Rose Conway Walsh (Sinn Fein) | Oireachtas source

I move:

That Seanad Éireann:

recognising that: - 632,000 patients were on published and unpublished hospital waiting lists at the end of January 2017;

- under the current waiting list system, waiting lists for outpatient appointments, diagnostic tests, day case and inpatient procedures vary drastically from one public hospital to the next;

- patients do not know where they stand on the list nor at what speed their list is moving relative to that of other hospitals within reasonable travelling distance; and

- people with comparable health concerns can wait very different lengths of time for assessment and treatment depending on the hospital to which they happen to be initially referred; notes the success of the integrated IT system used in the Portuguese NHS which has, alongside greater investment in public hospitals, delivered significant and sustained reductions in waiting times for surgery since it was first introduced in 2004 – namely over five years waiting lists for surgery have decreased by almost 35 percent, the median waiting times by almost 63 percent and variation across providers is also diminishing;

and calls on the Minister for Health to explore the feasibility of a new model to maximise the capacity of the public hospital system, purchase capacity from the private system and introduce fairness and strategic management across all waiting lists, the component parts of which should be: - the introduction of Comhliosta – a new and single Integrated Hospital Waiting List Management System to cover all public and participating private hospitals;

- the provision of a greater Core Activity Budget to public hospitals to increase their capacity;

- the introduction of a new Comhliosta activity fund to cover the cost of procedures for those patients transferred via the integrated waiting list to a different public or participating private hospital; and

- an end to the special treatment of private patients in public hospitals.

I thank the Minister for coming to the House. I apologise again for being late. This Sinn Féin motion puts forward a radical and pragmatic proposal to develop a new comhliosta model to maximise the capacity of the public hospital system to purchase capacity from the private system at a reduced cost and to introduce fairness and strategic management across all waiting lists.

Many Senators stood in this Chamber after the "Prime Time" programme which highlighted the scandal and inhumanity of people waiting in pain for medical treatment. They expressed their horror at a failed health system which was not fit for purpose. Today Sinn Féin is presenting those same Senators with an opportunity to instruct Government to explore the feasibility of a new single integrated hospital waiting list management system to cover all public and participating private hospitals. Today we will see if there are expressions of horror or just empty words, or if they can put party politics aside and support a new model which has delivered significant and sustained reductions in waiting times for surgery since it was first introduced in Portugal in 2004.

Sinn Féin had prioritised the issue of fair and transparent waiting lists long before the latest controversy surrounding inaccurate figures from the National Treatment Purchase Fund surfaced several weeks ago. It is also part of our response to the many problems facing our society to have workable and costed solutions that can be implemented at once. My colleague in the North, Michelle O'Neill, has recently sought cross-party support for the implementation of the Bengoa report which will see £31.2 million invested to clear the backlog on waiting lists in the North. All of this progress in health in the North is taking place in the midst of a political crisis within the institutions and on the back of years of brutal Tory austerity. Sinn Féin can deliver on health and is currently delivering under very difficult circumstances.

An all-island approach to health not only will benefit future patients but also holds the key to tackling regional imbalance in waiting lists. On Monday, Michelle O’Neill was joined by the Minister for Health, Deputy Harris, to open a cross-Border regional radiotherapy unit in Altnagelvin Area Hospital. This unit serves the north west of the island and now means that patients in Donegal, Derry and Tyrone can access cancer care within one hour’s travelling distance of their home. Once again, a genuine all-island approach is delivering real results for those most in need.

The comhliosta system we have proposed in this motion is in response to a plethora of announcements and promises by this and previous Governments that have at best delivered temporary and sometime illusory results. First, there is undeniably a two-tier health system which starts at the access point to care. This system involves the provision of a core activity budget to public hospitals. This would be based on the previous year's activity adjusted for inflation and any successful proposal made for a portion of the increased funding made available under Sinn Féin’s growing health budget. Increased capacity for the public health system is urgently needed. The recruitment of further consultants, in particular, would significantly reduce waiting times for initial consultations and the wider measures to tackle hospital overcrowding would shorten the second portion of waiting times, as a greater volume of elective procedures would be facilitated.

Sinn Féin wants to see an end to the special treatment of private patients in public hospitals by incrementally eliminating private activity and replacing the revenue lost with increased public funding to their core activity budgets during a term of government. According to the 2015 HSE financial statements, in 2014 the statutory public hospital sector got €298 million from private patients. This figure does not include the voluntary hospitals and no figure for that sector was provided in response to parliamentary questions tabled by Sinn Féin. However, the HSE estimated in its 2014 submission to the consultative forum on health insurance review group that "the Private Health Insurance market generates roughly €500 million per annum for the statutory and voluntary hospital system". Sinn Féin would make an additional investment of €100 million, rising to €500 million annually, for the core activity budgets of public hospitals to replace the revenue streams from private insurance.

Under the current system, waiting lists for outpatient appointments, diagnostic tests, day case and inpatient procedures vary drastically from one public hospital to the next. Patients do not know where they stand on the list nor at what speed their list is moving. People with comparable health concerns can wait very different lengths of time for assessment and treatment depending on what hospital they happen to be referred to initially.

We would introduce a version of the integrated IT system used in the Portuguese national health service, NHS, which would help to achieve new maximum wait times by actively transferring those on the list from hospitals that are failing to meet the target to hospitals that have the ability to offer the service on time. The new maximum waiting times should be developed to cover the entire period from referral to the end of the episode, that is, the time when either a decision is made to treat or not to treat a patient. The IT model introduced by the Portuguese, alongside greater investment in public hospitals, has delivered significant and sustained reductions in waiting times for surgery since it was introduced in 2004.

As described in the 2013 OECD publication, Waiting Time Policies in the Health Sector: What Works?, over five years waiting lists for surgery have decreased by almost 35%, the median waiting times by almost 63% and variation across providers is also diminishing. When a registered patient has reached 75% of the maximum waiting time allowed for their treatment, a voucher is automatically generated allowing the patient to obtain treatment in a different public or participating private facility. The payment is the same regardless of the status of the provider. Unlike the National Treatment Purchase Fund, in which we no longer have any confidence, fees for comhliosta activity would be centrally determined and set at a rate below that paid for core activity, which must take account of all hospitals' fixed costs. In Portugal, the additional surgeries conducted via the transfer system cost on average 70% of the price paid for basic surgery provision.Hospitals in Portugal have an incentive to engage in additional transfer activities over and above that contracted to attract the 70% funding which comes to them. Almost 80% of Irish consultants are currently engaged in some form of private patient activity outside of their contracted hours. This shows they have the capacity to carry out more public activity, which would allow us to treat everybody quicker, as well as on the basis of clinical need alone rather than patient status. Coupled with greater public investment, comhliosta could do just that.

Sinn Féin would seek to achieve public-only consultant contracts covering core activity on a full-time or part-time basis. Contracts would include protected time for teaching and facilities for research and academic collaborations. Further income could also be generated by consultants by undertaking additional activity transferred to them by comhliosta outside their contracted hours.

The plight of over 600,000 people waiting for hospital appointments means a fresh approach is needed to deal with these lists. The disparity of waiting lists between east and west is shocking. In UHG, University Hospital Galway, 1,093 people were waiting for over 18 months for appointments. The nearest in the east was Beaumont Hospital with 448 patients waiting. While there are over 600,000 people waiting nationally, the crisis is more severe in the west. As of the end of last month, in Mayo University Hospital, 53 people were waiting over 12 months for treatment while in University Hospital Galway, there were 2,190 people.

Comhliosta will provide for patients to be moved from one hospital to another to reduce pressure on those hospitals. Sinn Féin sees this extending to the entire island. From the implementation of the report in the North, Daisy Hill Hospital could take patients on waiting lists at Our Lady of Lourdes Hospital, Drogheda.

Our Private Members' motion is a positive effort to improve waiting times for patients and to provide clarity and fairness around the process. It is not a dig at the Government. It admitted there is a problem and also accepted that the manipulation of figures serves nobody, least of all the patients.

This current crisis did not start in 2011 with the current Government. In my area, Belmullet Community Hospital had 20 of 40 of its beds shut in 2009 under the Fianna Fáil Government, implemented by a Progressive Democrats Minister, Mary Harney. The reduction in beds at community hospitals was matched by a savage cut in home help hours. In Mayo alone, between 31 August 2009 and 31 August 2010, 32,000 home-help hours were cut. This left many vulnerable people with substandard care and meant they ended up in major hospitals.

I was shocked to read in the Irish Medical Timesearlier this month Senator Keith Swanick calling for the expansion of community hospitals. He cited Belmullet as an example, where he correctly stated the nearest acute hospital is over 50 miles away. In that same article, he said, "The community hospital network should not be seen as a relic of a bygone era." Against the wishes of the whole community of Erris and Mayo, his own party, Fianna Fáil, cut half of the beds in Belmullet Community Hospital. Are we now to believe he and his colleagues will rescue all community hospitals?

It is this type of hypocrisy from Fianna Fáil which has the health system in its current crisis. Fianna Fáil now extols the virtues of further investment in the vital services that it stripped bare of cash when it was in power. I will not allow this go unchallenged. A community hospital in my area, providing step-down and respite care, was shut down to satisfy the neoliberal privatising agenda of Fianna Fáil and the Progressive Democrats. Between 2007 and 2011, Fianna Fáil cut 1,274 acute beds and 1,123 long-stay beds, as well as hundreds of thousands of home-help hours. Are we to believe Fianna Fáil is now the party to solve the crisis it designed and delivered? I find it pathetic that Fianna Fáil saw fit to put forward a so-called amendment to a genuine attempt by my party to address the reality of this serious problem.