David Cullinane (Sinn Fein)
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I thank the Minister for coming to the House. I have raised the issue of long outpatient waiting times at Waterford Regional Hospital a number of times in the House. My party health spokesperson, Deputy Caoimhghín Ó Caoláin, sought from the HSE a full breakdown of the figures on all of the departments and specialties at the hospital in respect of outpatient waiting times to see exactly how long people wait to see a consultant and get into the system. It is fair to state that once people get into the system they get the very best treatment in our acute hospital services, and certainly Waterford Regional Hospital is a strong performing hospital where people get the very best treatment when they are in the system.

The figures released to us by the HSE show that a total of 28,479 people in the south east who depend on Waterford Regional Hospital are on outpatient waiting lists waiting to see a consultant. Of these, 11,338, which is 40% of the total number, have been waiting for longer than a year and 20% have been waiting for more than two years. The Minister has often said in the House that he wants all of the hospitals to meet the target he sets and that he will be very tough with the managers of the hospitals to ensure the targets are met. The problem is not getting tough with managers of hospitals. In some respects the problem is capacity and the fact we do not have enough consultants or staff to cater for the need.

Orthopaedics at Waterford Regional Hospital is a good example where the clinical director and the consultants who work in the sector will say if they are asked that twice as many referrals come to the hospital than there is capacity to treat. The target set by the Minister is a national guarantee that no patient will wait for longer than one year to see a consultant. Unfortunately this is not the case. To give the Minister a flavour of the areas involved, in dermatology 49% of patients have been waiting more than 12 months, the figure for general medicine is 37%, for ophthalmology it is 32%, for orthopaedics it is 44% and for pain relief it is 53%.

I know the Minister cannot micromanage everything that happens in the health service and he cannot comment on individual cases, but recently I dealt with a stroke victim who is having difficulty getting gallstones removed. She has been waiting for months to see a pain specialist. She has no speech whatsoever but has been waiting for months to see a pain specialist. Another person had a biopsy done on one of her glands and on two occasions she was booked into the hospital for elective surgery to have the lump removed but the procedure was cancelled on both occasions. A number of elective surgeries have been cancelled at Waterford Regional Hospital this year. The reason is very simple; it is capacity. We have closed a ward and two surgical theatres. The hospital gets full quickly which means there is no capacity to carry out elective surgeries. This means they are cancelled which creates havoc with waiting times. As the Minister knows it is very difficult on patients who are building up to having a procedure done and then it does not happen.

As the Minister is here he might also comment on plans to expand cardiology services at Waterford Regional Hospital. One of the hooks on which the Higgins report was sold to the people of the south east was that we would have a 24-seven cardiology service, but the Higgins report mentions enhanced cardiology services. Will we have 24-seven cardiology services? How will the Minister make it a reality? My main question is on the outpatient waiting times and the fact that unfortunately the targets set by the Minister are not being met.

James Reilly (Dublin North, Fine Gael)
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The targets were only set this year and my promise to the people is that nobody will wait longer than a year by the end of this year. We are the first Government to measure the number of people on outpatient waiting lists. The total number is 386,000 people, but we see 200,000 people at our outpatient clinics every month and I believe we will be able to deal with this problem as we have dealt with the other problems. After the urgent and cancer patients are dealt with the longest waiters will be looked after. The true scandal for me is not the 386,000 people which no previous Government acknowledged or measured, but that more than 16,000 people have been waiting for longer than four years.

I thank the Senator for raising this matter and for the opportunity to update the House on the significant progress being made on outpatient waiting times as a result of the measures introduced by my Department, the special delivery unit and the National Treatment Purchase Fund. Access to acute hospital services is a priority for me and the Government. Hospitals have responded impressively to this challenge, in the face of considerable pressure.

This is due to the hard work done by clinical and managerial leaders in individual hospitals, coupled with comprehensive and coherent strategies and programmes enacted by the special delivery unit, working with the National Treatment Purchase Fund, the HSE, the hospitals, the men and women who work on the front-line of the health service and supported by clinical programmes.

With specific reference to outpatients, the National Outpatient Service Performance Improvement Programme 2012-2015 has commenced implementation. Current improvements include: validation of current outpatient lists; the standardisation of current referral management processes; and improved turnaround times for categorisation of referrals; the utilising of clinic capacity effectively through booking of pre-planned appointment slots; configuring specific clinic templates to address varying requirements of different specialties; improvements in the discharge planning process; reducing the do not attend rates by patients; and identifying, understanding and resolving long-standing organisational behaviours, culture and attitudes towards the provision of outpatient services. These measures are being implemented for waiting lists in all specialties.

Underpinning all of these work streams is the availability of patient level waiting time data in all hospitals providing an outpatient service. The data has been systematically collated by the NTPF and is publicly available on its website. As I said, the maximum waiting time target for 2013 of 12 months for a first-time outpatient appointment.

The SDU and the NTPF will shortly publish outpatient waiting times by specialty which will add further to the visibility and transparency of waiting times in our health system. It is hoped that the publication of data will commence by the end of this month. Already this work has identified orthopaedics, ENT and ophthalmology as the services which, nationally, are most at risk of not achieving access targets.

Ultimately, each hospital must systematically achieve maximum waiting time targets each year by matching capacity with demand, eliminating inefficiencies in the patient pathway, ensuring the strict chronological management of patients of equal clinical priority and implementing the recommendations of the clinical care programmes. Establishing hospital groups will further facilitate hospitals in addressing waiting lists. These Groups will see small and larger hospitals working together as teams, in conjunction with their academic partners, to enhance innovation and effectiveness in service development and delivery.

Waterford is a busy hospital. It is a cancer centre, hub for the southeast renal service, provider of invasive cardiology services and a regional trauma centre including an emergency department, ear, nose and throat and ophthalmology. Given the level of activity, it is no surprise that midway through the year work is ongoing to accurately measure and validate outpatient waiting lists and to match these to capacity, taking into account the clinical needs of patients.

With regard to the specialties that the Senator mentioned, these services are delivered not just in Waterford Regional Hospital but in a range of outreach hospital and community clinics in the southeast. I acknowledge that the numbers are high at 2,814 for dermatology, over 4,000 for ophthalmology, over 5,000 for orthopaedics and over 6,000 for ENT. However, these numbers are being proactively tackled by the hospital with the assistance of the HSE.

I am pleased to advise that a candidate is in clearance for the third new post of consultant dermatologist, following the appointment of the second new post on 1 March 2013. A candidate is also in clearance for the replacement post of consultant orthopaedic surgeon at the hospital, following a consultant resignation. Finally, one consultant ophthalmic surgeon replacement post will be advertised shortly and a second replacement post is also being processed.

All of these appointments will lead to significant improvements in their respective services, particularly in respect of waiting times. Coupled with management plans, revised governance arrangements and additional clinics or clinical reviews in specialties such as regional orthopaedics, regional ENT and opthalmology, l am assured that the hospital is making every effort to ensure the 12 month target is achieved by November 2013.

Michael Mullins (Fine Gael)
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I thank the Minister.

David Cullinane (Sinn Fein)
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I thank the Minister for his response. I share his view that hospital management has responded impressively. He has acknowledged that the figures for opthalmology, orthopaedics and ENT are very high. I welcome the announcement of the new and replacement consultant posts. If the new posts do not allow the hospital to reduce its waiting times and numbers, is the Minister in a position to say whether extra posts will be made available? Capacity is important in order to allow hospitals reach their targets.

Perhaps he can answer my concern about the provision of 24-7 cardiology. It is a major issue for people in the southeast. I hope that he will positively address the matter. A commitment has been given to enhance such services but what does that mean?

James Reilly (Dublin North, Fine Gael)
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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.

Michael Mullins (Fine Gael)
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I thank the Minister.