Dáil Éireann debate -
Thursday, 27 Sep 2012

Vol. 776 No. 2

Priority Questions

Primary Care Centres Provision

Billy Kelleher

Question:

1. Deputy Billy Kelleher asked the Minister for Health the reason that two primary care centres in Swords and Balbriggan, County Dublin were added to the list of 35 primary care centres published by the Health Service Executive in July; the person who made the decision to add these two centres; the criteria for adding them and if different criteria was used compared to the criteria used for the original 20 on the list; and if he will make a statement on the matter. [41082/12]

Minister for Health (Deputy James Reilly)

Early in 2012 the HSE embarked on a prioritisation exercise for primary care, PC, centres across the country. It is the intention of the Government to develop as many centres as possible by one of three separate methods: direct investment; by way of leasing arrangements; or by way of public private partnership. The locations were then considered for development by way of PPP as part of the Government's stimulus package. Selecting the primary care centres under PPP was not - as is generally believed - done on the basis of one criterion, the deprivation index. Three criteria were deployed: the deprivation index for the catchment population of the centre; the service priority identified by each integrated service area-local health office; and an accommodation assessment which assessed accommodation available for the primary care team within the catchment area, the quality of the accommodation, and whether it was spread over more than one building.

The HSE in this new process identified 338 locations for PC centres. From this, 20 were selected on the basis of accommodation availability in the locale, service priorities, and deprivation. A total of 37 locations within the list of 338 had a similar ranking. I accepted the first list of 20 prospective centres presented by the then Minister of State, Deputy Shortall. However, I decided - in consultation with my Department officials and ministerial colleagues - to go beyond the initial mathematical model on the basis that the number was too small and that we needed at least 35 centres. Advice from the HSE and the Department of Health based on experience of PPPs is that if only 20 were pursued considerable slippage could arise and the health system could lose a badly needed investment. I also took into account that the track record of the HSE in delivering PCs on time is poor. In addition, the available €115 million stimulus fund could only be accessed by means of PPP.

As I wrote to the then Minister of State, Deputy Shortall, on 25 July, "A very strong consensus emerged at Government level that identifying 35 locations would stimulate and encourage wider interest and participation...". In other words, if we were to identify only 20, and stick with 20, GPs would then be able to sit back, await their completion and then enter on their terms only. If one looks at what happened in an urban area where a primary care centre was built, the process began four years ago with pre-contract discussions with local GPs, the building was completed in 2012, but it took several months to get the GPs to move in. A similar situation arose in a rural area. Therefore, the list was widened. In addition, new criteria were added. It was evident, for example, that consideration needed to be given to existing health facilities; GP to population ratio; pressures on services, particularly acute services; funding options, including Exchequer-funded, HSE build or lease; and the implementability of a PPP in terms of size, site and scale.

The criterion of existing health facilities was added because if they were not considered one could possibly have a health centre built in the shadow of an acute hospital, while a nearby area of great need would be left without a primary care centre, which would make little sense.

Under these wider criteria, 15 additions were made to the list, some of which had been identified as high priority by the HSE as far back as 2007, under a Fianna Fáil Government. However, because of the weighting I mentioned - namely, the multiplication of the deprivation index by three - two of the areas that had been identified in 2007, Balbriggan and Swords, lost out and were swept from high priority to low priority. Under the original priority system both would have been in the top 35 but under the new system, with an altered weighting system, they ended down the list. The realities had not changed but the weighting made it look as if they had.

Balbriggan is an area of high unemployment, with no existing primary care centre, whose current health centre is in a very poor state. It will proceed under a lease arrangement. Swords has a population of 48,000, no primary care centre and no direct public transport link to its nearest hospital, Beaumont Hospital. There can be no doubt that these two areas are high priority for primary care centres. It is my intention to further primary care developments as resources become available.

Deputy Billy Kelleher

I thank the Minister for his reply. Two weeks ago, the then Minister of State, Deputy Shortall, made a statement in the Dáil. There were two items of interest in that statement, one being the omission of any support for the Minister in the motion of confidence he faced. She did not mention the Minister for Health by name or by office in any part of her contribution. The other key issue of interest was the former Minister of State's statement that the public had a right to expect decisions on health to have a structure and that staffing decisions would be made in the public interest and based on health need and would not be driven by other concerns.

There are clearly other concerns at stake here. Originally, 20 primary care centres were selected according to the deprivation index. The Minister subsequently stated that others should be added to ensure that GPs could not hold the process to ransom. I can understand that. The most obvious scenario, however, would have been to take the next 15 choices on the list, if the Minister were to proceed with the 20 high-priority projects that had been selected according to the deprivation index. However, halfway through he changed the criteria to allow others be included.

Public private partnerships confer commercial advantage. The State enters into a contract with individuals or an entity and this confers a commercial advantage on them.

An Leas-Cheann Comhairle

Please frame a question.

Deputy Billy Kelleher

Would the Minister not agree that to do that there must be a transparent and open process that should be free from any form of interference, even alleged interference? I wondered at the time why a Minister of State would come into the Chamber, stand up and state that she had concerns and that the public had a right to ensure the process was carried out in an open and transparent manner, without any other concerns.

An Leas-Cheann Comhairle

Thank you.

Deputy Billy Kelleher

Ultimately, four centres were identified, two of which were in the Minister's constituency, one in Kilkenny and one in Ballaghaderreen. What type of criteria were used? Did the Minister run this by his Cabinet colleagues? Some of those colleagues stated clearly that he had not. The Minister for Transport, Tourism and Sport, Deputy Varadkar, said recently on television that this could be constructed to look like stroke politics. He was unaware of any consultation. Was an aide-memoire or memo sent to Government? How did the Minister consult with his colleagues? Was this done one night somewhere in the corridors? This needs to be clarified once and for all.

Deputy James Reilly

I agree absolutely that primary care centres should be chosen on the basis of need. The widening of the criteria helped to meet those needs in a much more complete manner. That manner and those criteria are transparent and I have outlined them to the Deputy today. I also indicated that as long ago as 2007, when his Government was in power - which is purely coincidental - the HSE identified the two towns of Balbriggan and Swords as being high-priority and in need of centres. That was more than five years ago. Since then the population of both towns has increased, employment has increased and the needs of the people could not be described as having diminished. They are greater than they were.

I reiterate that I stand over both the manner in which this was done and the criteria I used, and I will be happy to explain whatever aspect of this matter the Deputy fails to understand.

Deputy Billy Kelleher

I am not the only one who fails to understand this; the former Minister of State with special responsibility for primary care and some of the Minister's Cabinet colleagues also failed to understand it. It is not that Billy Kelleher is the only person in this House who cannot understand the criteria the Minister decided to use to select certain sites for primary care centres that were outside the matrix that was used previously - that is, the deprivation index. If the deprivation index is used to select 20 high-priority centres and then, all of a sudden, the entire set of criteria changes to include factors such as population and locations of other health centres, the process is undermined from start to finish. If the first 20 centres are chosen based on one index and the others are based on the Minister's own index, clearly the Minister has not prioritised the key factors as outlined in the original index.

It is not that I am trying to find anything untoward, but it is quite evident that there was not a transparent and open process in the awarding of commercial advantage to individuals by the State. That is of major concern to many people, including the former Minister of State, Deputy Róisín Shortall, who resigned because of it. Does the Minister agree that this issue does not sit well with many people, other than me, on this side of the House?

Deputy James Reilly

I have no wish to enter into argy-bargy with the Deputy opposite and I know that is not the tenor of his comments. However, I must point out that in my initial answer I stated that the deprivation index was but one of three criteria used in this process. There were also the service priority as identified by each integrated service area or local health office, and an accommodation assessment. These are three criteria that were used. What happened then was that the deprivation index was given a weighting, or multiplication, of three, which resulted in a considerable change in the prioritisation.

I put it to the Deputy that by broadening the criteria to take into account the issues I have mentioned to him - namely, the availability of or lack of health facilities in the area, accessibility to those facilities by way of public transport and the population-to-GP ratio - one gets a much wider and, in my view, fairer balance. If we were to use only the deprivation index it would have a very strange effect. In fairness to the then Minister of State, now Deputy Shortall, she did not do this but used two other criteria. I used additional criteria which I believe are also fair. In the Minister of State's resignation statement this issue is not mentioned per se.

I wish to put on record, if I may, my gratitude to the Minister of State, Deputy Shortall, for the hard work she did and the commitment she had to primary care, a commitment I share. I welcome the nomination of Deputy Alex White to the Department of Health. I know he will continue the work done by the former Minister of State - particularly, I hope, the great work she did in regard to alcohol, that scourge of a problem we have in this country. I hope her work in this area will be carried on by the new Minister of State, Deputy White. I have no doubt he will be as committed to the full range of issues as Deputy Shortall was.

Cancer Screening Programmes

Caoimhghín Ó Caoláin

Question:

2. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the progress he has made towards the planned roll-out of a bowel cancer screening programme before the end of 2012; if he will ensure that it is targeted at the 55 to 74 years age group; if he will confirm full-funding for this prevention programme that will not only save the State significant costs in treatment of advanced bowel cancer but will save an untold number of lives; and if he will make a statement on the matter. [41081/12]

Deputy James Reilly

I am very pleased to confirm that the colorectal screening programme will commence, as promised, on a phased basis in the fourth quarter of this year. This delivers on a key commitment of the Government.

Colorectal cancer is the second most commonly diagnosed cancer among both men and women in Ireland. Approximately 2,200 new cases are diagnosed each year and it is the cause of death in around 950 people each year. Colorectal screening works on two fronts: it provides early detection and therefore earlier and more effective treatment and it helps to prevent cancer in the first place by detecting pre-cancerous growths such as polyps. It is therefore imperative that the programme commences and continues on a sustainable basis.

When fully implemented the programme will offer free screening to men and women aged 55 to 74. The programme will begin with the 60 to 69 age group, covering approximately 500,000 people.

The screening programme is the first call-recall screening programme in Ireland to be offered to men as well as women. Organising a national programme of this kind is very complex. To ensure quality and safety it is imperative that the programme is introduced in a carefully managed and monitored way to minimise risks to patients and maximise best clinical outcomes. We will gradually build up the programme to ensure that it is sustainable over time.

A small proportion of those screened will require a colonoscopy, which is the next stage of the screening process. The HSE and my Department have been working together to develop the appropriate capacity in colonoscopy services nationwide for this purpose. At the same time we are working to maintain and enhance the capability of the symptomatic endoscopy service. The focus is on improving quality and access at all publicly-funded screening colonoscopy units, not just for those referred for colonoscopy as part of the screening programme, but for all men and women who require a colonoscopy or any other diagnostic endoscopic procedure. This will be achieved by building sufficient capacity in endoscopy services nationwide to sustain the implementation of the national screening programme, while maintaining and enhancing the symptomatic service.

I regard the colorectal screening programme as a national priority. I am pleased that it will now go ahead and I am committed to supporting it as it develops.

Deputy Caoimhghín Ó Caoláin

My question is focused first and foremost on how lives can be saved and, without doubt, that can and will happen with screening programmes and early diagnosis. It is not a small point to add that it will also save our health services enormously in terms of the cost of treatment for advanced bowel cancer. The quicker that this is rolled out the greater number of people that it can directly apply to will result in a very beneficial outcome, not only for the small number of people who will require treatment but in regard to the health budget.

I welcome the bowel cancer screening programme to be implemented by the National Cancer Screening Service and due to begin by the end of the year, and the Minister's confirmation of that. However, there is a problem. The Minister referred to a phased basis in his reply and indicated that the programme will be confined initially to the 60 to 69 age group. I am expertly advised. The Irish Cancer Society has strongly emphasised the need to widen the remit to the 55 to 74 age group to be most effective. The Minister has indicated that he intends to extend it in due course to cover that age cohort but will he undertake to widen the age group from the outset? All the information that has been shared with Members here indicates that is hugely important but not only in regard to the widening of the remit. We also need a commitment from the Minister on full funding for this programme as anything less will prove to be a false economy.

Deputy James Reilly

I agree with the Deputy that this programme will save many lives and it will save money, but it will not save money now. It will save money in the years to come. It has always been the struggle with preventative medicine and with screening that the savings come later but the saving of lives is immediate and that is something on which we have to put the priority. However, most people would agree that this being the first of its kind we need to walk before we run and we need to road test it to make sure it is working and is safe. That is sensible, but I undertake that it will be extended in due course.

Deputy Caoimhghín Ó Caoláin

Can the Minister be more specific? He referred to a phased basis and "in due course". The Irish Cancer Society is adamant. It did a briefing here last week of members of all parties and none and the clear message received by Deputies was the importance of the rollout covering the 55 to 74 age group, the body of people to whom this most especially applies, and not waiting for somebody to reach 60 years of age when polyps may be showing already since their mid-50s. The earlier detection will ensure the best outcomes and the greater saving in the long term. I implore the Minister again either to outline his programmatised approach to this as early as possible or accept the arguments put and widen the age group from the outset. If we do not ensure that there is full funding for the programme we are only storing up for the future the problems we are trying to avoid that will have real human costs in terms of life and real costs in terms of our health services.

Deputy James Reilly

The Deputy mentioned the Irish Cancer Society which does fantastic work in terms of fund-raising to create awareness among people of the dangers of lifestyle, the risks people take if they smoke and in encouraging men in particular who had a notoriously poor attitude to self-care in the past. I have often said that they are inclined to wait until they have a serious pain in their chest, as in going blue in the face, before they seek medical attention. That has been effective but we have to do more, although men, and women, are becoming more aware of their health and their health risks.

I would love to be in a position to say precisely when I can extend this programme but I am not in a position to do that at the moment. However, I want to reassure people that this is a screening service but as in the case of a woman who finds a breast lump, that is symptomatic and they should get it checked out. If someone develops symptoms suggestive of a change in bowel habit, bleeding or passing mucus, and I do not want to go into too much detail here, they should see their doctor. Anybody who has symptoms such as weight loss or abdominal pain should get that checked out, and the screening will be there for them. It is a different thing; it is symptomatic. I want to reassure people that within our service we have made sure, in terms of the prioritisation of people, that those with serious symptoms get seen quickly. Other questions have been tabled on this and the outpatient waiting lists etc. which I will answer when we reach them but the reality is that we need people to be aware of signs and symptoms that should be a cause of concern for them and about which they should see their doctor. I can assure them that with the new plans for protocols for referring, and electronic referrals, they can be assured that they will be seen quickly when their symptoms indicate that is necessary.

Services for People with Disabilities

Joan Collins

Question:

3. Deputy Joan Collins asked the Minister for Health the reason the Health Service Executive is still using the medical model of disability assessments; the reason occupational therapists are in total control of budgets and decisions for wheelchair repairs and replacements; the reason the HSE has not moved to a consultative model with the patient when it comes to these matters; and if he will make a statement on the matter. [41146/12]

Deputy James Reilly

Assessments of people with disabilities are conducted for many reasons. The type of assessment conducted reflects the purpose for which the assessment is being completed. Assessments for mobility aids are generally carried out by an occupational therapist or a physiotherapist. Items which are essential to ensure safety, dignity and independence are prioritised on the basis of the assessment and funded from the disability services budget. However, while assessments, including those relating to mobility aids, are not based on medical diagnosis, the Deputy may be referring to the fact that services for people with disabilities have traditionally been delivered according to the medical model of disability and the fact that decisions on the allocation of resources have rested with administrators and health professionals, rather than with service users.

The value for money and policy review of disability services which was published in July by my colleague, the Minister of State, Deputy Kathleen Lynch, notes that the objectives of the disability services programme have been pursued through an approach based on a medical model of disability which is heavily professionalised, resource intensive and delivered in segregated group-based settings. The review concluded that this model of service was not compatible with the achievement of best outcomes and the exercise of choice and control by the individual. It recommends a significant restructuring of the disability services programme through migration towards a model of person-centred, individually chosen supports and implementation of a more effective method of assessing need, allocating resources and monitoring resource usage. The Department of Health and the Health Service Executive are developing an implementation framework for the recommendations contained in the value for money report, including the move towards a person-centred model of service which will reflect the social rather than the medical model of disability in all facets of disability service provision.

Deputy Joan Collins

I thank the Minister. He used the words "safety" and "dignity" and referred to medical models which were not compatible. Mr. Dermot Walsh who is present in the Visitors Gallery was involved with the Disability Federation of Ireland's and the HSE's listening and changing, person-centred consultation. It is obviously this to which the Minister is referring. However, this system is failing very badly. Mr. Walsh is a wheelchair user. He uses a Storm wheelchair which is due to be changed as it is seven years old. In the meantime, he is obliged to get it fixed on each occasion on which it breaks down. It is specially adapted to meet the needs of Mr. Walsh who goes to work every day. In July one of the wheels fell off and he was informed that new wheel bearings would be required. He went to his usual engineer to have it fixed but was informed that he would first be obliged to go to an occupational therapist. As a result, he went to see the occupational therapist in Crumlin in an environment with which he was not familiar. He was asked to remove himself from the chair which was then assessed by an occupational therapist who had been only newly appointed and an engineer who was not aware of his needs. The report which was compiled as a result of this exercise stated the wheel bearings would have to be fixed and that the foot plates and arm rests would have to be changed, which Mr. Walsh did not want. He was not involved in the consultation in any way and it is outrageous that he was placed in the situation to which I refer. In the interim, he has been informed by the occupational therapist that he will be obliged to go to Thomas Street in order to have his chair modified. Is this the type of situation in which we want people to find themselves? This man has not been able to go to work because he is afraid to use the chair without the wheel being repaired. He did not want the chair to be changed or modified in a way which did not suit him. His chair was taken from him on Monday last and he has not yet got it back. This all resulted from the fact that he was not consulted about his needs. His life has been in chaos since July.

Deputy James Reilly

I am very disturbed by what the Deputy has just told me. We want to support people in maintaining their independence. It is unacceptable, therefore, that a person would not be consulted and that advice would be given over his head on his needs and preferences. I give the Deputy an undertaking that I will have the matter investigated. If a policy directive is required in respect of it, it will be forthcoming. I take the opportunity to apologise to Mr. Walsh for the inconvenience the service has caused him. We will rectify the situation.

Deputy Joan Collins

I thank the Minister. Perhaps, immediately after Question Time, he might discuss with Mr. Walsh a way in which the matter might be resolved.

Deputy James Reilly

Is Mr. Walsh here?

Deputy Joan Collins

Yes, he is in the Visitors Gallery.

Deputy James Reilly

Okay, I will do that.

Hospital Waiting Lists

Billy Kelleher

Question:

4. Deputy Billy Kelleher asked the Minister for Health the date on which he received the July performance report from the Health Service Executive; his views on the fact that the number of patients waiting to be seen at an outpatient clinic for the first time has almost doubled to 340,000 compared with figures released in April; if he will provide information on the true extent of the outpatient figures with some hospital deficits having doubled since April; and if he will make a statement on the matter. [41083/12]

Deputy James Reilly

The draft HSE July performance report was received in my Department on 7 September. The figure reported therein of 339,441 patients waiting for an outpatient appointment is not new. The HSE's May performance report indicated that 342,665 patients were waiting for outpatient appointments, while the June report showed that 361,000 were waiting for appointments. Representatives from the SDU held a media briefing for health correspondents on 21 June, at which they outlined the new approach to the collection of outpatient waiting time data. They also indicated that, when up and running, the new system would be likely to show approximately 350,000 patients waiting for appointments. This is broadly in line with the figures being reported by the HSE.

While the figures are unacceptably high, it is important to emphasise that the reported increase since April is not due to a sudden large increase in the numbers waiting but rather to more accurate data which present a more comprehensive picture of the problem. The problem of outpatient waiting lists is not new. What has changed is the level of information we are collecting and putting into the public domain on these lists. Under the previous Government, the scale of outpatient waiting lists was not measured. I am quite prepared to state we do not have a definitive figure in this regard. The final figure may be in and around the 360,000 mark.

This is the first time the position has been measured and from now on it is going to be monitored on a weekly basis. As is the case with the inpatient waiting list, those who have been waiting longest will be seen first. It is utterly disgraceful and unacceptable that some 16,000 people have been waiting more than four years for appointments. I have given an undertaking - this is not detailed in my written reply - to the effect that by the end of next year, no one will be obliged to wait more than one year for an outpatient appointment. I will do everything in my power to make this happen.

Together with the National Treatment Purchase Fund, the special delivery unit in my Department will shortly begin the systematic collection of waiting time data at an individual patient level in a standardised format from all hospitals providing a consultant-led hospital outpatient service. Also, it will shortly assume responsibility for the reporting of outpatient waiting time data from the HSE

Deputy Billy Kelleher

I thank the Minister for his reply. The figure to which he referred is alarming. He has stated the data are being collated in order to ensure efficiencies can be achieved and that pinch areas relating to waiting lists for outpatient appointments can be identified. It is disturbing that 360,000 people are waiting for outpatient appointments. I am not trying to pin the blame on the Minister for this. I welcome the fact that the relevant data are being collated and that resources will be allocated to address the issue. However, some 16,000 people have been waiting four years or more for outpatient appointments. It is clear, therefore, that there is a problem. It has been stated the numbers on the inpatient list are decreasing, which may be a result of the activities of the special delivery unit and further efficiencies in the system. If there is not, however, a throughput from the outpatient to the inpatient list, the numbers waiting will decrease. I am concerned that the numbers on the inpatient list are falling by virtue of the fact that outpatient assessments are being delayed. We want to reach a stage where we will know the exact numbers awaiting outpatient appointments. We also want the necessary resources to be allocated to ensure the numbers on the outpatient list will be brought down as soon as possible.

Does the Minister agree that the overriding problem facing the health service is the massive budget deficit and the huge overruns occurring in hospitals?

This was identified in the July performance report and in other reports and was highlighted on numerous occasions. Will the Minister agree that because of a lack of progress in addressing the budget deficit issues arising from as early as March 2012 there could be significant cutbacks in services in the last quarter to address the budget overruns in hospitals?

Deputy James Reilly

We had a good debate in the other House yesterday and this area was touched on. I will rehearse some of the issues which were mentioned with regard to outpatient statistics. A total of 360,000 may seem an extraordinary figure and a daunting prospect but it should be put in context. Approximately 200,000 patients are treated in outpatient departments every month. Some of the issues are disturbing and unacceptable. There needs to be a change in practices and I have already spoken to the acting chief executive officer of the HSE. I refer to the practice of calling 35 people to attend at the same appointment time. This is to suit the system rather than to suit the client - the patient. In my view, this shows tremendous disdain and disrespect for citizens that their time is of no consequence. I wonder if we were to compute the cost in time lost from work for people, the figures could be quite staggering. I want appointments to be arranged in a more structured way that is respectful of people. Equally, this is a two-way street. I see no reason all hospitals cannot institute a system which is used in some hospitals, a system for texting the people on the list a couple of days before the appointment date to ascertain if they will be attending. If a person does not attend, having confirmed the appointment, I am prepared to discuss the prospect - even in the House - of a €20 charge for the next appointment.

The situation can be improved by ensuring that the right person is seen by the right professional. A survey carried out in England was also done in Cork - in Deputy Kelleher's constituency. The physiotherapists screened the orthopaedic referrals from general practitioners and they found that in nearly 50% of cases the physiotherapist was able to deal with the complaint. In fairness to GPs, that could mean a couple of things. It is also the case with regard to psychiatry. The GPs cannot access the service of a physiotherapist for their public patients and the only way to access the service is by sending the patient to the orthopaedic clinic, which seems a very fruitless waste of everyone's time, including the patient's time. Similarly, a depressed person may require counselling but this is not available for a GP's public patients so they are referred to the psychiatric clinic. This is very inconvenient for patients and very costly for the system.

There are many actions we intend to take to address this problem. While I am deeply unhappy with the level, for the first time now - as I said in the Seanad yesterday - we are now driving with headlights and we can see where we are going. We can see the size of the problem and we can start to address it. I will undertake to the House and to my colleague opposite that we will keep everyone informed as to progress. We will not be afraid to talk about this. We will make a target and I will expect to meet it. I will expect Deputy Kelleher to castigate me if I do not meet it but it is better to have a target which is open and transparent so that everyone can aspire to it as opposed to not knowing what is the problem and therefore not know how to deal with it.

An Leas-Cheann Comhairle

A brief supplementary, Deputy Kelleher.

Deputy Billy Kelleher

The Minister will agree that I do not castigate but I hold him to account. I welcome his reply. He referred to physiotherapy services being used in the assessment of patients in Cork and this scheme has worked quite effectively. I welcome the Minister's commitment in this area and I hope to see some movement in this regard. The key issue is whether services can be maintained in the next number of months or whether there will be a build-up of a backlog because of hospitals having to reduce services. The key issue of concern is that the backlog would be very difficult to address in the year ahead. I do not expect the Minister to work miracles and there will be challenges for the budget in the foreseeable future. It was different in the past when money could resolve the issue of backlogs but now it is a case of getting better results from existing resources.

Deputy James Reilly

We have shown that we can work differently. If an analysis shows up the root cause of a problem we can deal with it. I think this has been achieved in the accident and emergency departments. We are not finished yet by any means and similarly with inpatient treatments. The Deputy is correct that we face a serious challenge with this year's budget although our activity levels are ahead of budget forecasts. I wish to reassure the House that activity will need to slow down in the areas where they have exceeded their levels. However, that does not mean that anyone who is acutely ill or who has cancer or needs urgent treatment, will not get it. We have been making progress on the waiting lists. I pointed this out to the House last week and to the Seanad yesterday that we have reduced the inpatient waiting list by 85% of people waiting one year or longer. We have reduced the waiting list of people waiting six months or longer by 63% and we have reduced the waiting list of those waiting for inpatient procedures for three months or longer by 18%. We are making progress and I ask people to bear with us.

Deputy Kelleher referred to the special delivery unit which has had a very beneficial effect. It is in the main due to the clinical programmes but mostly it is down to the excellence of the men and women working in our health service who have delivered this change and I thank them for it.

Hospital Waiting Lists

Seamus Healy

Question:

5. Deputy Seamus Healy asked the Minister for Health the extent of the waiting list, numbers and waiting times for in-patient and out-patient ear nose and throat services at Waterford Regional Hospital; and the measures he will take to address this situation. [41228/12]

Deputy James Reilly

Data on inpatient and day case waiting lists are collected by the National Treatment Purchase Fund. There are currently 136 adults on the in-patient and day case waiting list for ear, nose and throat services at Waterford regional hospital. A total of 73 adults are waiting for an inpatient procedure and 63 adults are waiting for a day case procedure. One patient is waiting longer than nine months but I am pleased to say that the nine month waiting time target set in the HSE service plan will be met. Overall, the numbers now waiting are down more than 28% on the numbers waiting in January this year.

There are currently 88 children waiting. A total of 21 children are waiting for inpatient treatment and 67 for day case treatment, with one child waiting longer than three months. I welcome the fact that the hospital is on course to meet the 20 week waiting time target set in the HSE service plan and that the numbers waiting are down by more than half on the January 2012 position. At that time, 197 children were waiting, of whom 115 had been waiting longer than three months.

These significant improvements in waiting times are evidence that the approach taken by the special delivery unit and the clinical programmes to address access to in-patient and day case procedures is having an effect.

Deputy Seamus Healy

I welcome the response from the Minister but he has only dealt with in-patient services. My question deals with both inpatient and outpatient services. The point of my question is the outpatient services. Nearly every day, parents contact me about the waiting lists for outpatient clinics at the hospital. I am informed by parents that an urgent case may have to wait for 18 months for outpatient ENT services. A number of parents have contacted me about the ear and hearing clinic waiting times. There is a significant waiting list for outpatient clinics. There appears to be a significant delay and I ask the Minister to examine that whole area.

In the case of children, for example, there is a particular urgency attached to diagnosis and treatment of hearing problems. Otherwise, there may well be a significant situation in terms of progress at school or preschool. In the case of tonsillitis, a failure to access treatment in a timely fashion may impinge on school attendance. Will the Minister refer specifically in his response to the statistics on access to outpatient clinics?

Deputy James Reilly

As I indicated in response to a previous question, we have only begun to get a handle on outpatient waiting times. A major difficulty in this regard is that the relevant statistics were never accurately counted in the past. The validation of all outpatient waiting lists commenced in June 2012. In respect of regional ear, nose and throat, ENT, services, GP referrals from the five south-eastern counties are received at Waterford Regional Hospital and patients are seen either at that hospital or at hospital and community clinics across the south east. Prior to the validation process, there were 8,319 patients on the outpatient waiting list, which now stands at 4,570. Of these, 2,337 have been on the list for up to one year, 1,179 for one to two years, 769 for two to three years, and 285 for three to four years. The figures are not broken down to show how many of the patients are children.

Although I covered this issue in an earlier question, I would like to make some comments from my own practice experience over the years. In regard to tonsillectomies, the first point to make is that the thinking around this procedure is changing. Second, my experience as a GP was that where I referred a child with tonsillitis symptoms to a paediatrician for assessment, eight times out of ten that child would not be referred for a tonsillectomy. On the other hand, if I sent the child to the surgical service, the old maxim, "If in doubt, whip it out" seemed to apply. My point is that we need to review this whole area of treatment, a task that is currently being undertaken in a major way in the United Kingdom.

That being said, the figures I have given for outpatient waiting times are clearly unacceptable. Our focus in this regard will be to deal in the first instance with those patients who have been waiting longest, as we did in respect of inpatient procedures. Our target is that by the end of next year, nobody will be waiting longer than one year. If we can ensure that patients are seen by the right people, in the right place and at the right time, many of these referrals might not be necessary.

Deputy Seamus Healy

The figures the Minister has given are completely unacceptable and indicate that what parents have been saying to me and other Deputies is accurate. Does the Minister have in mind any short-time measures which could be activated quickly to ease the backlog? As I said, I have spoken to parents whose children are waiting 18 months for what their GPs have indicated is urgently required treatment. It is entirely unacceptable that 285 people are waiting up to four years to be seen, 769 between two and three years, and 1,179 between one and two years.

Deputy James Reilly

I will not go into detail now, but I can certainly revert to the Deputy on this issue. A plan is being put in place to address this problem and to ensure those waiting longest are seen first. I will get back to the Deputy in regard to the exact plan as it applies to ENT services at Waterford Regional Hospital. That situation will be addressed in much the same way as we are addressing similar situations elsewhere in the country.