Other Questions

Ambulance Service Provision

Timmy Dooley

Question:

6. Deputy Timmy Dooley asked the Minister for Health how budget 2016 will improve the ambulance service, especially in the mid-west; and if he will make a statement on the matter. [36598/15]

On budget day the Minister referred to ambulance service improvements and indicated there would be additional funding, but he did not provide significant detail on that. Will he inform us now whether the mid-west can expect to get additional resources for the recruitment of staff and the provision of new vehicles? As he knows, there has been significant reconfiguration of acute services in the mid-west and, as a result, investment is required in the ambulance system and service. The reconfiguration process received widespread support but it was accepted on the basis there would be a consequent investment in the ambulance service. There is a problem in this regard. There is a shortage of staff and a difficulty with ambulances. Will the Minister enlighten us about funding for this need and when he expects it will happen?

A significant and ongoing reform programme has been under way in recent years in the National Ambulance Service and considerable advances have been made in 2015. In particular, the opening of the new national emergency operations centre in Tallaght and the establishment of the single national control system, which is now fully operational, will help to achieve improvements in ambulance control and dispatch performance throughout the country.

In recent years, the National Ambulance Service has changed and modernised its model of service delivery. It is no longer considered appropriate for an ambulance station to provide services only in its own local area. For this reason the ambulance service is moving to dynamic deployment where all resources in a region are deployed across that region as a single fleet in response to demand.

Among significant improvements to pre-hospital services in recent times is the emergency aeromedical support service, EAS, which the Government has established on a permanent basis. Since its introduction in 2012, the EAS, from its base in Athlone, has completed almost 1,200 missions for time critical and seriously ill patients, including those in the mid-west. In addition, the development of the intermediate care service, which is based in Limerick, provides vital support to the hospitals in the region, allowing patients to move to the most appropriate facility for the treatment they need.

In 2016, we will build on these improvements through the provision of additional resources to the National Ambulance Service. While I have no doubt that the mid-west will benefit from the additional resources, I am not in a position at this stage to give specific details in regard to any particular region. The details of the plan for all HSE services, including the ambulance service, will be outlined in the national service plan together with the allocation of existing and new resources. I can confirm that provision will be made for an increased ambulance service staffing intake and the expansion of community first responder schemes. Developments nationally will also be influenced by the National Ambulance Service independent capacity review, which will help to determine current and future service needs. Areas being examined include staff numbers and skill mix as well as resources and deployment locations.

I note the Minister is not in a position to provide specific details on the mid-west. I can help in that regard. In Clare alone, there is a shortage of approximately 20 staff and some vehicles are quite poor and need replacement. For that reason alone, I ask the Minister to use his influence for the development of the service plan for ambulance provision over the coming months. Will he ensure an additional staffing component of 20 for Clare and provide whatever other resources are needed in the mid-west generally? I call for this on the basis that the public representatives and the people of the region have accepted in principle, and to a large extent in whole, the reconfiguration of services from places like St. John's Hospital in Limerick, Ennis Hospital and Nenagh Hospital to the acute facility in Limerick.

This was a hard-won battle. It took a lot to convince people it was in their best interests and in the best interests of patient safety and outcomes. However, contingent on that acceptance was the expectation there would be a fit-for-purpose and fully staffed ambulance service fully provided for with appropriate ambulances. This has not happened to date. I appeal to the Minister in a non-partisan way to ensure the regions that have accepted the principle of reconfiguration get the appropriate investment in their ambulance service.

The budget of the National Ambulance Service will be increased for next year and was increased by approximately €5 million this year. Additional ambulances will be purchased, but how the funding and ambulances will be spread out by region throughout the country is up to the National Ambulance Service and I will be guided by its advice.

Deputy Dooley's point is valid and well made. Where reconfiguration has occurred - something we want to do in other parts of the country as well - it is difficult to maintain public confidence if there is not a good ambulance service. It is important to improve ambulance services where reconfiguration occurs. His point is valid for the midlands and north east also and I will take it on board.

I appreciate the Minister's commitment to reconfiguration. One of the main concerns around the reconfiguration process was that the benefits to the system would be realised, but that the potential upside for the patient would not in terms of the provision of ambulance cover. I am confident the Minister understands reconfiguration, but I am not sure the mandarins in the Department of Finance fully embrace and understand what is involved.

I welcome the Minister's commitment to engage with the ambulance service. I, along with Deputy Pat Breen, had an opportunity to visit that facility yesterday and the Minister is correct that a fantastic service is in place. I fully accept and understand the need for the dynamic deployment of ambulances. This is welcome but the service still requires a significant level of investment in staffing. It is often said by Ministers that there has been an increase in staff or that a Department intends to take on more staff, but that fails to recognise that people retire. What is important is that additional staff are required over and above those needed to replace those who retire.

We need is to improve the average age of vehicles in order that the fleet is more modern. If that happened, we would not have situations like those we have had in the mid west, particularly Clare, where one or two vehicles have broken down, creating trauma for families. In a particular case, a person died on the roadside, and although that was not because the ambulance broke down, it played a part in the trauma. Such incidents do not do anything to add to confidence in the reconfiguration process.

Deputy Willie O'Dea sends his apologies that he is not able to be present to deal with Question No. 7.

Question No. 7 withdrawn.

Hospital Waiting Lists

Dara Calleary

Question:

8. Deputy Dara Calleary asked the Minister for Health the reason for the 75% increase from August to September 2015 at Mayo General Hospital in the number of outpatients waiting longer than 18 months for an appointment; and if he will make a statement on the matter. [36591/15]

Rather unusually, I received a response from the hospital group before this question came up in the House. That is not always the way. From August to September there has been a 75% increase in the number of outpatients waiting longer than 18 months at Mayo General Hospital. There seems to be specific pressure on the National Treatment Purchase Fund, NTPF, figures in regard to dermatology, general medicine, nephrology, ENT and urology. What plans are in place to deal with this problem and does the Minister envisage any extra resources for the hospital?

In January, I put in place maximum permissible waiting times of 18 months for inpatient and day case treatment and outpatient appointments by the end of June and of 15 months by the end of the year.

In September, the number of outpatients waiting more than 18 months was 427 for Mayo General Hospital. As the Deputy points out, this represents, unfortunately, an increase over the August figures. However, it does represent an improvement of 120 on the January figures. In January, there had been 547 patients waiting more than 18 months. The figure dipped mid year, but has risen again, but not to as high a figure as at the start of the year. The hospital has confirmed that it is focusing on specific specialties and timeframes based on national targets and that it expects to achieve a maximum waiting time of 15 months by the end of the year.

The HSE has provided additional funding of €51 million this year to ensure these maximum waiting times are achieved by all hospitals. This funding is intended to maximise capacity across public and voluntary hospitals as well as outsourcing activity where the capacity is not available to meet patient needs within the maximum allowable waiting time. In June, the HSE reported a performance against the 14-month maxima of 99.6% for inpatient day cases and 92% for outpatients.

Concerted efforts have been made to reduce outpatient waiting lists overall by facilitating additional clinics outside conventional working hours and outsourcing where capacity is limited. The success of this approach is evident nationally, with the reduction of more than 4,300 in the overall outpatient waiting lists in the six weeks to the end of September. Approximately 4,620 outpatient appointments are being provided by mid-November, specifically for those waiting 15 months and more.

We are very proud of the work that goes on at Mayo General Hospital but it seems to be under pressure on many different fronts at the moment, in particular in regard to accident and emergency and surgery. Of the €51 million mentioned by the Minister, how much was allocated to Mayo General Hospital in the past 11 months? The Minister said earlier that 4,000 extra staff have been appointed to the health service in the past 12 months. How many of those have gone to Mayo General Hospital?

What is the role of the hospital groups in this context? With regard to Saolta, in the Minister's view, is there enough engagement between the various components of the hospital groups towards dealing with this on a cross-hospital basis as opposed to an individual-hospital basis? I am aware of one recent case where a person was brought to the hospital in regard to a condition but declined to be treated by the specific consultant attached to Mayo General Hospital and opted for a consultant who was part of University Hospital Galway, and that person had to make their own arrangements. Surely, with a hospital group, that could have been done on a group-wide basis. It suggests to me that, perhaps, the group concept is not working the way we want it to.

If an appointment is scheduled and the hospital cancels the appointment, does this count as an appointment taken off the waiting list and then put onto a new timeframe or a new waiting list?

I do not know the answer to that question for sure but I would assume that if the hospital cancels the appointment, the person retains the same position on the waiting list as they would have had previously. That is what I would expect to be the case, although I will have to double-check it. It would be unusual if anything else were being done.

I do not have the exact staff figures for Mayo but I can get my office to send them on to Deputy Calleary since they are available. Like all the hospital groups, Saolta hospital group is relatively new. Saolta is one of the more developed ones, having a directorate across the hospitals, which seems to be working quite well. Needless to say, all the hospital groups are relatively new and need further development over the next year or so.

Hospital Services

Brendan Griffin

Question:

9. Deputy Brendan Griffin asked the Minister for Health if a new dedicated obstetrics theatre will be provided at Kerry General Hospital; and if he will make a statement on the matter. [35551/15]

Currently there is no dedicated obstetrics theatre at Kerry General Hospital and mothers who need surgery while in labour must use the regular theatres. If a theatre is not available, they must wait, which is a particular difficulty in emergency cases, for example, where a caesarean section is required immediately. In that scenario, where a baby may be in distress, those involved simply cannot afford to wait. There is a continued risk of catastrophic brain injuries and other related complications as a result of not having the dedicated theatre. I acknowledge the Minister visited the hospital earlier this year, at my request. I would like to have an update on the request for this very much needed infrastructure for the hospital.

Much is being done to improve maternity services further across the country. Additional funding of €2 million, provided in 2015, is being used to fill front-line posts. In 2016, the HSE will again focus on maternity service improvements and implement managed clinical maternity networks across all hospital groups. The establishment of such networks will ensure that smaller maternity units, like Kerry, will be supported to provide high quality, safe services. An example of this initiative which was recently established is the memorandum of understanding agreed between the Coombe Hospital and the HSE to establish a managed maternity network within the Dublin Midlands Hospital Group. This will provide a single maternity service operating over two sites, led by the Coombe. This arrangement will serve as a model for other hospital groups.

We now have more midwives employed than ever before in the State, 1,438, which is an increase of 228 since 2011. Similarly, there has been an increase of five consultant gynaecologist and obstetricians, which represents an increase of 10.94 whole-time equivalents.

The HSE is also establishing a national women and infants health programme, modelled on the successful national cancer control programme. The programme will span obstetrics, gynaecology and neonatal services across community, primary and secondary care. This represents a fundamental reorganisation of maternity service governance structures and will, I hope, ensure the delivery of safe, high quality and sustainable maternity services. A recruitment campaign for the programme’s management team, comprising a programme manager, a clinical director and a director of midwifery has commenced.

In addition, my Department is currently developing the country's first national maternity strategy. This will provide a policy framework for the women and infants programme and strategic direction for the optimal development of maternity services to ensure that women have access to safe, high quality maternity care in a setting most appropriate to their needs. I have identified the publication of the strategy as a priority for this year.

Additional funding is being made available for the further development of maternity services in 2016. The use of this funding to develop the quality and safety of maternity services further will be finalised in the coming weeks in the context of the HSE's national service plan for 2016. I am aware that staffing requirements for a dedicated obstetric theatre have been identified by Kerry General Hospital and this will be considered by the HSE in finalising priorities for the 2016 service plan.

I very much welcome that the requirements of the hospital are being considered. I urge the Minister to use any influence he has to prioritise this matter, which is one of huge importance to County Kerry and all of the women who are using the maternity services and their families. I have an interest in this as someone who has been in the maternity ward of Kerry General Hospital twice in the last two and a half years. I highly commend the efforts of the very dedicated staff and the brilliant work they do. However, they need support and need the Government and the HSE to help ensure there are no other very sad cases as, unfortunately, have occurred in the past. We need to do everything we possibly can to ensure this does not happen.

It would be remiss of me not to acknowledge the many developments that have occurred at the hospital under the current Government in recent years, such as the new endoscopy unit, the new cardiology unit, the new medical assessment unit, the four-bed, high observation unit, of which the Minister of State, Deputy Lynch, will be aware-----

Thank you, Deputy.

A new CT scanner worth €700,000 is currently being installed. The Friends of Kerry General Hospital recently bought a bone density scanner and enabling works are ongoing currently to install that. Works have also commenced on the new diabetes day-care centre.

Thank you, Deputy. This is Question Time. The Minister wants to reply.

It would be remiss of me not to acknowledge this. We need to keep developing the hospital and the obstetrics theatre would be very welcome.

I welcome Deputy Griffin's comments. I had the opportunity to visit Kerry General Hospital with him and the Minister of State, Deputy Deenihan, some months ago, and I was very impressed by the performance of the hospital. It has its problems, like every other hospital, but it is going well in so many ways. It was very good to meet the staff there and see the important work they are doing.

The requirement to have a second on-call theatre team would require ten additional nurses and four additional doctors. Of course, even if that can be funded, there can often be difficulties recruiting them. However, it is certainly under consideration in the context of the service plan.

Hospital Waiting Lists

Seán Ó Fearghaíl

Question:

10. Deputy Seán Ó Fearghaíl asked the Minister for Health the reason for the increase, from August to September 2015, in the number of adult outpatients waiting longer than 18 months for an appointment in Naas General Hospital in County Kildare and in Tallaght Hospital in Dublin 24; and if he will make a statement on the matter. [36656/15]

This is a simple and straightforward question, focusing on the statistics available from the Minister's office which indicate that, in Tallaght Hospital and Naas General Hospital, the number of people waiting for outpatient appointments for more than 18 months increased quite dramatically between August and September of this year. The Minister worked for a while in Kildare so he will be appreciative of the importance of both these hospitals to the more than 200,000 people living in the county. We wonder why this problem is occurring and what the Minister is doing about it.

Improving timely access to care is a key priority for the Government which is why, in January, I put in place maximum permissible waiting times of 18 months by the end of June and 15 months by year-end for routine appointments. In June, the HSE reported a performance against the 18-month maximum waiting time for outpatients of 92%. In September, there was a slight increase in the number of patients waiting over 18 months for an outpatient appointment in both Naas and Tallaght hospitals. However, the overall number of patients on outpatient waiting lists in both hospitals actually fell during this period. Less than 1% of the total number of patients on the outpatient waiting lists in these two hospitals are waiting over 18 months, while almost 90% are waiting less than 12 months in Naas and 75% are waiting less than 12 months in Tallaght.

I want to assure the Deputy that the Dublin Midlands Hospital Group is actively engaging with the hospitals to support them in addressing capacity issues in specific specialties. Concerted efforts have been made to reduce outpatient waiting times nationally by facilitating additional clinics outside conventional working hours and outsourcing where capacity is limited. As an example of the volume of work which is ongoing at present, over 58,000 outpatient appointments are being provided in the next six weeks. Approximately 4,620 outpatient appointments are being provided by mid-November, specifically for those waiting 15 months and over. During that same period, almost 20,250 patients from the waiting lists will undergo an inpatient or day-case procedure or scope.

It is difficult to be reassured by the Minister's response. According to the statistics from August, 1,001 patients had been waiting for 18 months or longer in Tallaght. By September, that number had risen to 1,215, an increase of 21%. In August in Naas, just 12 people had been waiting for 18 months or longer. By September, that number had risen to 41, an increase of 241%. Why is this happening on the Minister's watch? In particular, why are there problems with urology, orthopaedics and dermatology in Tallaght hospital? Is it a staffing issue? Have we an inadequate number of specialists in place to deal with demand at these hospitals? Has the Minister identified where the problem lies and what will he do about it?

What has happened at Naas is similar to what has happened in other hospitals, in that there was a waiting list initiative to ensure that no one was waiting for longer than 18 months for a routine appointment. That initiative was delivered successfully in almost all hospitals across the State by July. By August and September, though, people had breached the 18-month period again. That is why additional finance has been provided to undertake the initiative again and to target in particular people who have been waiting for longer than 15 months for routine appointments.

I am not involved in the day-to-day management of Tallaght hospital. It is a statutory hospital with its own board and CEO. It is short a number of specialists and is experiencing difficulties with space for clinics and with capacity in general.

We know that the Minister is not personally responsible for the management of Tallaght hospital, but the situation there is a disgrace. Only University Hospital Galway had more people waiting in September and nearly one in ten people on the national list of those who have been waiting for 18 months or longer is in Tallaght. It is fine to comment on and identify these matters, but what the public wants is something to be done about them.

When discussing health, Deputies and politicians more generally often refer to millions of euro being spent, numbers of patients on waiting lists and percentages. The reality is that we are referring to human beings who, in many instances, are enduring suffering, pain and loss of participation in society and work because of these delays, which must be addressed as a matter of urgency.

The increase in the number of outpatients waiting for longer than 18 months at Tallaght is largely due to capacity pressures in certain specialties relating mainly to medical manpower pressures as a result of consultant retirements, maternity and sick leave and the inability to recruit locums into those positions. However, it should be noted that, overall, the 18-month target is being achieved and exceeded by the majority of medical and surgical specialties in the hospital. On 30 January, 4,082 people were waiting for 18 months or longer. By the end of September, this figure had decreased to 1,407. Continued efforts are being made to reduce that to zero by the end of the year.

I will allow Deputy Lawlor to ask a brief supplementary question.

It may assist Deputy Ó Fearghaíl. We are still awaiting the tendering process for the endoscopy unit at Naas General Hospital. Perhaps the Minister might write to me to let me know when that will start. The unit would help to reduce waiting lists at Tallaght as well as at Naas. Maybe we can get the tender documents out and the building work started as quickly as possible.

Will the Nursing and Midwifery Board of Ireland get more staff? That would ease staffing pressures, particularly at Naas General Hospital.

I do not have an update on the new phase of development of the endoscopy unit at Naas, but suffice it to say that the unit is included in the capital plan and we are keen to get it started and have works under way sooner rather than later.

Before the election anyway.

This is a matter on which I will follow up. The Deputy has a particular interest in it and has raised it with me many times.

Regarding the Nursing and Midwifery Board of Ireland, nine additional staff have been provided to accelerate the application process and a new call centre has been established, allowing staff to concentrate on processing the applications instead of having to take calls. The call centre seems to be working well. There has been a doubling in the number of nurses applying to register this year, which may surprise people who constantly hear the contrary narrative. The number of nurses seeking to register - those who are newly graduated, from overseas or returning to Ireland - has increased by 122%, which has put the board under a great deal of pressure.

National Dementia Strategy Implementation

Billy Kelleher

Question:

11. Deputy Billy Kelleher asked the Minister for Health for an update on the implementation of the national dementia strategy; and if he will make a statement on the matter. [36661/15]

The national dementia strategy was launched in December 2014. It delivers on a commitment in the programme for Government to develop a national Alzheimer's and other dementias strategy to increase awareness, ensure early diagnosis and intervention and develop enhanced community-based services.

The Department of Health and the HSE have agreed a joint initiative with Atlantic Philanthropies to implement significant elements of the strategy over the 2014-17 period. This implementation programme represents a combined investment of €27.5 million, with Atlantic Philanthropies contributing €12 million and the HSE €15.5 million. Key elements of the initiative include the roll-out of a programme of intensive home supports and home care packages for people with dementia, valued at €22 million over a three-year period; the provision of an additional dementia-specific resource, valued at €1.2 million, for general practitioners, GPs, to include training materials and guidance on local services and contact points; and measures to raise public awareness, address stigma and promote the inclusion and involvement in society of those with dementia, valued at €2.7 million.

A national office for dementia, which was the key request from Atlantic Philanthropies, has been established within the HSE to co-ordinate the implementation of the strategy. Up to 500 people with dementia and their families are expected to benefit from intensive home care packages over the lifetime of the implementation programme. Work on the design of a programme of education and training in dementia care for primary care teams and GPs has commenced and is being led, the Deputy will be glad to hear, from UCC in conjunction with DCU and the Irish College of General Practitioners, ICGP. Work has also begun on a dementia awareness campaign, entitled "Dementia Friendly Ireland", which is being led by the HSE's health and well-being division. A monitoring group, chaired by the Department of Health, has been established to assist with and advise on implementation of the national dementia strategy. This group includes health professionals, administrators, researchers and advocates. It also includes someone living with dementia and a representative of those who care for people with dementia. It is an extensive programme.

We welcome everything that has been done, but if one considered the demographics and the projected trends in Alzheimer's and dementia, one would see a trebling in the incidence of both in just a generation. That will be a major demand on resources. Even in the context of the national dementia strategy, I do not believe that enough planning is being done to provide the resources that will be required. We know what will be necessary in the years ahead, given the increasing prevalence.

Intensive home care packages represent a key issue. Atlantic Philanthropies is involved in their funding, but we need to put in place proper systems with seamless supports in the community. We discuss primary care and community care, but families do not have the supports that they deserve. We should start being imaginative in the strategy as regards how we care for Alzheimer's or dementia sufferers in a community or home care setting.

That involves community-based services and voluntary organisations all coming together to deal with what will be an avalanche. If we do not have the resources in place, we will deny very many people basic dignity.

I agree with the Deputy. Planning, including evidence-based planning, and research are key to all of this. The combination of both the delivery of services within communities and research will give us the tools we will need to deliver what is essential. The Alzheimer Society of Ireland was the key driver in all of this and the conduit between Atlantic Philanthropies and the Government in terms of how we would put this package in place. It delivers an incredible service to its clients on behalf of the Government. Everyone I know who has used it raves about it. I agree that we need to know what is coming down the track and what we will need to ensure people can stay increasingly within their own communities. We should be glad that the leading clinician in all of this is Dr. Tony Foley from Kinsale. He is leading the whole project in terms of the community-based delivery of services for those with dementia and Alzheimer's disease. We are well on the way to knowing what we will need in the future.

One way of showing a continuing commitment would be increase the number of intensive home care packages for 2016 in the context of the HSE service plan. We know from all the empirical evidence and the collation of data that the prevalence of the conditions will increase dramatically in the years ahead. By any stretch of the imagination, we do not have the supports or infrastructure in place to deal with them currently. There needs to be a ramping up of investment to meet the demands outlined in the national dementia strategy. I am reluctant to applaud until we see some firm commitments in the HSE's service plan, for example, in the area of intensive home care packages, and a broadening of community-based supports in conjunction with the primary care strategy.

I do not believe we are disagreeing but that we need to be cautious about ensuring what we are doing and proposing are actually working. That is essential. What we are doing right now is working but it needs to be bedded in. We need to be absolutely certain that this is what we need and that it is where we need it. That is essential.

Having come through the process in which it was said there would be a pensions time bomb and that all would be doom and gloom, I believe conditions change based on research. Both the numbers and direction in which one goes can be changed. I am very hopeful because I know research in this area is very active. From time to time, I see signs of breakthroughs that are very encouraging. There is a need for a combination of approaches rather than a single pathway.

Hospital Waiting Lists

Billy Kelleher

Question:

12. Deputy Billy Kelleher asked the Minister for Health the reasons his targets for waiting lists have not been met; and if he will make a statement on the matter. [36662/15]

I ask the Minister for Health the reasons his targets for waiting lists have not been met and whether he will make a statement on the matter.

In January, I put in place maximum permissible waiting times for inpatient and day case treatment and outpatient appointments of 18 months by the end of June and 15 months by the year's end. I refer to routine appointments, not urgent or emergency appointments. It was always made clear that, for some specialities, this would not be possible due to a lack of capacity in both the public and private sectors.

The HSE was provided with additional funding of €51 million to ensure these maximum waiting times are achieved. The funding provided is intended to maximise capacity across public and voluntary hospitals as well as outsourcing activity where the capacity is not available to meet patient needs within the maximum allowable waiting time. In June, the HSE reported performances against the 18-month maximum waiting time of 99.6% for inpatient and day cases and 92% for outpatients.

Concerted efforts have been made to reduce outpatient waiting lists by facilitating additional clinics outside conventional working hours and outsourcing where capacity is limited. The success of this approach is evident with the reduction of over 4,300 in the overall outpatient waiting lists in the six weeks to the end of September. An example of the volume of the ongoing work is that over 58,000 outpatient appointments are being provided in the next six weeks. Approximately 4,620 outpatient appointments are being provided by mid-November, specifically for those waiting 15 months and over. During that same period, almost 20,250 patients from the waiting lists will undergo an inpatient or day case procedure or scope under the initiative.

As of 30 September 2015, there has been a reduction of 11,671 in the number waiting more than 18 months for an outpatient appointment. Addressing the longest waiting periods for treatment is a key performance objective for the remainder of 2015.

At the start of 2015, the Minister abandoned his predecessor's targets of a maximum waiting time of 18 months for inpatient day case appointments and one year for outpatient appointments. There is no point in pretending in this Chamber that circumstances have improved. The Minister has moved the goalposts and has set diminishing expectations. Charles Dickens' novel Great Expectations comes to mind. If it were about the Minister's tenure, it would be called Diminishing Expectations. Creating diminishing expectations is what the Minister has been doing consistently. Every target set by his predecessor has been moved to make it look better but the bottom line is that people are still waiting for inordinate periods. For the Minister to applaud himself for moving the goalposts and deeming it acceptable for people to have to wait 15 months or 18 months for various appointments is simply not credible any more. The statistics show that 64,985 people are waiting for more than a year for an appointment and that 4,476 of these are for the National Children's Hospital. Behind the Minister's statistics are individuals who are waiting for inordinate periods. While the Minister is saying the statistics do not include emergency appointments, he should realise each case is an emergency for the individual concerned. The patients would at least like a timely appointment with the consultant in terms of diagnostics.

No targets have been abandoned.

A change from eight months to 18 months is an abandonment of targets.

Every month, the authorities report waiting times based on three-month intervals, making reference to those waiting for fewer than three months, those waiting for between three and six months, those waiting between six and nine months, and those waiting for between nine and 12 months or more. All the figures are very transparent for anybody who wants to see them. We have been very clear from day one that there would be difficulties in some subspecialties where there are no consultants or where there is no capacity. However, even if one leaves aside any targets or maxima, one notes the number of people waiting for an outpatient appointment, for example, is down by 5,776 since the start of the year. We will continue to invest additional resources so we can continue to lower the figures.

Written Answers follow Adjournment.