service, there is a new waiting list and that every time a new consultant is appointed, people will be waiting to see him or her. We have waiting lists now for services we were not providing a year or two ago. As such, this is a trickier matter than people may think.

In terms of the most up to date figures for Waterford, the total waiting list on 28 May for inpatient or day-case treatment is 4,210, of whom 1,195 have been waiting for less than three months.

A further 1,700 are waiting less than nine months, but there are more than 1,000 waiting more than nine months and 624 waiting more than 12 months. With respect to outpatient appointments, approximately 6,000 are waiting more than 18 months and we would expect all of them to have appointments by the end of this month. When we consider the figures in the round, 26,553 people are waiting for treatment but the largest single number of that group are waiting less than three months.