Frank O'Rourke (Kildare North, Fianna Fail)
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I am grateful for the opportunity to raise this matter. Two weeks ago a surgeon requested to meet me and my colleagues, Deputies Lahart and Troy, regarding his concern for his patients due to the current unacceptable delays in adult spinal surgery at Tallaght Hospital. Grave concerns exist regarding the growing outpatient waiting list and there is currently no dedicated spinal theatre in Tallaght. While five surgeons are attached to Tallaght, three are jointly appointed to Crumlin children's hospital, one is working half-time on a temporary basis and one is a recent appointee. I met the consultant who carries out spinal surgery as a result of the seriousness of the issue and the impact it is having.

Tallaght Hospital currently services hospitals such as Naas, in my constituency of Kildare North, Tullamore, Portlaoise and St. James's, among others. It is a wide catchment area, given that my constituency has a population in excess of 100,000 people. As far as I am aware, the only hospitals that have theatres equipped to carry out spinal surgery and are dedicated as such are Beaumont Hospital and Cork University Hospital.

In response to the front-line staff - the surgeons and all of their teams - and the patients on these excessive waiting lists, can the Minister and the Department give a commitment that they will invest in one, and ideally two, spinal surgery theatres in Tallaght and provide the required staff?

I am told the cost of a theatre is approximately €4 million and the cost of staffing to carry out operations adequately is approximately €300,000 per annum. Those are the figures I have been given but the Minister of State, Deputy Finian McGrath, may correct me on them. I am being told there is now an urgent requirement to have one theatre but that, given the waiting list, the service would operate very effectively and efficiently with two.

Statistically, our population is ageing. The demands for spinal surgery will increase as the population ages and the service will become more critical. Therefore, it is imperative to have in place the necessary infrastructure, such as the dedicated theatres.

The total number of patients currently on the waiting list for outpatient surgery in Tallaght is approximately 412. One hundred and ninety of those are waiting for between 12 and 24 months. One hundred and seven are waiting for between six and 12 months. The lists are becoming longer all the time, for the reasons we have outlined. This is because the facilities are not in place. The service is covering such a wide catchment that it is just not able to keep up and deal with the number of people referred to it for various types of surgery.

The adult waiting list to see a spinal consultant is currently in excess of 400. Most of these people will need surgery. The spinal surgeon I met made this known to me purely out of concern for his patients. The waiting lists are getting completely out of control, with no end in sight. The surgeon said the target waiting time for urgent cases is approximately one to two months, but the actual waiting time is 13 months. For a routine procedure, the next available appointment is the target, but the actual waiting time is in excess of 23 months. Currently, there are 93 patients awaiting urgent surgery. It is very important to address this and I would appreciate the feedback of the Minister of State on ascertaining how this issue can be dealt with. It is important that the Department takes this on board and consider an investment plan and policy so we can deal with this issue.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Frank O'Rourke for raising this important issue and giving me an opportunity to outline to the House the current position on this matter. Tallaght Hospital adult service is part of the Dublin Midlands Hospital Group and Tallaght is the principal provider of elective orthopaedics in the group. The hospital's spinal orthopaedic service provides emergency and elective access for varying acute and degenerative spinal conditions with a tertiary referral base.

The hospital service for chronic degenerative disorders includes surgery for conditions such as sciatica resulting from spinal degeneration, degenerative spinal deformity, bone fragility-related disorders of the vertebral column and spinal fractures. Patients with abnormal curvature or deformities of the spine may also require corrective surgery. Approximately 30% of spinal patients operated on in Tallaght Hospital are patients who transition from Crumlin children's hospital. In cases involving the severely disabled, complex reconstructive surgery provides real capacity for improvement in life quality, pain and spinal function. The service at Tallaght Hospital includes a pioneering physiotherapy-led back pain clinic screening, which ensures that only 20% of the GP referrals require onward referral to a consultant-led clinic. There are also linkages with pain management services so that patients have access to pain management clinics.

It is acknowledged that spinal orthopaedic activity levels at Tallaght Hospital have fallen in recent years. There has been a reduction in consultant staffing numbers in this sub-specialty area due to consultant departures and difficulty in recruiting replacements. This is an important issue. In an effort to address inpatient and outpatient spinal orthopaedic waiting lists, an additional half-time consultant was appointed in late 2014. This appointment has assisted in managing emergency admissions and in running additional waiting list clinics. In 2015, €1 million was provided by the HSE to fund 100 degenerate spinal surgeries. An additional consultant is due to start work at the hospital in July 2017 and it is expected that this appointment will assist in addressing the hospital's capacity deficit in the long term, particularly in respect of the issues the Deputy raised today.

Furthermore, the winter initiative funding for 2016 and 2017 includes a €7 million fund for a targeted waiting list programme for orthopaedics and spinal and scoliosis procedures in designated sites, including patients on the Tallaght Hospital waiting list. This includes €2 million provided specifically for scoliosis patients to treat the 39 adolescent patients on the Tallaght waiting list and additional 15 to 20 paediatric patients by the year's end. I am aware that the long-term strategy for Tallaght Hospital is to provide spinal degenerative surgery, with a gradual transfer of the adolescent scoliosis surgery from Our Lady's Children's Hospital, Crumlin, to the new children's hospital.

Hospital groups must focus increasingly on networks of service provision, with smaller hospitals managing routine, urgent or planned care locally and more complex care managed in the larger hospitals, such as Tallaght Hospital.

Frank O'Rourke (Kildare North, Fianna Fail)
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I thank the Minister of State and welcome this reply but the difficulty is that the number of patients waiting to have surgery is still in excess of 400. The information I am getting from the surgeons and the front-line staff who must deal with the waiting lists and reduce them to a manageable size is that there ought to be a commitment to invest in delivering the theatres. I know the Minister of State understands this. We are trying to ascertain whether the commitment will be given. Ultimately, it is what will deal with the backlogs initially and have them managed thereafter.

I welcome the €15 million investment in the National Treatment Purchase Fund. I hope some of this will assist in dealing with some of the backlogs and waiting lists in this area. It is a short-term solution for dealing with waiting lists that is to be welcomed but in the longer term we must plan and strategise. The best way to deal with this for the future is to ensure we have the necessary infrastructure and appropriately staffed theatres ourselves.

The surgeon to whom I spoke highlighted that when surgeries are being carried out in private practice in Blackrock, for example, four to six can be carried out per day. In the same period in Tallaght Hospital, the maximum number carried out is two. This needs to be examined, regardless of whether it is a staffing issue or an efficiency issue. The people at the front line are doing everything they can. They are working in difficult circumstances, as we all know, but what is occurring is adding to the problem.

Those who need the procedures carried out are suffering from horrendous pain. I accept what the Minister of State said about pain management but I note, having spoken to the affected in recent days, that it is not working and it is having a serious negative impact on the patients' mental health. There are many consequences arising from having people suffering and waiting for over 24 months to have necessary procedures. I hope there will be a genuine refocusing on this issue, based on the delivery of the measures needed at the front line to deal with this unacceptable problem and the unacceptable waiting lists.

Finian McGrath (Dublin Bay North, Independent)
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I thank the Deputy. Spinal injuries comprise an important issue for me, the Minister, Deputy Harris, and the Government in general. Only last week I had a very informative meeting with a group of affected patients, and they raised many of the issues raised by the Deputy today. I arranged to meet with my adviser on disabilities, Mr. Gerry Maguire, in the past couple of days. We are focusing on the issue. I totally accept the Deputy's point about there being 100,000 people in his constituency in Kildare.

The Deputy mentioned Beaumont Hospital and the unit in Cork, which do great work on these issues. As the Deputy knows, Beaumont Hospital is in my constituency. I am well aware of the work. The Deputy referred to the cost of a theatre. He is correct it is the region of €4 million. Staffing a theatre costs in the region of €300,000 per annum. Our plan is to invest in the health service. We have started that investment. It is important that we recognise that.

I am working on the issue of investment very closely with the Minister, Deputy Simon Harris, whom I commend for his recent work, particularly on the budget, on which we also worked very closely. We are talking about actions, not just issues, for example, the provision of €3 million for an additional 570 orthopaedic procedures in the national tertiary referral centre at Cappagh; €2 million for additional orthopaedic procedures in Beaumont Hospital, Tallaght hospital and the hospitals in Tullamore, Waterford and Galway, with the objective of achieving the 18-month waiting list target by year end; and €2 million to treat the 39 scoliosis patients on the Tallaght hospital waiting list and an additional 15 to 20 paediatric patients by the end of the year.

The important message from the budget - I am standing beside the Minister for Finance, Deputy Michael Noonan - is that we are focusing on investing in health services. I hope to be able to do something about many of the issues raised by the Deputy. As I said, I am working very closely with the Minister, Deputy Simon Harris. The issues raised by the Deputy are among my priority issues in the context of the HSE service plan. I hope, therefore, that we will see some movement in dealing with them in the next few months.