Dáil debates
Thursday, 21 September 2017
Topical Issue Debate
Hospital Waiting Lists Action Plans
5:55 pm
Louise O'Reilly (Dublin Fingal, Sinn Fein)
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The Minister and I have discussed the scandal of lengthening hospital waiting lists on many occasions. Thanks to the very great efforts of campaigners such as the Scoliosis Advocacy Network and staff in RTE, this issue has been highlighted. It is only a tiny part of what we now refer to as the "waiting list scandal". As the Minister is aware, the Government has presided over that scandal as it continues to worsen. As is the form with this Government, people who get the opportunity to appear on RTE then find themselves in a situation where they get an answer to some of the questions they have been asking. The Minister is looking at me quizzically but he knows that is true because it has happened on more than one occasion. I accept fully the Minister's bona fides and that he stated he regrets that this has happened. The Minister went on to say that this matter would now be a priority for the Government. I am at a loss to know what would be happening if it was not a priority for the Government, but I welcome that the Minister has set himself a target.
One aspect of the target to which I refer is a reliance on outsourcing some procedures, as I understand it, to two facilities in England and one facility in Germany. Five children have travelled to England to have procedures. Those children were on a waiting list of 300, so what is happening does not exactly represent making significant progress. Five children have had procedures but, to date, the Minister has not signed a co-operation agreement with the other two facilities - the second one in England and the one in Germany - which means that we are at least three months away from any child being able to access the relevant services. It is not simply a case that the Minister can snap his fingers and these children will be transferred.
I have some fairly particular questions to ask the Minister. The first relates to the theatre in Crumlin, which is only open three days a week. That is an scandal. If this matter was a genuine priority for the Government, that theatre would be open seven days a week to take account of the 300 children who are awaiting surgery. I ask the Minister specifically what can be done for those children who have been transferred from Crumlin to the Mater and then back again. It strikes me that is a way to massage the figures. Those patients disappear off the list in Crumlin and they do not appear for a while on the list in the Mater. When they do appear on the list in the Mater, they are then told they have to go back to Crumlin because they are not suitable for treatment in the Mater. That is cruel. Those patients have been waiting for years, notwithstanding the fact that it takes two years to even get an appointment. It strikes me that there is not a plan in place that will, by the end of the year, deliver on the commitment that no one will have to wait four months for treatment. I say this because it will take at least three, if not four, months to get these children to either Germany or England. Their parents have not even received letters initial appointments.
What will the Minister do for those children who are waiting. What will he do, specifically, for the 68 children who have conditions that are medically complex? These are not spinal fusion cases. I understand that the majority of the spinal fusion cases will be dealt with through outsourcing. The Minister knows well my views on that and I will not repeat them. However, what will happen to the 68 children to whom I refer? The theatre in Crumlin is only open three days each week. They are being shuffled around from Crumlin to the Mater and to Cappagh and then back to Crumlin. This is not fair. If the Minister has a plan, I ask him to outline it. If the targets are not going to be achieved, he should be at least honest with those children and their families.
Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I thank Deputy O'Reilly for concluding right on time.
Simon Harris (Wicklow, Fine Gael)
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I thank the Deputy for raising this serious matter and for giving me an opportunity to update the House on the position. I assure colleagues that improving scoliosis services is an absolute priority for both me and the Government. I am monitoring closely - indeed, on a weekly basis - the progress being made on addressing waiting lists.
As the Deputy will be aware, the HSE, working with a number of stakeholders, is currently implementing the action plan it developed for 2017 in order to ensure that, where clinically appropriate, no patient who requires surgery will be waiting more than four months for scoliosis surgery by the end of the year. Both the director general of the HSE and the Children's Hospital Group have confirmed that they are committed to ensuring that no child will be waiting over four months by year end - contrary to what I sometimes read in newspapers, they recommitted themselves to that publicly in recent days - and they are focused on maximising all available capacity, both internally and externally, to achieve this.
Additional nurses are now in post in Crumlin and Temple Street. An additional consultant orthopaedic surgeon commenced in Crumlin earlier this month. Up to 15 September, a total of 216 scoliosis surgeries have taken place in Crumlin and Temple Street and the hospitals are committed to delivering their activity target for scoliosis services this year.
The following important fact needs to be acknowledged because there is a great deal happening. These hospitals have already equalled the number of surgeries that were undertaken in the whole of last year, with over three months still remaining this year to undertake further procedures. Crumlin and Temple Street hospitals have appointed liaison officers to support patients and families during the treatment process. In addition, a project manager and co-ordinators have been appointed to ensure the efficient and timely management of this action plan. Since February of this year patients are also being transferred for treatment to the Mater, Cappagh and Stanmore in the UK and up to 15 September, 22 surgeries were completed in these hospitals.
The HSE, as the Deputy correctly says, has also completed an international tender for paediatric spinal fusion procedures and three hospitals have been successful in their applications. To assure the Deputy, two of those hospitals, the one in Germany and one of those in the UK, have already signed their contracts and begun reviewing patient files with a view to commencing treatment in October - there will not be a wait of three months. They are telling us, as per their tenders and the contracts signed, that next month they will start treating patients whose families take up the offer of having procedures carried out in overseas hospitals.
The HSE is also developing a forecasting model to predict, on both a weekly and a monthly basis, the numbers of patients expected to have surgery by year end. This will assist the HSE and my Department in continuing to monitor the progress made in achieving the target.
To improve scoliosis services in the long term - I agree with the Deputy that sending children abroad for treatment is not what we want to do and that we need to do when we meet the four-month target in terms of a sustainable service in this country - the Children's Hospital Group established a co-design group, which includes scoliosis advocacy groups, to design a comprehensive contemporary and patient-centred approach to the delivery of scoliosis services. This has provided an important and useful forum for discussing and working through issues of concern.
I am pleased to say that the overall number of patients awaiting scoliosis procedures has been reducing throughout the year and fell from 312 in February to 252 as of 15 September. Progress is continuing in order to deliver on the HSE's four-month target by the end of 2017 in a planned, safe and sustainable way.
Criticism of the HSE is often rife in this House and is often deserved. In this instance, however, I assure the Deputy that everything that can be done by a range of staff - in the individual hospital, at Children's Hospital Group level and right up to the director general - is being done. Progress is being made. The target of reducing the waiting time to four months is ambitious and would bring us in line with the position in the NHS. The HSE has recommitted to the target. I will come back to the Deputy on the specific cohort of 68 patients she mentioned.
I am assured by the HSE that it is going to move might and mane to achieve this target by the end of the year. That is its public commitment and we expect the executive to get on and deliver it.
6:05 pm
Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I was contacted very recently by a mother whose 19 year old son was waiting for treatment in Crumlin. He was then transferred over to the Mater Hospital. She got a phone call about him yesterday. This is a young man with a 100 degree top curve. He needs surgery and the doctors have said that he must have that surgery but he has now been sent back from the Mater. She described her mood at the moment as both "confused and angry". She does not feel that there is a plan in place for her son. Similarly, the five families who have been waiting since last July to hear back from Stanmore in relation to their treatment do not feel there is a credible plan in place.
I welcome the fact that the Minister will come back to me about the 68 children with complex needs because they too need to be dealt with. The Minister did not say anything about the operating theatre, which is only operating three days per week. This is supposed to be a priority. The Minister is right that sometimes we criticise the HSE where that is in order. Indeed, sometimes we criticise the Government and individual Ministers where that is in order. We are also capable of recognising where progress has been made but it is cruel to tell parents and their children that they will have a procedure when that does not look likely in many instances. I have spoken to the parents themselves who have told me that a transfer abroad for treatment takes three to four months from the time a decision is made to transfer a child. I cite the cases of those children who have been waiting to hear from Stanmore since last July. The available evidence suggests that there is a time lag and that it stretches to months rather than weeks. I ask the Minister to give those parents an absolute commitment and assurance that surgeries will start in Germany and in the second site in England in October, as he has just said.
Simon Harris (Wicklow, Fine Gael)
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I only relay to the House information given to me that I believe to be factually correct. I am told that two hospitals, one in Germany and one in the UK, have signed their contracts and have begun reviewing patient files with a view to commencing treatment in October 2017 for those families taking up the offer of surgery in overseas hospitals. That is the information that has been made available to me as recently as today.
When I said last year, following the RTÉ programme on waiting lists, that I was ashamed of the way we treated these patients, I meant it. I mean it now and we have to get on top of it. We are making good progress and in fairness, Deputy O'Reilly has acknowledged some of the progress that has been made. The goal here is that the HSE is working to make sure that no child waits over four months. It is not easy because we are dependent on outsourcing overseas-----
Louise O'Reilly (Dublin Fingal, Sinn Fein)
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There is a theatre here.
Simon Harris (Wicklow, Fine Gael)
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We are also dependent on parents being able to travel and in that regard, I understand that it is not always straightforward. In terms of the theatre, we had this conversation this time last year. Indeed, the same conversation was had by many others who were in government before my time in this post. We had a theatre that was closed, that was not performing surgeries. We have hired nurses, the theatre is open and we have an additional consultant. The Deputy is right - the theatre is operating three days per week. If it can do more, I am assured that it absolutely will but I am not going to tell people false information. The theatre is open and is providing more surgeries. Already Crumlin and Temple Street have done the same amount of operations this year as they did in all of last year. This year they will end up doing far more than they did last year. We are using the Mater, Cappagh and Stanmore. We are utilising everything at our disposal. There is no shortage in terms of funding or a determination to make this happen. However, it is complex and is an extraordinarily ambitious target. The HSE is right to have set an ambitious target because, as a country, we were so appalled at the waiting times. However, we need a longer-term, sustainable plan to deal with this within our own country which is why the work of the co-design team is so important. We will try to reflect that progress in the Estimates process as well.