Seán Sherlock (Cork East, Labour)
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I wish to raise the lack of access to women's gynaecology services in Cork University Maternity Hospital, CUMH. Women in the Cork region have drastically longer waiting times for these services than women elsewhere in the country. It is causing devastating consequences for the women and their families in the region served by the Cork University Hospital and CUMH.

I will outline some facts that have been communicated to me. I admit to being quite new to this issue. The matter was referred to me by a consultant gynaecologist and the director of the gynaecology unit at Cork University Maternity Hospital. She told me the gynaecology service for women in Cork has been neglected in the past decade. There are currently 4,058 women waiting for an outpatient appointment. It is the longest waiting list of all gynaecology units nationwide and is increasing by approximately 1,000 per year. It is also three times the size of the Cork University Hospital general surgery outpatient waiting list, with 35% of women waiting over a year for an outpatient appointment and many waiting two to three years.

Many women arrive in emergency rooms in crisis due to long waiting times. I have been told there is a risk of delayed diagnosis of cancers in women who are forced to wait for years for their outpatient assessment, and this is a clinical assessment of that. There are 518 women on a waiting list for surgery, 38% of whom have been waiting at least one year. Cork has the longest waiting list for gynaecological surgeries, being twice that of the Rotunda Hospital, which ranks second.

In the past decade, no new consultant gynaecologist posts have been created in Cork, despite the fact that 26 such posts have been advertised nationwide in a one-year period during 2015 and 2016. Gynaecology theatres in CUMH are functioning at only 40% of their originally intended capacity. CUMH has two fully commissioned, state-of-the-art gynaecology theatres, only one of which is used for surgery and for just four days per week.

I want to distinguish between gynaecology and maternity services. I anticipate that the Minister of State's reply may refer specifically to maternity services. I hope it will not. I refer specifically to gynaecology services and the lack of services for women's health. This is not a call for additional funding. The issue is one of governance and ensuring the HSE makes a greater effort to allow the services to be put in place. I do not believe for a minute that it is due to a lack of funding. It is due to a lack of will.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank the Deputy for raising this important issue and I welcome the opportunity to provide information to the House on the matter. In light of increasing demand, a key challenge for our health system is to ensure patients have timely access to health services. The Government is committed to a sustained focus on improving waiting times, particularly for those waiting longest. The number of patients who are waiting to be seen or treated must be considered in the context of the total numbers of patients seen and treated. Every year, there are 3.2 million outpatient attendances at our hospitals. Some 94,000 patients have an elective inpatient procedure and 1 million have a planned day case procedure.

There has been a 4% increase in inpatient and day case activity and more than a 1% increase in elective activity. The HSE has advised that outpatient lists have been increasing since the beginning of the year due to a typical weekly growth of approximately 1,400 patients per week. The HSE has explained that this growth is in part due to a 14% increase in referrals to acute outpatient services. The HSE outpatient services performance improvement programme is working on targeted programmes with a number of specialties to put sustainable solutions in place to address general access times, which will, in turn, address long waiters. These specialties are orthopaedics, urology, general surgery, and ear nose and throat, ENT. Pathways of care that will extend access options for patients are being developed in those specialties as well as in dermatology, rheumatology and ophthalmology. While gynaecology is not yet included in the improvement programme, the programme will be extended to all specialties in the future.

My colleague, the Minister for Health, Deputy Harris and I are aware that there is a difficulty with waiting times for gynaecology services in CUMH. However, the hospital is undertaking a number of initiatives to address outpatient waiting times. I very much welcome these initiatives, as will Deputy Sherlock. They include the provision of additional evening outpatient review clinics which are led by a member of the consultant gynaecology team. The service has recently appointed a gynaecology sonographer who will lead an ultrasound service in liaison with the consultant gynaecology team. With the scheduled additional consultant-led evening sessions, it is anticipated that the gynaecology ultrasound waiting list will be cleared by December 2016.

A national women and infants health programme is being established to lead the management, organisation and delivery of maternity, gynaecological and neonatal services by bringing together work that is currently undertaken across a number of HSE divisions. Spanning primary, community and secondary care, the programme will create the essential cross-sectoral framework to provide the necessary governance, integration and leadership to drive reform and standardise care across maternity, neonatology and gynaecology services. Noting that the international trend in gynaecology service provision is moving towards more day case services and the provision of community one-stop-shop type facilities, it is intended that the programme will be instrumental in driving much-needed reform of gynaecology services. This will include the potential to adopt a multidisciplinary approach and move some service delivery to community settings. Work to establish the programme is ongoing.

Seán Sherlock (Cork East, Labour)
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I thank the Minister of State for her reply. She spoke of some progress in the appointment of a sonographer and a clear schedule to clear the ultrasound waiting list by 2016. In that sense, I accept the Minister of State's reply. In raising the issue, I am trying to examine the governance issue regarding the relationship between CUMH and Cork University Hospital, CUH. Although the HSE will examine it as coming under the umbrella of CUH, it must be recognised as a separate governance procedure similar to other hospitals in the South-South West hospital group. We need to examine how we provide for the reduction in waiting times for women who have been waiting too long for access to services. We also need to examine the risk that is built in regarding the potential for the development of cancers as a result of overly long waiting times.

I acknowledge the response. I ask the Minister, Deputy Simon Harris, his colleagues and the Minister of State, Deputy Marcella Corcoran Kennedy to interrogate the dynamic between those who manage CUMH from a HSE perspective and those who are clinical leads. At one stage, when we were going through a reconfiguration of hospitals in the Cork region, clinicians were taking the lead and decisions were being based on clinically led practice. Now, it has shifted back to the HSE. While I will speak to the Minister of Health myself about it, will the Minister of State convey to the Minister that we need to improve the gynaecological services in CUMH?

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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Gynaecology services in general hospitals are, in the main, linked to local obstetric services through shared consultant appointments. These services are seen as the poor relation to maternity services. Given that obstetric patients cannot wait for services, in times of high demand, the gynaecology patients can be left to wait longer than one would have hoped. Nationally, waiting lists for inpatient and outpatient services are increasing. I acknowledge the Deputy's concerns about surgeries. I did not address it in my response, given that the issue the Deputy submitted was more general. I will raise it specifically with the Minister, as well as the governance arrangements between CUH and CUMH, which are also of concern to the Deputy.

I assure the Deputy that I will do that. I thank him for raising the matter.