Tom Neville (Limerick County, Fine Gael)
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This issue arises from a reply received to a question about waiting lists in University Hospital Limerick and non-attendees. Some of the figures I have been presented with are quite startling. The answer I received outlined outpatient department attendance in 2015. The number of new appointments was 34,900; of these, 5,633 did not attend.

Outpatient department review appointments totalled 115,649, with 18,701 non-attendances, representing 16% of the total. In 2016 new appointments totalled 35,536, an increase of approximately 600. There was also an increase in the number of no-shows which was up by between 400 and 500. That figure was creeping up to 17%, at 6,029. Review appointments in that year totalled 120,875, with 21,294 non-attendances, representing 17.6% of the total. We need to quantify the exact percentage each year. If one takes the cataract waiting list in University Hospital Limerick, for example, reducing the 16% no-show figure could increase the number of patients seen by between 130 and 140 per year.

Even from a standing still position, this would be a way of combating long waiting lists and increasing efficiency. The HSE has pointed out that the statistics to which I have just referred represent the total numbers of new and review outpatient clinic attendances between 2015 and 2016. The data include patients who do not attend. However, since the launch of the new iPMS patient administration system in 2016, the HSE has reintroduced text reminders for patients. This measure is being rolled out on a phased basis. The HSE will be assessing the benefits of the system and adding additional functionality throughout 2017. The word "reintroduced" was used in the context of text reminders. Were they used previously? If so, why were they not maintained? In the private sector text reminders are used by utility companies, telephone service providers, alarm companies and so forth. Everything is connected to the customer's mobile phone. Mobile phone operators alert their customers to the fact that their bills have been issued; waste companies remind customers to put out their bins in two or three day's time and so forth. Reminders are issued regularly. Such customer-focused, interactive systems are needed in the health service, particularly in the context of reducing waiting lists, because such systems would allow us to combat the challenges presented by such lists. We must identify efficiencies that can be made. In the context of the HSE assessing the benefits of the system, what criteria will be used? I also want to know what additional functionality will be added in 2017.

I am sure there is a lot more knowledge within the HSE than I have of technology that could be utilised. I should not even be raising the matter in the House. It should just be a fait accompli; it should be done. I want to know if a text reminder system was in place previously and, if so, why it was not maintained. I would also like to see the statistics for the rest of the country, given that we are looking at a 17% no-show rate in Limerick. The reminder system should be rolled out across the country as soon as possible.

Minister of State at the Department of Health (Deputy Catherine Byrne):On behalf of the Minister for Health, Deputy Simon Harris, I thank the Deputy for raising this issue. I agree with him on the need to reduce non-attendance for hospital appointments. According to the latest published HSE data, in 2016 there were over 135,000 patients who did not attend new appointments and over 343,000 patients who did not attend review appointments, comprising a general non-attendance rate of approximately 13%. The cost of these non-attendances is difficult to ascertain. In order to ensure outpatient clinics and the time of clinical staff are used to best effect, hospitals usually schedule a greater number of patients in order that clinics are fully utilised in the event that some patients fail to attend. The administrative cost associated with non-attendance is approximately €25 per patient visit. Even more significant, however, is the loss of allocated clinical time which could have benefited another patient. In that context, it is important that the HSE progress initiatives to reduce the numbers of people not presenting for outpatient appointments.

Technology has its part to play in a modern, efficient health care service. The Department of Health has asked the HSE to identify quick, practical solutions to resolve some of the challenges that face the health service on a daily basis. One of these challenges is to provide digital solutions in the area of non-attendance by patients for appointments. One of the solutions eHealth Ireland has proposed is to provide a standardised national patient reminder service using SMS or email. This solution has the potential to reduce the numbers who do not show up for appointments and, in addition, to allow current processes to be adapted and new procedures built to reallocate appointments slots to other patients. This standardised national text reminder service project has been initiated.

Some hospitals such as those in the University of Limerick hospital group have a text messaging reminder service which is integrated with the patient administration system and allows a texting reminder service to operate. This tailored solution will be evaluated when the project is in a later stage to determine if it would be appropriate as a standard approach across the system. In addition, under the new outpatient reform programme, the hospital system will be moving to advanced booking systems which will give patients two choices of appointment time. This has been shown internationally to dramatically reduce patient failure to attend. There is also a further proposal to validate waiting lists using SMS reminder messages which would quicken the validation process, reduce workloads and increase efficiencies. A pilot scheme is to be initiated shortly for both inpatient and outpatient services using SMS reminders for appointment validation purposes. These initiatives are being progressed in conjunction with the HSE’s outpatient waiting list action plan for 2017. The Minister for Health will be communicating the details of these plans shortly.

Before I finish, I highlight the fact that the University of Limerick hospital group has been identified as a good performer in scheduled care. For instance, as reported in the waiting list figures published by the National Treatment Purchase Fund, NTPF, in the month of March, it was the hospital group with the lowest total number of patients waiting for an outpatient appointment.

Tom Neville (Limerick County, Fine Gael)
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It is welcome that the University of Limerick hospital group performed well in the context of scheduled care. However, we must be more proactive in the use of the available technology. In the public sector we always seem to be behind the eight ball when it comes to technology, whereas the private sector is often ahead of it. We need to foster a culture within the health service that embraces technology and uses it efficiently to, first and foremost, help patients on waiting lists. That would have a knock-on effect in assisting front-line staff, for whom I have the height of admiration for how they go about their duties and their commitment to their jobs. Ireland is noted for the use of information technology in the private sector. We were the largest exporter of software 17 years ago. The text messaging service is 20 years old, but still we are pushing, scraping and fighting to try to have a text messaging system up and running in the public service. It should have been up and running years ago. We need to have more interactive technological systems in place in hospitals. While the University of Limerick hospital group has been a good performer, 5,633 patients or 16% of the total did not attend their appointments in 2016. I do not know how many of them were no-shows from 2015 and who had come back into the system. We need to get behind the figures to have the necessary intelligence, data and analytics. That is what happens in every business that survives; it gathers analytics and data and uses them to drive strategy, policy and decision-making.

Catherine Byrne (Dublin South Central, Fine Gael)
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I agree entirely with the Deputy who I know has a huge interest in ICT and how it should work. That said, it is remiss of patients not to keep their appointments. Given that there are so many on waiting lists, when people do not show up, it causes difficulties for the staff running clinics. It is for this reason that most hospitals over-estimate the numbers who will not show up when making outpatient clinic appointments. I agree with the Deputy that a significant number of people do not show up for recurring appointments.

The Minister has outlined that we are in the process of moving to an advanced booking scheme which will give patients two choices of appointment time. I think that is a step in the right direction. These initiatives are being processed in conjunction with the HSE outpatient waiting list action plan. It is important that we develop the IT systems right across all hospitals and not just in particular mainstream hospitals. There is a need for us to catch up with the times, as the Deputy said. We are well noted around the world for our specialties in the IT systems. It is time to implement that in the health service, particularly around hospital appointment lists. I will bring some of the notes I have taken, particularly in respect of UL, to the attention of the Minister and I will ask him to reply directly to the Deputy on the two specific issues he has raised.