Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context | Oireachtas source

I am glad to have four minutes to address this matter. I will speak slowly to let the figures sink in. The outpatient waiting list for orthopaedic services at University Hospital Galway includes 6,487 patients. Some 80 of those have been waiting for more than four years. Some 292 patients have been waiting for between three and four years. The inpatient waiting list has 1,390 patients. In a letter dated 11 December I made representations for a specific patient and raised some general points. The specific individual was put on the waiting list on 24 January this year. They were categorised as "urgent" and told there was an 18-month waiting list. Given those figures, I would say that is the very best estimate.

The reasons for this are where we really need the Minister of State's help. First, the service has developed a significant backlog of patients due to demand for the service outweighing capacity. Unfortunately, more people have become sick than the service is capable of helping. Imagine that. The second reason is that operating capacity has been significantly reduced since September 2017 when the hospital roofs began to leak and water came in. I will take the Minister of State on a quick tour of the four years since then. We have been told that the HSE plans to replace the theatre by the end of next year. This operating theatre was leaking in 2017. In 2017, all of the TDs in the area met with the then Minister for Health, Deputy Simon Harris. Following that, we were told on 29 November 2017 that a tendering process was progressing for the procurement of a temporary theatre facility. We were told this was being pursued as a matter of urgency. The word "urgency" seems to have taken on a new meaning. This is the 21st century. Waiting lists are at this level just before Christmas. I am only mentioning a selection of the events surrounding this issue.

We were going to facilitate some of the patients in the hospital facilities outside of Merlin Park. Some were to be accommodated in private hospitals. We then learned that very few were cared for in University Hospital Galway facilities and none was facilitated in private hospitals. We were told that Saolta University Health Care Group was working to have a modular theatre open in mid-2019 and enabling works were being carried out. Putting it as benignly as I can, the Minister subsequently had to clarify that he was given contradictory information. He was told that there was an enabling contract. In a letter on 5 March, he stated that he was subsequently told it was actually a letter of intent. That letter of intent was then withdrawn. We were then told there would be a rapid build, which has not happened.

I conclude by referring to a letter I read out previously, in which a surgeon stated that there were 2,000 people on the waiting list. That is half the current number. He stated that this was too big for management to address and that it was a regional crisis. He stated that it was unbearable for the patients, who were clinically deteriorating.

I ask the Minister of State to take a hands-on approach to this matter. At the very least, I ask him to agree that this is unacceptable and to give me a date on which the theatre will be open.

Frank Feighan (Sligo-Leitrim, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank Deputy Connolly for raising this issue and for giving me the opportunity to update the House on waiting times for orthopaedic services in University Hospital Galway on behalf of Minister for Health, Deputy Stephen Donnelly.

I sincerely regret that patients can experience a long waiting time for hospital appointments and procedures and I am conscious of the burden this places on them and their families. I also recognise that waiting times for scheduled appointments and procedures have been impacted by the Covid-19 pandemic. In response to the Covid-19 pandemic, the HSE has had to take measures to defer most scheduled care activity in March, April and May of this year. This was done to ensure patient safety was maintained and all appropriate resources were made available for Covid-19-related activity and time-critical essential work. This decision was in line with the advice issued by the National Public Health Emergency Team, NPHET, in accordance with the advice of the World Health Organization.

As a result of the significant disruption in scheduled care, hospital waiting lists peaked in May. However, the resumption of services from June onwards has allowed for increased activity. The number of patients awaiting an inpatient or day case procedure dropped by 16% from May to November and the rate of growth of the outpatient waiting list has slowed in recent months. Regarding University Hospital Galway's orthopaedic waiting list, I note that while the number of patients waiting for an outpatient appointment has increased this year, the number of patients waiting for an inpatient or day case procedure has fallen by 7% compared to the same time last year.

Patient safety remains at the centre of all hospital activity and elective care scheduling. Hospitals are following HSE clinical guidelines and protocols to ensure services are provided in a safe, clinically aligned and prioritised way. The HSE continues to optimise productivity through alternative work practices such the use of alternative settings, including private hospitals, community facilities and alternative outpatient settings. For example, University Hospital Galway has advised my Department that a very successful physiotherapist-led musculoskeletal triage process is in place there. Under this process, patients are first seen by a physiotherapist and are then directed to the most appropriate care pathway. This pathway reduces the number of patients being added to the consultant waiting lists and allows quicker access to services for many patients. University Hospital Galway is examining ways to provide additional access to theatres, including setting up Sunday lists for surgical procedures.

University Hospital Galway has also advised my Department that it has tendered for the construction of a modular theatre facility which will provide two orthopaedic theatres at Merlin Park. The enabling works and the construction tender for this project have been completed and the contractor is to commence construction in January 2021. It is expected that the works will be completed in late 2021. The National Treatment Purchase Fund continues to work with hospital groups, including Saolta University Health Care Group, to support additional activity through insourcing and outsourcing initiatives for inpatient and day case procedures and outpatient appointments. I heard the number the Deputy quoted. Some 6,487 persons on the outpatient waiting list is a huge number. We hope to address it in the coming months.

Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context | Oireachtas source

I will take the two paragraphs at the end of the Minister of State's statement, because that is the only part of his reply that addresses the question. I accept his bona fides. Covid-19 has nothing to do with this. How the replacement of two modular theatres has taken from September 2017 until the end of 2021 should be the subject of an inquiry. A brand new hospital could have been built in that time. There is something seriously wrong.

The Minister of State mentioned the NTPF. Not a single patient on these waiting lists has been referred through the National Treatment Purchase Fund. I have my own difficulties with the NTPF, but it is there as a matter of Government policy. I have asked why none of these patients has been referred through the NTPF, despite waiting times of more than four years. I have received no answer.

Language fails me.

I will go back to using the surgeon's language. As the Minister of State will be aware, surgeons are not known for their radical nature or for writing letters. I refer again to the letter from the consultant surgeon in March 2019, addressed to all Deputies and many more people besides. It describes the problem as "too big for management to address" and "a growing regional crisis". The surgeon states: "This situation is becoming unbearable for the patients who are on the waiting list and are clinically worsening as they wait to be admitted for surgery." I can give the Minister of State a copy of the letter. It is dated. The situation is now worse. It is now 2020; the letter was written in 2019. I absolutely despair of the reply, notwithstanding the Minister of State's bona fides, because it gives me only two paragraphs that relate to the question. How could it take this long? Where is the sense of outrage in the Department that two modular theatres could not go up and, in the meantime, alternative provisions be made?

Frank Feighan (Sligo-Leitrim, Fine Gael)
Link to this: Individually | In context | Oireachtas source

The Minister, Deputy Donnelly, and I are acutely aware of the distress and inconvenience caused to patients and their families when urgent care is delayed. Improving waiting times for hospital appointments and procedures remains a key commitment of the Government. It is acknowledged, however, that the challenges faced by the health system in 2020 are unlike anything we have faced before. We are very aware of the impact Covid-19 has had on our health service and the delivery of scheduled care. The Minister and I welcome the progression of University Hospital Galway's modular theatre facility, which will provide important additional capacity for the hospital's orthopaedic service. We also recognise the work that has been done not only by Galway but by the wider HSE to identify alternative pathways to facilitate patient appointments and procedures.

As for broader service planning for the year ahead, my Department continues to engage with the HSE and the National Treatment Purchase Fund on the development of the access to care plan 2021 which will set out measures to improve care for patients waiting for scheduled care in 2021. As the Deputy will be aware, an additional €240 million has been provided in budget 2021 for the access to care fund, €210 million of which will be allocated as required to the HSE and €30 million to the National Treatment Purchase Fund for the provision of treatment in both private and public hospitals to address capacity issues in acute hospitals and waiting lists. Officials from my Department continue to engage with representatives from the HSE to monitor access to services, waiting lists and activity levels.

The Deputy is right that from September 2017 to today is a long time. I have seen this before. Projects in the public sector can sometimes take far too long. I appreciate her concern in that regard. If she has a copy of the letter to which she referred, I would be only too delighted to take it and follow it up within the Department.