Vol. 413 No. 7
7 Mr. J. O'Keeffe asked the Minister for Health her views on whether delays of up to three years for medical card patients awaiting hip operations are entirely unacceptable; and if she will outline her proposals to deal with this situation.
The development of new techniques, such as hip replacement surgery, has coincided with the growth of an elderly population and these, together with other advances in health care, have resulted in infinite demands being placed on finite resources.
The waiting time for hip replacement surgery varies from centre to centre. While the longest waiting patients may experience delays of the order outlined by the Deputy, the majority of patients received surgery within a shorter period of time. At St. Mary's Orthopaedic Hospital, Cappagh, for instance, the largest orthopaedic centre in the country, the average waiting period is four months.
I should explain that the admission of a patient to hospital for hip replacement surgery is a clinical decision for the consultant in charge of the case. Waiting lists are kept under review and priority is given to urgent cases. If a patient's condition is causing concern it is open to his or her general practitioner to contact the consultant concerned in order to stress the urgency of the case.
The following table shows the number of patient's nationally receiving hip replacements.
|
1986 |
1,790 |
|
1987 |
1,624 |
|
1988 |
1,859 |
|
1989 |
1,905 |
|
1990 |
2,174 |
|
1991 activity |
2,100 |
With regard to waiting times generally, the Deputy will be aware that the Dublin Hospital Initiative Group focused on the management and review of waiting lists and general strategies to improve waiting times for treatment. The group recommended that: comprehensive, standardised, information be maintained and reviewed by each hospital concerning the numbers and types of patients awaiting admission; validation to establish meaningful waiting list data be adopted as a firm policy in each hospital; hospitals should carry out bulk postal reviews of waiting lists where patients have been on waiting lists for more than an agreed period of time; hospitals should target waiting lists by ensuring that explicit account is taken of waiting times in scheduling admissions including theatre list.
The group have recently been reconvened and part of their new remit is to pursue the implementation of the recommendations in relation to waiting lists in the Dublin hospitals. In addition, health boards and hospital authorities in the area outside of Dublin have been asked to consider the good practice recommendations contained in the report and to report back to the Department on their plans for implementation of the recommendations, including those in relation to waiting lists.
The Minister will be aware that it can take from six to nine months to see a consultant and get on a waiting list while the average waiting period is one-and-a-half to two years thereafter.
Has the Minister ever had the experience of an elderly constitutent visiting her clinic and crying in front of her with pain having had to wait one-and-a-half to two years for a hip operation? If so what was her reaction to that constituent?
I do not intend to respond to a question from Deputy O'Keeffe as to how I do my constituency business. That is my political business which I do in my home or at my clinic. I assure the Deputy that the midlands are very well looked after as I am sure is the Deputy's constituency.
We do not have a Minister in Cork.
As to the Deputy's question as to how I deal with my constituents and I have vast experience of dealing with my constituents and the level of service I give them and the one-to-one approach I adopt with them is well known.
The Minister was facetious in her response. I was trying to bring home to her the impact it has on me when my constituents question these delays which appear to be entirely unnecessary. I should like to put one policy proposal to the Minister. In relation to delays of this kind for hip operations, is there not a case for an emergency approach which would involve hijacking — I deliberately use the word hijacking — the national lottery surplus for a limited period to clear these waiting lists? Such a move would have the support of all sides of the House if the Minister agreed, and, indeed, it would have support throughout the country.
It is always interesting to hear policy points put forward. I suppose the Deputy ment the word "hijacking" to be dramatic and it would have that effect.
I say it in the best sense.
One of my first items of interest when I moved to the Department of Health was that of waiting lists. Yesterday I met with Mr. David Kennedy, the head of the initiative group, as they were about to have their renewal meeting and set themselves up again for the implementation of the good practice recommendations which have been set out in the initiative report. We had a very thorough discussion on that and the good practice recommendations have been sent or are about to be sent to other hospitals. It is a matter in which I will continue to exercise a very keen interest.
Will the Minister agree to the proposal in the report of the Commission on health funding that a maximum waiting time be spelled out for surgery such as hip replacement so that all patients can be assured that they will not in any circumstances have to wait beyond a certain date?
That recommendation, and many others contained in the report of the Hederman Commission on Funding has been taken up by the other groupings involved in the reviews. The question of a specified time on the waiting list, and patients' entitlements were taken up by my predecessor, Dr. O'Hanlon, and were enunciated by him in the patients' charter.
No; he rejected the proposal.
Matters such as that are being considered in the Department. Since I went to the Department I have taken a particular interest in that issue. I am sure that in the months ahead, with the co-operation of the good Deputies on all sides of the House, and in consultation with interested parties, we will be able to tackle the issue of waiting lists. There has been much talk over the last number of years but nobody has commented upon the increase from around 1,700 to over 2,000 in the greater throughput in those years. I gave the figures in my reply to Deputy O'Keeffe.
Is the Minister aware that the Mid-Western Health Board have the longest waiting list in the country for hip operations, in excess of two years. Can the Minister reconcile the appointment exactly a year ago of a fourth orthopaedic surgeon backed up by an anaesthetist with the failure to provide the nursing staff to support them? Would the Minister agree that in order to do something about waiting lists in the Mid-Western Health Board region to expedite operations it will be necessary to provide support nursing staff to specialist skills who are extremely difficult to get in the first place? Will the Minister examine this and try to resolve it?
The Deputy is hijacking the questions because he has three more questions related to the Mid-Western Health Board on the Order Paper which I studied carefully this morning.
The Deputy's question is related to specifies and the question put by Deputy O'Keeffe is a general one. I have prepared lovely answers for the Deputy.
I want statistical information.
Will the Minister admit that there is a much shorter waiting list for private patients as opposed to public patients and that this is a scandal, bearing in mind the three year wait for some patients? Will the Minister consider prioritising low cost operations like hip replacements rather than glamourous ones like heart transplants.
I would not like to differentiate in that way or talk about health matters in the way the Deputy has done. Those who need an operation of whatever kind must be considered. I would not differentiate in the way Deputy Garland did. I said that I am taking an interest in the matter of waiting lists and that considerable progress has been made. Of course, it can be bettered and more can be done.
