Billy Kelleher (Cork North Central, Fianna Fail)
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I raise this issue on foot of the grave disquiet earlier in the year when the "Prime Time" programme, "Living on the List" unearthed the fact that the information on which we depend to know about the varying degrees of lists, the number of people on them and for how long they are waiting is not always collated correctly, efficiently or accurately. I have always said that we are especially good at waiting lists. We have 685,000 people on some list or other in our health services. This cohort is from one half of the population, as the other half has private health insurance. In effect, it is 685,000 people out of approximately 2.3 million or 2.4 million people who depend on the public health system. Clearly, there is a huge difficulty in dealing with patients on waiting lists in a timely, effective and clinically sound manner. On top of that, we are not collating the information correctly.

On foot of the "Prime Time Investigates" programme, the National Treatment Purchase Fund was requested to audit waiting lists and come up with recommendations. The key findings of the audit were exceptional and extraordinary. The hospitals audited did not comply with national protocols on date capture. The audit team found evidence of a combination of non-compliance and inconsistent practices in how date captures were being recorded across all hospitals for outpatient, inpatient, day-case and planned procedure pathways. In some cases, the audit team found evidence of long delays in wait-listing patients, as well as retrospective wait-listing of patients. As a consequence, there were implications for overall waiting list management, including incomplete tracking of patient journeys and incorrect waiting times. All of this resulted in inaccurate reporting of patient waiting times at local and national level.

The audit team observed a number of patients across all hospitals who had been directly listed on an inpatient or day-case waiting lists. The findings are extraordinary in view of the fact that we at least assumed the information we were getting in the Dáil was always accurate as to the number of people on waiting lists and how long they were waiting. It was also assumed that information as to when they were transferred from one consultant to another was accurate. Interestingly, the audit team found evidence that direct listed patients were either referred to the listing consultant by another hospital consultant or community physician, for example a community ophthalmologist, or seen by the listing consultant in another hospital. The audit team observed variation in the management of referrals to ophthalmology services, in particular for cataract surgery.

4 o’clock

"Some referrals from community ophthalmologists were accepted onto an inpatient and day case waiting list, by-passing the outpatient service, whilst other patients referred from community ophthalmologists were placed on an outpatient waiting list to be seen prior to listing for their surgery." In that case it was wholly inaccurate:

The Audit Team found evidence of significant variance in the 'date placed on waiting list' as a result of the length of time between receipt of referral and the clinical decision to 'direct' list patients for cardiology and ophthalmology. As a result, there were inconsistencies in how patient wait times were recorded.

This is highlighting the problems. We need to ensure that the recommendations of the audit and quality assurance report presented to the Minister at the end of September, and carried out on behalf of the National Treatment Purchase Fund, NTPF, are implemented and that we can now depend on wholly accurate information when we raise these issues in the Dáil.

Catherine Byrne (Dublin South Central, Fine Gael)
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I will be taking this matter on behalf of the Minister for Health, Deputy Harris. The "RTÉ Investigates" programme in February highlighted the deeply moving personal stories of people waiting for treatment in public hospitals. Following the programme the Minister was determined that the health service must learn from those patients' experiences. Patients deserve timely, effective and safe treatment from a compassionate and caring health service.

For these reasons, the Minister asked the NTPF to examine waiting list practices in the hospitals highlighted in the programme. The NTPF has now reported to me on its findings and last week the Minister published the findings of the special audit. The NTPF's report has a number of actions to be implemented by the individual hospitals and across the public hospital system as a whole, to drive better performance in how waiting lists are managed in our hospitals. Arising from the audit, the HSE has taken immediate steps to put in place a plan at national level that will focus on driving system-wide implementation of performance and process improvement in waiting list management.

As part of this plan, the HSE will assess, review and oversee implementation of performance and process improvement to address the special audit findings across all hospitals. Addressing the special audit report's recommendations will also be a priority for the HSE for the remainder of the year and will form a core pillar of the waiting list action plans for 2018 as well as the HSE's national service plan. In addition, the Minister has asked the NTPF to develop a plan to extend the special audit process in 2018 to other public acute hospitals.

The Government's commitment to addressing waiting times is clear. Funding of €20 million was allocated to the NTPF in 2017 for waiting list measures and for three months in a row we have seen reductions in the total numbers of patients on the inpatient-day case waiting lists. To continue this strong focus on waiting lists, €55 million will be allocated to the NTPF in 2018 for waiting list measures and a further €10 million will be made available to the HSE for waiting lists, including scoliosis and paediatric orthopaedics.

Addressing waiting lists is, however, not only a question of funding. Since the "Living on a List" programme, several initiatives have been under way to reform and improve how our health service manages hospital waiting lists. These initiatives seek to drive sustainable, multifaceted and innovative approaches in waiting list management. These include a range of initiatives including a study ongoing by the NTPF working with Trinity College to examine international best practice in how waiting list information is collected and reported, and progressing towards more integrated approaches in waiting list management at hospital group level as part of the feasibility study recently carried on by the NTPF. In addition, the HSE is undertaking a national waiting list validation project run by the HSE, to improve the quality of our waiting lists and get an up to date picture of how many patients are actually waiting for care so that the hospitals can plan better and manage waiting lists more efficiently. Initiatives are also ongoing to develop capability in our hospital system in waiting list management best practice and to utilise technology to best effect to support more responsive, effective and efficient waiting list management. The Minister is committed to the idea that the health service learns from the NTPF special audit and the experiences of the patients concerned in order to improve services for all patients.

Billy Kelleher (Cork North Central, Fianna Fail)
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The key recommendations are the important points in this report. Having unearthed what it did we need to address that. The heading "Date captures along the patient journey" is critically important. Under "Direct referral/direct listing of patients onto an inpatient and day case waiting list" it states: "The current pathways for managing patients who are 'direct' listed either as a result of a 'direct' referral from another hospital consultant, community physician or having been seen by the 'listing' consultant elsewhere should be reviewed by all hospitals." That must be carried out immediately. As a Deputy the Minister of State knows that when clinicians write "urgent" on a list it is meaningless. I know of people being marked "urgent" for a hip or knee replacement who have to drag themselves around their kitchens and put rails in their houses so they can move around them. There have been amazing instances of people being referred as "urgent" by their physician or their general practitioner which the system parks on a waiting list like any other. We are debasing the word "urgent". More important, we are debasing the patients who need this urgent treatment or diagnosis. "Clinical Prioritisation" is recommendation No. 3: "All hospitals should review their systems tracking capability to ensure that revisions to clinical priority are clearly documented and are visible from a waiting list management perspective." That is a fundamentally important recommendation in this report, that they be clearly visible so the system will highlight clinical priorities which are deemed urgent, and that clinically urgent requirements do not get lost in a black hole. I urge that this recommendation be prioritised.

Catherine Byrne (Dublin South Central, Fine Gael)
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I agree with Deputy Kelleher that when information comes to the Dáil it must be correct because we can only act on correct information. He is right to highlight the fact that some of the information we received in the past was not as clear as it should have been. Many of those who work in the health service, clerical staff, doctors and nurses, do their jobs very well but only when proper management and chief executive officers are in place can any hospital function properly. It is up to the board and management of the hospital to make sure that things are in order. The audit and the RTÉ programme truly identify the need for all hospitals to provide correct information.

I appreciate Deputy Kelleher's knowledge and his recommendations based on the audit. I spent some time with him on the Oireachtas health committee and he was always very straight in bringing issues to the fore. We all know there are many cases around the country where personal stories have been highlighted and have in many ways clarified for those of us in government and in other parties how important it is to act on emergencies. I have taken note of Deputy Kelleher's concerns and will highlight them for the Minister who may give the Deputy a response to some of them.