Paul Coghlan (Fine Gael)
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I welcome the Minister of State at the Department of Health, Deputy Jim Daly.

Colm Burke (Fine Gael)
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I thank the Minister of State for taking the time to deal with this issue. I am concerned about the waiting time in having cataract operations performed and accessing the required expertise to deal with eye problems, particularly for elderly persons. In the past six months I have received many queries about the waiting list and waiting time for cataract operations, particularly in Cork. One of the things I want to find out is how the issue can be dealt with now to make sure patients receive treatment in a timely matter. I ask the question because the greater the delay in receiving treatment the less likely it is that a specialist will be able to solve eye problems. The issue is extremely important because the loss of eyesight leaves a person extremely limited and in need of a lot support from the health service. It is extremely important, therefore, that anyone who has problems with his or her eyes, his or her eyesight in particular, and requires a cataract operation have the procedure carried out at the earliest possible stage. It is in that context that I raise the question. I want to know, in particular, whether services for the people who are waiting can be outsourced and the number who can be accommodated in accessing treatment, particularly in Cork.

Jim Daly (Cork South West, Fine Gael)
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I welcome the opportunity to address the House on this issue. The Minister for Health, Deputy Simon Harris, has committed to tackling long waiting lists. It is acknowledged that cataract surgery is among the most common surgical procedures carried out in the ophthalmology speciality. It was with this knowledge, when proposals for the joint HSE-National Treatment Purchase Fund, NTPF, inpatient and day case action plan were under development earlier this year, that the Minister sought a particular focus on waiting times for a number of high volume specialties, including cataract surgery. The action plan allocated one quarter or 5,000 of the 20,000 planned NTPF procedures to cataract treatments. Furthermore, under the action plan, the NTPF commits to offer treatment to all clinically suitable patients who have been waiting more than nine months for a cataract procedure. By the end of August over 4,100 patients had received cataract treatment through NTPF funding. This represents 83% of the target of 5,000 set in the action plan.

The impact of the action plan can be seen in the improvements to waiting lists for cataract procedures which have seen a reduction of over 3,100 in the past 13 months. The August 2018 figures show that there are 6,868 people on the waiting list for cataract procedures compared to over 10,000 in July 2017. However, the reduction in waiting list numbers does not fully reflect the progress made. In January 2018 as many as 8,027 patients were awaiting cataract surgery.Between January and August, 5,982 patients were added to the waiting list, therefore numbers have more than halved from 14,000 to 6,900 in the eight-month period. In addition, the number of patients waiting longer than nine months for a cataract procedure has gone from over 4,300 in July 2017 to 1,078 in August 2018, with 64% of patients waiting three months or less. Between January and August, the NTPF issued almost 7,300 offers of treatment to patients awaiting cataract surgery who were clinically suitable for outsourcing.

The action plan also recommends that the HSE and the NTPF identify sustainable initiatives to improve waiting times. A dedicated cataract theatre in Nenagh hospital opened in July. Since the service commenced in July, 53 patients have been treated and it is expected that more than 200 cataract procedures will be undertaken by the end of the year. Yesterday's budget announced an allocation to the NTPF of €75 million in 2019 from which the NTPF plans to fund 25,000 inpatient day case treatments. Under these plans, I would expect that the number of cataract procedures to be funded in 2019 will be similar to 2018 levels.

Colm Burke (Fine Gael)
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I thank the Minister of State. I note the figures to which he referred. Unfortunately, the people who have been in contact with me have not benefitted under outsourcing. It is in that context that I raised the question. How are people selected to receive treatment under the NTPF? How are they prioritised? Is it based on the period of time they have been waiting or on decisions made by people within the administrative system? I am a bit concerned as to why some people who have been on the waiting list for quite a long time are not selected. It does not appear to be based on the time one has been waiting but rather on random selection. I am not clear on how it is being dealt with. Could I have some clarification on that?

Jim Daly (Cork South West, Fine Gael)
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The important thing to note is that the number of patients waiting longer than nine months for a cataract procedure has gone from over 4,300 in July 2017 to 1,078 in August 2018. It is clear that in that 12-month period almost 3,300 people were taken off the list of those waiting in excess of nine months. That is where the focus has been.

If the Senator looks at the earlier figures with regard to the number of patients who have left the list altogether, which states that 83% of the 5,000 person target has been achieved, he will see that the majority of that decrease, 3,000 of more than 4,000 patients, came from the list of those waiting in excess of nine months. The primary focus is on those waiting longer than nine months. They would all be offered treatment. Not everyone would want to accept, but they are the first priority. There would then be a number of exceptions made on clinical grounds and so on. I assume the HSE or a clinical team could make a decision in that regard. The primary focus, however, is on those waiting a long time, as evidenced by the figures which show that 3,300 have left the list of those waiting longer than nine months.