Paul Murphy (Dublin South West, Anti-Austerity Alliance)
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It is a pity the Minister for Health is not here. We heard today that more than 500,000 people are on hospital waiting lists. That is a really shocking figure. Sometimes figures like that are so big that they almost may not be real for people. To help make it real for the Minister of State I will read a letter sent today to my colleague, Deputy Coppinger.

On Thursday the 2nd of June 2016 my mam had a fall at home out in her back garden ... My mam is currently waiting on getting a hip replacement and has no power in her right leg due to this. We waited [from 4.50 p.m.] until 6:35 for an ambulance to get to my mam. [...]

My mam who was face down in the garden was like this for over three hours, she had tried to pull herself up the garden on her stomach as she needed to get to the back door to get some help but she was unable to do this. We were informed when we rang 999 not to move my mam in case she had injuries that we could not see or any internal injuries ... at 5.30 we were assured that an ambulance was on the way to us, we even gave them a second phone number [...]

My mam is 68 years old and because of waiting for a hip replacement she has had knock on affects [sic] to her health and daily life. In November last year, my mam had another bad fall in which she ended up in hospital for over two weeks in which they found that she had fluid on the brain. My mam I feel is a prisoner in her own home as she cannot leave to carry out daily tasks due to her hip it restricts her in every way and it makes simple tasks very difficult for her to carry out. [...]

My mam is on a state pension and has a medical card and I feel that she is being treated like she is in a third world country in respect to her appropriate health care. She is a second class citizen in the Irish health care system as, private patents are seen for hip replacements in a matter of weeks. [...]

We feel the situation she found herself in on the aforementioned date is a result of a failing healthcare system.

The writer of the letter asks several very pertinent questions of the Minister:

How can this be the norm in our health care system? How can people with money or the means to fund an operation get it done in a matter of weeks and vulnerable people have to wait years? Why do we have a two-tier healthcare system? How can a pensioner in Dublin be left for one hour and 45 minutes to be responded to by an ambulance?

That woman and 500,000 other people throughout the country need to hear answers because these waiting lists are not just numbers. They can prove deadly. The so-called cancer gap exposes the reality of what faces ordinary people who are not wealthy enough to get private health care. If people do not have it they can be left waiting on lists for tests and examinations; as the case of Susie Long tragically showed this can result in death while those who have health insurance can be seen more quickly and have a far lower mortality rate. Today we understand the Government agreed a €480 million top-up of funding for the HSE. This is to fill a funding gap for current services but the current services are completely insufficient if each month thousands of people join waiting lists.

Since the beginning of the capitalist economic crisis, more than 5,000 nurses have been lost to the health service. Pay levels have been slashed resulting in newly qualified doctors and nurses leaving the country. Late last year an independent study backed up the position of the Irish Nurses and Midwives Organisation, INMO, that accident and emergency departments have only 60% of the staffing level needed. Despite all of that, the HSE last month directed hospitals not to hire new staff to fill positions which had not already been agreed. The approach of the Government is to base itself on the bottom line. For it, the bottom line is money and for most people, certainly for the Anti-Austerity Alliance, the bottom line is patients. The 500,000 on waiting lists is the bottom line in a health service that shows that funding and staff are required.

We warn the Government not to use this crisis as an excuse to increase the levels of privatisation already in our health service, as planned in the programme for Government. The model of hospital trusts and a management unit is taken straight out of the playbook of the British Tories, a model that has resulted in nearly 40% of contracting services in the National Health Service, NHS, going to the private sector in 2015. The programme for Government will also force hospitals to use their funding to pay private companies to provide services if they do not meet their targets. Private companies and for-profit organisations have no place in our health service. They will not end or assist in any way in dealing with this health crisis. We need to work right now to create an Irish national health service, which is free at all points of access and paid for through progressive taxation.

Catherine Byrne (Dublin South Central, Fine Gael)
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I thank Deputy Murphy for his question.

Every year there are 3.2 million outpatient attendances at our hospitals. A total of 100,000 patients have an elective inpatient procedure and 800,000 have a planned day case procedure. For those waiting to see a consultant or to have tests or surgery, the biggest worry is not the size of the list but how long they are likely to be on it.

Adding the total number of all patients waiting for treatment, regardless of whether they are waiting for surgical or diagnostic procedures or for a consultant-led outpatient appointment, and regardless of whether they were placed on the list two days, months or years ago, produces, as the Deputy says, a headline figure of more than 500,000.

Those headline figures, however, do not tell the story of the approximately 300,00 people on those lists whose wait will generally be less than six months. Nor do they illustrate the point that approximately 75% of people waiting for an outpatient appointment will not require any further treatment arising from that initial referral.

I fully acknowledge that there has been a considerable increase in demand for care in our health service in recent years. However, I want to acknowledge two examples of what has been achieved - the numbers waiting for outpatient appointments have gone down by almost 23,000 compared with May 2015, and the number of people waiting in excess of 18 months for a routine gastrointestinal endoscopy reduced from 87 to 28 within the past month.

The National Treatment Purchase Fund, NTPF, figures for May illustrate the absolute need for a sustained commitment to improving waiting times for patients from across the health service. Clinical need will determine that some patients require care more urgently than others and it is appropriate that patients are prioritised on this basis. After those who require critical or urgent care and in order to provide a fair and equitable service those patients waiting longest must be prioritised and the programme for partnership Government commits to continued investment of €50 million per year specifically for this purpose.

A scheduled care governance group has been established in the HSE to co-ordinate key initiatives to reduce waiting time and the number of patients awaiting treatment. Actions overseen by this group include driving greater adherence to chronological scheduling, relocation of low complexity surgical procedures to smaller hospitals and administrative and clinical validation procedures to ensure that patients are available for treatment. In addition, each hospital group has been mandated to designate a key person to lead and support waiting list management improvements to advance towards compliance with maximum waiting times.

I wish to reassure the House that the officials in my Department are working with the NTPF and the HSE in planning a designated waiting list to initiate focused endoscopy implementation this year and, on further investigation, to address urgently the waiting list for those waiting longer. There will be funding of an annual commitment of €50 million, including ring-fenced funding of more than €15 million in 2017 for the NTPF. This will allow us to balance demand and capacity in our acute hospital service and utilise primary, social and community care services to support the health of our citizens.

I refer to the Deputy's comments regarding someone having to wait for an ambulance for an hour and a half. I can assure him that I do not consider that to be appropriate. The issue needs to be examined.