Fergus O'Dowd (Louth, Fine Gael)
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I thank the Ceann Comhairle for allowing us to raise this issue, which represents a decisive moment for this Dáil and for the health services. How can we accept what we saw on the "RTE Investigates" programme last night? The anger and hurt of the families who featured is repeated in thousands of homes throughout the country. We must take decisive action to address these issues. In that context, I welcome the Minister's commitment to increased financing. However, the reality is that in Ireland, there are three waiting lists in the health service. In Britain, by contrast, there is only one list. In that country, people are assigned to it when their consultant says they require a treatment or procedure, and they go off it once they receive that treatment. That is not what happens in this country, however, and it is unacceptable. As we now know, we have 23,000 people on a pre-admit list, with no monitoring of that list whatsoever.

Billy Kelleher (Cork North Central, Fianna Fail)
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I have no monopoly on empathy with the families whose plight was highlighted on the "RTE Investigates" programme last night. Collectively, we in this House have an obligation to address the issues with meaningful policies that will impact on people's lives immediately. We need, first, clarity on the issue of the waiting lists, in terms of who knew what, why people were on different lists and whether there was intentional reasoning to keep the list numbers down. The policies of the past six years in terms of shrinking the public hospital system via bed closures and not funding the National Treatment Purchase Fund were only ever going to lead to more people waiting for longer on waiting lists across the acute and elective hospital systems. Will the Minister commit to expanding the role of the National Treatment Purchase Fund by ensuring there is adequate funding in place, more so than just the €15 million we sought last year? Funding must be front-loaded to deal with this chronic problem immediately.

Margaret Murphy O'Mahony (Cork South West, Fianna Fail)
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I thank the Minister, Deputy Harris, for coming into the Chamber to respond to this matter. Like the whole nation, I was very moved by last night's programme. I was not, however, shocked by what I saw, because my constituency office is full of files with details of people waiting for operations. The Minister told RTE:

It is principally about the management of resources. It is about the HSE, who are in charge of operations. They are the ones responsible for delivering our health service.

The Minister further stated that where people do not live up to their responsibilities to implement important plans, they will be removed from their roles. Will he tell us who exactly is not living up to his or her responsibilities in this matter? Is it the director general of the HSE? Who does the Minister believe should be removed from their roles given that we have children waiting 18 months and longer whose conditions are deteriorating by the day and who are suffering because they cannot get the treatment they need and deserve?

John Lahart (Dublin South West, Fianna Fail)
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A Programme for a Partnership Government refers to the Government's efforts to ensure safe, timely care, as close to patients' homes as possible, and undertakes to reduce emergency department overcrowding and address hospital responsiveness to increased demand. As we saw in the programme that aired last night, the Government is struggling to do that. One of the most striking aspects of the report was the remark by a surgeon that if a particular patient is marked as a routine case, he or she will never be seen. Will the Minister give the House an assurance that the Government will use the National Treatment Purchase Fund to address waiting lists in the short to medium term? Will he give specific figures for how much he proposes to invest into the scheme to ease the plight of the people whose stories were so eloquently told on the "RTE Investigates" documentary?

Mick Barry (Cork North Central, Anti-Austerity Alliance)
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We found out last night that there are two secret waiting lists in the health service. The HSE fiddled the figures and, in so doing, made the official lists look not as bad as they really are. Who benefited from that fiddling? The HSE did and so, too, did the Department of Health. In addition, successive Ministers for Health benefited from the fiddling of the figures, including the current Minister, Deputy Harris. Did the Minister have any idea these secret lists existed and, if not, why not?

Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I first raised the issue of waiting times for scoliosis patients with the Minister's predecessor in September 2015. Since then, I have raised the matter consistently as the situation worsened to unprecedented levels. The co-founder of one advocacy group, who was featured in last night's RTE programme, told me, "There are children in Ireland who are being left on waiting lists for so long that doctors are travelling abroad to study their condition because their scoliosis has developed to an extent that is not seen in other countries." Doctors are coming from as far away as Africa to examine Irish children whose scoliosis has developed beyond what is seen elsewhere. That tells its own story.

In a response I received to a parliamentary question last week, the Minister stated that the children's hospital group has begun a process of engagement with advocacy groups on developing a partnership approach to the design and planning of services for children with scoliosis. Therefore, the Minister stated, an independent clinical review of scoliosis services is not required at this time. In light of last night's programme, will he now undertake to initiate such a review?

Niall Collins (Limerick County, Fianna Fail)
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On behalf of Ms Megan Halvey Ryan and her family, I appeal directly to the Minister here in the Chamber to intervene in her case, which was highlighted last night. Megan is 13 and suffers from scoliosis. The curvatures measured 83° on her top curve and 65° on her lower curve. She has a very high degree of rib rotation which means her internal organs are being squashed. Her consultant says she needs surgery immediately and she is still on the waiting list.

Megan cannot attend school. She has problems eating and breathing and this is due to her rib configuration because of the condition. She has poor quality of life. She is on medication to get through the day and to sleep at night.

Two years have passed since Megan's diagnosis and she has been on the waiting list in Crumlin for 18 months. Can the Minister arrange for her to receive the care and the procedure which she needs as soon as possible? Her consultant has requested it from the private sector and the Minister has the wherewithal to arrange it.

Simon Harris (Wicklow, Fine Gael)
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I thank the Deputies for raising this important matter and for giving me the opportunity to address Dáil Éireann this afternoon.

One thing the programme last night showed is that I am far from the first Minister for Health to try to address the issue of waiting lists. I recognise it is an issue of great concern to all parties and none in this House and I continue to believe that improving our health service requires an all-party collective effort. However, what the programme last night really brought home is the genuine pain and suffering of patients who are waiting far too long for treatment and the impact this has on their lives and on the lives of their families.

I said I was ashamed. That was not just a word; I meant it. It is simply wrong. How can anyone watching that programme not be ashamed? It is not good enough for me to just be sorry or for me to say we feel ashamed. What are we going to do about it? That is why I began unapologetically targeting resources at the specialties with particularly long waiting lists, such as scoliosis and orthopaedics, and at treating those patients waiting the longest - something that did not always happen.

More that 50 additional children and teenagers with scoliosis were treated with funding made available from the winter initiative but I recognise that this has not been enough for children such as Megan, Kira and Darragh. However, the additional investment achieved progress for those children and young people waiting over 18 months, which is obviously a completely inexcusable length of time for children with this condition to continue to wait. We also made progress on the overall waiting list of over 18 months. This was done in 2016 with limited additional funding and in a limited timeframe. Now, we must do more and I will make sure we do more.

I have just come from a meeting with the CEO of Crumlin children's hospital and the CEO of the Children's Hospital Group and the director of nursing. I am pleased to inform the House that from April, the new theatre built for the purpose of scoliosis will open. This will see 194 spinal procedures carried out in Crumlin - significantly more than last year - and will see significant reductions in waiting lists for scoliosis and waiting times for scoliosis patients. At the end of this month, I will receive from the HSE and the Children's Hospital Group an action plan for scoliosis and I will engage with all parties and none in this House and with advocacy groups in respect of that. In addition, by June we will have an additional orthopaedic post filled within Crumlin.

Therefore, we are responding to what we saw last night, which was unacceptable and needs to be addressed. Everybody in this House highlighted the many issues in the programme last night that need to be addressed. The issue of scoliosis in our children and the length of time they are waiting is not acceptable. That theatre will open in April as a result of the nurse recruitment, an extra orthopaedic post will be in place by June and we will see at least 194 procedures carried out.

In addition, we will have a priority initiative on scoliosis as part of the HSE 2017 waiting list action plan with the aim of every child being treated within the clinical timeframe and if that means outsourcing, that is what we will do as well. We will eliminate the day-case waiting list of over 18 months by the end of June through the NTPF. This will see more than 2,000 patients begin to receive their treatment from March.

The HSE action plan, which I will receive at the end of this month, will work in conjunction with the NTPF to utilise capacity within the private sector and maximise capacity and co-ordination within and between hospital groups to treat the patients waiting the longest. This will be supported by a further €10 million fund for the NTPF.

I expect the action plan combining these measures to be complete by the end of this month and for patients to begin to be treated under it by March.

These measures are to support us moving towards a position where no patient waits for any procedure or any hospital appointment longer than 15 months by the end of October, which still is too long but constitutes progress.

I have also today directed separately that the NTPF will audit the practices in the hospitals highlighted by the individual cases featured in the programme last night. It is important that lessons are learnt and that the NTPF carries out its audit function to see exactly how each of those cases was dealt with in each of the hospitals. The NTPF is already undertaking a review of best international practice on waiting list data publication models and I look forward to that work being concluded.

Let me be clear. When people ask about these waiting lists, this is the waiting list model that has been in place since 2002 under six Ministers for Health and five successive Governments. It did not alter and it did not change. Perhaps I say things are "unacceptable" too much but I say it because I mean it and we will work to fix this.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The Deputies have one minute each.

Fergus O'Dowd (Louth, Fine Gael)
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I welcome the changes the Minister has made. I welcome the proposals on scoliosis. I wait to hear his proposals on the waiting list at Cork University Hospital. I wait to hear his proposals on eye operations, such as for cataracts. I know of a lady aged 90 who is being told she must wait two years before she will get her operation. That is unforgivable and is not acceptable. I accept the Minister's commitment.

While time is short, I note that notwithstanding everything else, Ireland was among the 35 countries that were assessed by the Health Consumer Powerhouse index survey of EU health and was placed 21 out of 35. It has the longest waiting lists in Europe. That is why I say this is a decisive moment. I welcome the Minister's decisive action but he needs to ensure the HSE is accountable and it is not. The HSE is not doing its job. It is getting away with this triple list, which does not make sense. We seek a single list including every patient.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister must get rid of any preordained views he may have on health and the outcomes of the debate on the broader health services. He must invest in the National Treatment Purchase Fund in the short and medium term while we try to expand the capacity in the public hospital system but, more importantly, he must address an issue that is now arising in the public hospital system. Hospital managers and CEOs of hospitals are head-hunting for private patients. Private patients undoubtedly are being put ahead of public patients in public hospitals to fulfil their stretched budgets. That is an issue the Minister must examine thoroughly. I have major concerns that those who have private health insurance and who should be treated in a private facility are now in public hospitals because there is a fee per bed in this regard. That is simply inexcusable. It is wrong morally, ethically and for every other reason. Public hospitals, by and large, should be used for public patients and only if private patients cannot be treated in a private hospital should they be treated in a public hospital. I ask the Minister to visit that issue.

Margaret Murphy O'Mahony (Cork South West, Fianna Fail)
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I note the Minister did not answer some of my questions.

Simon Harris (Wicklow, Fine Gael)
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I will.

Margaret Murphy O'Mahony (Cork South West, Fianna Fail)
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I presume the Minister will do so at his next opportunity.

I also humbly suggest that if smaller hospitals were funded, it would help relieve the bigger hospitals' waiting lists. There is a great hospital in my constituency, Bantry General Hospital, and when it was being properly funded it took the pressure off the bigger hospitals in Cork. It helped with endoscopies, with rehabilitation and endocrinology and were it properly funded again, it would ease the lists in the bigger city.

John Lahart (Dublin South West, Fianna Fail)
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I thank the Minister for his reply and his efforts in this regard. It is not only about spinal issues and I would not like to see the Minister's replies limited to that. I am familiar with, and raised with the Minister, the issue of tonsillectomy queues of young children waiting for ages.

One of my colleagues adverted to the necessity for clinical judgment to be in play here. I wonder how many cases that a consultant takes on privately are routine or acute. In other words, I mean where a consultant would sit by and watch acute patients suffer in the public system while dealing and treating with routine cases in the private system.

When will operating theatres be open at weekends? A spinal surgeon who was featured in the documentary last night is willing to work at weekends but finds it extremely difficult to make that happen in Tallaght hospital. That is merely one of the issues.

A final question to ask of the Minister, because we are so restricted in time, concerns the major investment hospitals such as Tallaght need. In respect of these three waiting lists, were the results of the documentary last night news to the Minister?

Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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The Minister did not respond about the independent clinical review. That was sought by the advocacy group and by professional people. Would having that independent review not help? I welcome that the new facility in Crumlin will be commissioned shortly, but I understand that another theatre will be closed when it comes on stream. Will closing that be an advantage? I am told by the advocacy group that one facility will replace the other, although the new one is welcomed. Hiring theatre nurses is the most important aspect of this matter. The facility is already in place but will there be nurses and back-up teams for it? That is very important. How many theatre nurses will be hired by July this year? That is the date the Minister has given for opening this theatre facility.

Mick Barry (Cork North Central, Anti-Austerity Alliance)
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The Minister read from a prepared script and did not answer the questions. Did the Minister know about these secret waiting lists? If he did not, why not? How much of the delay in access to treatment for public patients is due to private patients being taken ahead of them? Is it the case that if one cannot pay one suffers, even if one is a child and that if one can pay one can go ahead even if one has less medical need? How can any health service and Minister for Health stand over that? Given that, is it not time for a well resourced, single tier health service in this country? Does the Minister not believe that the time has come for an Irish national health service?

Niall Collins (Limerick County, Fianna Fail)
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I will focus my comments on the case of Megan Halvey Ryan. Other Members have raised broader issues. Can the Minister give me a commitment as to when Megan Halvey Ryan will receive the procedure she needs? Will it be done through the public or private sector or through the NTPF system? Many of the people who participated in the "RTE Investigates" programme last night subsequently received their treatments and procedures. That is not the case with Megan Halvey Ryan, whom I know as she is from Limerick. I am making the case for her to the Minister now and I would appreciate if the Minister would reply today or write to me as soon as possible to let me know exactly when she will receive her much needed procedure.

Simon Harris (Wicklow, Fine Gael)
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I will respond first to Deputy Niall Collins. I will ask the CEO of the children's hospital group to revert to the Deputy directly about Megan's situation, because she would be better placed than me to do so. I will arrange for that to happen.

I agree with Deputy Murphy O'Mahony about utilising our smaller hospitals. That is the reason I said earlier that part of the HSE's plan for this year must be about hospital groups. Where some of our larger, level four hospitals are busy there is no reason that there cannot be more elective procedures carried out in the others. I expect that to be a feature of the HSE's waiting list action plan, which we will publish at the end of the month.

With regard to issues such as cataract procedures, raised by Deputy O'Dowd, these are part of the more than 2,000 day case procedures that will be carried out with €5 million of funding from the NTPF. That will start in March. The Deputy is correct with regard to CUMH. I spoke about this yesterday on the Claire Byrne programme. I am concerned about what has happened in CUMH and I have asked the new clinical director of maternity services to report to me on that matter.

I intend to publish an action plan for scoliosis and I will take what Deputy Aylward said on board in that context. The plan for scoliosis will take on board the concerns of the advocacy groups and will dramatically reduce waiting times and waiting lists for scoliosis treatment for children and teenagers in this country. That is what we all wish to do and I will make sure we do it. If that involves outsourcing, we will do that also.

I have asked the NTPF to audit the practices in each of the hospitals featured in the "RTE Investigates" programme. I have asked it to use its audit function and check exactly how the waiting list procedure was dealt with and if everything was done correctly. We saw one case where there was a clinical note and the child did not go on a waiting list for a period of eight months. What happened there is not acceptable. I look forward to the results of the NTPF audit, which today I directed it to undertake.

Deputy Murphy O'Mahony spoke about performance and accountability. I believe managers must be accountable. I am the Minister for Health, so I set policy and provide funding. Then I expect our managers to get on with doing the job. I have written to the director general to ask how each of the managers across the health service measure up in respect of performance and accountability not just on the financial side, which they are good at measuring, but also with regard to access to services.

To respond to Deputy Mick Barry about the lists, this is the same way the NTPF has calculated the list since it was set up in 2002 by the then Minister. There is nothing new here. Did I know, and did many Members of the House who have been talking about health for a long time know, that when people have their procedures and an appointment for a procedure they do not appear on the waiting list? I did. Did I know the size of that? I did not. Did I know there was a specific other list? I did not. However, I am concerned about the people who do not have appointments for hospitals and who clinically need procedures and about getting that done as quickly as possible. We are going to make serious inroads and, in response to Deputy Lahart, I did not mean to talk about scoliosis alone. Across a range of issues we will utilise the NTPF and the capacity in our public hospitals. We will hold our managers to account. I hope we will work in a cross-party way to address these serious issues.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I should point out to Deputies that, on foot of the proposal made by Deputy Martin and others this morning, the Business Committee is proposing to hold a special debate on Thursday morning on these matters which will be more extensive.