Dáil Éireann debate -
Tuesday, 11 Apr 2000

Vol. 517 No. 6

Adjournment Debate. - Hospital Waiting Lists.

Mr. Flanagan:

I am pleased to have the opportunity to raise this matter. This is not something that has happened since the elevation of the former Minister for Health and Children, Deputy Cowen, to the position of Minister for Foreign Affairs, but it is something of which he is aware as a constituency colleague as well as a Cabinet Minister.

It is extraordinary that over the past few years, in spite of increased spending on the health services of the order of 45%, there is little in terms of a service to the community by return. The situation in Tullamore General Hospital, which is the orthopaedic unit serving the midland counties of Longford, Westmeath, Offaly and Laois, is such as to give rise to serious concern. The increase in the hospital waiting list is to the order of 52% since the Government took office.

In mid-1997 there were 1,378 persons on the waiting list and in April 2000 that number has risen to 2,127. The bulk of these are persons waiting for orthopaedic and ear, nose and throat surgery, many of whom are children, many of whom are suffering and many of whom are in pain. Clearly, the current Government strategy, if there is one, is failing abysmally as far as the Midland Health Board is concerned. I charge the Minister for Health and Children, Deputy Martin, with responsibility in that regard.

Of the 2,127 people awaiting treatment in Tullamore hospital, 815 people have been on the waiting list for treatment for a year or more. These 815 people have been waiting for a bed for a period in excess of 12 months. Almost half, or 443, have been waiting over a year for ear, nose and throat procedures. Some 88 people have been on the waiting list for hip or knee operations for over a year in the Midland Health Board area. The sample profile is that of a man, a breadwinner in his early sixties, almost immobile, suffering considerable pain while waiting with his 87 colleagues for over a year for a bed in the hospital.

These figures surely demonstrate the very serious problems within the health services, with particular reference to the Midland Health Board. The response of the Government, as the Minister of State at the Department of Health and Children, Deputy Moffatt, will surely inform us again, is to increase the health spending by the order of 45%. Simply throwing money at the problem will not resolve the issue. There appear to be more serious problems, particularly in the area of orthopaedics.

Many of these people who are waiting are elderly. They are sick, sore and suffering. It flies in the face of a booming economy that we have 815 people awaiting treatment for over a year. If any of these people had a cheque book or a healthy bank balance they would not be waiting for a year or for a month but would have their treatment straight away. Such is the inequity within our health services that persons who cannot pay top dollar or top buck will not have the opportunity to have their procedure, be it surgical or otherwise, dealt with to relieve them of the pain and suffering.

The situation in Tullamore hospital is the fifth worst in the land. The waiting list, outside the Dublin area and excluding University College Hospital, Cork, is the longest in the country.

I appreciate the dedication of the staff at Tullamore General Hospital. Recent criticism levelled at those who engage in quoting figures for waiting lists seems to suggest that there is some correlation between persons waiting in a queue and a less than efficient attitude on the part of the staff. The staff are in no way to blame for the waiting lists in this instance.

Let me refer to remarks attributed to the chief executive officer of the Midland Health Board who stated that the quoting of figures such as I have cited is not only less than helpful but, as he says, 'political nonsense'. I take severe exception to these comments. The role and function of the chief executive officer of the health board is not to act in any way as a ministerial side-kick in this issue. He should get on with the job of ensuring there is an efficient service and deal with the thousands of applications from persons waiting for treatment at Tullamore General Hospital. I look forward to the Minister's response.

Minister of State at the Department of Health and Children (Dr. Moffatt):

I thank Deputy Flanagan for raising this issue on the Adjournment. I fully appreciate his concerns regarding waiting lists for treatment at Tullamore General Hospital and this is reflected in the priority that the Minister is attaching to addressing comprehensively the issue of lengthy waiting lists and times for in-patient treatment.

The overall objective the Government has set itself is to ensure that all public patients are treated within the target waiting times of 12 months for adults and six months for children. The Minister is committed to endeavouring to achieve that objective. To do so, the problem must be addressed on a number of fronts to take account of both the need for immediate action to enable more waiting list work to be performed and the more strategic approach required to tackle the underlying factors that give rise to lengthy waiting lists and waiting times in the first place.

In terms of the latter, the Deputy will be aware that former Minister for Health and Children, Deputy Cowen, established an expert group to review the waiting list initiative which reported to him in 1998. In considering the multi-faceted nature of the issue of waiting lists this group took full account of the international experience, carefully examining the dynamics at work in the health system and how it can be better organised and managed to achieve easier access to services for public patients.

The result of the analysis was a comprehensive series of wide-ranging recommendations of short, medium and long-term nature aimed at addressing the underlying causes of the problem. My Department has been reviewing progress to date with the individual chief executive officers concerned in the implementation of the review group's recommendation. This is encouraging evidence of good progress in putting in place many of the organisational arrangements recommended, including IT systems, liaison arrangements with general practitioners, management and validation of lists, management of out-patient facilities and the appointment of dedicated waiting list co-ordinators, bed utilisation committees and bed managers.

It is possible to identify a certain correlation between the level of progress achieved by agencies in implementing the review group's recommendations and their performance on reducing waiting lists. This provides encouraging evidence that progress is possible and enables us to identify the particular areas where more attention needs to be focused.

It has to be appreciated also that some of the measures recommended in the review group's report have not achieved an immediate impact on waiting lists due to their being aimed at addressing underlying factors and will, therefore, by nature, take time to bear fruit. In addition, many of the infrastructural capacity issues, particularly in relation to the availability of long-term and step-down facilities, can take more time to address comprehensively. The availability of £1 billion for the non-acute sector under the national development plan will enable significant progress to be made in this area. In terms of overall capacity in the acute sector the capacity review committed to in the Programme for Prosperity and Fairness is now being progressed.

In the specific case of Tullamore General Hospital, the Deputy is aware of the concrete steps being taken to address the clear capacity issue there in the form of a major £70 million hospital development that is currently in planning.

This planned development is a clear acknowledgement by the Government of infrastructural deficits at the hospital that have been present for some time. More importantly, it is testament to this Government's commitment to address these deficits and I am confident it will have a major impact in the medium and longer term on access to hospital services in the region.

In the shorter term, this Government has committed major funding under the waiting list initiative. This year £23 million of dedicated funding has been allocated, which includes £1.372 million to the Midland Health Board for additional waiting list procedures and improved management processes. To maximise the impact of the available funding, there are a number of practical short-term steps the Minister has proposed in his discussions with the chief executives and that have been followed up in the Department's ongoing contacts with them. These include achieving more flexible use of available capacity and closer collaborative arrangements between the different parts of the system. For example, we need to examine arrangements such as doing concentrated, protected, waiting list work during traditional summer closure periods, or cross-contracting activity from agencies where spare capacity exists. My Department has just completed a round of discussions with the health board chief executives aimed at moving forward on this basis and proposals are now awaited from each, including the Midland Health Board.

Taken together with the longer term measures associated with the investment of resources available under the national development plan, it is possible to make significant inroads to tackle unsatisfactory access to certain services. The Minister intends to address these issues through the practical short and longer term measures I have outlined and I am confident, on this basis, of reducing waiting lists and times for access to services at Tullamore General Hospital and throughout the acute system.