Vol. 441 No. 3
2 Mr. Durkan asked the Minister for Health whether he has satisfied himself that heart/hip/cataract patients in this country can gain ready access to surgery when so required; if such access is equally available to both public and private patients; if waiting lists in respect of either category are within tolerances anticipated in the Programme for a Partnership Government, 1993-1997; and if he will make a statement on the matter.
23 Ms F. Fitzgerald asked the Minister for Health whether he has satisfied himself that adequate medical, surgical or special bed complements are sufficient to meet current needs throughout the country, with particular reference to specialist areas; and if he will make a statement on the matter.
138 Mr. Durkan asked the Minister for Health whether he has satisfied himself that facilities for such surgery as eye, hip, heart or kidney operations are sufficient to ensure that no patient in this country has to wait unnecessarily to the detriment of his or her health; and if he will make a statement on the matter.
180 Mr. Durkan asked the Minister for Health whether sufficient public surgical facilities, such as beds, theatres and other such facilities exist to meet requirements by way of shorter waiting lists; and if he will make a statement on the matter.
I propose to take Questions Nos. 2, 23, 138 and 180 together.
I am satisfied that there are sufficient beds to meet the acute hospital needs of the population and the hospital facilities generally are sufficient to maintain the high level of throughput at present achieved within our hospital service. Access to surgery is based on clinical need and urgent cases are always given priority.
All persons are entitled to opt for public hospital treatment as a public or as a private patient. The objective of Government policy is to ensure equitable access to necessary care. This objective is being pursued through the operation of appropriate admission arrangements at hospital level and through the waiting list initiative which was an important feature of the Programme for a Partnership Government.
Waiting lists are of concern in the context of equity and access to care. The principle of equitable access to hospital care led to the agreement, in the Programme for Economic and Social Progress, that specific beds should be designated for public and private patients so as to achieve total transparency. This system has now been put in place and, while not restricting admission of patients needing emergency treatment, it ensures that private patients requiring private elective procedures are only admitted to private beds. The operation of this system will continue to be closely monitored.
As a direct result of the Government's waiting list initiative last year the numbers waiting in the acute public hospital sector at June 1993 were reduced from 40,130 to 25,373 at December 1993, a reduction of 37 per cent. Furthermore, there was particular success in reducing the numbers of adults and children waiting for periods in excess of 12 months and six months in the problem specialties. These numbers were reduced from 14,624 at the launch of the initiative to 6,240 by December 1993, an overall reduction of 57 per cent.
Among the specialty areas covered by the initiative were those which include cardiac procedures, hip replacements and cataract procedures. The target of 17,254 additional procedures announced at the launch of the initiative was exceeded and the overall number of additional procedures performed in 1993 was 18,768.
The allocation of £20 million last year enabled agencies throughout the country to invest in the facilities, equipment and/or personnel required to help them to reduce waiting list numbers in the most cost effective manner. The funds for the waiting list initiative in 1993 were in addition to the extra resources allocated in 1993 for a range of other service developments throughout the hospital services.
The Government is anxious to build on the success of the 1993 initiative and a further £10 million has been provided this year.
The principal objective will continue to be the elimination of waiting times in excess of 12 months for adults in the problem specialties. A detailed review on the experiences gained during 1993 has been undertaken and my Department is discussing with the health agencies the arrangements to be put in place during 1994 to further reduce waiting times.
Has the Minister identified the main problems which impede ready access to surgery in the areas I mentioned? To what extent have problems in these areas been tackled in the past 12 months?
From the outset we identified the areas which had long waiting times as distinct from large numbers on the waiting list. The key issue is the length of time one is waiting rather than the number of people waiting. We identified the geographical areas with long waiting lists and provided resources on a contract basis hospital by hospital to deal with them in the areas of orthopaedics, hip replacements, ophthalmology, cataracts, ear nose and throat, and cardiac, vascular and plastic surgery.
What facilities were lacking to cause the problem and to what extent has the problem been resolved? I note that extra facilities were provided and also the exodus of patients from Cork in one specialty.
There is a specific question tabled about Cork and I will certainly be very happy to discuss the matter when we reach that question. The Southern Health Board took a very good initiative to solve the problem it had. My objective in the Department of Health and the objective of each health board is to provide a service to the patients who need it as expeditiously and as cost effectively as possible, and whatever mechanisms are employed to achieve that will be in the patients' interests. Obviously there will be long term positive results from the waiting list initiative in terms of the capital investments that were part of that initiative which will continue to have an effect into the future.
