Louise 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.