Thursday, 12 July 2018
Topical Issue Debate
Hospital Appointments Delays
I thank the Ceann Comhairle for the opportunity to present this issue to the House at the eleventh hour. He did so because it is a time sensitive issue. With regard to health advice on cataract care, the HSE's website states:
[A] cataract will continue to develop, and the only way to restore vision is by having surgery to remove the cataract. Cataract surgery is one of the most common and quickest forms of surgery.
According to the Association of Optometrists Ireland, at the end of 2017 some 40,000 people were on the outpatient list waiting for that surgery. Its statistics show that the problem has deteriorated since; the number of people on the waiting list has increased by 21%. The largest proportion of the waiting list for eye surgery relates to cataracts, with 8,500 people waiting for surgery at the end of 2017, including some who have been waiting for up to four years in certain parts of the country.
I want to talk about a man in my area. He is housed by the council in a nice apartment, but he is a poor man. He lives on the carer's allowance. His wife has MS, and he is her carer. She is on disability allowance. Patrick Foley is 42 and is the carer for his wife, Carmel. He has been on the waiting list for cataract surgery for three years now. He is suffering from blinding headaches while waiting for this surgery and he is starting to go blind. His eyesight has started to deteriorate more rapidly recently, and his GP has written several referral letters to the Royal Victoria Eye and Ear Hospital. He was advised to look at the cross-Border healthcare scheme. To do this he needs to find someone to care for his wife. His eyesight is so bad that he will do anything to get surgery. He does not have the financial means to save up or bring the money forward or to go to a credit union for a loan. My office has continually asked the HSE to make an exception in this case, where this man cannot get the funding upfront. I have asked that an allowance be made in these circumstances and the HSE's answer has been "No". However, considering that this man is a carer and has been on the list for some time, and the fact that he may go blind and that his wife may be taken into care, the State is cutting off its nose to spite its face by not paying upfront for Patrick to have this cross-Border treatment, or, preferably, to have the surgery carried out here.
People who can afford to pay wait for three months. People like Patrick have to wait for three years. The Department of Employment Affairs and Social Protection told Patrick that the emergency needs payment would not cover him when the responsibility lies with another Department, which in this case is the Department of Health. I wrote to the HSE to highlight the urgency of this case, but to date I have received no reply. He is going to go blind unnecessarily, and is suffering terribly in the meantime. This is happening as a result of our failed health system. If Patrick had money he would be sorted out, but because he is poor and does not have the money, he is suffering unnecessarily and will go blind. That is why we needed to bring this matter to the urgent attention of the Minister of State. His needs have to be met. Judging by the state of our home help care, I do not believe the needs of his wife will be met urgently.
It is startling that the National Council for the Blind of Ireland, NCBI, has been pushing hard for the State to invest more money in this area. Some additional funding was provided this year to the National Treatment Purchase Fund, NTPF, but it does not cater for people who cannot pay upfront. I am quite sure that the case of Patrick Foley is not an isolated one. I do not know whether the Minister of State has come across Patrick - she is a local Deputy in his constituency - but I have witnessed how rapidly his eyesight is disappearing and how desperately his life his changing. We need to do something. We must find a way for some Department to pay for the surgery he needs upfront to allow him to live his life with full eyesight.
I am taking this matter on behalf of the Minister for Health and I thank the Deputy for raising it. Improving waiting times for hospital procedures is a key commitment in the programme for Government and a number of waiting list initiatives are currently under way to improve access this year. In particular, I refer to the inpatient and day case action plan which was launched in April 2018, and the allocation of €50 million to the NTPF in budget 2018 to secure treatment for patients and reduce waiting times. The action plan targets a reduction in the waiting list for inpatient and day case treatment to less than 70,000 by the end of 2018. Under the plan, the HSE will deliver 1.14 million hospital procedures.
The NTPF will deliver additionality to the health system with the provision of 22,000 inpatient day case treatments, including 5,000 cataract procedures and 1,200 tonsillectomies. The action plan has been developed to ensure an appropriate balance between high-volume activities and offering treatment to complex long-waiting patients, as well as maximising the number of patients treated in both public and private capacities.
Over the past year the Department of Health has worked with the HSE and the NTPF to identify sustainable initiatives to improve waiting times. Last year, funding was allocated to provide additional capacity at the Royal Victoria Eye and Ear Hospital, which has augmented capacity to increase clinics focused on paediatric and adult ear, nose and throat, ENT, procedures. The NTPF funding has also allowed the hospital's cataract theatre to be operational three days per week. The impact of these initiatives is clear. To date this year, the hospital has seen significant reductions in waiting lists for cataracts and waiting times reduced to six months. It is expected that the hospital and the NTPF will continue to work together to maintain and even improve on these waiting times. Overall, the inpatient and day case waiting lists for the end of June show that waiting times at the hospital have fallen by almost one quarter in the past year.
The Children's Hospital Group is also working with Royal Victoria Eye and Ear Hospital to determine the feasibility of the hospital providing additional services across both outpatient and surgical services over the next year in order to reduce waiting times for children.
The Minister for Health has long said that the outpatient waiting list is a challenge which must be addressed. The HSE is working with the NTPF and the Department to finalise a joint plan focused on improving overall use of resources to tackle long patient waiting times and ensure timely access to treatment care for patients. The Minister hopes to publish this plan shortly. As part of this process, the NTPF and the HSE are currently reviewing proposals from hospitals for outpatient initiatives. I am aware that the Royal Victoria Eye and Ear Hospital is developing a proposal to address the new patients' ENT outpatient department waiting list. The Minister encourages all hospitals to submit proposals as soon as possible.
I will deal with some of the issues that were raised by Deputy Smith in my supplementary remarks.
I will just reiterate that the HSE website states: "Cataract surgery is one of the most common and quickest forms of surgery". It also says that this surgery will help to save sight. The NCBI has said that waiting lists are out of control. That is much more shocking when we consider that 75% of sight loss is avoidable. That organisation has called on the Minister for Health to publish the implementation of the primary eye case services report, which was expected in the summer of 2015 and still has not been published.
I acknowledge that the Minister of State will not know the detail of the individual case I have brought before her, but with all due respect, nothing in her answer shows that any consideration is given to those who cannot afford to pay up front for the NTPF. The Department of Employment Affairs and Social Protection will not pay it and the HSE will not answer. Meanwhile this man, who is a carer for his wife, is going blind. If I have one example of this, a man in the Minister of State's constituency, there must be dozens of others.
The NCBI and Dr. David Keegan, a consultant ophthalmic surgeon, have been campaigning for this national vision strategy for the past six years. Dr. Keegan has warned us that we have a national scandal on our hands. Medics have also warned that the long waiting lists are particularly harsh on patients whose deterioration in sight could be reversed. That is the case for Mr. Patrick Foley. His problem is that he is poor. He does not have the money to pay for the surgery up front, and no matter what Department we turn to, everybody is ignoring him as though he was not a human being, not to mention his wife, whom he looks after. This is shocking in the 21st century and the fastest-growing economy in Europe. I recognise that the NTPF is trying to deal with the backlog, but there are some people who fall through the cracks. They are the people who are the most vulnerable, the weakest and the least represented. I am asking the Minister of State to intervene on behalf of her constituent, Patrick Foley, and ensure that he is looked after by the NTPF, or preferably gets the eye surgery he needs in this State before the man goes blind.
I assure the Deputy that the engagement between the Royal Victoria Eye and Ear Hospital and the NTPF provides a clear example of positive impacts. Such collaboration can only have a real effect on waiting lists, and, ultimately, benefit all the patients that are receiving treatment. However, if the Deputy will give me the details of the particular case she has raised, I will certainly bring them to the attention of the Minister and see what can be done.
Some 37,863 people attended the Royal Victoria Eye and Ear Hospital according to the outpatient attendance list. Out of that, 3,494 patients did not show up for appointments. That shows how difficult it sometimes is to reach patients and get them in for appointments. That is a clear indication that we do have high numbers, and nobody is disagreeing with the Deputy on that. I will now read a note I was handed in the past few minutes. Last year, there were 34 patients in the hospital who had been waiting between 24 and 36 months. That number is down to five this year. Those are the latest figures. Last year, 290 patients had been waiting between 18 and 24 months and that figure has decreased to nine.
I will bring all of the Deputy's concerns back to the Minister. I assure her that representing the same constituency, I, like her, am very concerned about the number of people who come to our clinics and have difficulty in having cataracts removed. It is surgery that is now regarded as a much more simple procedure than it was in the past. I will certainly bring the Deputy's concerns, which I have written down, to the attention of the Minister. Again, I ask her to forward this man's details to me. I did not get his second name.
It is Patrick Foley. The matter is time sensitive. That is why the Leas-Cheann Comhairle allowed me to bring it forward today. I do not want him to go blind, and he certainly does not want to go blind.