Dáil debates

Wednesday, 20 June 2018

Health Waiting Lists: Motion [Private Members]

 

2:55 pm

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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I move:

“That Dáil Eireann:notes that:

— there is not a family in the State currently unaffected by the crisis of hospital waiting lists;

— excessive waiting times are an indicator of poor quality of care in a health system because it shows that the system does not have the capacity to meet the demand for the service;

— because of the two-tier health system in the State, long waits also result in unequal access to care, since waiting is a feature of the public system to a much higher degree than it is for private patients;

— there are more than 707,000 people on a waiting list for a medical procedure as of May 2018;

— statistically speaking, one in every seven people is on a waiting list across the State;

— there are 511,904 people on outpatient waiting lists across the State;

— there are 147,387 outpatient appointments outstanding for over a year as of May 2018;

— 79,647 outpatients were on the waiting list for more than 18 months in May 2018, an increase of 29,956 on May of last year;

— there are 78,596 people on inpatient waiting lists across the State;

— 5,929 people are on the inpatient and day-case waiting lists for more than 18 months;

— these people are not numbers, they are living, breathing, feeling people who are on a waiting list because they need medical attention; and

— the Euro Health Consumer Index of 2017 found that Ireland has the worst hospital waiting lists in Europe;

recognises that:

— under the current waiting list system, waiting lists for outpatient appointments, diagnostic tests, day-case and inpatient procedures vary drastically from one public hospital to the next;

— patients do not know where they stand on the list, nor at what speed their list is moving relative to that of other hospitals within reasonable travelling distance;

— people with comparable health concerns can wait very different lengths of time for assessment and treatment depending on the hospital to which they happen to be initially referred;

— the introduction of an integrated IT system in the Portuguese National Health Service (NHS) helped to achieve new maximum wait times by actively transferring those on the list from hospitals that are failing to meet the target to hospitals that have the ability to offer the service on time;

— the IT model introduced by the Portuguese, alongside greater investment in public hospitals, has delivered significant and sustained reductions in waiting times for surgery since it was first introduced in 2004;

— in the 2013 Organisation for Economic Co-operation and Development (OECD) publication entitled ‘Waiting Time Policies in the Health Sector: What Works?’,

described how over five years waiting lists for surgery have decreased in Portugal by almost 35 per cent, the median waiting times by almost 63 per cent and variation across providers is also diminishing; and

— a similar waiting list management system has been proven to work on a smaller scale in the Royal College of Surgeons in Ireland (RCSI) Hospital Group, the result being that they were the only hospital group in the State who managed to reduce their outpatient waiting lists from May 2017 to May 2018, reducing the waiting list by 2,613; and

calls on the Government and the Health Service Executive to:

— urgently move to implement the Sláintecare Report in its entirety;

— introduce a new and single integrated hospital waiting list management IT system as used in the Portuguese NHS and the RCSI Hospital Group;

— properly invest in our public health system to help tackle waiting lists and stop diverting public monies into the hands of private health interests;

— liaise with hospitals and staff to ensure that as many elective diagnostic investigations are being carried out on a weekly basis as is possible, and to determine whether further surgeries can be carried out over weekends;

— liaise with hospitals and staff to ensure that as many surgeries are being carried out on a weekly basis as is possible, and to determine whether further surgeries can be carried out over weekends;

— ensure proper recording of all time worked by consultants on Type B contracts, including theatre time, so as to monitor the 80/20 split of their private and public work;

— open, without delay, all ward beds that have been closed in hospitals throughout the State;

— examine the possibility of hospitals without emergency departments increasing elective work; and

— adequately staff community hospitals so the Community Hospital Network can be utilised more efficiently, to help alleviate pressure on general hospitals.”

I will share time with colleagues. There is not a family in Ireland unaffected by the crisis of hospital waiting lists. Statistically, one in every seven Irish people is on a list across the State. In May, the list grew to a new record of more than 707,000 people waiting for a medical procedure. On this list, there are 511,904 waiting for an outpatient procedure, 147,387 of which are outstanding for more than a year as of May. The inpatient waiting list was no different in its severity. In May, it stood at 79,649 with almost 6,000 waiting for over a year. These people are not numbers. They are living, breathing, feeling people who are on a list because they need medical attention and this State is washing its hands of its responsibility to them.

These lists can never be normalised or accepted. Excessive waiting times are an indicator of poor quality of care in a health system because they show that the system does not have the capacity to meet the demand for the service. The Minister will tell us, in some convoluted statistical way, how he is succeeding in reducing waiting lists but waiting lists are up, month on month, under this Minister and the Government. That is the truth, it is reality and it is life under this Fine Gael Government. I do not ask Members to take my word for it, however. The Euro Health Consumer Index 2017 found that Ireland has the worst hospital waiting lists in Europe. We are topping the league tables but, funnily enough, the Taoiseach left this out of his list of achievements last week.

The real cost of excessive waiting times is the huge distress and pain it causes to those people who are suffering, as well as to their families. The inability to see and treat patients within a medically acceptable and humane timeframe leads to poorer clinical outcomes and increased mortality. According to researchers at Trinity College Dublin, problems arise when waiting times grow longer than three months for non-urgent cases and some patients suffer deterioration in physical functioning, vitality, social functioning, mental health and general health when waiting longer than three months for a procedure. Excessive waits also contribute to hospital costs and inefficiencies because hospitals must use resources to administer waiting lists and to reassess patient conditions after their long waits.

Since my first day in here I have identified problems and I have proposed solutions. Waiting lists is one area where I have been consistent in arguing for proven solutions. The introduction of an integrated hospital management waiting list IT system in the Portuguese national health service helped to achieve new maximum wait times by actively transferring those on the list from hospitals that are failing to meet the target to hospitals that have the ability to offer the service on time. The IT model introduced by the Portuguese, alongside greater investment in public hospitals, has delivered significant and sustained reductions in waiting times for surgery since it was first introduced in 2004. The 2013 OECD publication, Waiting Time Policies in the Health Sector: What Works?, described how in Portugal, over five years, waiting lists for surgeries decreased by almost 35%, the median waiting times decreased by almost 63% and how variations across providers is also diminishing. That is international evidence but a similar, smaller system is also working right under our noses. The RCSI group was the only hospital group in the State which managed to reduce its outpatient waiting lists from May 2017 to May 2018, doing so by 2,613.

The Minister should look at the evidence as it is all there for us to see. He should introduce a new and single integrated hospital waiting list management IT system as used in the Portuguese national health service and by the RCSI group. He should properly invest in our public health system to tackle waiting lists and stop diverting public money into the hands of private health interests. I have said on many occasions - I hate to have to repeat myself but I love to be right - that when one invests in the private sector one will never improve the public sector. Investing in the public sector is how we improve the public sector and investing in the private sector is how we improve the private sector.

The motion also calls for the immediate implementation of the Sláintecare report in its entirety because the longer we wait for Sláintecare to be implemented, the more time will have to be made up. The solutions are there and there is an alternative. Those on the right of politics tell us there is no alternative and that the health service is broken beyond repair but I have argued for a long time that it is not. The solutions are there and we need to implement them.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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There are 361 citizens lying on hospital trolleys in the corridors of our hospitals all over the country as this motion is being debated. This figure represents 72 more than on the same date in 2017 and 43 more than on the same date in 2016. It is an indictment of us as a society that, when it comes to our health system, we now reference the suffering of our citizens as figures. We need to remind ourselves that these figures are our parents, our partners, our siblings, our children, our extended family members, our friends and our neighbours. Day after day, patients lying on these trolleys end up joining the ever-growing waiting lists for medical procedures across our health system. We have to realise that these waiting lists represent people suffering and in pain and, for many, lives suspended until they secure the operation they need.

In April, the Department launched a plan to reduce hospital waiting lists for those waiting longest to have the procedures carried out through the national treatment purchase fund, NTPF. I am sure these people will welcome the fact that, for them at least, an end to their suffering is in sight. There is, however, a systemic problem. The NTPF is a fudge, another Irish solution to an Irish problem. Capacity is the only solution to the seemingly never-ending problem. It is simply logical to decide that the only way to end years of long waiting lists, once and for all, is to build more capacity.

It frightens me when I hear of tax cuts and sweeteners for the rich in the upcoming budget and then look at the waiting lists in our hospitals and the lists to get our homeless families into suitable accommodation. The ordinary, decent, socially just people of Ireland deserve and demand better. Yes, those who get up early would much rather sacrifice an extra couple of euro weekly from their pocket if the Government could present and commit to a clear solution to a hospital waiting list crisis. I urge the Minister to be ambitious, to reach for the socially just conscience which I know he has to end the misery of our people and to choose investment in budget 2019, not giveaways to those who quite clearly do not require them.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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It seems that, as we approach budget 2019, the big debate in Fine Gael and the Government is how they will cut taxes, which taxes, by how much and for whom. I do not hear much from the party about fixing the problems in our health service or, indeed, any of our public services.

The Minister will know that there are long waiting lists in many specialties in University Hospital Waterford, as long as four years in some cases for people to see an orthopaedic consultant because we do not have enough of them. We still have beds closed in the hospital in Waterford and in community hospitals elsewhere in the county, because we do not have enough nurses to reopen beds that were closed. People are waiting for two years and more to see consultants across a range of specialties, even though Government policy is that the maximum should be 15 months.

Only this week we heard that three consultant psychiatrists have resigned their posts. I listened to one of them this morning on the local radio station talking about the difficulties and the challenges he and his colleagues faced on a daily basis because of the very poor and archaic conditions under which they worked, as well as the extreme pressure they were under day in, day out. We had four consultant psychiatrists in University Hospital Waterford a number of weeks ago but we now have one, while a part-time locum consultant has been drafted in from Galway to supplement the team following the resignation of three members. Is it not enough of a shock to the Minister that we have consultant psychiatrists, of which there is already a shortage in the public system, resigning their posts because of the failure of the Government to deal with the very real challenges they meet on a daily basis?

I have met the Minister several times to discuss the issue of cardiac care. He knows that while the mobile laboratory deployed has done a good job on the diagnostics side, waiting times for interventions have increased. Time and again, we have asked for a modular laboratory to be put in place to provide, certainly in the short to medium term until we get a second permanent laboratory in place, an opportunity to reduce waiting times which are a big issue for patients. It may not be a big issue for those in Fine Gael who are talking about tax cuts, but it is for the people we represent outside this bubble. It is high time the Minister did his job. He needs to ensure at Cabinet level that we will get the resources necessary in the budget to invest in public service and thereby reduce waiting times across the board.

3:05 pm

Photo of Denise MitchellDenise Mitchell (Dublin Bay North, Sinn Fein)
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The position on waiting lists is a scandal. In May more than 700,000 people were on waiting lists. We have the worst waiting lists in Europe. Patients have no idea where they are on waiting lists. As a result, people are left in pain and discomfort for years. To top it all off, 54,306 children are on waiting lists across the State. The Government should be ashamed of that record.

That there is still no integrated waiting list management system is ridiculous. It means that it is pot luck whether someone is treated in a few weeks or a few years because patients have no idea how lists for certain procedures are dealt with in each hospital. Fine Gael's solution to this problem is to throw money at private healthcare providers, while the reality is that we should be investing in the public health service. That is reason people pay their taxes. Many who want to receive treatment in a timely fashion are being forced to go to private hospitals. I do not know on what planet members of Fine Gael live, but citizens in my constituency who are hard workers, raising families and trying to keep a roof over their heads simply cannot afford private healthcare, nor should they have to do so.

The huge waiting lists are causing massive distress. I want to raise a case with the Minister. Last Thursday a lady in my constituency telephoned me. She was very upset about a letter which had arrived from Beaumont Hospital addressed to her son. It was to remind her son that he had an upcoming outpatient appointment. Her son had died in April 2006. Twelve years after his death, his mother received a letter to remind her of an outpatient appointment.

The position on waiting lists is a disgrace. We need to get a handle on the issue.

Photo of Imelda MunsterImelda Munster (Louth, Sinn Fein)
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The health system has always been dysfunctional. We have always had unacceptable waiting lists for procedures. Even when the State had more money than it could spend, we could not get the health system right. That is because it is a two-tier system and such a system cannot work. Fianna Fáil and Fine Gael cannot accept this because it goes against their neoliberal agenda. When successive Governments value the earning potential of consultants and insurance companies more than the health and well-being of the people they serve, it is always going to be a disaster. It is to the Government's shame and that of Fianna Fál and the Labour Party that the problem is still ongoing.

I recently raised the case of a nurse in my constituency who had been waiting for than a year for back surgery to treat scoliosis. On two occasions surgery was cancelled on the morning it was scheduled to take place because there was no high-dependency bed available. Her surgeon advised her that further cancellations were likely because nothing was being done to address that issue.

Another constituent, also with scoliosis, has been waiting for seven years for an operation. Every day she is in agonising pain. If the HSE cannot manage simple matters such as this and the system is that dysfunctional, we need an overhaul of the entire health service.

At Our Lady of Lourdes Hospital in Drogheda staff have serious concerns about the provision of services owing to insufficient staff and resources such as equipment. The computed tomography, CT, scanner is out of date. A new one was approved on paper in 2016, but there is still no sign of it. The old scanner is constantly breaking down. Daily patients are being sent to Dundalk in a taxi to have scans. People have to wait for five months for a CAT scan, nine to ten months for an ultrasound and 59 weeks, or more than a year, for magnetic resonance imagining, MRI, scans. These are diagnostic tests, not treatment. If people are left to languish on waiting lists for months and years, the Government ought to be ashamed of itself. The Minister knows the condition and state of the health service day in and day out. If it was not for the dedication of front-line staff, we would not have a health service.

Photo of Gerry AdamsGerry Adams (Louth, Sinn Fein)
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I commend the Minister for his leadership role in the referendum on the eight amendment. I have not had the chance to say that to him until now. That shows what is possible if there is a will to achieve such outcomes.

At the core of the crisis in the health service is a lack of will to build a genuine public health service, which is creating difficulties, as is evident in the cervical screening scandal and the ongoing crisis in emergency departments. Some 9,000 patients were on trolleys last month and they included 92 children. The crisis is evident in the failure to retain staff. In that respect, I commend health workers.

The failure to provide children in north Louth with access to child and adolescent mental health services and the absence of a minor injuries unit at Louth County Hospital are examples of the crisis. There is a chronic lack of capacity as a result of Government policy, which means that there is a perpetual crisis in the health service. It is no more obvious than in the 700,000 on hospital waiting lists. More than 500,000 citizens are on outpatient waitings lists, while there are almost 80,000 on inpatient waiting lists. The two hospitals in County Louth, Louth County Hospital and Our Lady of Lourdes Hospital in Drogheda, have almost 15,000 on their outpatient waiting lists and 1,330 on their inpatient waiting lists. As a practising politician, the Minister will know that behind these statistics are stories of real stress, hurt and distress caused in people's lives. It is a scandal.

We have suggested alternatives. I commend Teachta Louse O'Reilly for her leadership role and bringing forward this Private Members' motion. We have forwarded our alternatives to the Minister. We need to work towards the creation of an all-island public health service. I commend the motion to all Deputies.

Photo of Dessie EllisDessie Ellis (Dublin North West, Sinn Fein)
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The numbers on waiting lists are at their highest since records began. An astonishing 707,000 patients are waiting for treatment. Repeated comparisons of healthcare waiting times with those in other OECD countries show that there is very significant scope for improvement in Ireland. An example at which we could look is the Portuguese IT model which has led to significant reductions in hospital waiting times. If we consider the position in Ireland, as far back as 2001, there was a commitment given in the health strategy, Quality and Fairness, that by the end of 2004 no public patient would have to wait for more than three months to commence treatment, following referral from an outpatients' department. However, no serious effort was ever made to achieve that target and waiting times have grown substantially ever since. The reality is that the number waiting for more than 18 months for inpatient or day case treatment has soared. The number of long-term waiters on outpatient waiting lists has increased substantially. They show an increase of 29,956 since May last year. According to the 2017 Euro Health Consumer Index, Ireland had the worst hospital waiting lists in Europe.

The report also concluded that the number of Irish patients waiting for surgery or an outpatient appointment is “abysmal”. The ever-lengthening hospital waiting lists are a product of understaffing, a lack of capacity, and inefficiencies in the system. To resolve this ever-growing crisis the Government must increase the capacity of the hospital system by recruiting the necessary staff, opening more beds and investing in care in the community.

To reduce waiting times further, Sinn Féin would introduce an integrated hospital waiting list management system which we call Comhliosta. This is a waiting list initiative similar to that used by the Portuguese national health system, which has proven to have had a sustained and positive impact on waiting times.

Will it require more people to continue to suffer while on waiting lists before this issue is finally sorted? Tá áthas orm go bhfuil an tAire ag glacadh leis an Private Members' business seo. Tá sé thar am.

3:15 pm

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I thank Deputy Adams for his kind words on the referendum and I acknowledge the commitment of Sinn Féin, and especially Deputies O'Reilly and McDonald, on the issue.

I very much welcome the opportunity to address the House on this important issue. Reducing waiting times for patients is a key priority for me as the Minister for Health and for my Government colleagues.

I acknowledge that waiting times for hospital procedures and appointments are often unacceptably long. Many areas in our health service lack sufficient capacity to meet the ever-increasing demand for services and the needs of patients. The evidence of this can be seen not only in the waiting lists but also in my Department’s health service capacity review. Therefore, maximising the use of existing capacity in the short term and seeking to build new capacity through the national development plan is central to improving waiting times. I will outline the approach the Government is taking in this regard in the course of my address.

Increasing capacity alone will not position our system to provide the services and access that our citizens demand. The Irish health service is undergoing a major transformation. The Sláintecare report, and the cross-party support that it enjoys, presents a unique opportunity to embed long-lasting reform in our health system. It is against this background that the Government will not be opposing this motion. It is clear to me that all of the Deputies here today have the same objective in mind, which is to improve access for patients. I would like to approach this debate in the spirit of solutions, and I am here to listen and consider ideas from all Deputies for sustainable solutions to improve access for patients. I hope that, in that spirit, it is also possible to acknowledge some of the progress and to accept the factual context that our health service will treat 3.3 million patients as outpatients this year and deliver 1.7 million hospital operations or procedures outside of the additional work undertaken by the National Treatment Purchase Fund, NTPF.

The NTPF is responsible for collecting and validating all waiting lists for public hospitals. The most recently published NTPF figures for the end of May confirm that just under 78,600 patients are waiting for a hospital inpatient or day case procedure. In July 2017, the number of patients waiting for an inpatient or day case procedure stood at 86,100. This represents a fall of more than 7,500 patients, or almost 9%, in just ten months. The NTPF figures for the end of May this year also show that 56% of patients who are on the waiting list for a hospital operation or a day case procedure were waiting less than six months. In much of the coverage on waiting lists, one never gets the impression that 56% of patients wait less than six months for a hospital operation and 82% were waiting less than 12 months for their procedure. In the area of day case procedures, operations and procedures, we are making good progress as a result of the investment being made and we have much more to do in that regard. This progress in reducing the time patients are waiting for a hospital procedure is a result of the focus and investment by Government in this area. In budget 2018, for example, €50 million was provided to the NTPF to provide treatment for public patients this year, which more than doubled its 2017 total allocation.

I published the inpatient and day case action plan in April, which marked a very important milestone in delivering on the Government’s objective to tackle waiting lists. The action plan is a joint initiative between my Department, the NTPF and the HSE with the aim of reducing the overall number of patients waiting for treatment. One of the central goals set out in the action plan is that by the end of 2018, the number of patients waiting for treatment will fall below 70,000, down from that historic peak figure of 86,100 in July 2017, and that the number of patients waiting longer than nine months will also fall dramatically.

To the end of May the NTPF has organised treatment for almost 7,600 patients. The total number treated in 2017 through the NTPF was just over 6,600, so already this year we have treated more patients through the NTPF than were treated in the entirety of 2017.

There are seven high-volume procedures that are the focus of the action plan, specifically, cataracts, hip or knee replacements, tonsils, angiograms, cystoscopies, skin lesions and varicose veins. All patients who are waiting more than nine months and are clinically suitable for treatment in an outsourced facility will be offered treatment in 2018 for these seven high-volume procedures. I hear a lot from Members about waiting times for cataracts and hip and knee replacements. If a Member's constituent is waiting for longer than nine months for any of those seven high-volume procedures and he or she is clinically suitable to have the procedure carried out, then he or she will have it carried out by the end of the year. For patients who are waiting longest for other procedures, the NTPF and the HSE will work together to identify their requirements, develop treatment plans and, where possible, offer treatments from within existing HSE or NTPF resources.

The cancellations of elective treatment and the increase of emergency procedures arising from significant emergency department pressures have resulted in some difficulties in tackling waiting lists. In the action plan the NTPF has committed to provide 20,000 procedures for patients. This activity is being actively monitored by my Department.

The NTPF will provide all the treatment for patients in both public and private hospitals. This is an important point because it is not always about private hospitals and the NTPF is also investing resources in public hospitals. The NTPF has invited all hospital groups to develop proposals for its consideration to maximise the use of existing facilities. Through the University of Limerick hospital group, for example, a dedicated cataract theatre is being opened in Nenagh Hospital and the NTPF will fund treatment for patients in this new facility in 2018. I look forward to opening that facility in the coming weeks. In addition, my Department, the HSE and the NTPF recently met representatives from the Royal Victoria Eye and Ear Hospital, and we have asked them to put forward a new proposal for priority consideration. These are two practical examples of where we work with the public sector to invest in more capacity.

While positive results have been witnessed through the work of the inpatient day case action plan, and while we are making progress in reducing the numbers of patients on the lists and in reducing the length of time people wait for a hospital operation or procedure, I acknowledge that the outpatient waiting list remains a significant challenge, with 511,000 people waiting for an outpatient appointment. This figure, however, needs to be seen in the context of the 3.3 million patients attending hospital outpatient clinics for appointments every year. It is important to say that more than 70% wait less than 12 months, 60% wait less than nine months and just under half wait less than six months. Sometimes in this House we get the impression from some Members that everybody waits for 18 months or two years on the waiting lists. It is unacceptable for anybody to wait that length of time but the statistics do not back up the idea that this is the norm. We see that a majority of patients are being treated in less than nine months. This does not in any way down play the very serious situation for those people who are waiting too long, which we are determined address. We have made progress with inpatient and day case procedures and we have worked with Opposition parties to re-establish the NTPF to do work on this. We now need to apply the same level of focus to our outpatient waiting lists. This is why I have asked the HSE and the NTPF to develop and outpatient waiting list plan, to provide the same degree of targeted focus to the lists.

In 2017 some 477,000 outpatients did not attend their appointment. This shows the importance of validating hospital waiting lists, given there are 477,000 missed outpatient appointments. Deputy Mitchell raised this issue, and I have had a private word with the Deputy. I will take the details of that case. It shows the importance of having accurate lists when 477,000 people last year were offered outpatient appointments and did not take up the appointments. This week I approved the establishment of a central validation office in the National Treatment Purchase Fund to centralise the validation of all waiting lists across the HSE. Our citizens deserve to have accurate lists so we can target the resources to where they are most needed and so we do not have almost half a million outpatient appointment slots missed each and every year.

I note and share the concern expressed in the motion about the monitoring of private practice in public hospitals. Under the consultant settlement agreement, all parties acknowledge that they are committed to providing a high-quality public health service and recognise that the consultant contract is fundamental to that provision. A central concern of mine and of this Government is the monitoring of the private practices in public hospitals, and my Department and the HSE have recently agreed a robust framework at national and local level to ensure compliance. I heard some stereotypes and labels thrown at me, at Fine Gael and at the Government. It might be useful politics to try to label one's opponents, but let me be very clear that I want to see the ending of private practice in public hospitals. This is why I have signed up to the commitment in Sláintecare and why I have established the Donal de Buitléir working group, which is under way. I hope that all other parties will make their views clear on this issue also. I want to see private practice removed from public hospitals, but done in an organised, intelligent and logical way as envisaged in the Sláintecare report.

I turn now to Sláintecare. It presents the opportunity to reform our health service and the implementation of this report is central to the development of sustainable solutions to reduce waiting lists significantly. In the 12 months since the publication of the Sláintecare report, the Government has taken significant steps to commence the programme of reform, including a commitment to the establishment of a Sláintecare programme office, the establishment of an independent review group to consider how best to remove private practice from public hospitals, and the completion of a consultation on the geographical alignment of hospital groups and community healthcare organisations.

The development of an integrated waiting list solution tailored specifically to meet the needs of our complex health system is being considered as part of this major reform programme. I fully support the view that there is a need for a more integrated approach to waiting list management at hospital group level. At my request, the NTPF has examined the feasibility of progressing to an integrated system. The report which includes a review of models used in jurisdictions such as Portugal is being considered by my Department.

The national development plan provides for a major increase in capacity across the health system. It is an exciting development that we can build three new dedicated elective-only hospitals to drive down waiting lists - one in Dublin, one in Galway and one in Cork. When the same was done in Scotland, waiting lists were reduced dramatically. We now have the funding to develop the three hospitals. They will not have emergency departments to provide emergency care; rather, they will just drive down waiting lists. This was a key Sláintecare recommendation, for which I have received full funding under the recent development plan.

I welcome this debate. I am committed to working collaboratively with all Deputies to find solutions. We can report some progress on the issue of hospital operations and procedures, as shown by the independent figures from the NTPF. However, we still have a large amount of work to do, particularly in outpatient services and ensuring we have accurate lists in order that 500,000 patients will not take up outpatient slots, which indicates a difficulty with the waiting lists. We must work together to increase capacity.

3:25 pm

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I commend Deputy Louise O'Reilly for tabling the motion which Fianna Fáil will support.

Imagine spending every day in intense and debilitating pain knowing that there is a standard operation available but that, because one lives in Ireland and does not have private health insurance, one has to wait two and a half years for it. That is the story of Sarah from Wicklow who is waiting for a hip replacement operation. Imagine having a daughter with scoliosis and seeing her spine curve more and more to the point where she will no longer fit in her wheelchair and knowing that because she lives in Ireland and her parent does not have private health insurance she must wait for more than a year for an assessment to receive a new wheelchair. That is the reality for a mum and her daughter in Bray. Imagine being a manual labourer with shoulder pain that has got so bad that they cannot work who faces the prospect of losing their home because they live in Ireland, do not have health insurance and have waited a long time, not even to be treated but only to be assessed. Imagine being the patient of a GP who contacted me this week, having just been told that she would have to wait for 160 weeks to see an ear, nose and throat specialist. That is the reality on the ground. Some 55,000 children are waiting to see specialists, never mind receive treatment. For the first time in the history of the State, more than 10,000 children are waiting for longer than a year and a half to see specialists. There are not many of us living in the Republic, but more than 500,000 are waiting to see specialists and more than 700,000 are waiting for procedures, the highest number in the history of the Republic.

This morning I met two mothers whose sons had scoliosis. It was difficult to listen to what they and their sons were going through. If a GP believes a child might have scoliosis, that child will be referred to a specialist in a children's hospital. In the case of Crumlin, the child will have to wait between two and three years to be seen by the specialist. That is where we are with waiting lists for children with scoliosis. In January 2017 the target for the length of time taken from finally being seen by a specialist to undergoing a procedure was set at four months. The women whom I met and the parents of other children with scoliosis were told that an action plan would be published by the end of last year. Needless to say, it has not been published and the four-month target has not been met.

The latest Euro Health Consumer Index, EHCI, shows that, of the 35 European countries surveyed, Ireland came last in ease of access to healthcare. It noted that in 2015 Ireland had set a target of no patient having to wait for longer than 18 months for a specialist appointment. The authors put a large exclamation point in one part of their report. It read: "Even if and when that target is reached, it will still be the worst waiting time situation in Europe". To be clear, Fine Gael's target for waiting lists which it cannot even hit would still leave us with the worst waiting times in Europe.

It is not down to a lack of funding. Ireland spends more money per person on healthcare than almost any country on Earth. Since Ireland has a significantly younger population than most other countries, we should be getting better healthcare for the same amount of money that other countries are spending. Instead, we are spending more and receiving worse healthcare. Neither are the problems due to a lack of talent or passion on the part of clinicians. We have some of the best trained doctors and nurses in the world who, as we all know, are dedicated to the cause and want to do the best job possible. It is down to a lack of ambition, vision and competence.

In 2011 Fine Gael announced that the HSE would be disbanded. In 2012 the Government fired the HSE board in front of the cameras. In 2014 the HSE was again told by the Government that it would be disbanded. This time ot was told that it would happen by 2020. In 2016 it was told by the Government that it would no longer be disbanded. In 2017 it was told that it would be reorganised according to Sláintecare. In 2018 it was told that it would be getting its board back. There is not a management team on Earth that could deliver for the people a great healthcare system, given this level of organisational chaos. In that chaos waiting lists have spiralled and men, women and children are suffering everyday.

What did the Government try to do to tackle waiting lists? It moved the target from six months to nine. As it did not achieve it, it moved the target to 15 months. As it did not achieve it, it moved the target to 18 months, which is where we are now. Will it, please, not do that? Will it provide clinicians and managers with the tools they need and identify where things are working? In some places they are working. In the RCSI hospital group many waiting lists are decreasing. We should find out why and share the learning across the system. The Government should help hospitals to reduce admissions from their emergency department. In some hospitals the relevant figures are in the teens, but in others, they are in the high 20s. Why is that the case? The Government should help hospitals to find appropriate step-down care when they discharge patients in order that they will not end up back in emergency departments a few weeks later. The Government should help hospitals to tackle bottlenecks owing to bed shortages, be it in ICUs, wards or elsewhere. The Government should deploy technology and education to help patients to manage their own care. The Government should held GPs to provide as much care as possible in their surgeries in order that they will not need to keep referring patients to local hospitals. The Government should ensure spare capacity in hospitals is being used. In many cases, it is not. The Government should balance the load between hospitals throughout the country in order to reduce the worst waiting lists. The Government should provide higher volume, simpler care in smaller hospitals, provide complex care in larger hospitals and ensure doctors get to work in both settings. The Government should use the NTPF as a temporary measure to provide men, women and children the care they so desperately need.

If the Government sets targets that will give us the worst waiting times in Europe, we will have the worst waiting times in Europe; therefore, it should do not do that. It should set targets that are humane and ambitious and reflect the level of service we want and that the people deserve. It should work closely with doctors, nurses and hospital managers to turn the targets into the reality they must become.

Photo of Robert TroyRobert Troy (Longford-Westmeath, Fianna Fail)
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In the limited time available to me I wish to outline my grave concerns about the current state of the health service. Its deterioration under Senator James Reilly, the Taoiseach and the Minister for Health, Deputy Simon Harris, has been appalling. The figures mentioned in the debate so far are unbelievable. The Minister stated that, if there was a clinical need, patients would be seen within nine months. He should tell that to the lady in Mullingar who has been waiting for 24 months to have a knee replaced and cannot walk. He should tell it to Maureen who is over 80 years of age, has worked long and hard all her life and been told that it will be 36 months before her cataract will be removed. He should tell it to the countless scores of teenagers in my constituency who have been waiting for 36 months for referrals to orthodontists.

The figures the Minister has outlined are inaccurate and untrue.

We have such a crisis in our health service because we have a staffing crisis. I will give an example from the Midlands Regional Hospital in Mullingar. A woman, a qualified nurse, was appointed in September 2017. She is still awaiting a contract. Another person was appointed in June 2017 and is still awaiting a contract. Senior people leave our health service day-in, day-out. They leave our health service because of the lack of flexibility, poor pay and conditions and the lack of availability of proper career progression. In the Midlands Regional Hospital in Mullingar, the prefab that was opened to deal with the winter initiative is now operating 24-7 and is doing so predominantly with agency staff. Mullingar hospital and the maternity hospital are down by 15 whole-time equivalents and the only reason it continues to keep going is because of the goodwill of the people who operate it. The Government needs to wake up and address the challenges facing our health service before it is too late.

3:35 pm

Photo of James BrowneJames Browne (Wexford, Fianna Fail)
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Waiting lists are now the worst ever. There are 707,000 people on waiting lists for medical procedures, 511,000 on outpatient lists, 147,000 waiting for over 12 months and almost 80,000 waiting for over 18 months. We have the worst waiting times in Europe for specialist treatment. We have a target of 18 months and the targets are failing. We are the second worst for value for money. These lists are serious, dangerous and very real. They include very serious cardiac and neurosurgery procedures, children with debilitating pain and spinal deformations and children who are self-harming and suicidal. General practitioners, GPs, are leaving. Nurses are lining up at the airport to get out. Psychiatrists are resigning in a last, desperate protest to highlight the Government's failure in our child mental health services and nobody is listening. The Government is in its eighth year of power yet still behaves as rubberneckers, looking on at a car crash, shaking its head and saying that this is awful, when in fact it is responsible. There has been no vision, no plan and no responsibility. The Government has had eight years. Why should anybody trust it to give it any more?

I want to give one example, of a lady who is 79 years of age. In November 2016, she underwent a procedure relating to her gallbladder which resulted in perforated bile ducts. As a temporary measure, a drain was put in her side. Some 20 months later, waiting for corrective surgery, the drain remains in place. Every Monday, she attends her local GP to make sure it is okay and every six weeks, she attends a hospital appointment where nurses and doctors query why the temporary measure is still present. This lady is in chronic pain, on a specialised diet and she cannot get help. There is a 34 month waiting list for child psychology in my county and no emergency appointments are available. This is unacceptable and needs to be addressed.

Photo of John BrassilJohn Brassil (Kerry, Fianna Fail)
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Waiting times are off the rails. The figures speak for themselves. I want to address a couple of issues that we should look at that are of no great cost to the Exchequer but would, in my opinion, make an appreciable difference. The first is that the winter planning should be done now so that when the crisis occurs and our emergency departments start to fill up in the winter months, we have a plan in place that does not result in cancelling elective procedures and closing up all other areas of the hospital to deal with an emergency department crisis. I ask that, in the winter planning process the Government is undergoing, which I hope it is undergoing as we speak, that no elective procedures are cancelled as part of that plan. All the Government is doing is exacerbating the problem and further increasing waiting lists.

I have just come from a briefing by Nursing Homes Ireland in Buswells, and I am reliably informed that, at any one time, there are approximately 1,000 to 1,200 beds in the system which are unused. Surely it is within the mindset and ability of the HSE to liaise with Nursing Homes Ireland to get patients who are well enough to be out of hospital but not well enough to be at home to convalesce in nursing homes, which would free up, at any one time, 1,000 to 1,200 places, where elective surgeries and waiting lists could be dealt with in a manner which would improve the situation. Rather than rattle out figures to the Minister of State and tell him the obvious that he knows already, I make those two suggestions as something that he could work at to try to improve the situation because, for a population of 4 million people to have a waiting list in excess of 500,000 is unacceptable.

Photo of Margaret Murphy O'MahonyMargaret Murphy O'Mahony (Cork South West, Fianna Fail)
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The programme for Government provides that continued investment of €50 million per year will be made available to reduce waiting lists and overcrowding, particularly for urgent cases and for those who have been waiting longest. Yet over 660,000 people are currently on waiting lists. Alarmingly, this represents a steady increase of approximately 30,000 since last February. Behind all these figures are human beings and the Minister of State knows as well as I do that many people in west Cork are now on waiting lists for long periods and this really has to addressed. Aside from the distress these long and protracted waiting lists have on patients and the impact it has on their medical conditions, there is also the knock-on effect that waiting lists and overcrowding have on day-to-day treatments and procedures, particularly if emergency departments are only dealing with overcrowding and emergency situations. There is no doubt that making more facilities available at primary care level will help to alleviate the pressure experienced in hospital waiting rooms and emergency departments. However, it also needs to be noted that extra resources afforded to general hospitals would certainly ease the burden on the larger university hospitals. I know the Minister of State is working on it and that progress is slowly being made on a rehabilitation unit and endoscopy unit for Bantry General Hospital in our constituency of Cork South-West. Should these facilities be in place, there would be no need for patients to present at the various Cork city hospitals for such treatments. Efforts to address waiting lists and overcrowding should be all-encompassing and inefficiencies in the health system will prove to be counterproductive in the long run.

Photo of Declan BreathnachDeclan Breathnach (Louth, Fianna Fail)
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We all know that the hospital waiting list times are appalling and something needs to be done to alter the situation. I believe that no patient who is in pain should have to languish on any waiting list for any long period. Fianna Fáil wants to see legislation similar to what has been enacted in Scotland whereby there would be a guaranteed maximum waiting time for any procedure, whether an inpatient or day case patient. The maximum time under the legislation in Scotland is 12 weeks. There are two hospitals in Louth, Our Lady of Lourdes Hospital and Louth County Hospital. Our Lady of Lourdes Hospital has over 446 people on waiting lists for over three months while Louth County Hospital has over 155. It is too long for people, particularly those who are in pain. It is shameful that we have over 10,000 children nationally who have been waiting over 18 months for an outpatient appointment. I have had representations, like many in this House, from many families of those children. It can be extremely frustrating to have a child who one knows needs attention from a consultant and needs pain relief left waiting. Apart from making greater use of the National Treatment Purchase Fund, I have been amazed, since I came into this House, that not just the National Treatment Purchase Fund but the Cross Border Directive have been so badly advertised. One would expect that in a Border county like my own and right across the Border region, people would be aware of it. I call on the Minister of State to ensure that proper advertising about this is put in both hospitals and general practitioners' clinics to make people more aware of it.

Photo of Jackie CahillJackie Cahill (Tipperary, Fianna Fail)
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Fine Gael's record on waiting lists for the hospital service, having been in government since 2011, is shocking. If we are to see any solution to this waiting list crisis, the Taoiseach and the Government must accept that there is a crisis. In July 2014, there were 360,000 on the outpatient waiting list. In May 2018, that had risen to 511,904, an increase of 151,151.

It is truly shocking that more than half a million people are now stuck on outpatient waiting lists. The latest waiting list figures for May 2018 show that we are further away than ever from reaching the targets set by the Taoiseach three years ago. The half a million people on the outpatient waiting list is another new record. However, the waiting times being endured within that list are truly shocking. Approximately 80,000 people who need to see a specialist have been waiting for more than 18 months, another all-time high. These figures are not in dispute; they are cold facts. However, behind those facts are patients of every age waiting to be seen by a specialist. Families with children waiting for much needed care are at their wits' end with worry. The quality of life of older people is being badly affected while they wait months for a simple procedure and during that time, the HSE is involved in controversy after controversy.

The situation has reached such a level that people are losing faith in the HSE's ability to solve the waiting list crisis. That is where political accountability comes in. The Taoiseach seems to believe he can float through these scandals offering soft intellectual observations without taking any real responsibility. If the waiting list crisis is to be resolved, the Taoiseach must cancel the promotional tour he has embarked on and get back to reality. Being Taoiseach is not some sort of reality TV show where he plays the hero. It is about working hard for the people of this country and it is about time he understood that.

3:45 pm

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
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I have a sense of it being Groundhog Day again. We have been here many times. One of my daughter's favourite artists is Pixie Lott who has a song called "Here We Go Again". We could recycle much of the debate from the previous three or four discussions we had on this issue. I will not bother the Minister of State, Deputy Jim Daly, with any political point-scoring, but I will make a few points that might be helpful. We are aware of the issues concerning emergency departments and waiting lists. We know the consequences in terms of the number of people who die as a result of waiting lists and the current crisis. That is not a reflection on health service staff and I dare say it is not a reflection on management. One significant issue is that we do not have enough consultants or specialists. Hiring consultants who are not even on the register poses a serious risk. Hospitals are acting at a capacity that would be considered a national crisis or emergency in most other jurisdictions. In Britain and other jurisdictions hospitals stopped taking on new cases and cancelled elective surgery because of the situation with emergency theatres in particular. We could also create greater efficiencies.

I will make one or two points which I believe will improve matters. We have a number of different tiered hospitals. In fairness to the Minister of State, Deputy Jim Daly, he was in the grounds of Nenagh hospital not so long ago where he saw the extensive space available and the major advances that are taking place. Let us take the mid-west as an example and, if necessary, the south west and Bantry hospital. In the cases of Ennis hospital, St. John's Hospital and Nenagh hospital, the pathways for managing how people are treated in hospital networks must change. The minor injuries units are too restricted in terms of what types of patients they can take. They should be able to take fracture patients and deal with a number of other issues. That would mean University Hospital Limerick would not be clogged up. I have been making that argument for some time.

The grade 2 hospitals should be open for longer and be able to deal with a wider range of ailments. They should also be able to provide step-down facilities and take patients preparing for surgery and following surgery. They should be able to do so more quickly to free up beds in the acute hospitals, in this case University Hospital Limerick and in the case of the Minister of State, University College Cork. The cost of such an initiative would be small and it would save money because people would no longer block beds. In many cases, people cannot be transported from Limerick to Nenagh. We have transport known as intermediate care vehicles but there are not enough of them, they only run from Monday to Friday and sometimes they are not available. Ambulances transport people from an acute setting to the grade 2 hospital where they are treated in a fantastic setting but we cannot move enough people out quickly. The same story is replicated across all the networks. I urge the Minister of State to take that on board. I sound like a broken record speaking about this issue.

We also need to create greater capacity in hospitals. It is proposed to build a new 96-bed unit in University Hospital Limerick. Given that it will take years to build the new unit, we will have to consider taking a modular approach. A proposal has been put together which would cost the HSE €19.45 million in capital expenditure following the bed capacity review.

In the south of my county, in Clonmel hospital, the situation is chronic and to the north, in Limerick, the situation is woeful. The two worst emergency departments in Ireland in terms of overcrowding and trolleys are on either side of me. There are plans for a modular unit in Clonmel hospital and I am told this will be built and ready for the coming winter. I hope it will be ready but I have my doubts. The biggest issue in the country is in Limerick. We will have to support the CEO of the University Limerick hospital group in the application the group has made for funding.

I have a concern about Sláintecare not being implemented. A head of Sláintecare has not been appointed despite the post being advertised for a long time. I understand a number of other positions are being advertised within the HSE. If these positions are filled, I wonder how the roles we have planned in Sláintecare can be upfilled. I urge the Minister of State to examine the issue.

I will not repeat what is already on the record about the necessity for primary care but the current model, under which bundles of primary care buildings are being developed across the country, is not working in some cases. It has led to speculation. Speculators are getting a licence to build a primary care centre, sitting on it for a period and then trying to sell it on at a profit. This practice should not be tolerated. A deadline should be set within which a developer must meet all requirements in terms of providing general practice and other facilities. The project should be taken off any developer who fails to meet the requirements and re-advertised because speculation is taking place all over the country, including in my county.

Issues affecting waiting lists span a range of areas. I wish to raise two cases which I have been given permission to bring up. One is a case I raised previously with the Minister of State involving a young man who is not even from my constituency - he is from Waterford. We will call him by the initials ND. He has various issues affecting him and his family has been looking for residential care for a long time. I will not name him or his family but I have permission to do so if the need arises. I have written to the Minister of State to explain that some families are being put in dangerous situations due to the lack of residential care. This will become the next scandal if physical violence or issues relating to sexual activity arise. I have dealt with a number of such cases. In fairness to the HSE, it has dealt with many of the cases I have raised with it, but this is one of the more worrying cases. I urge the Minister of State to examine it.

I also raise the case of Matthew Quinn, which is a little closer to home. Matthew lives about a quarter of a mile away from me, just over the hill. He was delighted to feature on RTÉ last week. He is a 14 year old with Down's syndrome who has been waiting for a hip replacement for two years. He asked Santa Claus to bring him a new hip and when I visited him he asked me to help him to get a new hip. He does not want anything else except a new hip because he is totally immobile and in pain. He featured on "Six One" news last week. We fight for various issues but this young boy, who is a big lad, deserves to have his surgery. Issues have arisen between the paediatrics services in Crumlin and Tallaght hospitals. I have been raising these for months and I do not understand what is going on. I have spoken to the surgeon and there is no reason this issue cannot be dealt with. It is symbolic of a bigger issue between the hospitals. I urge the Minister of State to investigate this case because this young man, and others like him, do not deserve to be left in this position.

3:55 pm

Photo of Bríd SmithBríd Smith (Dublin South Central, People Before Profit Alliance)
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I welcome this Sinn Féin motion. We all know that the solution is not one based on information technology, software or even better administration. The health crisis and the lengthy waiting lists are not caused by unfortunate incidents that somehow result in thousands of citizens being left to languish on lists for an eternity but are the result of political decisions that prioritise certain interests over others. Decisions taken in here by this and previous Governments led by Fianna Fáil or Fine Gael have promoted privatised health care over and above health care for the public. Successive governments put recruitment bans in place during austerity, cut hospital bed capacity repeatedly and accepted and enthusiastically enforced neoliberal management models that saw a mushrooming of management structures and a diminishing of front-line services. We have a public health system that is designed to fail to frighten people into taking out private health insurance. The guarantee people get by taking out such insurance is that they will be seen first and will get a diagnosis faster than would be the case if they remained in the public health system. The private system and the profits that accrue to it would not be possible if we did not have a failing public system.

A person born into a lower socio-economic group has, on average, four years less to live than someone from an upper professional group. The higher rates of lung, stomach and cervical cancers in deprived areas mean that there is a lower chance of survival. The real scandal is that these facts have been known to us for a very long time but the political establishment deliberately devised health policies which exacerbate rather than reduce the health divide, not to mention the class divide. There is no strategy to increase the life expectancy of the poorest groups in Ireland. The health system encourages a certain sector to profit from human misery.

We can scratch our heads and seek solutions here but we must start by accepting that cuts to the pay and pensions and increases in the working hours of front-line staff, including nurses, do not help. We can wax lyrical in here about the great efforts being planned by the Minister for Health, Deputy Harris, and the Government, but the Minister for Finance, Deputy Donohoe, will come into the House next week and tell us that we still have a financial emergency. He will then pass the financial emergency measures in the public interest, FEMPI, legislation for another year which maintains inequality and division and keeps public servants working in hospitals and other areas of our health service on lower rates of pay.

I want to deal with an issue that is not covered in the motion but which is very familiar to many parents, namely, the dire situation with regard to assessments of needs for children. Just 25% of needs assessments were completed by the HSE within the three-month timeframe provided for in the regulations. The target is 100%. A High Court judge made an order earlier this month giving the HSE between six to eight weeks to complete assessments of health needs for 12 children with suspected autism and other conditions. One example of the profound and telling effect of this failure is a three year old lad called Carter Keogh from the Coombe . He was seen by his GP seven months ago. He was then seen by a developmental paediatrician and referred on to the very badly named early intervention team. His parents were told that they would have an appointment at the end of 2019. It is not rocket science to figure out that the earlier an intervention happens with children like Carter, the better the outcome. As soon as a diagnosis is made, then getting the intervention of a speech therapist, a psychologist and other intensive front-line services that are required can make a real difference to this young boy's life and that of his family, but the State is completely failing thousands of families in this regard. This is not an IT problem. This is a systemic problem stemming from decisions made about resources.

I refer to the shocking resignation of three consultant psychiatrists in the south east. Dr. Kieran Moore addressed the Joint Committee on the Future of Mental Health Care recently and told members that he and two of his colleagues were resigning. He said that patients were coming into a building that is in a dreadful state and that staff are burnt out. That says it all. Dr. Moore has just been awarded a pay increase but he has resigned, along with two of his colleagues, because of the state of our health service.

Photo of Ruth CoppingerRuth Coppinger (Dublin West, Solidarity)
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One in seven people in this country is on a waiting list of some kind. We have the highest bed occupancy rate in the OECD. We have a shortage of doctors, nurses and therapists due to an ongoing recruitment embargo initiated during the bailout programme. I agree that any computer system that assists in reducing waiting lists is welcome, but that is not the solution.

I want to focus my remarks on the impact of lengthy waiting lists on children in particular. More than 10,000 children are waiting for more than 18 months for a hospital appointment. That figure has multiplied by a factor of 12 in two years on this Government's watch. The crisis is most acute in Dublin. The three Dublin children's hospitals have 80% of the total number of children on waiting lists, and 99% of those children have been waiting for 18 months or more. This is clearly a failure to meet the needs of the growing population in our capital city.

I will mention some cases in Dublin West, the Taoiseach's constituency, which demonstrate the extent of the problem. These are just some random people who have contacted my office recently. One mother has been waiting for a psychiatric appointment for her eight year old son who is partially blind, has autism, attention deficit hyperactivity disorder, ADHD, and is physically violent, including towards his teachers. There is one psychiatrist in Beechpark and the waiting list has been suspended for a full year. There will be no new appointments for an entire year.

Another mother contacted me who has been waiting for occupational therapy for her six year old daughter who has developmental issues. She failed an eyesight test. One can only imagine how traumatic it must have been for her to try to learn in school. Her mother paid privately for a diagnosis but cannot afford to pay privately for occupational therapy. Three members of staff are on long-term illness leave or maternity leave and have not been replaced.

In terms of autism and speech and language difficulties, people are waiting for eight to ten months for a needs assessment but when they get that assessment, they then have to go on another waiting list for therapy. Children are being left with no help whatsoever. As for orthodontic services, teeth are obviously considered a luxury, cosmetic item in this country.

What is the solution? We have these ongoing issues for children in particular but we have a refusal by this Government to use the Apple surplus. Ireland is one of the biggest corporate tax havens in the world. We partied here. It was great to hear some of the contributions from Fianna Fáil and, indeed, the Labour Party but we all know that they are collectively responsible for this situation thanks to the last ten years of the austerity bailout programme which they agreed with the EU and the IMF. The only solution is to use our wealth and resources to create a publicly funded national health service.

Photo of Joan CollinsJoan Collins (Dublin South Central, Independent)
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There are many good proposals in this motion and I thank Deputy Louise O'Reilly for tabling it today. The issue of our health service is raised in the Dáil every couple of weeks because the agreed Sláintecare report, which received all-party support, has not been implemented yet.

Not only do we have exceptionally long waiting lists for medical procedures, the figures for which are contained in the motion, in recent months there has been a marked increase in the numbers of people who have gone into hospital for surgery only to have the procedure cancelled at the last minute. Patients are going off their medication, fasting and so forth only to have the scheduled procedure cancelled, in some cases two or three times. This seems to be a new feature of our health service.

I wish to concentrate on the key issue referenced in the motion, namely, the urgent implementation of the Sláintecare report. I was very disappointed to see that the summer economic statement published yesterday, which outlined the general approach of the Minister for Finance and his Department in preparing for the budget in October, makes no mention whatsoever of funding for Sláintecare. This follows on from the 2018 budget which contained not a single reference to Sláintecare. The whole emphasis of the summer economic statement was to maintain services at existing levels given the demographic pressures and to improve public services within existing allocations.

A key point of Sláintecare was the establishment of a national health fund. It called for a transitional fund of €3 billion, to be implemented over five years at €600 million a year, over and above the funding for the service in general. The report also called for €2.8 billion in ring-fenced funding to be provided over ten years to pay for expanded entitlements. Again, this would be extra funding for specific targeted entitlements and would be in addition to the funding needed to maintain the existing level of service. Sláintecare cannot be implemented without this ring-fenced funding and the proposed national health fund.

Sláintecare also set quite clear targets for action towards its implementation. The report proposed that a programme implementation office, under the remit of the Taoiseach, should be established in July 2017 and fully staffed by October 2017. It called for the appointment of an independent lead official and the establishment of a Cabinet sub-committee to oversee the implementation of the report. The reason for these measures were very clear: there was no confidence in the ability of the Department of Health to oversee and introduce the radical reform of healthcare that is envisaged in the report. When these measures were proposed, it was anticipated that there would be opposition from vested interests in the health care service and it was suggested that the authority of the Taoiseach and his Cabinet colleagues would be necessary to drive through these reforms. None of this has happened - quite the opposite. Despite the claims of the Taoiseach and the Minister, Deputy Harris, that they support Sláintecare, they have set up a committee in the Department of Health to respond to the report. If they want to kill Sláintecare, they could not have chosen a better way to go about it.

All the signs are that the Government will quietly shelve Sláintecare and pick certain aspects of it for implementation. The Minister referred in his speech to elective hospitals and electronic health data, which were proposed in the Sláintecare report. The report, which received widespread support in this House, represents a once-in-a-lifetime opportunity to give the people of this country a modern universal healthcare system that is fit for purpose. If the State fails to take its responsibilities seriously and bends the knee to vested interests, that opportunity will be lost and history will repeat itself. It was proposed in Sláintecare that legislation setting targets for phased reductions in waiting times over five years would be introduced by spring 2018. It was suggested that waiting times for inpatient procedures would be reduced to a maximum of 12 weeks, for outpatient appointments it would be reduced to ten weeks and for diagnostic tests it would be reduced to ten days. The proposed target for waiting times in accident and emergency units was four hours. That legislation was supposed to be introduced in spring of this year. How long will we be waiting? Is it going to be shelved again?

4:05 pm

Photo of Tommy BroughanTommy Broughan (Dublin Bay North, Independent)
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I am grateful to have an opportunity to speak briefly on this motion. I commend Sinn Féin on its introduction this afternoon. More than 700,000 people are on health waiting lists for treatment and assessment. The figures from the National Treatment Purchase Fund for May 2018 represent an increase of 6,200 on the figures for April 2018. There has been a jump of 4,300 to 511,904 in the number of people awaiting initial assessment by a consultant following a referral from a general practitioner. More than 147,000 people have been waiting for more than a year for an outpatient appointment. Almost 80,000 people have been waiting for more than 18 months for such an appointment. Almost 79,000 people are on inpatient waiting lists and almost 6,000 of them have been waiting for more than 18 months. These figures are appalling and shameful. It was laughable and disgusting to listen to the Taoiseach responding to Deputy Pearse Doherty this morning. Deputy Doherty rightly took the Taoiseach to task with regard to the pathetic figures in the summer economic statement, which indicates that the Government has precisely no plans whatsoever to do anything about these horrendous statistics.

The health service has been decimated over the decade of austerity. The Taoiseach played a crucial part in precipitating that austerity by voting for the blanket bank guarantee, aligning with Fianna Fáil and being prepared to allow people to suffer, particularly with regard to health and housing, over a disgraceful decade. Like other Deputies, I meet families that are desperate for early interventions and assessments for children who may be on the autistic spectrum. I meet people who are in pain, probably like the Ceann Comhairle, as they await treatments like cataract operations and knee and hip replacements. I meet people who are waiting to get home help hours and home care packages. I meet siblings and children who are desperately trying to assist elderly relatives in their 80s and early 90s who are not getting the supports they need from the Minister and the State.

I have been calling for increased resources for our health services, along with improved accountability for those in management positions, for a long time. The hard-working nurses and staff on the front line of service delivery are not sufficiently appreciated or remunerated. It is unsurprising that there is a recruitment and retention crisis in the health sector. Galway University Hospital is experiencing the longest waiting lists, with almost 40,000 people on those lists. One of my local hospitals in Dublin, the Mater Hospital, is not far behind, with almost 39,000 people on waiting lists. There are just over 36,000 people on waiting lists at Waterford University Hospital. Appallingly, from next month children in Waterford and Wexford might not be able to access consultant psychiatric services from the south-east CAMHS.

We ask the Minister for Health question after question and we keep getting distressing news about waiting lists in various areas where urgent treatment is needed. We learned yesterday that almost 10,300 children have been waiting for more than 18 months to see specialists. Almost 54,500 children are awaiting appointments with specialists, including for orthopaedic and cardiac care. In February 2017, we were all shocked and devastated to watch the RTÉ Investigates: Living on the List documentary. Over a year later, children with spinal scoliosis are still awaiting treatment. The motion before the House rightly references the 2017 European health consumer index, which rated Ireland as the worst country in Europe for hospital waiting lists. According to the Irish Nurses and Midwives Organisation's Trolley Watch figures for May, there were 9,091 people waiting for inpatient beds in that month. As we prepare for budget 2019 - we will get another chance to talk about the summer economic statement this evening - I hope the Taoiseach and his Ministers are working on measures to begin the implementation of the Sláintecare report at long last, as my colleague has said. The statistics revealed in the Sinn Féin motion this afternoon are utterly shameful. We need to take action to remedy them.

Photo of Michael HartyMichael Harty (Clare, Independent)
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The reality in this motion is that HSE management structures are not fit for purpose because they cannot deliver a timely service. That is the issue which underpins Sláintecare, about which many Deputies have spoken this afternoon. HSE management structures are not fit for purpose. Sláintecare underpins that and offers solutions to that. In addition, the Department of Health is not fit for purpose because it cannot develop policies to modernise our outdated health service. This is a huge issue. The HSE is unable to deliver. The Department of Health is unable to develop policies that will deliver a modern service. I was very disappointed with the Minister's delusional comment that the situation in respect of waiting lists is getting better. It is getting worse as each month goes by. He said that health reform is a key policy of the Government, but those were empty words because there is no evidence that the Government is developing any key policy that will help the health service. There is a lack of vision, ambition and curiosity about why we are in the situation we are in. The Sláintecare report is one of the most abused reports in this Dáil. The report sets out a ten-year vision, but the Government does not have any vision. The Government claims that Sláintecare is one of its central policy planks, but it has done nothing to implement it. No Sláintecare recommendation of any significance has been implemented. It is important for patient testimony to be heard. The Minister spoke in abstract terms about the hundreds of thousands of people who are on waiting lists and the percentages that are increasing and decreasing, but his remarks did not encompass the individual person who is suffering. I am aware of a patient who was diagnosed with bowel cancer four months ago. It is absolutely scandalous that this person is still waiting for surgery even though the actual diagnosis was made four months ago.

Photo of Michael CollinsMichael Collins (Cork South West, Independent)
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I want to express my utter disappointment that this country's excessive waiting lists have continued since well before I was elected to this House. People of all ages are having to wait for unacceptable lengths of time. My offices are inundated with people who are suffering with medical conditions and are looking for help because they have been on waiting lists for excessive periods of time. Many people have been waiting for two years or more to be treated.

In west Cork, many people are waiting up to five years for cataract operations. Many of them are elderly. This is an utterly unacceptable length of time to wait for a procedure that takes only ten or 15 minutes. As we cannot resolve this issue in the Republic, Deputy Danny Healy-Rae and myself have sent ten buses to Belfast to relieve the pressure we have in west Cork.

West Cork has the largest population of elderly people in Ireland and we need extra beds for respite care. Waiting times for respite beds need to be reduced. We also have children waiting a year and half or longer for ophthalmic appointments while children with scoliosis are on long waiting lists as well. Their medical conditions worsen while they are waiting to be seen and treated. This is a disgrace. The children of today are our future of tomorrow and they deserve better. The closures of the accident and emergency departments in Bantry, Mallow and the South Infirmary hospitals without sufficient capacity being made available in Cork University Hospital, CUH, and the Mercy hospitals have contributed to the excessive waiting lists. The programme for Government promised the most fundamental reform of our health service in the history of the State. The need for change in the health service is unquestionable and waiting lists need to be dramatically reduced. Where is this change and when will we see it?

4:15 pm

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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I feel sorry for the Minister of State, Deputy Catherine Byrne, who was shoved in here to take this. Harris was here but he fled when someone wanted to come in to talk because he cannot face the heat in the kitchen.

Last year I had confirmation of patients in Tipperary who were routinely waiting for 51 months for an appointment with a consultant urologist at University Hospital Waterford, UHW. This is absolutely outrageous. What is worse is that it is not getting any better. The problem is literally deepening with every passing week. I have had to make representations to UHW for a constituent and was told that the waiting time for urology was 48 months - four years. In a Third World country it would not happen. Less than a month after that, I was informed that the waiting time for the same consultant was now 51 months, steadily approaching five years. Every week, the waiting time is increasing by a month. What on earth is going on when it takes nearly five years for a patient to be seen? Has the Government no shame and no moral compass that it would allow that to happen? It is getting worse by the hour.

My main concern is that in the intervening time period, what might initially have been a routine or non-urgent case may develop into something far more invasive and dangerous. The people of Tipperary and the south east generally are appalled by this kind of service. I am also aware that even urgent ear, nose and throat patients can now expect to wait between 15 and 18 months. This would not be tolerated in any democracy. The Government is just hiding behind the HSE. In any other democracy, the Minister, Deputy Harris, would be long gone. He would have been long gone with the cervical scandal but the Government wanted to get the referendum over the line. It stuck together like glue to get that over. Where is the compassion now for women or patients? It is disgusting. It gets worse and worse; to hell with the people. Let them eat cake. Let them do what they like. Let them die on the side of the road or whatever. Next the Government will probably want to bring in euthanasia to get rid of them. It is nothing short of a disgrace and I do not know how the Government has the guts or moral feeling to listen to this puppet Minister who would not even come to the House to listen. He is nothing short of a puppet.

Photo of Danny Healy-RaeDanny Healy-Rae (Kerry, Independent)
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Parents are waiting with sick children. They cannot sleep as they are worried about when consultants will see them and they are waiting for treatment. Elderly people are waiting for hips and knees and every other type of operation. The most serious thing at present is that people are waiting in our cardiac unit, a unit that does massive work for many people in Kerry, Cork and the south of Ireland. In CUH there are people waiting as we are speaking. We have five Ministers for Health, a Government and a Department of Health but we do not have a health system. That is the truth of the matter.

One man I know very well was to have a planned triple bypass. It was arranged for sometime at the start of April. The day he was to go in, it was cancelled and then he was waiting for three or four weeks. The next thing that happened was he got the heart attack and he was admitted to the hospital and he was there for three weeks. He was promised day after day that he would be done the next day and he was only done in the last week. That is not good enough. I have raised this point at different times on the Order of Business. It is happening again. There are several patients there at present in the same capacity, waiting for a triple bypass. What is wrong? The Government needs to put more resources and more surgeons in there. The work needs to be done. These people do not have time. They will get a heart attack and die and that will be the end of them.

The other thing is intermediary care vehicles. It is a nonsense - a joke. The Government did this thing called "reconfiguration of the ambulance service" in Kerry and emergency ambulances were cut way down. That is the result of it. An 85 year old man was to be taken from Tralee to Cork and because the emergency ambulance could not or would not take him, he remained on a trolley for two whole days. That is not good enough. That is not the way to treat our elderly who have served our country and brought us to where we are. I am told there is a way better health service in Cuba where there is a dictatorship. That is the truth. In spite of having five Ministers for Health, a Government and a health service, we cannot serve the people.

Photo of Séamus HealySéamus Healy (Tipperary, Workers and Unemployed Action Group)
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I commend Deputy O'Reilly of Sinn Féin for proposing the motion. The motion and the whole waiting lists scandal emphasises again the dysfunctional nature of the HSE and the fact that it is not fit for purpose. There is absolutely no democratic control of the HSE. It should never have been established. Many of us who voted against its establishment warned of situations just like this arising. The HSE was never fit for purpose.

It is worthwhile putting the numbers on the record again: 700,000 people waiting for medical procedures in May of this year; 511,000 on outpatient waiting lists; 147,000 awaiting outpatient appointments for over a year; and almost 80,000 awaiting outpatient appointments longer than 18 months. These are scandalous figures. They affect not just the patients but also their families. The two-tier health system that we have ensures that the vast majority of people on these waiting lists are in the public system. They are people on social welfare payments, people on low incomes, people who are PAYE workers. There is very little waiting at all in the private system. This system affects ordinary individuals and families almost exclusively. That needs to be changed.

The summer economic statement we saw yesterday indicated that the situation is going to continue into the future. There is no significant development in that statement to suggest there will be any additional money, for instance for the Sláintecare report. It condemns 700,000 people to waiting lists right into the future. Waiting times for scoliosis, cataracts, orthopaedic procedures, urology and for the child and adolescent mental health services are absolutely outrageous. I got a letter recently from the HSE referring to urology waiting lists, on which the waiting times are about four years for urgent cases. The HSE now refuses even to put a time limit on it. The letter states that the current waiting time for the urology list is extensive - four years.

The other area I want to address specifically is the question of assessment of needs for children with disabilities.

As the Minister of State is aware, the Disability Act 2005 provides that in respect of children who are referred for assessment, the commencement of assessment should be within a three month period and should be finalised within a further three month period. This is simply non-existent now. Thousands of children across the country are waiting to be assessed. There are hundreds of children waiting to be assessed in my constituency of Tipperary. I remind the Minister of State that there is a legal obligation on the HSE to provide this assessment of needs. It is breaking the law by not doing so. A blind eye is being turned to it. I have raised this matter on a number of occasions in this Chamber and have asked the Minister to deal with the matter. He has indicated that he would but, effectively, nothing has happened. We are allowing the HSE to continue to break the law and discriminate against children who require an assessment of needs and services deriving from that assessment.

I have a letter from the HSE dated 24 May 2018 that refers to an individual child. The letter states that this child's case was discussed at a recent disability services administration meeting and that the HSE could confirm that the scheduled date for assessment would be April 2020 - two years hence. That child will be over five years of age in two years time. We all know how necessary it is for these assessments to be carried out early and for services to be provided early to children who need services such as speech therapy, psychological services, occupational therapy and a range of other necessary services. The HSE is breaking the law with regard to this service and these children. It is the duty and responsibility of the Minister to take this matter up urgently with the HSE and to have it rectified immediately.

I refer to the final item referred to by Deputy O'Reilly in the motion, which is the role of properly resourced and staffed community hospitals in taking pressure off the main hospitals and helping to reduce waiting lists. I refer to Our Lady's Hospital in Cashel in my constituency. This is a refurbished hospital that cost about €14 million. It was refurbished to provide 65 beds consisting of convalescent, district hospital and palliative care beds. That hospital has been lying idle for eight years. It has been fully refurbished at a cost of some €14 million. It is a white elephant without a single bed in it. It is empty. This hospital should be opened immediately to provide the kind of beds to which I referred. That is what the refurbishment was about. It would take huge pressure off South Tipperary General Hospital, which works at about 120% capacity every hour, every day, every week, every month and every year. The hospital should be opened immediately. The Minister has already been to the hospital and has seen the modern standards provided there and the fact that it is a white elephant that is vacant. It is time he opened that hospital. This would help with regard to waiting lists.

4:25 pm

Photo of Pat BuckleyPat Buckley (Cork East, Sinn Fein)
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I take this opportunity to thank Deputy O'Reilly for bringing forward this motion. The Sláintecare report was mentioned a couple of times tonight. Yes, it could be the blueprint for the future if the Government would actually implement it or even set up an implementation body to implement it. We are talking about waiting lists. There is another side to waiting lists, namely, the impact on families and the individuals in pain. The documentary entitled "Living on the List" was mentioned. It brought me to tears a number of weeks ago to look at a 16 year old girl with scoliosis. It took nearly three years for her to get an operation. When she was eventually operated on, her condition has got so bad that the operation was far more complicated. Complications became apparent a number of months later when the spinal cord came off where it had been pinned. Instead of taking that young girl back to the hospital and rectifying that problem, she was nursed at home by her mother, could not go to school and was in pain 24-7. It was only when the wound at the back of her neck became septic that her mother brought her to a hospital and eventually they decided to rectify the problem. These are the real issues when it comes to waiting lists. We know that we can all provide figures but the human cost of all of this and the suffering are atrocious.

A number of weeks ago, I raised the case of a lovely little lad from east Cork who has Escobar syndrome - one of only 200 cases in the world. That poor little lad, who is seven years of age, could not even get on to a waiting list because there was no waiting list for what he needed, which was a specialist wheelchair. It was budgetary so it just goes to show how unfit for purpose the HSE is. We need to think outside the box and start looking at people again who are human.

There are over 2,400 people on the mental health waiting list waiting for CAMHS. It is totally understaffed. The fact that Waterford and Wexford will lose their full service by July was mentioned.

We must remember and be respectful towards the front-line staff in the HSE working across all services. They are stretched to the limit. It is disingenuous to knock everybody. They are the heroes but when there are constant and long waiting lists, mothers suffer mental torture and are broken emotionally because they cannot look after their child. This year alone, I sourced three wheelchairs through my office for old people because they could not even get on to a waiting list to get help. They are relying on the wheelchair until the problem festers so much that it becomes an emergency. It has been absolutely atrocious. We must sort this out. I have to say that the HSE is not fit for purpose

Photo of Donnchadh Ó LaoghaireDonnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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I will begin with some statistics. Between the various hospitals in Cork, there are 31,265 people on outpatient lists and 998 inpatients on waiting lists while 707,000 people are waiting lists nationally. Statistics can serve a good or bad purpose. On the one hand, they are evidence of a reality and outline the scale of a problem. In this instance, that is quite stark. A total of 707,000 people are on waiting lists in a State where the population is only about 5 million. A total of 35,000 or so people are on waiting lists in a city and greater region with a population of 300,000. In both instances, that is in or around one in ten or over one in ten for the State as a whole so the scale of this is enormous.

On the other hand, statistics can obscure the reality of each of those individuals and the situations they face because these people are not simply waiting. They are suffering, their condition is deteriorating, their pain is increasing, their options are reducing, their health is declining and in quite serious circumstances, their prognosis is in serious decline. This is particularly stark in disciplines such as obstetrics and gynaecology, ophthalmology, neurology and, obviously, mental health. I also note the serious waiting list that exists in Cork University Maternity Hospital, which is a absolute scandal. The numbers are way above national averages and the hospital is desperate need of further investment.

This needs to be resolved. It is not just a question of resources. There is also the question of management. Sometimes there is a lack of common sense. I came across a case recently where a lady needed an ultrasound for two knees.

She was in contact with the hospital and then received two different dates for the two knees. She spoke to the receptionist who was trying to arrange it, and who obviously had no control over it, and said to her, "Look, I will be bringing both knees with me on the day". Nonetheless, it ended up being done on two different days.

Deputy O'Reilly has clearly given real options. This is not just a debate that is trying to put it up to the Government. We have given alternatives which have been on the table for some time. The Government needs to implement them.

4:35 pm

Photo of Peadar TóibínPeadar Tóibín (Meath West, Sinn Fein)
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There are 707,000 people waiting for medical procedures in this country. That is equivalent to everyone living in Westmeath, Laois, Offaly, Cavan, Sligo, Roscommon, Fermanagh, Monaghan, Carlow, Longford and Leitrim. The Fine Gael hospital waiting list is equivalent to the total population of 11 Irish counties. For the majority of these people, there are serious consequences. Many are in constant pain and discomfort, many are incapacitated or disabled by their illness, many will not be able to work and are forced to live on disability payments and many will watch in horror as their health slowly deteriorates while Fine Gael stands idly by.

Our Lady's Hospital in Navan has seen a doubling of figures for waiting lists in the outpatient clinic. In the past two years there has been an increase of 1,255 people waiting for treatment. There are 347 people who have been waiting more than 18 months for treatment whereas, two years ago, there was only one person in that position.

Even if we delete the humanity from this shocking crisis, we are talking about a false economy. Timely medical intervention saves money whereas conditions left to worsen for months and years need more invasive and costly interventions. For the past seven years we have come in here and the Government has pleaded the poor mouth and said it does not have the money. However, in the past three years the Government has given back €1.5 billion in tax breaks to people who are mostly on upper incomes. The front page of theIrish Independenttoday is splashed with speculation that a further €250 million will be given back in tax breaks in October.

It is important to remember that, as Deputies, we are individually and personally responsible for the outcomes of the decisions we make here. It seems Deputy Simon Harris has recently become the Minister for saying sorry. Year after year, Fine Gael makes budgetary decisions that prioritise those living on Fine Gael street and it allows thousands of others to rot on waiting lists.

Photo of Carol NolanCarol Nolan (Offaly, Independent)
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I commend the Sinn Féin party on bringing forward this very important motion. It is, yet again, with great frustration that I speak on this issue. Many of us have spoken time and again but the Minister is clearly not heeding us. He needs to take action because this cannot go on any longer. We cannot allow our citizens to languish on long waiting lists with nothing being done about it. We need an efficient health service that cares for people. In May of this year the Government was presiding over a waiting list of 707,000 people, which is incredible and unacceptable. This waiting list includes, for example, children suffering from juvenile arthritis. As of 22 May, 120 children were awaiting inpatient rheumatology treatment and 976 were awaiting outpatient treatment. Of these, 1,200 children have been waiting beyond the Sláintecare recommended wait time of 12 weeks.

I have been contacted by many distressed parents on this issue. It is unacceptable. We need urgent intervention. If we really want to be a caring society, let us show that we care and let us lead by example. We know there are 3,180 older people waiting for cataract surgery. Again, we see that it is the most vulnerable - the young and the elderly - who are suffering.

According to a survey carried out by the Association of Optometrists Ireland, the average wait time across the country is 28 months and up to five years in some areas. We also know the overcrowding in our hospitals is having a major impact on waiting lists. It is leading to the cancellation of the much sought-after elective surgery that an elderly patient or young person needs.

We need to take action. Today, as we gather in this Chamber, there are 30 people awaiting a proper bed at the Midland Regional Hospital in Tullamore. That is totally unacceptable but is a regular occurrence. We need action from the Minister, not a great, aspirational speech. He needs to prove himself as Minister for Health and he is not doing that. He is homing in on certain areas with a certain agenda but he is neglecting many in society. It needs to stop.

Photo of Catherine ByrneCatherine Byrne (Dublin South Central, Fine Gael)
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I thank Deputy Louise O'Reilly for bringing the motion before the House. As the Minister, Deputy Harris, has outlined, the Government will not oppose the motion.

I want to comment on some of the remarks before I deliver my speech. Deputy Joan Collins referred to the killing of Sláintecare. I assure the Deputy that the Taoiseach, Ministers and the Government are committed to Sláintecare. Deputy Harty relayed a story about a man who has been diagnosed with cancer and has not received the necessary treatment for the last four months. I will certainly raise that with the Minister, Deputy Harris, when I see him this evening. As for Deputy Mattie McGrath, what can I say? I do not know whether to be amused or bemused, to be honest. I know where my moral compass is and I do not need anybody in this House to tell me where it should be. As for where the Minister has fled to, I cannot comment on that as I have no idea.

All Deputies have spoken from the heart, which I would expect on an issue such as waiting lists and people attending accident and emergency services. I am somebody who has experience from recent months of the importance of having accident and emergency departments where people can be taken in emergency situations, given I had to go there on Christmas morning with my husband. I was taken aback by the fact there were only six people in the intensive care area on Christmas morning, with the patients waiting in cubicles. I am not sure if that happens every Christmas but it certainly happened last Christmas.

The reduction in the number of patients waiting for a hospital procedure over the last ten months, from 86,100 in July 2017 to 78,600 in May, is significant. The target of below 70,000 by the end of the year is equally significant and demonstrates that investment in our health services, in combination with a solid implementation plan, will deliver results. Regarding the request to properly invest in our public health system, I draw attention to the fact the Government has committed a record level of €10.9 billion in the national development plan to the health sector over the coming decade. This is building on the momentum of past years, where the Government increased funding for health services each year since 2013, totalling a 19% increase over the period. A Programme for a Partnership Government commits to sustain these increases.

Investments in budget 2018 were closely aligned with the recommendations in the Sláintecare report. New initiatives included investing €25 million in a new primary care fund, additional funding of €25 million for home care and transition beds, €17 million to reduce medicine and prescription charges, €75 million targeted to reduce waiting lists and €1 million for the Sláintecare programme office.

The demand for nearly all health and social care services is growing, primarily as a result of overall population growth and the ageing of the population. This trend has been demonstrated by analysis from the ESRI last year and the Department's health service capacity review 2018. The review stated that the system will need nearly 2,600 additional acute hospital beds by 2031. The Minister has asked the Department to work with the HSE to identify the location and mix of beds across the hospital system which can be opened and staffed this year and into 2019 in order to improve preparedness for winter 2018-19.

As outlined in the capacity review, the demographic pressures being experienced by the health service are such that they demand not just additional capacity but also continued emphasis on health and well-being initiatives, an improved model of care with a stronger role for enhanced community-based services and continued improvement in productivity, including in acute hospitals. Importantly, the accelerated introduction of additional capacity for 2018-19 will be matched by forthcoming reforms, including the publication of a detailed Sláintecare implementation plan and the overhaul of the current GP contract.

In addition, a review of the winter initiative 2017-18 is being undertaken which will inform a three-year plan for unscheduled care and support the provision of additional capacity in winter 2018-19. The Government is committed to investment in additional capacity in line with the national development plan which includes provision for 2,600 acute hospital beds, including three new elective facilities, 4,300 community care beds, diagnostic hubs in the community and the roll-out of e-health infrastructure across the health system. Work is also under way to identify the number and location of additional beds that can be opened and staffed in 2018 and into 2019. This increase in capacity is at the centre of future-proofing our health system.

One way to increase elective work is through the provision of new dedicated ambulatory elective-only hospitals as proposed for Dublin, Galway and Cork in the national development plan. The introduction of these dedicated day and ambulatory centres is in line with health care developments internationally and the recommendations of the 2018 health service capacity review. They should both increase capacity in the hospital system and provide a better separation of scheduled and unscheduled care. However, investment and reform must go hand in hand.

The Sláintecare report and its recommendations will transform how our health system functions in the very best interest of patients. There is the opportunity for many of the patients who are currently waiting for an appointment to a hospital outpatient clinic to receive care in the community. Early intervention in the community can play a key role in reducing the number of patients referred to acute hospital services. There has been continued investment in the primary care sector to enable people to be treated in their communities or at home and 118 primary care centres are now operational across the country. Of these, ten have opened in 2018 while a further nine are scheduled to open before year end. These centres provide modern, well-equipped infrastructure and are central to the effective functioning of multidisciplinary teams providing a range of therapy and other services on-site. There is also the opportunity to ensure that patient stays in hospital are as short as is clinically necessary and that facilities in the community are available for patients who require them.

The implementation of Sláintecare provides the opportunity to transform our health services and to ensure access for patients to care when they need it and in the most appropriate settings. However, we must continue to take action to improve access to services. Patients receive a high quality service in our health system as confirmed in patient satisfaction surveys. The major challenge is to secure access to those services in the first instance. As the Minister for Health, Deputy Harris, outlined earlier, the Government is acutely aware of this challenge, is taking action to address it and welcomes and will consider proposed solutions from all Deputies on this important issue. I thank Deputy O'Reilly for proposing the motion.

4:45 pm

Photo of Maurice QuinlivanMaurice Quinlivan (Limerick City, Sinn Fein)
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I thank Deputy Louise O'Reilly for bringing forward the motion. I am disappointed that the Minister, Deputy Harris, is not here. While he was here at the start of the debate, he has now left. In fairness, this is a very important issue and he should have been here for the duration of the debate. I have raised the issues at University Hospital Limerick with the Minister on numerous occasions, but he has yet to turn up to address a Topical Issue Matter or a parliamentary question.

It is a damning indictment of our country that 707,000 people are on hospital waiting lists. Over 20,000 of those people have joined the lists since the Taoiseach took office. Unsurprisingly, these figures do not appear on the self-congratulatory posters or social media notices he produces on an almost daily basis. Fine Gael no longer has the option of passing the buck to Fianna Fáil, which caused the financial crisis. Fine Gael has had ample time and money over seven years in government to invest in change and assure Irish people of access to quality medical facilities. University Hospital Limerick remains in a ridiculous state of overcrowding. There are 31,117 people waiting for outpatient appointments while 2,805 are on inpatient waiting lists. It is ridiculous. To put these figures in perspective, Limerick city has a population of 100,000.

I hope the Minister will examine the issue of the full-capacity protocol which was designed as an emergency measure to deal with overcrowding. It results in patients being placed in inappropriate areas of hospitals, overcrowding on wards, the cancellation of elective procedures and aggressive discharging practices. The protocol was not intended to be used every day or to become the norm. While the protocol was used 30 times in 2011, the year Fine Gael took office, it was, unfortunately, used every single day in 2017. It has also been used every single day this year so far. That is simply not good enough. The Minister must come to the Chamber to tell us when the use of the full-capacity protocol will be discontinued in Limerick.

Photo of Martin KennyMartin Kenny (Sligo-Leitrim, Sinn Fein)
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I commend Deputy O'Reilly for bringing forward the motion. At the core of this issue is Sláintecare, which must be implemented. I have read the speeches of the Minister and Minister of State. While they are not opposing the motion tonight and are supporting its general context, the public is not seeing Sláintecare being implemented. No one is seeing that. These lists are not merely about numbers or statistics. The point has been made that a lot of people are seen within a short period while very few are on long-term lists. People on long-term lists are human beings, however, and they are suffering, which seems to have been missed in all of this. The issue at the centre of all this is staffing. The reason we do not have enough staff in the HSE and the reason it has failed is that it is an overmanaged service which has been understaffed in all areas. Frontline staffing is the big problem everywhere we go. When one talks to staff, who do a tremendous job and their very best, as everyone in the House acknowledges, they will tell you that it is such a pressurised atmosphere in which to work that people do not stay. They look for somewhere else to go. The only way to fix that problem is with vision. This or some other Government must have the vision to create something different which will work and deliver for people.

This has become an enormous problem over the years. Ministers may come and go, but if we do not recognise that the HSE has become a hostage to the private sector, nothing will change. That is the issue which has not been faced. While the Minister told the House this evening that he wants to ensure no private work is done in public hospitals, it continues to happen. There is no plan to stop it. In my constituency, the neurology list for Sligo Hospital includes people who have been waiting for more than two years to see a neurologist. Think of the pain, discomfort and agony people are in. Even if they are not in pain, their lives are on hold during that time. That is what is happening to people out there. Their whole lives and the lives of their families are frozen because of the waiting lists. Continuing to privatise services will simply not work. What we need in the end is vision. We need a Government with the vision and capacity to put the funding in place to implement the policies we need. At the core of that is the Sláintecare report which to date the Government has failed to do anything about.

Photo of Brian StanleyBrian Stanley (Laois, Sinn Fein)
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The two-tier health system which puts private patients first and leaves public patients to wait must end. The system is not an accident and has been overseen by successive Governments over the years. A constituent of mine in Laois contacted the HSE this month and was given a shocking waiting time of four to five years for her child to see a psychologist. The same timeframe applies in Offaly and in many other parts of the country. There is a one to three year waiting period for an assessment of needs. Parents are being told that there are extreme staff shortages across the two counties. Almost 2,000 children are on waiting lists for occupational therapy in Laois-Offaly, of whom 1,000 have been waiting for more than 12 months, and there are almost 400 children waiting for physiotherapy. This is to mention only two waiting lists among many. There are 436 people on a hospital waiting list in Portlaoise while there are 1,918 people on waiting lists in Tullamore.

Instead of increasing facilities across Laois and Offaly and across the system in general where we have a growing population in the State, we are cutting services. In the case of Portlaoise, we need retention of the full services in that hospital and we need to expand and provide more beds. We need the renovation of nursing homes such as those in Abbeyleix and Mountmellick and their expansion for use as step-down facilities to care for the elderly.

That there are more than 700,000 on waiting lists is outrageous. I thought when it hit 500,000 a national emergency would be declared. We have now broken 700,000 on hospital waiting lists and this needs to be treated as a national emergency.

The problems in the health services will take time to solve but nothing will happen if the Government does not begin the process. The Minister of State, Deputy Catherine Byrne, mentioned the implementation of the Sláintecare report. Most parties were on board with that. We need to push on with that and implement the Sláintecare report. We need to create a proper national health system here in this country - a single-tier public health system.

4:55 pm

Photo of Pearse DohertyPearse Doherty (Donegal, Sinn Fein)
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Is ceart a rá go bhfuil beagán ábhair níos tábhachtaí nó níos práinní ná an ábhar a táimid ag plé. Ba mhaith liom mo bhuíochas a chur in iúl don Teachta Louise O'Reilly as ucht an rún seo a chur os comhair na Dála.

Deputy Louise O'Reilly, my party's health spokesperson, deserves commendation on bringing forward again in the House the issue of our health service. In the motion that Deputy O'Reilly has tabled on behalf of our party, she not only analyses the issues that face hundreds of thousands of people but also comes up with the solutions in the form of a nine-point action plan that we are asking the Government to implement.

As on previous occasions, Deputy O'Reilly has shown leadership on this issue in dealing with the crisis in our health service. It was only a number of months ago that the Deputy won popular support for her realistic proposals to deal with the issues of recruitment and retention.

We have heard from previous speakers of the crisis that we are facing with 707,000 people waiting for medical procedures across our public hospitals. No county is immune from that crisis. In my county, the National Treatment Purchase Fund, NTPF, tells us that 17,673 patients either require outpatient or day-case treatment in Letterkenny University Hospital. When we break these figures down, we see the pain and suffering that these people have to wait through. A total of 2,319 of them have been on a waiting list for more than a year and a further 2,308 have been waiting for more than 18 months.

At Letterkenny hospital's emergency department, we see more turmoil. We see there were 4,889 patients forced onto trolleys last year, an average of 19 patients every day. Meanwhile, beyond all comprehension, only a number of metres away is a closed ward with 19 beds. A closed ward has been lying empty for the past number of years. The Government refuses to provide the funding to reopen it and to ensure that every patient on a trolley has a bed, which in itself would allow for more capacity within the system to deal with the atrocious waiting lists.

It is easy to focus on statistics but we must be mindful that behind every one of these numbers is a human being. They are our mothers, our fathers, our brothers, our sisters, somebody's son or somebody's daughter. They are people, just like the Minister of State and me. They are sick and vulnerable and they need the State to help them, to care for them and in some instances to save their lives, and yet, month after month, year after year, they are being failed by the Government. Tá siad á ligint síos arís agus arís eile ag an Rialtas They are being failed by a Government whose policies and reluctance to prioritise health more broadly put the health, well-being and lives of patients and their families at risk. That is the reality of the situation.

Yesterday, we heard that despite having €1.4 billion available to invest to deal with this crisis and address this challenge head on, the Government has decided in the summer economic statement that is not the best course of action.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I thank the Deputy.

Photo of Pearse DohertyPearse Doherty (Donegal, Sinn Fein)
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I will finish on this. This is socially and economically irresponsible. The health service is far too important for it to be made a political football.

We in opposition, under the leadership of Deputy Louise O'Reilly, have shown the solutions. The Minister of State has told us that the Government will not oppose those solutions. We want her to implement them and start to get to grips with a crisis that she and her Cabinet colleagues have created for far too long.

Question put and agreed to.