Thursday, 1 December 2016
Hospital Waiting Lists
10. To ask the Minister for Health the measures that will be put in place to assist the 4,038 persons waiting more than 18 months for an outpatient appointment in Cork hospitals; and if he will make a statement on the matter. [38058/16]
A total of 11,468 people have been waiting for outpatient appointments in Cork for more than a year. That is across a range of specialties. Earlier this year, I raised with the Minister the position regarding gynaecological services in Cork, which has the largest waiting list for those services and which is far ahead of anywhere else in the country. Women in need of those services are being left for well over a year and a year. They need action.
I propose to take Questions Nos. 10 and 12 together.
I thank Deputy Moynihan for tabling that important question. Similar to Deputy Lahart's question, I would begin by pointing out that we have seen a significant level of underinvestment, perhaps due to the difficult challenging economic years, in addressing waiting lists. There is a direct correlation between under-investing in waiting list initiatives and the impact on the size of waiting lists. We are rectifying that now with the co-operation of people across this House by putting ring-fenced funds into the National Treatment Purchase Fund, NTPF, and into dedicated initiatives within the public health service.
I would also make the point that this time last year approximately 25,000 people a month were being referred by GPs for outpatient appointments. That number has risen to approximately 35,000 a month, so there is a massive increase in capacity in terms of the number of the outpatient appointments being sought.
We are committed to improving waiting times for patients. While recognising that demand for acute hospital services has increased, the important issue for patients is, as the Deputy said, how long they wait. According to the October waiting list data published by the NTPF, nearly 80% of patients on the outpatient waiting list for hospitals in Cork are waiting fewer than 12 months and 93% are waiting fewer than 18 months so I just need to put them into some context.
In August, I asked the HSE to develop a waiting list action plan for 2016 to reduce by year end the number of patients waiting over 18 months for an inpatient or day-case procedure. Since then, we have seen approximately 6,500 patients being removed from that national waiting list. It has clearly had an impact.
Regarding outpatient waiting lists in particular, the HSE recently launched the strategy for design of integrated outpatient services 2016-20. It seeks to improve waiting times for outpatient services by enhancing patient referral pathways and utilising technology to enable better planning.
As I told the Deputy's colleague, this year's budget provides moneys specifically for the treatment of our longest-waiting patients, and this will benefit patients in Cork hospitals as well. Deputy Aindrias Moynihan has referred specifically to the issue of gynaecological services, which extends beyond the answer I have given the Deputy. I want to make it clear that I am concerned by what I read about the waiting times and the concerns that have been expressed by a number of Cork representatives, including by the Deputy. I have asked the HSE for a report on the maternity services and gynaecological services in Cork. I also intend to visit the hospital concerned in the coming weeks to meet directly with management and clinicians on these issues.
While people are languishing on waiting lists they have diminished quality of life. Their distress and anxiety must be unimaginable. There is significant suffering and it is cruelly compounded by that long wait. Those outpatient waiting lists are causing delayed diagnosis of cancers and other serious conditions. While we can consider the different statistics, I am seeing the real people who are calling into my clinic, the person hobbling who has been waiting two years to have a hip operation etc. Also, in the case of gynaecological services, I dealt with a woman who was in the bathroom in a puddle of blood and I had to phone for an ambulance for her. She was on a waiting list for well over a year and had to repeatedly go to the accident and emergency department until she finally received treatment. It is not acceptable.
When I raised the issue of the gynaecological services in Cork with the Minister earlier this year, I pointed out to him the unused theatres in Cork and that theatre in that hospital remains unused. I pointed out to him earlier this year the need for additional consultants in Cork. Of the 28 who were appointed, no consultant was appointed in Cork and there still is not a consultant on the ground, even though the Minister has figures for one to take up position sometime next year. When I raised the issue of the gynaecological services in Cork with the Minister last summer, there were 1,213 waiting for those services for more than a year. That number has risen to 1,628. There needs to be action, not reports. Services need to be delivered for those people in Cork.
There does, there will be and there are. That is seen by the increased level of investment in the health service, which is being translated as we speak into a HSE service plan which will see more funding going into the health service in 2017 than in 2016, which is more funding than ever before. I am not suggesting in any way, shape or form that we can rectify all of the challenges and issues in one budget or in one short period of time. We must have context when we quote figures. When a Minister quotes statistics, people will say do not drown us in statistics, and that is a valid point, but 80% of people in Cork are waiting fewer than 52 weeks for an appointment, the position is not acceptable for the 20% but let us not suggest that everybody is waiting over 12 months or over 18 months. People are clinically prioritised. The Deputy spoke about important issues like cancer and clinical decisions are made in regard to prioritisation of lists, which is important.
The South-South West Hospital Group, which is the group for Cork, has advised me that both it and Cork's hospital management teams continue to work together on solutions to reduce outpatients waiting lists. Clinical capacity is being increased and managed by different initiatives such as extra consultant clinics, musculoskeletal physiotherapy clinics, chronological booking to make sure people who are waiting the longest are being seen first, an ongoing validation of waiting lists, and an IT solution to improve communication with patients and help reduce the extraordinarily high rate of "do not attends" where people have an outpatient appointment and do not attend. We had 400,000 last year, which is a massive number. This is currently at pilot stage in Cork; it will commence this month to try to reduce the number of "do not attends". The South-South West Hospital Group also has a dedicated scheduled care manager who co-ordinates and manages all waiting lists across the hospital group in co-ordination with hospital managers. I take seriously the points Deputy Aindrias Moynihan has raised. I have already been in Cork University Hospital but I specifically want to visit it with a focus on its maternity and gynaecological services, and I will do that in the coming weeks.
I thank the Minister for those details. For each of those people, and their families, who are on that waiting list suffering significantly, there is a fear of a delayed diagnosis of cancers and other conditions. We have already seen the different reports. We know there was plan for a one-stop-shop for gynaecological services in Cork. That needs to be acted on. When I raised this issue with the Minister in the summer, we discussed the possibility of the NTPF. Can it be advanced to aid those people who are still on those waiting lists, suffering and left in limbo?
I will certainly ask that this be considered in the context of the NTPF funding. It has €20 million for expenditure in 2017. I have approved the first €5 million of that which is for day-case procedures largely because we can get through quite a volume of day-case procedures which takes pressure off the acute hospitals and allows them to do other procedures as well. I have asked the HSE for a specific report on gynaecological services in Cork and on what I have been reading in regard to them. I am happy to share that with the Deputy as soon as I receive it.
This question asks the Minister what he will put in place to assist the 4,038 persons waiting more than 18 months for an outpatient appointment in Cork hospitals and if he will make a statement on the matter. We have been highlighting this for some time. Deputy Aindrias Moynihan has been consistently raising the issue of the problems with gynaecological services in Cork. To give the Minister some figures, 4,193 women are waiting for an outpatient gynaecological appointment in Cork. This is the longest waiting list of all gynaecological units nationwide. The waiting list is twice as long as the gynaecological waiting list in the Rotunda Hospital in Dublin. One in three women will wait more than an year for an outpatient appointment with many having to wait two to three years. That is what women are facing in Cork on a consistent basis.
Rather than just visiting the hospital, there needs to be a co-ordinated response to address what is an alarming continual delay in accessing vital services.
I replied to both questions as a group and, therefore, the points I made in response to Deputy Moynihan regarding what I wish to do to tackle waiting lists and the longest waiters stand in the context of this question about Cork. I intend to take the steps I have outlined and that the South-South West Hospital Group will outline as well. Although the Deputy is not suggesting that I am visiting the hospital for the sake of it, I am visiting because I want to meet the clinicians who I have read have a number of views on measures that should be undertaken. I want to hear directly from them and I will make arrangements to do that as quickly as possible.
I welcome the fact the Minister will visit the hospital and I do not suggest he is doing so just as a photo opportunity. I hope he will recognise the difficulties and challenges facing staff. However, there are a few problems we know about in advance of his visit. The CUMH has only one gynaecology theatre in operation. There is a huge opportunity because the infrastructure is in place for some services but the clinicians and support staff are not in place. A gynaecology one-stop-shop, which was envisaged and costed, should be built, as Deputy Moynihan said. A minimum of four additional consultant gynaecologists should be employed as well as nursing and support staff. If all this was put in place, it might improve services. We must avoid a scenario where women are potentially not being diagnosed with life limiting illnesses and potential threats to their lives because they cannot access services or because of inordinate delays. I urge the Minister to do something quickly and proactively prior to his visit to Cork.
I take seriously the points raised by Deputy Kelleher and, indeed, a number of Cork-based Deputies have brought these to my attention. I will act on them. I have asked the HSE to provide a report on gynaecological service waiting times and what it proposes to do to reduce them. I expect to have that in hand before I meet directly with clinicians in Cork, who also have a range of options. We need action on this and I am determined to deliver it.