David Cullinane (Sinn Fein)
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I have raised this issue several times with the Minister for Health in respect of the orthopaedic unit at University Hospital Waterford, what was Waterford Regional Hospital. There are two issues, the trauma aspect and the matter of elective surgeries. Let us consider trauma first. We have the busiest trauma unit in the State at University Hospital Waterford but we only have one trauma theatre. Each of the next three busiest trauma units outside of Waterford have two trauma theatres. Obviously, there is a problem with capacity and this is leading to long waiting lists for people who need treatment. There is also a problem with people getting access to consultants and with referrals coming from general practitioners to consultants in respect of treatment for elective surgeries. One way of getting around these problems as well as addressing the long waiting lists is for the hospital to refer patients to private clinics and the hospital in Waterford has made arrangements with clinics such as Cappagh National Orthopaedic Hospital, Dublin. Patients were to be referred to Cappagh, where they would be seen by a consultant, a report would be produced on whatever surgery may be needed and then the patients were to get the surgery at that hospital. Many people - this applied to hundreds of people - were referred to Cappagh. Some were seen by consultants but others were not. Many who were seen never got treatment and their files were then sent back to Waterford. Some of the files have not been sent back and people are trying to find out where they are on the waiting list. These people have not seen consultants; they were told they would be seen but that did not happen. I spoke to an orthopaedic consultant before I came to the House and he indicated that he was rather concerned about the situation. Let us consider elective surgeries as an example. There are twice as many referrals going into the hospital than the hospital can cater for. Therefore, unless more consultants, more capacity and more staff are provided, the situation will get worse and worse.
What are the waiting times? Are we seeing dishonest means being used to massage waiting list figures by sending people to the likes of Cappagh? Arrangements were to be in place whereby the patients would be seen by a consultant and treated but that is not happening. In the meantime they are off the waiting list in Waterford, but the files will come back and they will eventually get back on the waiting list again.
I have dealt with several cases involving people who simply do not know where they stand. It is not good enough. If the orthopaedic consultants who work in the area are concerned, if the general practitioners are concerned - these are the people making referrals - and if the patients are concerned, then we have a serious problem. The problem can only be addressed by increasing capacity. I appeal to the Minister of State to examine this issue, to address it with the Minister for health and to ensure that people are seen as quickly as possible. Furthermore, once they are seen by a consultant and if surgery is required, then they should get the surgery as quickly as possible. There should be no massaging of the figures and no dishonest means used to reduce waiting lists. We need to be honest with people about the position and ensure that the appropriate resources are put in place to ensure patients in Waterford and the south east are seen as quickly as possible.

Alex White (Dublin South, Labour)
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I thank the Senator for raising this issue and for allowing me the opportunity to outline the progress made on reducing waiting times for treatment. I assure the Senator and the House that there is no question of any dishonest means being used in any respect with regard to the information that I will give to him and the House and I reject any suggestion to the contrary.
The special delivery unit was established, as the House will be aware, almost three years ago. Since then significant progress has been made on reducing the numbers of patients on hospital trolleys and waiting lists. The number of people waiting longer than the 52 week target reduced from 27% in April 2013 to 7% in April this year. In addition, the period from January to April 2014 saw a 6% increase in outpatient appointments provided by the HSE, that is, an extra 56,810 appointments compared with the same period in 2013. Furthermore, in terms of scheduled care, inpatients and day cases, a comparison of April 2014 against April 2013 data shows a 5% decrease in the number of patients waiting over eight months.
The Senator made particular reference to orthopaedic services in Waterford University Hospital. I understand that the current waiting time for outpatient orthopaedic referrals is 20 months. I am acutely conscious that this waiting time of 20 months is outside the so-called no-longer-than-12-month-target that has been set for outpatient appointments. I am, however, advised that the SDU and the HSE are working on a series of options to address waiting list issues and are continuing to explore options to reduce waiting times for patients requiring treatment. The consultant staffing complement of the orthopaedic department at University Hospital Waterford is eight whole time equivalent posts. Currently seven posts are filled, two of which are filled on a temporary basis. I am advised that the vacant eighth post will be filled on a permanent basis with effect from Monday next, 7 July. The filling of this consultant post should help ease the pressure on the orthopaedic department in the hospital and have a positive impact on waiting times.
In 2012 University Hospital Waterford undertook an initiative with Cappagh National Orthopaedic Hospital and the National Treatment Purchase Fund. As a result, a total of 1,871 patient referrals were sent from Waterford to Cappagh with an agreement that Cappagh would complete the episode of care for this cohort of patients. The initiative progressed as planned and Cappagh managed the patients as required including: validation, musculoskeletal review, investigations, procedure and follow-up discharge. In June 2013 this initiative came to an end and responsibility for the care of these patients was returned to University Hospital Waterford. All of the patients who were previously seen in Cappagh will be seen by University Hospital Waterford orthopaedic consultants to complete their episodes of care. Some of these patients have already been seen in Waterford and any patients with appointments outstanding will be seen as soon as arrangements can be made.
University Hospital Waterford has assured me and the Minister that it is committed to completing the episode of care for the cohort of patients who had their care transferred back from Cappagh and the hospital will continue to work to ensure that the care pathway is completed in each case.
I referred to the current waiting time of 20 months for orthopaedic treatment in UHW. The SDU and the HSE are working on a series of options to address waiting list issues and are continuing to explore options to reduce waiting times for patients requiring treatment. This initiative, along with the appointment of a new consultant to University Hospital Waterford next week, will, I expect, lead to an improvement in waiting times for patients.

David Cullinane (Sinn Fein)
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The response from the Minister of State on behalf of the Minister for Health only reaffirms my fear because the Minister of State accepts that 1,870 patient referrals were sent from Waterford to Cappagh. Furthermore, the Minister of State has accepted that there was an agreement that Cappagh would complete the episode of care.

That did not happen. The Minister of State then indicated that the initiative came to an end in June 2013. Why was that the case and why was the care not followed through on? He further indicated that people should return to Waterford for treatment. The logic behind sending them to Cappagh Hospital in the first instance relates to the fact that there are capacity issues in Waterford. In that context, the Minister of State accepted that there is a waiting time of 20 months.

This is a complete mess. No one is able to inform the patients why the arrangement with Cappagh Hospital was brought to an end in the way it was and neither can they tell them when they will be seen. With respect, all we get from the HSE in respect of this matter is spin and, in that context, the Minister of State was obliged to use the phrase "continuing to explore options to reduce waiting times". What options is it exploring? I have been raising this issue for almost 18 months and I have been continually informed that options are being examined. I do not see any options, nor do I see any solutions. All I see is waiting times increasing constantly. Arrangements that were put in place - such as that relating to Cappagh Hospital - which were designed to reduce waiting times have been brought to an end without an explanation being provided.

I am not sure whether the Minister of State is in a position to respond to me in respect of these matters. If not, perhaps he could revert to me on them. This is a crucial issue for people who are awaiting treatment. I genuinely believe the situation is unsustainable. It is also unfair on the excellent staff employed in Waterford University Hospital.

Alex White (Dublin South, Labour)
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The objective of all concerned is to ensure that patients receive treatment. I do not know why the arrangement with Cappagh Hospital came to an end. If the Senator is unable to discover why that occurred, I will certainly assist him in trying to establish the facts. I reiterate that patients who were previously seen at Cappagh Hospital will now be seen at Waterford University Hospital in order to complete their episodes of care. Some of them have been already seen and any with appointments outstanding will be seen as soon as arrangements can be made. That is the commitment which has been made.

On the additional questions posed by the Senator, I am, as always, available to try to assist in any way. If he contacts me separately, I will try to obtain for him the information he is seeking.