Dáil debates
Wednesday, 12 May 2021
Saincheisteanna Tráthúla - Topical Issue Debate
Hospital Waiting Lists
9:20 am
Richard Bruton (Dublin Bay North, Fine Gael)
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I thank the Leas-Cheann Comhairle for the opportunity to raise this issue. It is going to become very important and it is absolutely critical that a coherent plan to address it is put in place. Just as much thought should be put into that plan as went into the Covid crisis. The truth is that the health service will face a backlog of treatment and people seeking treatment at a time when hospital staff are stressed out after a very difficult period. It is really important that the management goes into how this can be dealt with in a fair way.
The data speak for themselves. Inpatient numbers stand at 80,000. Surprisingly, that is only up 10,000 or 14%. Many people may have thought that, with two years of disruption, it would have increased by more. The number of outpatients is 630,000, an increase of 82,000, or 15%, compared with two years ago, before Covid struck. The numbers have got worse but are not as bad as people might think. However, if one looks beneath the numbers to see how many have been waiting more than a year, that is where the real rub comes. The number waiting more than a year for inpatient treatment is 24,000, comprising nearly one third of all those waiting. That number has more than doubled in the past two years. A similar picture is presented in the context of outpatients, with 284,000 waiting more than 12 months, an increase of 70%. They comprise very close to half of all those on those lists. There is no doubt that a new wave of people will soon have the confidence to go back and schedule treatments and appointments.
Overall, these numbers are manageable. Every year, 3 million outpatients are seen and, against that background, a figure of 600,000 is manageable. More than 1 million patients are discharged from hospitals and, in that context, a figure of 80,000 seems manageable. We know, however, that there will be a very mixed picture of various people, some of whose conditions will have deteriorated significantly. A risk-based approach to this will be needed. What planning is going into that?
We will need innovation in the way this is approached. For example, it would be good to have GP-supported reviews looking at critical indicators that would be presented to the lead consultants and their teams such that a review of the condition of various patients could effectively be done remotely. Remote consultation should be extended. It became a pattern when it was a necessity during the Covid crisis, but, as the saying goes, necessity is the mother of invention and we should make sure that remote consultations become embedded. They can be very effective in the context of some disciplines in circumstances where a procedure is not necessary and a face-to-face consultation is not always needed. Some of that face-to-face element could be carried out in GP surgeries and there could be more of a team approach to attacking this issue.
I would like to see the role of the National Treatment Purchase Fund, NTPF, integrated into such a plan. There is no doubt that during Covid it has not been using resources to the level it did previously, so it may have reserve budget. It would be very good to see it integrating into the approach.
I am calling for a planned, strategic approach to this issue, one which considers fairness and how to use the resources available in the way that is most efficient and innovative in order to avoid a build-up of people who feel the urgency of their cases has been overlooked by those managing the process.
9:30 am
Anne Rabbitte (Galway East, Fianna Fail)
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I thank Deputy Bruton for raising this issue, on which I am responding on behalf of the Minister for Health, Deputy Donnelly.
It is recognised that the waiting times for hospital appointments, procedures and services have been impacted in the past year by Covid-19. On 23 March last, the HSE published A Safe Return to Health Services plan. The plan outlined a three-phase approach for the proposed restoration of services across community services, acute hospital operations, cancer services and screening services. It sets target times for the safe return and details the conditions and challenges that will have to be met. Every phase in the plan has been informed by clinical guidance, putting patient and staff safety first.
A key action of this Government is to address the backlog in the demand for services that may have arisen across all healthcare settings since the onset of the pandemic. Budget 2021 included central commitments to provide funding to improve access to services and reduce the number of people waiting for important appointments and procedures. Hospital inpatient day case, IPDC, waiting lists reached a peak in May 2020 due to the deferral of elective care. However, as a result of modified pathways to care and utilising innovative methods of providing scheduled care, the growth trend in the IPDC waiting list was reversed and the number waiting for a hospital appointment procedure dropped by 8% from the end of May 2022 to the end of March 2021.
Some €240 million has been provided in budget 2021 to improve access to care for acute hospital procedures, €210 million of which has been allocated to the HSE and a further €30 million to the National Treatment Purchase Fund, NTPF. This will be used to fund additional capacity to address the shortfall arising as a result of the measures taken in the context of Covid-19 as well as to address hospital waiting lists.
The Department of Health and the HSE continue to plan for any surge in demand for mental health services. Launched in January, the HSE psychological response to the Covid-19 pandemic provides a clear framework to build on existing psychological support to the public and healthcare workers with a co-ordinated, consistent and collaborative approach to the mental health services. An additional €2.2 million was allocated in 2020 to develop telehealth and the psychological response to Covid-19 for healthcare workers and the general public.
As part of budget 2021, an additional €50 million funding was secured for mental health, bringing the annual budget to in excess of €1 billion. Of the additional €50 million, €23 million is allocated to the implementation of many of Sharing the Vision’s short-term recommendations and €15 million to address the additional challenges posed by Covid-19.
In response to the challenges faced in primary care, the Department of Health secured €150 million in funding for an enhanced community care programme in budget 2021. This represents an unprecedented investment in our primary sector that will see the establishment of community health networks and specialist teams to serve older persons and those with chronic disease, as well as other initiatives such as the nationwide expansion of the community intervention teams. A focus of the enhanced community care programme is on the recruitment of front-line staff, particularly nurses and community therapists, to build capacity in the sector to help address waiting lists and backlogs in appointments, while helping to ensure the primary care sector is sustainable over the long term.
On cancer care services, the national action plan on Covid-19 identified the continued provision of cancer care as a priority. Cancer services continue to operate in line with guidance issued by the HSE’s national cancer control programme. Funding of €12 million has been allocated this year for the restoration of cancer services to 95% of the 2019 pre-Covid levels. This funding will support hospitals in addressing the backlog.
Richard Bruton (Dublin Bay North, Fine Gael)
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I thank the Minister of State and welcome that a plan is in place and there is innovative thinking within it. I would like the plan to provide for monthly published data so that we could see how the numbers are going and how cases are being reviewed and prioritised, particularly those of the 284,000 who have been waiting over 12 months, to ensure people with urgent needs are not being overlooked. It should also involve GPs. The oversight team must also have the capacity to step in and intervene. It is all very well to record the data but there has to be capacity to intervene and manage this process in a way that is in the interests of public health.
We have, to some degree, become used to people telling us how we must manage in this pandemic but if we want to avoid backlogs getting out of control, similar powers must be provided to managers to step in and require things to be done in individual hospitals.
I am gratified to see that in my area, Beaumont Hospital is one of the few hospitals where both outpatient and inpatient waiting numbers have declined. That is a sign of good management of a process and needs to be done at scale. In addition to publishing a plan that shows how to do this safely and well, we must also monitor how effective the innovation is and the extent to which remote diagnosis is being used in an innovative way, the extent to which GPs are being given the opportunity to participate in the prioritisation of cases that are drawn on the basis of need, and how the NTPF responds to these need assessments as simply using its procedures to determine that action is needed on an individual case because it has been ongoing for nine months. This has to be managed in an active process to avoid the deterioration of a situation that is a risk factor for the health service and citizens.
Anne Rabbitte (Galway East, Fianna Fail)
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I totally concur with the Deputy. We have a plan and the money. Now we need business management and skill sets. We need to hold the service to account and it needs to be monitored on a monthly basis. My assessment of needs is a clear demonstration of how I secured funding to clear a backlog. This was done monthly by the managers of the various disciplines in community healthcare organisations, CHOs, around country and we have driven down the backlog by 78% in eight months. That is exactly what the Deputy is talking about, namely, ensuring that the leads in the various CHOs are held to account. The Minister is responsible for bringing them to order on a monthly basis to see exactly how we are prioritising. It is not determined that we are in a crisis on the basis that a waiting time has reached nine months. It is done on the basis of advance planning under which managers must manage in a business-like format. I completely concur with the Deputy on that point.
On the NTPF, the work of the HSE to improve access to elective care and reduce waiting times for hospital appointments and procedures is supported by the NTPF. This includes increased use of private hospitals funding; weekend and evening work in public hospitals; funding see-and-treat services where minor procedures are provided at the same time as outpatient consultations; funding hybrid services for public and private hospitals which contribute to the treatment of patients; virtual clinics; and clinical validation. The additional €240 million provided in budget 2021 will positively impact waiting times for patients waiting for acute hospital appointments and procedures. In this context, the Department of Health, with the HSE and the NTPF, is working on drafting a Sláintecare multiannual waiting list plan to address backlogs in waiting lists and bring waiting times in line with Sláintecare targets over the coming years.
A new community model is in place for older persons and community care. Under the integrated progressing disability services for children and young people, people access services on the basis that there is only one waiting list once they are inside the front door.