Dáil debates
Wednesday, 2 December 2015
Topical Issue Debate
Hospital Waiting Lists
1:15 pm
Arthur Spring (Kerry North-West Limerick, Labour)
Link to this: Individually | In context | Oireachtas source
I thank the Minister for Health for joining us. Many issues come in to us in our constituency offices that are pertinent to society, yet very few have come across my desk recently that are as serious as this matter. It concerns the cataract extractions that are necessary for elderly people, the most dominant section of society suffering from cataracts. I will give an example of the timeframe for treatment and its consequences. As a medical doctor, the Minister will, I am sure, appreciate this. Ophthalmologists and eye specialists are giving me first-hand data.
Currently, there are people in their 70s, 80s and 90s telling me they are being seen by a community medical ophthalmologist for the purposes of identifying whether they need a cataract extraction. These individuals are being put on a waiting list by the HSE and are waiting two years, on average, to be seen by - believe it or not - another community medical ophthalmologist, not in County Kerry, but in County Cork. Thereafter they are actually allowed to go and see a surgeon, following another 12 month period. There is a waiting time of up to three years; I have first-hand information from medics that it is currently a three year process. It is like a Kerryman joke that a community medical ophthalmologist in Kerry is not taken seriously enough and people have to go and see another one in Cork two years later to confirm they need a cataract extraction.
There are about 40 people in the Tralee area currently who need this because they can no longer read, see TV or drive their cars. One person - this is a very pertinent case, if the Minister does not mind - is deaf, lip-reads in order to communicate and is on a two year waiting list. That person is elderly, as is the majority of these people. Their quality of life is poor and becoming poorer and their standard of living, as influenced by those who are caring for them, is becoming more needs-based than compassion-based. There is a need for them to be brought shopping, collected and kept in care.
The knock-on effect is that there is more demand for home help and carers. There is also the threat of serious injury if someone is not able, while walking, to identify potholes, steps or other obstructions on the day-to-day route to the shop and so on. If they fall they are inclined to break a hip or do some other serious injury to themselves. Then we are into long-term care for the individual and the costs incurred by that.
I can cite many examples and have submitted some parliamentary questions to the Minister lately. It is not for the purposes of trying to heighten or exaggerate the matter. There is a problem and there is a solution. I am aware that people are travelling to Cork, many of them 80 or 90 years of age, to go to a community medical ophthalmologist. That is a six-hour ordeal at a minimum. For someone to be asked to do that at 90 is a little bit much. The Minister should accept the bona fidesof what is going on in County Kerry. He should go straight into looking at the national treatment purchase fund as the solution.
Kerry General Hospital does not have autonomy in this matter and cannot operate on these patients. It is sending them to Cork University Hospital, CUH. Half a mile over the road, however, the Bon Secours Hospital has a theatre lying idle when we have the funding. I ask the Minister to tell me in his first response how much money is being spent on the national treatment purchase fund currently. I have information that Cork - not Kerry - patients are going to the Mater Private in Cork for the purpose of having cataract extractions. That is not happening in County Kerry.
Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I thank Deputy Spring for raising this issue and giving me the opportunity to confirm to the House that reducing waiting times for scheduled care is a key objective for the Government. In January, I put in place maximum permissible waiting times for inpatient and day case treatment and outpatient appointments of 18 months by 30 June, and 15 months by the end of this year.
The HSE was provided with additional funding of €51 million to ensure that these maximum waiting times are achieved. In June, the HSE reported a performance against the 18 month maximaof 99.6% for inpatient and day case procedures, and 92% for outpatients. The additional funding provided by the Government in 2015 to reduce waiting times for scheduled care is being used to maximise capacity across public and voluntary hospitals, as well as outsourcing activity to private hospitals where the capacity is not available to meet patient needs within the maximum allowable waiting time.
The HSE is addressing performance against maximum waiting times with hospital groups as part of the regular performance and accountability review process. Fines are being applied at the average cost of inpatient, day case and outpatient appointments, with a view to incentivising improved performance for those waiting longest. The total value of fines levied to the end of October is of the order of €8.47 million.
The latest national treatment purchase fund, NTPF figures, published on 6 November, show some improvements. This is positive and is the first time recently that we have seen reductions across the three key categories of inpatient, day case and outpatient waiting lists.
In line with the reconfiguration of acute services for Cork and Kerry in 2013, the elective surgical component of the ophthalmology service transferred to South Infirmary Victoria University Hospital. All ophthalmic surgery is now carried out in south infirmary. The ophthalmology outpatient department remains in CUH until the full transfer of service has been completed.
I am disappointed that the numbers on the waiting list for ophthalmology procedures in south infirmary have increased between March and October. However, I have been assured that in line with the waiting list initiative, the hospital has written to all patients waiting longer than 15 months for an ophthalmology surgical procedure, to offer outsourcing to a private health care provider. I am also pleased to confirm that the numbers waiting for an outpatient appointment in CUH have reduced overall from 5,513 in March to 4,378 at the end of October. I am advised that the hospital is committed to ensuring that by 31 December 2015, no patient will be waiting more than 15 months for an outpatient ophthalmology appointment. I also want to assure the Deputy that urgent referrals are triaged appropriately and seen in a suitable timeframe, in line with the clinical requirement.
To pick up the Deputy's question, the budget for the NTPF for the entire country for the entire year is €1 million. The NTPF ceased to exist as it used to in 2012. Any outsourcing to private hospitals that is now done does not take place through the NTPF as used to be the case. It is done directly by the hospital group or the hospital itself.
1:25 pm
Arthur Spring (Kerry North-West Limerick, Labour)
Link to this: Individually | In context | Oireachtas source
According to the Department, the budget for the NTPF was €17 million in 2013 while it was €5 million in 2014. That is why I am asking what the budget is for 2015. It does not concur.
I have hit the nail on the head regarding what the problem is. The Minister said, "However, I have been assured that in line with the waiting lists initiative, the hospital has written to all patients waiting longer than 15 months for a ophthalmology surgical procedure to offer outsourcing to a private medical provider." A community medical ophthalmologist in Kerry refers people to Cork University Hospital. At the end of a two-year period - it is even longer than the 15 months the Minister cited - they are referred to a private community medical ophthalmologist, who has exactly the same qualifications as the original ophthalmologist, and then referred to a surgeon. This is over a three-year period.
It is not the Minister's fault. The reason I raise it with him is that I know he can go about solving it. Unlike many of the problems raised here, I will not just tell him about the problem but will also provide him with the solution. There is an ophthalmologic surgeon in the Bon Secours Hospital in Tralee. Kerry General Hospital does not have the ability to procure the services for these people, one of whom is an amputee with diabetes, one of whom is 90 years of age and can barely see and one of whom can barely hear and uses lip reading. It costs €3,000 per eye for this to be done privately. These people do not have that kind of money. What funding is available in the HSE? The Minister's budget is increasing rapidly. We are talking about at least 40 people in the Tralee area and more than 100 in County Kerry. The quality of life of these people, who are in their twilight years, is declining. We need to operate on their eyes, remove their cataracts and give them a better quality of life. It is not rocket science but it is a joke that people see a person in Cork who has the same qualifications as the person they saw in Kerry and that they end up on a three-year waiting list. I implore the Minister to take action and secure some funds to give these people quality of life. We need to show some compassion as a Government.
Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I will double check the NTPF figures in case I am mistaken. The NTPF does a number of things. It calculates the waiting lists and negotiates prices with private nursing homes for the fair deal scheme. Its traditional role prior to 2012, where people telephoned it and were able to go private, ended some time ago. I think only €1 million, or perhaps a couple million euro, is provided for that. This is usually done towards the-----
Arthur Spring (Kerry North-West Limerick, Labour)
Link to this: Individually | In context | Oireachtas source
Who is buying the services?
Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I have already told the Deputy but will do so again. It is usually done towards the end of the year. I think it was used for endoscopy last year. A total of €50 million has been provided this year and certain amounts, although not as much, have been provided in previous years. That budget is controlled by the HSE and the hospital groups, so the €50 million provided this year, all of which has not been spent, is available to the hospitals and hospital groups to enable them to outsource their patients. Where they have patients who are waiting more than 15 months, they can now use that money to outsource outpatient appointments and procedures and they are doing that.
I will certainly check up on this matter. Anyone waiting more than 15 months should have been offered the opportunity to go private. I am told that anyone waiting more than 15 months for an ophthalmology surgical procedure has been written to and offered outsourcing to a private health care provider.
Arthur Spring (Kerry North-West Limerick, Labour)
Link to this: Individually | In context | Oireachtas source
Can I clarify something for the Minister? Patients in Cork are going to Mater Private in Cork. There are no patients from Kerry being dealt with in the same manner. The waiting list of two years is made worse by the fact that they see the same person before they see a surgeon. That is the essence of it.
Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I do not have knowledge at the level of individual hospitals but I will certainly check that matter out. I will check the issue of them going to community medical ophthalmologists first before going to surgeons but it may well turn out to be the case that the surgeons are not happy to operate on a patient they have not seen. Often surgeons will want to see the patient before they operate on him or her. This has arisen in a number of cases where patients have been outsourced to a private surgeon who had never seen them before in his or her clinic. There is a clinical risk in that, so there may well be a reason for it.