Michael McGrath (Cork South Central, Fianna Fail)
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This issue concerns the second gynaecology surgical theatre at Cork University Maternity Hospital, CUMH. It is a fact that, since the CUMH opened in 2007, that theatre has remained closed. Last January, Deputy Ó Laoghaire, others and I attended a briefing from Professor John Higgins, the clinical director of the maternity directorate in the South/South West hospital group. He provided an update on the positive and significant progress that had been made in dealing with what had been a lengthy gynaecology outpatient waiting list at CUMH. It was as long as 4,700 women in April 2017, but the latest parliamentary reply that I received from the Minister, which issued just last week, puts the outpatient waiting list at 1,854. That is a reduction of almost 3,000. I acknowledge the work of everyone involved in the maternity directorate in achieving that. The directorate at CUMH also covers University Hospital Kerry, University Hospital Waterford and South Tipperary General Hospital. The initiatives that it has taken to eat into the backlog have proven successful. Many of the consultant gynaecologists at the hospital commenced additional gynaecology outpatient clinics out of hours; a weekly outreach outpatients' clinic was held in the Mallow primary healthcare centre; the number of new patients seen at all clinics was increased; additional daily gynaecology clinics were set up from July 2018; and, in January of this year, a comprehensive drive to see an additional 500 outpatients at out-of-hours clinics was planned. To my knowledge, the consultants achieved that, which contributed to the reduction. While I welcome all of these initiatives, I do not want women simply being transferred from the outpatient list to the inpatient and surgery waiting lists. This concern is shared by the clinicians.

The second operating theatre has lain idle since 2007.

In recent times, however, CUMH has rented theatre space in the Mater Private Hospital in Cork. While I do not have any ideological hang-up about the use of spare capacity in the private system, I believe the operating theatre that is lying idle in the CUMH building should be put into use in the first instance. I understand that the Minister, Deputy Harris, signed off on the gynaecology business case, which involved initiatives for dealing with the outpatient waiting lists, in 2017. We need the funding and the staffing to be provided in order that the second theatre can be opened without any further delay. I am not a medic and nor is the Minister of State, but both of us are well aware of the impact of this delay on the quality of life of many women who are on the waiting list for inpatient and day case surgery procedures. Some of them are continuing to wait long periods. The overall number of women on the waiting list is 421, some 12 of whom have been waiting for over two years, a further 23 of whom have been waiting for between 18 and 24 months and a further 31 of whom have been waiting for between 12 and 18 months. This needs to be dealt with. I hope the Minister of State has some positive news for the women of the region.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Michael McGrath for raising this important issue. I welcome the opportunity to address the House on it. The HSE advises that while it has not been possible to provide funding this year for the opening of the second gynaecology theatre, a new commissioning process has been established by the HSE through which all proposals for funding will be considered within the framework of the annual Estimates process. I am advised that the HSE is reviewing all possible ways to achieve a sustainable solution to the challenges being experienced in CUMH in the short and medium terms. It has advised that the possibility of NTPF support is an option that will be considered. It has further advised that a funded and targeted waiting list initiative is under way in Cork specifically to address the gynaecology outpatient waiting list in the region. This has resulted in a decrease in the number of patients on the outpatient waiting list from 5,000 in early 2017 to just over 1,500 patients on 2 May last. The South/South West hospital group is aiming to reduce this number to 1,000 by June 2019. The initiatives being pursued to meet this target include the commencement of additional out-of-hours gynaecology outpatient clinics, the commencement in November 2018 of a weekly outreach outpatient clinic at Mallow primary health centre in conjunction with the GPs in the clinic, an increase in the number of new patients being seen at all clinics and the establishment of additional daily gynaecology clinics from July 2018.

Last year, the support of the South/South West hospital group and funding from the NTPF to the CUMH enabled the treatment of 87 long waiters from the waiting list. This year, funding has been agreed through the NTPF for the treatment of almost 850 patients who are waiting for inpatient day case or outpatient appointments. The total that is due to be received from NTPF in 2019 is over €630,000. The Department of Health recently convened a working group to develop a scheduled care improvement plan. The objective of this working group, which comprises representatives of the HSE and the NTPF as well as departmental officials, is to examine medium to long-term initiatives to improve access to outpatient services, in particular. Gynaecology will be among the specialties examined by the working group. The group is examining the current models of care, the current and projected demand and capacity of services, the short-term, medium-term and long-term initiatives to improve access for patients at community and acute hospital level, the best way to move care to more appropriate settings and the best way to provide care at the lowest level of complexity.

Michael McGrath (Cork South Central, Fianna Fail)
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I thank the Minister of State. The bottom line is that the women in Cork and surrounding counties who are on the waiting list for day case procedures and inpatient surgery want to know when the second operating theatre will open. The reality is that it has been lying idle for 12 years while the HSE has been paying for capacity in the private system through the NTPF. In my view, the NTPF should be used primarily where the capacity does not exist in the public system. The capacity exists in this instance. An operating theatre is lying idle. The business case was made by the maternity directorate to get the necessary funding in place to enable the theatre to open. I have acknowledged the significant progress that has been made with the outpatient waiting list. Very dramatic progress has been made. Other areas within the HSE could learn from the initiatives that have been undertaken by the maternity directorate. While the numbers outlined by the Minister of State when he spoke about the reduction from approximately 5,000 patients to approximately 1,500 patients are impressive, we do not want women who have been seen by a gynaecologist, and in respect of whom a referral for surgery has been made, merely to go onto another waiting list for that inpatient or day case surgery to take place. Although I welcome initiatives like the establishment of working groups and the new commissioning process, I did not hear anything in the Minister of State's reply that gives me confidence or, more important, gives the women concerned confidence that the second operating theatre at CUMH will open any time soon. I ask the Minister of State to take up this issue within the Department of Health, the HSE and the South/South West hospital group in order that this project can be accelerated. It should be a priority. The infrastructure is in place. It was paid for by taxpayers 12 years ago. It is a great shame to see it lying idle while women are on waiting lists, in some cases for over two years, for what could be life-changing surgery.

Finian McGrath (Dublin Bay North, Independent)
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I take the Deputy's point on the capacity issue. I strongly accept the point that the reductions in waiting times are impressive. It is a key priority of the Government to reduce patients' waiting times for hospital operations and procedures. The Minister and I acknowledge that waiting times are often unacceptably long. We are conscious of the burden they place on patients and their families and on hospital staff. We take that point. I will bring the Deputy's message in respect of confidence back to the Minister. The overall outpatient waiting list, which includes those on gynaecology waiting lists, remains a significant challenge. Therefore, I welcome the great co-operation of the CUMH and its continued work to reduce outpatient waiting lists this year. The Minister welcomes the engagement of the South/South West hospital group and CUMH with Sláintecare and the NTPF. I share the Minister's position. I encourage all hospital groups and individual hospitals to engage with the NTPF to develop proposals for waiting list initiatives for inpatient day case procedures and for outpatients. Under the scheduled care access plan, the NTPF will provide funding for 40,000 new outpatient appointments this year. The HSE advises me that a new commissioning process has been established through which all proposals for funding will be considered within the framework of the annual Estimates process. I will bring the Deputy's concerns back to the Minister.