Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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8. To ask the Minister for Health the reason the 18-month target for outpatient appointments set by his predecessor has yet to be met at Sligo University Hospital. [40988/17]

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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14. To ask the Minister for Health the assistance that will be given to reduce the waiting times for outpatient consultations at the Royal Victoria Eye and Ear Hospital [40991/17]

Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Why is the 18-month target for outpatient appointments set by the Minister's predecessor, now Taoiseach, Deputy Varadkar, yet to be met at Sligo University Hospital?

Simon Harris (Wicklow, Fine Gael)
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Are we taking Deputy O'Callaghan's question too?

Pat Gallagher (Donegal, Fianna Fail)
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Yes, but only one Deputy can use the 30 seconds to introduce his or her question. Deputy O'Callaghan will have an opportunity to ask supplementary questions. We will have the Minister first.

Simon Harris (Wicklow, Fine Gael)
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I was just checking.

I propose to take Questions Nos. 8 and 14 together.

I thank Deputy MacSharry and Deputy O'Callaghan for their questions on waiting times at Sligo University Hospital and the Royal Victoria Eye and Ear Hospital.

I acknowledge that waiting times are often unacceptably long and I am conscious of the burden this can place on patients and their families. Reducing waiting times for those on the list longest is one of our key priorities. Consequently, €20 million - rising to €55 million in 2018 - was allocated to the National Treatment Purchase Fund, NTPF, in budget 2017. In order to reduce the number of those waiting longest, I asked the HSE to develop waiting list action plans for 2017 in the areas of inpatient-day cases, scoliosis and outpatient services. The inpatient-day case action plan is being delivered through a combination of normal hospital activity and insourcing and outsourcing initiatives utilising NTPF funding. Since early February, almost 24,000 patients have come off the inpatient-day case waiting list, 84,000 have come off the outpatient waiting list and 249 children have received necessary scoliosis procedures.

In the context of Sligo University Hospital, I acknowledge the point Deputy MacSharry makes about too many patients waiting too long for outpatient appointments. I will highlight some progress being made as a result of the investment that has been made. Out of a total of 11,833 people on the outpatient waiting list at Sligo University Hospital, 567 - 4.7% of the overall number - have been waiting over 18 months. On inpatient cases, 3,412 people are waiting and 228 patients have been waiting over 18 months, which is 6% of the total list. Not everybody is waiting a long period of time and I want to highlight that many people are being seen much more quickly.

There are still too many people waiting too long. We saw in last month's NTPF figures that there is beginning to be a reduction in the length of time relating to and the total number of people on our inpatient-day case waiting list. We hope and expect to see progress on our outpatient waiting list. We have now developed a new strategy for the design of integrated outpatient services. This strategy seeks to improve waiting times for outpatient services by restructuring referral pathways and utilising technology to improve service delivery. I have also asked the HSE to put in place capacity to ensure the validation accuracy of our outpatient waiting list which is something many of us come across in our constituency clinics.

On the Royal Victoria Eye and Ear Hospital, which is the subject of Deputy O'Callaghan's question, I opened a new theatre there in July which will enable over 1,000 additional cataract procedures to be carried out this year and to have no waiting lists for cataract procedures at the hospital by the end of 2018, and no waiting lists for cataract procedures within the hospital group by the end of 2019. On outpatient appointments, when I visited the Royal Victoria Eye and Ear Hospital, those with whom I spoke highlighted their view, which I share, that the primary care eye service review, which was published in the past number of months, provides a way forward whereby a number of these procedures and a number of outpatient appointments will actually take place in primary care. This is something I hope to be able to act on in the context of the HSE service plan for 2018 and the Estimates discussions in which I am currently engaged.

Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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This target has not been met once in the past two years. While the Minister has correctly said that the number is 567, the response he gave, which was prepared by someone in the HSE, is a celebration of all that is not happening. The number increased from 73 in February to 123 in March to 182 in April to 297 in May to 353 in June to 437 in July and to 567, as the Minister rightly said, at the end of August. That is an almost eightfold increase in six months. Despite the great many people who are being seen and the great work those in the hospital are doing, the 18-month target has been an abject failure. Instead of a reduction, there has been an eightfold increase. There are specialties in particular that stick out. In neurology, there were 28 people waiting 18 months ago and in February and now there are 192. In the context of ear, nose and throat procedures, there was one person waiting six months ago and there are now 224.

The trend is not just upwards, it is out of control and accelerating, and we are doing nothing about it. What is the Minister going to do? He mentioned the NTPF. Are we going to expand the restoration of the latter to address outpatient procedures?

Simon Harris (Wicklow, Fine Gael)
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Yes, I am considering that. We need to be very careful in doing that because with certain specialties, outsourcing one outpatient procedure may adequately address the patient's needs but others might require the patient to go back into the public system for an inpatient or day-case procedure.

In recent weeks I met representatives of the NTPF and asked them to look at what role, if any, they can play in respect of outpatient procedures. I hope to be able to progress some of that in the context of the funding that will become available to the HSE in 2018. The number of people in Sligo waiting more than 18 months is a small percentage of the overall list. However, that is no consolation for the people on the list. Some 4.7% of people waiting for outpatient procedures have been waiting for more than 18 months. I accept that is too long. Demand continues to grow. More outpatient procedures are being done in the health service, but we also have a growing and ageing population requiring more medical care.

The referral pathway is the approach for this. As the Deputy knows, as part of our negotiations on the GP contract, we are investigating if things we do in acute hospital settings could be done in primary care which will free up more capacity. That will not work for everything but will provide more capacity. I will take on board the points the Deputy has made about Sligo University Hospital as we develop and frame our NTPF and waiting list plans for 2018.

Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I welcome that the Minister is considering expanding the NTPF to include outpatients. He should do that as a matter of urgency. The trend is accelerating. We must have an answer to the question. Is it a question of resources or of management? What is the problem in Sligo? A sixfold increase, regardless of the percentage of the overall total, is completely unacceptable in a six-month period. I appeal to the Minister to address the House on this as a matter of urgency.

Simon Harris (Wicklow, Fine Gael)
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I would certainly be happy to talk to representatives of the Saolta hospital group and seek a greater understanding of the issues the Deputy wishes to have addressed regarding Sligo University Hospital. As the Deputy did, I wish to thank the people working in the hospital for the number of people they are treating and for the fact that it compares very favourably with another hospitals. I will revert to the Deputy directly.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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The situation in Sligo may be significant, but there is also a very serious issue in respect of the outpatient waiting list at the Royal Victoria Eye and Ear Hospital in my constituency. At the end of August, a total of 2,486 patients were waiting for outpatient appointments at the hospital. As Deputy MacSharry noted, the Taoiseach - who formerly served as Minister for Health - gave an assurance that there would be a time when no one would be waiting 18 months for an outpatient consultation. That objective was achieved in respect of the Royal Victoria Eye and Ear Hospital in December 2015, but matters seem to have gone completely out of control since then. One would have expected that having solved the problem on one occasion, we could have kept that solution in place.

At present, many people are waiting for these operations to be performed. As the Minister knows, it is crucial that sight operations are performed early. The conditions are avoidable and reversible if treated early. However, these 2,486 people are dependent on the Minister to provide a solution.

Simon Harris (Wicklow, Fine Gael)
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The Deputy makes a fair point. We have the makings of a solution in respect of the Royal Victoria Eye and Ear Hospital that is twofold in nature. The first part relates to providing additional capacity in the hospital, which we did. I was in there in July to open its new cataract theatre. That will result in 1,000 additional cataract procedures being carried out this year, meaning there will be no waiting list for such procedures at the hospital by the end of next year. That is not a target set by me, as Minister. Rather it is the target the hospital is publicly professing and confident of reaching. That will provide additional capacity for the people working in the hospital to address the outpatient list, which is to be welcomed.

Clinicians remind me that considerably more eye and ear work could be carried out in the community. A number of clinicians at the Royal Victoria Eye and Ear Hospital were involved in the primary care eye review, which have rise to a number of proposals to move services out of acute hospitals and into primary care. I hope and expect it can act on that in 2018.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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Yesterday, Deputy Micheál Martin and I met representatives of the national Council for the Blind in Ireland to discuss its pre-budget submission. We also had a broader chat with them about the number of people, not just at the Royal Victoria Eye and Ear Hospital but throughout the hospital system, who are on ophthalmology waiting lists. They brought to my attention that up to 75% of sight loss is avoidable if treated early. We need to consider other proposals. It is not fair for us simply to state that the people who are on the waiting list now will have to wait until the end of 2018 or 2019. There is no assurance that will happen. The Minister needs to consider innovative proposals, perhaps using the NTPF, as mentioned by Deputy MacSharry. Something needs to be done.

I recognise that eye procedures can be done very quickly and often outside hospitals. It is not satisfactory for people who are waiting on a list to be told we will have a solution in a year or so; they need a solution now.

Simon Harris (Wicklow, Fine Gael)
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I am sure the Deputy would not wish to misrepresent me because that is certainly not what I said. I said that as a result of investing in and opening the new theatre at the Royal Victoria Eye and Ear Hospital, an additional 1,150 cataract procedures will be performed there by the end of the year. This means that 1,150 people will have the gift of their sight restored, which is obviously a great relief to them.

The Deputy is correct on the broader point. When it comes to eyes and ophthalmology, many of the procedures are simple procedures that can be done quite quickly. That is why we are targeting the resources of the NTPF at cataract procedures. In addition to the NTPF continuing to do that, I also want to see a much quicker migration of some of these services to primary care, which makes sense from a cost point of view and much more importantly from the patient's point of view. I will come back to the Oireachtas shortly with proposals in that regard.