Cecilia Keaveney (Fianna Fail)
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I thank the Cathaoirleach for selecting this matter for discussion on the Adjournment. I also thank him for his forbearance during this session and accommodating many of the important issues I have raised.

I raised this issue, waiting lists in Letterkenny General Hospital and access to the National Treatment Purchase Fund, in the House on 8 May. There appears to be a problem in County Donegal. The statistics show that four out of every ten people waiting for an operation for longer than 12 months are either in Letterkenny, Sligo or Limerick and that six out of every ten are awaiting a procedure in Letterkenny General Hospital, Sligo General Hospital, Temple Street Hospital, Limerick Regional Hospital and Cork University Hospital. Regardless of how one looks at the statistics, Letterkenny is on the hit list for the longest possible waiting times for patients.

When I raised this issue previously, I thought people might not be aware of the National Treatment Purchase Fund, NTPF, and strongly advocated its use. I must declare my interest because a member of my family successfully used the NTPF in recent months. I continue to advocate its use. After three months on a surgical waiting list a person is entitled to either self-refer or have his or her general practitioner or hospital refer him or her to the fund. I was under the impression that patients were not being referred and was blaming the wrong people in some respects. Then I was told people were offered the NTPF but were not prepared to take up the offer. However, I was also told that, in the case of Letterkenny General Hospital, unless one was waiting for more than nine months or one year, one did not qualify for the NTPF. The reason it was doing this was to get rid of the long waiting lists. The reality is that people in my part of the country are being treated differently from people in others. If I am on the waiting list of a hospital for more than three months in another part of the country, I can be referred to the NTPF.

I am seeking clarity on this issue. If there are consultants with particularly long waiting lists and others within the same discipline who do not have long lists, what can the Department do to encourage general practitioners to direct their patients to the consultants with the shorter lists? There should be more discussion between general practitioners, consultants and the HSE about the difficulties. I am aware that meetings take place but my experience is that when I make pronouncements calling on people to use the NTPF and state, from personal experience, that it is wonderful, I will receive a telephone call from somebody who has been told they will have to wait one year for their operation or that their child's urgently needed operation will not be carried out in the foreseeable future.

It is wrong, when so much Government funding is being put into this very good scheme, that people in my constituency are being forced to go private. The need to opt for private care should have been abolished the day the NTPF was established. I am a strong advocate for the NTPF but there should be fair play. If there is an internal war between one side and another with regard to who has these long lists and why they are so long, the patient should not suffer. People in County Donegal are being discriminated against. They do not have the same access to the NTPF as others. That is the basic tenet of my argument.

I am seeking clarity on this issue. I might be wrong and would be happy if people were able to correct me, but the evidence does not indicate it. In recent weeks Letterkenny General Hospital topped the list of hospitals with the longest waiting times. I have told people they can self-refer or ask their general practitioner to send them to a different consultant in an effort to speed up matters but the statistics are clear. I accept they are improving. When I raised this issue previously, there were 2,900 people in the country waiting for longer than 12 months but now the figure is only 1,846. However, if I was one of the 1,846, I would like to know when I would be operated on and would also like to think I would not stop somebody else having an operation.

The NTPF chief executive, Mr. Pat O'Byrne, has been quoted as saying many are waiting needlessly. Why are they waiting needlessly? What can we do to ensure the system is better streamlined? Wherever the blockage is, be it with consultants, hospital administrations or people within the NTPF, it must be removed.

Máire Hoctor (Tipperary North, Fianna Fail)
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I am pleased to reply on behalf of my colleague, Deputy Harney, Minister for Health and Children. I thank Senator Keaveney and the Seanad for giving me the opportunity to address this important matter.

The National Treatment Purchase Fund was established to tackle the issue of excessive waiting times for hospital treatment for public patients. The fund has been very successful in fulfilling this remit and arranged treatment for some 135,000 patients to date. It is on target to arrange treatment for a total of 37,000 patients in 2008. On average, public patients are waiting 2.9 months for their operation, down from two to five years before the NTPF was established.

Notwithstanding this success, there remain a number of hospitals in which there are significant numbers of patients waiting for more than 12 months for treatment. The Minister has asked the NTPF and the HSE, working together, to give this issue particular attention. As a result of the efforts made by both organisations during 2008, the total number of persons waiting over 12 months has been reduced by 60%, from 4,594 in October 2007 to 1,846 in November this year.

It is important to ensure waiting lists reflect the numbers in a position to avail of treatment when it is offered to them. This includes offers of treatment via the NTPF, given that this is a statutory body which is provided with significant funding to facilitate treatment of public patients. The Minister has, therefore, asked the HSE to ensure there is consistent and active management of waiting lists. The NTPF, working with representatives of both the HSE and voluntary hospitals, has drawn up the national guidelines for management of inpatient and day case waiting list data which provide a basis for a consistent approach.

At this point, the problem of particularly long waiting times for patients is largely confined to a small number of hospitals. Five hospitals — Letterkenny General Hospital, Sligo General Hospital, Temple Street Hospital, Limerick Regional Hospital and Cork University Hospital — account for some 60% of those waiting over 12 months for surgery. While substantial reductions have been achieved, the latest returns from the two hospitals in the north west, Sligo General Hospital and Letterkenny General Hospital, show that there are still 337 and 316 patients, respectively, waiting over 12 months for surgery.

In line with the requirement to focus particularly on those who have been waiting for excessive periods, the NTPF has asked the HSE and the hospitals concerned to accord priority to facilitating the treatment of these patients. The Minister supports this approach. The fund has the resources to arrange treatment for these patients and wishes to see the hospitals concerned referring their longest waiting patients in order that treatment can be arranged for them. Treatment is free of charge and in most cases can be arranged within weeks. It makes sense to ensure there is a concentration on this group ahead of persons who have not been waiting as long for treatment. The fund also arranges treatment for patients waiting for under 12 months in these hospitals.

In 2008 to date, 974 Letterkenny General Hospital patients have been referred and treated under the NTPF, 260 in the last two weeks. This is progress, but it has to be said the NTPF could have treated substantially more patients had more referrals been made.

I emphasise a recent initiative by the Minister. In approving the HSE's service plan for 2009, the Minister indicated her particular concern about patients having to wait a long time for hospital treatment. She said the HSE needed to give consideration, where necessary, to directing co-operation with the NTPF, including through the imposition of financial penalties for hospitals failing to refer patients who could benefit from NTPF-funded treatment. A long delay in treatment for public patients, when treatment is actually available, cannot be excused. If it takes financial penalties on hospitals to drive home this point, so be it, but we hope this would not be necessary. The Minister looks forward to continued effective co-operation between the NTPF, the HSE and individual hospitals in order that the unnecessary and unacceptable situation where people are waiting for 12 months and more for surgery will be eliminated.

Cecilia Keaveney (Fianna Fail)
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I welcome the honesty of the Minister of State's reply. In May this year, 400 people had been waiting for more than 12 months for treatment at Letterkenny General Hospital. While the figure stood at 316 in December, the decrease is not significant when one considers that 260 patients can be referred to the National Treatment Purchase Fund in two weeks. While I commend the efforts being made to address this problem, I reiterate that some type of obstacle is preventing those waiting longest from being called for treatment. It is this that is stymieing use of the facility to refer those waiting for three months to the National Treatment Purchase Fund, as is done elsewhere in the country. I ask all those concerned to ensure this matter is addressed and patients do not suffer as a result of a geographical bias.