Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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Back in June, I raised the issue of outpatient appointments at Waterford University Hospital, which is the closest hospital for many people in south Kilkenny. At that time, I was highlighting the fact that 10,000 were waiting more than a year for an appointment. During June - I must praise someone for this - that dropped by a remarkable 6,000 plus at a rate of around 300 per day. Whether that was due to people actually getting appointments, or simply resulted from a re-checking of the list, I do not know, but it was welcome. Maybe it was a case that I raised it here or maybe something happened and we got some work on it. However, there are still 855 waiting for more than 18 months and I hope progress is made on that.

Today I want to raise the inpatient-day case list in Waterford. As the Minister of State knows, Waterford University Hospital is part of the South/South West Hospitals Group. A lot of people were not happy with this, as the Minister of State also knows, but that is how it happened.

New figures published by the National Treatment Purchase Fund for August 2015 indicate that the number of people on the inpatient-day case waiting list now stands at 4,409 in Waterford University Hospital. This is the highest figure in the South/South West Hospitals Group. It represents almost half the numbers waiting in that group. This also represents an increase of more than 80% in Waterford since August 2013. For the group at large, there has been an increase of 20.17% over the past two years. The percentage increase in Waterford is around four times the rate for the group as a whole and about double the national average increase.

The increase in Waterford means that its share of the group total has risen from just 32% to 45% since August 2013, when the Waterford total stood at 2,433 out of 7,688 patients. By contrast, Cork University Hospital, which had a higher number of inpatient-day cases than Waterford in 2013 - 2,576 out of 7,688 - now stands at 1,447 out of a group total of 9,360, just over 15% of the total. Over the past two years, a situation has developed whereby Waterford, which previously had fewer people on its inpatient-day case waiting list, now has three times as many as Cork University Hospital. Why is this happening? Why is Waterford doing so much worse in the group?

As Waterford University Hospital represents the catchment areas of Counties Kilkenny, Wexford, Carlow, south Tipperary and Waterford, it is a very important regional hospital. Why have the numbers quadrupled? This is a serious situation and we need to do something about. I ask that the Minister for Health investigates this immediately and puts in the man power and resources we need in order to reduce the list. We want for Waterford what has happened at Cork University Hospital. I ask the Minister of State to give me some guarantees in his reply.

Seán Sherlock (Cork East, Labour)
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May I belatedly congratulate Deputy Aylward on his re-election? I served with him on the agriculture committee under a previous mandate and warmly welcome him back.

I am taking this issue on behalf of the Minister for Health and I thank the Deputy for raising it. Improving waiting times for scheduled care for patients is, of course, a key priority for the Government. Under Future Health, significant structural changes are envisaged for the acute hospital sector, with the formation of the hospital groups and the reorganisation of services to improve both quality and access. These structural changes are under way, but will take some time to fully implement. In the meantime, operating pressures remain on acute hospitals. In January, taking into account current pressures on acute hospital services, the Minister for Health put in place maximum permissible waiting times for inpatient-day case treatment and outpatient appointments of 18 months by 30 June and 15 months by year end. The HSE was provided with additional funding of €51 million to ensure that these maximum waiting times would be achieved. In June, the HSE reported a performance against the 18 month maxima of 99.6% for inpatient day cases, IP-DC, and 92% for outpatients, OPD. In order to maintain progress and to make further improvements to achieve a 15 month maxima by the end of December, the HSE has directed that hospitals which breach the 18 month maximum waiting time in August are to be fined.

The fines will be calculated on the basis of the activity-based funding cost of each procedure and are being imposed from 1 September. The HSE, in conjunction with hospital groups, is focused on delivering the improvements in waiting lists through maximising the use of internal capacity within and across hospital groups in the first instance. Hospitals have been requested to produce waiting list clearance plans in this regard. The HSE has already put in place specific measures to address waiting lists more efficiently in collaboration with acute hospitals, the special delivery unit and the National Treatment Purchase Fund. These include observation of the national waiting list protocol of 2014, adherence to relevant HSE national clinical programme guidelines and prioritising day-of-surgery admission where clinically appropriate. The latest published National Treatment Purchase Fund waiting list figures, from 27 August, indicate there were 306 patients waiting over 15 months for inpatient or day-case treatment in University Hospital Waterford. The hospital is working with all relevant parties as regards meeting the national targets. It has now developed and is implementing a plan to reduce the longest waiting times to 15 months by the end of December 2015. This will be achieved by the treatment of patients in routinely available hospital theatre sessions, the provision of additional weekend sessions and the possible outsourcing of the balance of patients.

The hospital is also in the process of reopening theatre sessions that were closed for cost-containment purposes previously. The Department of Health will continue to work with the HSE to ensure that all issues relating to hospital waiting lists are resolved.

Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I will not need my two minutes to re-emphasise what I have already said. I do not like repeating myself. However, as I said, the catchment area of Waterford Regional Hospital is big. How come there was so much success in Cork? Why is the system not working in Waterford? Is the Minister of State blaming the administrative staff in Waterford hospital for not being able to reduce the numbers? We are not talking about a small increase but about an increase of 80% since 2013, which is two years ago. It is a massive increase. Not being a health professional, I do not know why the inpatient number has risen so much. I complimented the Minister on the success with outpatient figures this year. The figures do not lie. I can give them to the Minister of State on the way out. Why, if there was success with outpatient numbers, was there no success with inpatient numbers? Was it a question of money? Did available resources reduce the outpatient number? Why is the trend for inpatients the opposite? Based on my having raised this matter today, can we find out the reason for the increase of 80% in Waterford? Can we do as was done for outpatients?

I will not go through all the figures again. There is no use blathering across the floor of the House. Can we take some action to reduce the number on the waiting list? There has been an increase of 80%. I referred to 4,400 inpatients on the list. This is too many and there is something seriously wrong somewhere along the line. I ask the Minister of State to investigate this or ask the Minister to do something about it.

Seán Sherlock (Cork East, Labour)
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The Deputy mentioned a figure of 4,409. I just had a brief chance to analyse some of the figures. A figure of 3,066 is related to ophthalmology, for instance. This is a significant number. If one parses out ENT, one gets a figure of approximately 556, assuming that the figures I have are right up to date. With regard to gastroenterology, breast surgery and general surgery, the figures seem to be a bit more manageable. Further investigation is definitely needed into why the vast bulk of those on the list are associated with ophthalmology, for instance. We must determine where the lag is in this regard.

I assume the administrators in the HSE and hospital group are watching this debate. I do know that they tune into these debates. I would be very surprised if they were not in a position to provide the Deputy with an actual breakdown of the figures and where the time lags are being generated across the disciplines. Certainly, the matter has now been raised on the record of the House. I could tell the Deputy that I will raise it directly with the Minister, Deputy Varadkar, but the facility exists for Deputy Aylward to do it himself. The matter is on the record of the House.

Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I believed he would be here today.

Seán Sherlock (Cork East, Labour)
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I apologise for his absence. It is significant that a significant figure is attributable to one particular discipline. That needs to be interrogated closely.