Jack Chambers (Dublin West, Fianna Fail)
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12. To ask the Minister for Health the number of persons on waiting lists who were due to receive scheduled treatment during October, November and December 2017 and who have been notified that their procedures have been postponed; and if he will make a statement on the matter. [40956/17]

Jack Chambers (Dublin West, Fianna Fail)
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I want to ask the Minister for Health the number of persons on waiting lists who were due to receive their scheduled treatment during October, November and December 2017 and who have been notified that their procedures have been postponed or cancelled.

Simon Harris (Wicklow, Fine Gael)
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I thank Deputy Jack Chambers for his question. I fully acknowledge, as all Deputies would, the distress and inconvenience for patients and their families when elective procedures are cancelled. Maintaining scheduled care access is a key priority for hospitals, and balancing this with emergency demand is challenging. However, all efforts are made to limit cancellations, particularly for clinically urgent procedures.

Cancellation of elective procedures can occur for a variety of reasons. The classifications for cancellation of elective surgery include the following: patient had procedure externally; already had procedure in-house; cancelled by a consultant; cancelled by a patient or guardian; cancelled because of no bed; correction of clerical error; no theatre time available; patient did not attend; patient has undergone emergency admission; and patient unfit for procedure. Based on data provided by the NTPF, approximately 3,400 elective procedures are cancelled per month on average. However, this must be seen in context of the reasons I have just listed, which can be complex, and an average of 53,000 admissions to acute hospitals on a day-case and inpatient basis per month.

The NTPF national inpatient-day case planned procedure waiting list management protocol, published in early 2017, sets out the national protocols for the management of waiting lists including the scheduling of patient treatment. Under this protocol, and in line with best practice, patients should not be scheduled for treatment more than six weeks in advance. On this basis, the HSE has advised that patients will not have been scheduled, as yet, for treatment in November and December. I am happy to come back to the Deputy when we have the relevant data. Also, data on cancellations are reported to the NTPF after cancellation and therefore are not available in advance.

The HSE continues to work with hospitals to improve the management of emergency care demand and planning of elective procedures to minimise the impact on patients, as well as the number of sessions lost through cancellations or non-attendance. As the Deputy is aware, the Department of Health has commenced a health service capacity review, the findings of which are due to be published before the end of the year and which will inform future capacity developments. We need to arrive at a place where there is a decoupling between the beds needed for elective care and those needed for emergency care.

Jack Chambers (Dublin West, Fianna Fail)
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I thank the Minister for his response. My question concerns a number of examples of which I am aware, whereby someone was given an appointment for six weeks' time and then the appointment was cancelled the following week. This is not an emergency process. It is not about capacity or urgent demand in a hospital in a particular week. It is scheduled postponement which I see as taking place on a systemic basis. As we enter the winter period, my fear is that the HSE is trying to scale down its operations in our tertiary hospitals to the detriment of people who are trying to get treatment for which they have been waiting many months and, often, many years. As the Minister and the Taoiseach have repeated this week, we have the biggest budget for health care ever in the history of the State. If appointments are being postponed a week after they have been scheduled, it shows complete management dysfunction and a total disintegration of our hospital system. I fear the winter ahead because we are going to see massive systemic cancellations across our hospital system to the detriment of many patients who had hoped to have treatment.

Simon Harris (Wicklow, Fine Gael)
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I would genuinely ask the Deputy to provide me with information on this if he can because I would be more than happy to look at it. As already stated, I am informed that the NTPF can only report cancellations after the fact. Nor should patients be scheduled for treatment more than six weeks in advance. If there is an issue in that regard, I would be more than happy to look into it if the Deputy can provide me with the information.

In the context of the coming of winter and ensuring that we continue to drive down the number of people on waiting lists, 2,100 fewer people were waiting for hospital procedures or operations last month than was the case the month before. We need to build on that month on month. We continue to utilise the NTPF so that procedures will continue to be performed at a time when our emergency departments are extraordinarily busy.

We will also continue to utilise public hospitals with non-emergency departments and smaller public hospitals, including Cappagh Hospital and some of the level 2 hospitals, in order that it is not all about insourcing. I will be more than happy to correspond with the Deputy on the issues he has raised.

Jack Chambers (Dublin West, Fianna Fail)
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My example goes outside the criteria listed by the Minister. I have seen a number of cases in which people who were given appointments for planned procedures have had those procedures systemically cancelled by the hospital system in a manner which is devastating for them. The hospitals in question have stated in their correspondence that they will be in touch in due course, but they have not given the patients another date. I will explain what I think is happening. I suggest the hospitals are removing particular patients from the planned electives list when they give them appointments, only to cancel the procedures the following week. Are we seeing a vacuum in the statistics caused by the systematic cancellation of apparently scheduled appointments? If so, it is a cause of serious concern for me and everybody else. This does not relate to the criteria listed by the Minister. I think it goes to the heart of the problems we are seeing with the HSE. I do not blame the Minister personally for this; the health care system is broken and disintegrating. It seems we are going to see implementation of the Sláintecare report, but I do not know whether the HSE is fit for purpose in the context of its delivery. The HSE has the biggest budget we have seen, but we are not seeing the output. We need to have a broader debate about the how the HSE, as an entity, can implement a better public health strategy.

Simon Harris (Wicklow, Fine Gael)
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Obviously, the NTPF is responsible for the auditing of waiting lists. I will be more than happy to pass on to it any information the Deputy might have. Very strict rules apply to the waiting list protocols. They govern how patients are added to lists and how they can be removed from them after they have undergone procedures, clinical decisions have been made or validations carried out. These strict rules should be applied consistently across the system. I will be very happy to pass on to the NTPF any information the Deputy might have on its audit function. I agree with what he has said about Sláintecare and the HSE. I do not believe the HSE, as constructed, is fit for purpose. The Sláintecare group shares that view. When I went before the committee, I said we needed a much slimmed-down HSE. I accept that there are things that need to be done at national level such as having cancer standards, maternity standards, procurement and central budgeting systems. There are also things that need to be devolved to the hospital group structure, as constituted, which we hope will become regional structures that will include community care, primary care and acute hospital services. That is the Sláintecare way. I hope we can make quick progress on some of this in the coming weeks and months.