James Reilly (Dublin North, Fine Gael) | Oireachtas source

I shall address the question posed by the Senator. A commitment has been given to enhance cardiology services and it will be honoured.

With regard to outpatients, one of the underlying principles of the Government is that the patient should be treated at the lowest level of complexity that is safe, timely, efficient and is as near to home as possible. In many instances, throughout the health system, including Waterford, patients are being seen by consultants who could be seen by GPs, GPs are seeing patients who could be seen by nurses and nurses seeing patients that healthcare assistants should be seeing. I do not know whether Waterford hospital has adopted the same approach as Cork hospital but I have no doubt that it will adopt the measure. In Cork, all orthopaedic referrals were screened by its physiotherapy service and that unit was able to deal with 50% of the referrals without going near the orthopaedic team. That reflects the inability of a GP to get a service for a patient who cannot afford private care. The same applies to the mental health service when trying to access counselling.

I wish to point out a number of things. GPs are well aware that if they refer a patient with a recurring sore throat to an ENT surgeon that it is likely to lead to a tonsillectomy. However, if GPs refer patients to a paediatrician the patients are much less likely to receive a tonsillectomy. Therefore, we need to measure what we are doing, why we are doing it and the outcome for patients. The information will help to considerably improve hospital waiting times. Delays are caused by the way the system is organised. Let me give the simple example of people who do not arrive for appointments. I have asked the HSE to put in place a system of collecting mobile telephone numbers in order for patients to be sent a text the week beforehand. A patient is asked to send a return text consisting of a Y or N to indicate if they will attend. If he or she confirms their attendance then they shall receive another text on the morning of the appointment. If the patient does not turn up then, having confirmed that he or she would attend, then there should be a compulsory charge of at least €25. Their non-attendance will have wasted the appointment and deprived somebody else.

A corollary of that is respect. I do not believe that a system that demands 30 people to turn up for an appointment at 9 a.m. shows respect for patients. It clearly indicates that the system and time is more important than that of a patient. That is not correct if we want a patient centred service. There must be a mutual understanding between those who provide the service and those who use the service. It must be conveyed that healthcare is a limited resource and has an impact on other people in our communities, our families and our friends. We all have a responsibility to use healthcare in an appropriate fashion. We, as service providers, must treat people with respect by not calling 30 people to attend at the one time. Instead, they should be given staggered appointment times thereby greatly improving the situation.

I have outlined some of the ideas that are being put in place. As hospital groups come together their scale of size will allow them to buddy up with national and international partners to develop new ways of organising and delivering care. Dr. Susan O'Reilly, Director, National Cancer Control Programme, has stated that better organisation and management can result in a 10% better outcome for the patient. That is important.