Dáil debates
Tuesday, 17 October 2017
Topical Issue Debate
Hospital Waiting Lists
6:05 pm
Frank O'Rourke (Kildare North, Fianna Fail)
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I welcome the opportunity to raise this issue to the Chamber again and discuss it with the Minister of State. I discussed a similar issue with her last week. It is important that we make progress on these issues. The length of time that patients wait for adult spinal surgery and orthopaedic surgery is unacceptable. Each time we raise this issue in the Chamber we are given a commitment that it will be dealt with comprehensively and that waiting lists will be reduced, but since I raised this issue previously the waiting lists have gone in the other direction. The issues I will deal with specifically relate to Tallaght hospital and the statistics refer to one particular senior surgeon. The figures are not for a multiple of surgeons, and if they were they would be dramatically worse. These are accurate statistics for the outpatient list of one particular surgeon working directly with Tallaght hospital. At present, he has 500 patients on an outpatient list at Tallaght hospital. Of these, 170 need surgery. In addition to this, he deals with referrals from a hospital in my constituency, Naas General Hospital, which deals with north Kildare in particular. He also deals with referrals coming from other hospitals in Dublin and the midlands. If we were to combine all of these other referrals and the other surgeons, we can appreciate the extent of the list, how long it is and the length of time people wait, which is completely unacceptable.
When I raised this in October last year and again in May this year, and looked for the required and requested investment, I was given a somewhat positive response that it would happen but, unfortunately, I am raising the matter again this evening because no progress is being made.
6 o’clock
We want to acknowledge the management, surgeons and front-line staff in Tallaght hospital, who are working tirelessly with restricted and limited resources to try to deal with this issue. Its impact on people's lives is very significant, in a negative way. It is affecting their well-being and mental health. The pain and suffering they are experiencing is quite extensive, as the Minister of State can appreciate. It is affecting their ability to deal with everyday life. It is clearly very difficult and it is impinging on them in a very negative way. When people are suffering like this, it results not only in trauma for them and their families but it also has a negative effect on their contribution to society generally. Owing to waiting, they can do only what they are able to do rather than what they want to do.
Currently, the routine waiting time is 38 months. If one is on a routine waiting list seeking to go to Tallaght hospital to have adult spinal surgery, the waiting time is 38 months. The target is from three to six months. If one's case is urgent, the waiting period is 23 months, and the target is one to two months. At present, Tallaght hospital is hiring or renting theatre space from the Beacon Clinic for one day per week. That confirms the lack of resources, theatre space and infrastructure required in Tallaght hospital. It is an admission that it is not geared up to do what is required. It does not have the theatre space or necessary infrastructure. The crux of the problem is that the required facilities are not in place. I have been asking the Minister for some time to invest in this theatre to deal with the waiting lists and get them under control. There is a lack of central funding. This funding is urgently needed in Tallaght Hospital so these waiting lists can be got under control and so people can have control and regain quality of life, which they certainly do not have at present.
6:15 pm
Catherine Byrne (Dublin South Central, Fine Gael)
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I thank the Deputy for this Topical Issue matter. Unfortunately the Minister, Deputy Harris, cannot be present so he has asked me to reply. I will refer to one of the issues he raised in a little while.
Tallaght hospital is part of the Dublin Midlands Hospital Group, and the hospital is the principal provider of elective orthopaedics in the group. The hospital's spinal orthopaedic service provides emergency and elective access for a varying degree of acute and degenerative spinal conditions with a tertiary referral base. No spinal surgery is performed at Naas General Hospital.
The Minister acknowledges that waiting times are often unacceptably long and is conscious of the burden that this places on patients and their families. Reducing waiting times for the longest-waiting patients is one of this Government's key priorities. Consequently, budget 2018 announced a total allocation of €55 million for the National Treatment Purchase Fund, NTPF, for 2018. This allocation more than doubles the 2017 total allocation, which was €20 million.
Early planning for tackling waiting lists in 2018 is key. This funding will enable the provision of treatment for 18,000 inpatient/day case patients across a range of specialties, including spinal surgery, and procedures. The NTPF will work with both public and private hospitals in order to acquire treatment for these patients. Additional funding of €10 million in 2018 will be dedicated to addressing other waiting lists, including for children in need of scoliosis procedures.
Building on the momentum achieved in 2017, planning for 2018 is ongoing by the HSE and the NTPF. The organisations will work together to develop a coherent 2018 waiting list action plan. This approach is to ensure a seamless continuation of this year's work on addressing waiting lists into next year.
It is worth noting that 2017 has seen the HSE and NTPF make inroads into the inpatient-day case waiting lists and they are well on target to have removed 29,000 patients from our waiting lists by the end of October. To ensure the continuation of this strong focus, additional funding in the region of €10 million has been allocated for the remainder of 2017. This will fund patient treatment across a range of key specialties and procedures, such as those for hips, knees and cataracts, and also for ear, nose and throat and others.
Outpatient waiting lists remain a challenge, however. Over 92,000 patients have come off the waiting list so far this year but there remain almost 500,000 patients on the OPD waiting list nationally as of the end of last week. Outpatient waiting lists do not lend themselves to outsourcing initiatives because the full episode of care would have to be outsourced. The NTPF has advised, however, that it will seek to commission treatment on a see-and-treat basis, which could be used to assist with the management of OPD waiting times.
I assure the Deputy that the significant increase in funding to the NTPF reflects the ongoing commitment of this Government to reducing waiting times for the longest-waiting patients. Next year will see a continued focus on our longest-waiting patients and overall waiting list numbers, including access to spinal surgery at Tallaght Hospital.
On the Deputy's question on the number of people being referred by the surgeon in Tallaght Hospital, I do not have any information but I will certainly revert to the Deputy. I will ask the Minister whether he will consider specifically the case of the 500 on the surgeon's list, 170 of whom need surgery. I have no specifics on this for the Deputy at present.
Frank O'Rourke (Kildare North, Fianna Fail)
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I acknowledge the Minister of State is filling in for the Minister. I met the Minister in June or July of this year and raised this issue, among others. It is disappointing that we are not able to have a full debate on it here. It is not a matter of having the post mortem but agreeing on a strategy to deliver and make progress. With respect, the answer given covered the proposals dealing with outpatients, surgeries and procedures in general but it was not specific to adult spinal surgery or orthopaedics, which represent a massive issue. I am focusing on this issue because it is so urgent and important.
What is required is a €4 million investment. When I spoke with the senior surgeon, I noted this was costed. What the hospital is seeking is a €4 million investment in providing the theatres, the necessary facilities and infrastructure in Tallaght hospital to allow it deal properly, strategically and in an orderly manner with reducing the waiting lists once and for all. That is what I sought 12 months ago and in May and July. That is what I am seeking today. We need a commitment on that because the lack of funding is the problem.
The Minister of State talked about the NTPF. We acknowledge that because putting funding into it in 2017 and increased funding 2018 was part of the confidence and supply agreement. The reality is that, based on how it is being managed or channelled, it is having zero impact on the waiting lists. Figures show that people on the routine list must wait 38 months, yet the aspiration is three to six months. An urgent case - it could be a family member or someone who comes to the Minister of State's own constituency office - must wait 23 months although the target is from one to two months. This is the crux of the matter. It needs to be addressed and we need to bring forward proposals to deliver solutions and results so the people who are suffering can receive the treatment they need and get their lives back on track and so they do not have to wait 36 or 38 months for routine surgeries to make them mobile again and let them have some quality of life.
Catherine Byrne (Dublin South Central, Fine Gael)
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I have taken note of the Deputy's concerns and I will certainly raise them with the Minister. Maybe my reply was not specifically dealing with some of the issues the Deputy raised. A permanent spinal consultant took a post on 17 September 2017. Some 50% of the consultant's capacity is already dealing with immediate, emergency and urgent spinal cases. Tallaght Hospital is in the process of completing its theatre reconfiguration to facilitate a dedicated spinal theatre and address the question of the future appointment of a spinal consultant in 2018. I will certainly raise the specific issue concerning the surgeon. If the Deputy gives me his or her details, I will certainly pass them on to the Minister and bring to his attention again the urgent needs of 179 patients on the surgeon's list and the fact that they need to be seen to urgently.
Frank O'Rourke (Kildare North, Fianna Fail)
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The investment is critical.
Catherine Byrne (Dublin South Central, Fine Gael)
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I have that down here.