Other Questions

Hospital Waiting Lists

Jim O'Callaghan


19. Deputy Jim O'Callaghan asked the Minister for Health the targets in place for reducing outpatient waiting times in St. Vincent’s University Hospital in 2017. [12113/17]

St. Vincent's University Hospital is in Elm Park in my constituency. I want to ask the Minister about the outpatient waiting lists there, which have exploded recently. What is the Minister's plan to deal with the waiting lists? Are there targets in place to ensure we get the waiting lists down to manageable proportions?

I thank Deputy O'Callaghan for this important question on outpatient times in St. Vincent's University Hospital specifically. I am absolutely committed to reducing waiting times for patients, both for patients waiting for inpatient or day case procedures and for outpatient appointments. During 2016, there has been evidence of a considerable increase in demand for health services as our population grows and ages. In order to reduce the numbers of long-waiting patients, the HSE is developing waiting list action plans in the area of inpatient, day case, scoliosis and outpatient services, which is the issue the Deputy has raised. Draft waiting list action plans for outpatients, inpatient, day case and scoliosis are with my Department, and it is reviewing these plans. Engagement is ongoing with the HSE and I expect to be able to publish them in the coming weeks.

In November 2016, the HSE launched the Strategy for the Design of Integrated Outpatient Services 2016-2020. The strategy seeks to improve waiting times for outpatient services in the long term by restructuring referral pathways and utilising technology to improve service delivery. The HSE has significantly progressed the development of a draft outpatient waiting list action plan. In the plan, the HSE will identify proposals to reduce the number of patients waiting long periods of time for outpatient appointments across all hospitals, including St. Vincent's University Hospital. A number of initiatives are in place in St. Vincent's hospital to address waiting times, including the introduction of virtual clinics and pooling of referrals, which means people are not referred to a specific consultant. The target is that no patient will wait longer than 15 months by the end of October. While it is still too long, it would constitute significant progress on current waiting times. I expect to make known the details of the outpatient waiting list action plan in the coming weeks.

It is important to put on the record of the Dáil the waiting lists for outpatients in St. Vincent's hospital. In January 2016, there was a total of 15,612 people on the outpatient waiting list. By January 2017, it had increased to 17,526. What is most significant about the figures is the increase in the amount of time and the number of people who have been waiting for 18 months or more. In January 2016, 19 patients on the outpatient waiting list had been waiting 18 months or longer. By January 2017, the figure had exploded to 491 people. Although the Minister has been in office for only ten months, his party has been in power for six years. The explosion in those figures, particularly for people who have been there longer than 18 months, needs to be explained and we need a plan in respect of it.

My office contacted St. Vincent's University Hospital specifically to ask what measures it will put in place to target the very specific outpatient waiting list to which the Deputy has referred. I have been informed that it is putting in place specialty-specific meetings with the specialties concerned to identify the issues. The "did not attend", DNA, rate is a serious issue in our health service and St. Vincent's hospital has established a task force to focus on reducing the DNA rate. Last year, 450,000 people did not attend scheduled hospital appointments and this has a significant burden in terms of time and cost on the Irish health service. It is anticipated that through the reduction in the number of DNAs and compliance with the one-strike national policy, the number of patients awaiting first appointment will be reduced.

The hospital has introduced a number of virtual clinics which have been a great success and have allowed specialties to increase the number of new appointments per clinic. This has assisted in reducing the new to review ratio within specialties. St. Vincent's hospital is leading in this way. The hospital has introduced urgent and routine new appointments in outpatient department clinic profiles, the pooling of referrals across a number of consultants, a project to review the discharge process and validation completed on a biannual basis to ensure the outpatient appointment list is valid. I will send the Deputy further details of these initiatives.

The fact that people are not attending hospital appointments does not explain the extraordinary figures, for instance in respect of cardiology, where 233 cardiology appointments have been outstanding for more than a year. It does not explain the situation regarding plastic surgery where 456 people have been waiting to be dealt with by plastic surgeons, which is an increase of 265 on last year. There are significant delays in respect of people seeking ear, nose and throat, ENT, treatment. The Minister's predecessor, Deputy Varadkar, had set a target of July 2015 for nobody to be waiting more than 18 months. We need the Minister to recognise that the Government's strategy simply is not working. We need to know what plan has been put in place regarding the usage of the National Treatment Purchase Fund, NTPF, or other mechanisms to ensure people do not find themselves in this inhuman position of waiting longer than 18 months for treatment.

The DNA rate has a bearing. While it is not the only factor, consultants have a certain number of appointments available and when a person does not turn up for an appointment, the slot is wasted. Given that there were 450,000 such instances, there is an onus on me to expect the health service to put in place methods to ensure patients are reminded of appointments and, ultimately, wait less time, which makes them more likely to remember the appointment.

The NTPF has a role. Fianna Fáil pursued it during the confidence and supply discussions. We have it back up and running after years of it not having any specific budget for dedicated waiting list initiatives. We have a budget of €20 million for the NTPF this year, rising to €55 million next year.

It is one the few areas of the health budget in respect of which we got a commitment during the Estimates process, and not just for the level of funding for 2017 but also for the level of funding for 2018, so we can plan for the future. The pooling of consultant appointments and the utilisation of the hospital groups is essential. If a consultant at St. Vincent's University Hospital cannot see a patient, but the consultant up the road can, then we need to have a situation where the consultant does not own the patient and the patient should be directed to whichever consultant can see them quickly. I will send further details specifically on St. Vincent's University Hospital to the Deputy.

Hospital Beds Data

Billy Kelleher


20. Deputy Billy Kelleher asked the Minister for Health the status of the hospital bed capacity review; and if he will make a statement on the matter. [12078/17]

I wish to ask the Minister for Health about the status of the bed capacity review. I have raised this issue on a number of occasions and I would like to know the status of the review and where we are in the context of the terms of reference. Who will be independently validating the bed capacity review, particularly in view of the fact that for many years it was the policy of the Department of Health to reduce bed capacity? The Department, through the Minister and his predecessors, defended, quite robustly, the policy that bed numbers should be reduced and that beds were not always the answer to the issues of capacity in the hospital system.

Due to the fact that I am a great champion of new politics, I am not going to get into a debate about bed capacity, closures and the records of various Ministers for Health in various Governments. As the Deputy has correctly pointed out, however, my Department has commenced a capacity review in line with the commitment in A Programme for a Partnership Government. I would like to assure Deputy Kelleher that this is a priority action for me and my Department.

As I have previously advised, my intention is that the review will have a wider scope than previous exercises - I believe there would be agreement in the House on the importance of that - and it will examine key elements of primary and community care infrastructure in addition to hospital facilities. It cannot just be about the hospital beds, it must be about the spectrum of beds across the health service.

Terms of reference for the review have been developed, these are as follows: to consider current capacity in the health system and benchmark with international comparators; to determine drivers of future demand for health care including demographic and epidemiological trends; to analyse how reforms to the model of care will impact on future capacity requirements across the system; and to provide an overall assessment of current and future capacity requirements for the period 2017 to 2030.

The review is being led by my Department. The Department of Health develops policy and the HSE is the operational arm of the health service. The review will also be overseen by a steering group, which is now in place. It includes senior officials from my Department and the Departments of the Taoiseach and Public Expenditure and Reform, the HSE and experts with a clinical and academic background. It will hold its first meeting this month. I expect the terms of reference for the review to be adopted and explained in full to the group at the meeting and that the group will begin detailed planning for the review process - including around the external expertise requirements, which I know the Deputy feels strongly about - and in respect of stakeholder consultations. An independent peer group of international health experts will also be established to review and validate the review methodology and findings. There will be an international dimension to this review.

I am keen that this review will be progressed sufficiently to enable it to feed into the mid-term review of the capital programme, which will take place later in the year. I must have a crystallised ask with regard to the number of beds, and I will have that information in time for the review. While the review will consider capacity requirements over the next decade or so, I am also anxious that it have a short-term focus and determine how capital investment over the coming years can be best targeted, given the current pressures being experienced within our hospital services.

The mechanisms for the review are now in place, as is the steering group. I look forward to the emerging findings later in the year.

I thank the Minister for his reply. The fact that there is outside oversight in the context of the bed capacity review is welcome. Let us be under no illusions. For the past six years, the policy of the Department of Health, regardless of which Minister was defending it, has been to reduce the capacity of beds in the public hospital system. This policy was robustly defended for a long period and we were told that beds were not necessarily always the answer to increase the capacity to address the issues of waiting lists and other difficulties in the hospital system. If we were just independently evaluating bed capacity, on foot of the Department of Health pursuing a slash-and-burn policy in recent years, then I would have had a concern. I welcome that there will be outside observance of that issue.

Perhaps the Minister could clarify if intensive care unit, ICU, beds and theatre capacity will also be looked at in that context and whether there will be a differentiation between paediatric beds and adult beds in the assessment.

I do not believe there is any degree of urgency on this by the Minister, but there should be. Will he indicate if the report will be ready in time to feed in to the winter initiative? The last winter initiative was not exactly a massive success since everybody got surprised by the flu. I wonder if the report will be ready to feed into and inform the winter initiative.

No matter how many times Deputy O'Reilly says that I was surprised by last winter's flu outbreak, I was not. I get this at least once a week from the Deputy. I had been relaying the advice made available to me by doctors and medical experts that the flu in question was a strain we had not seen in the State since 2009. I would hope that the entire report would be ready. Considering that a sufficient amount of material must be ready for the mid-term capital review, I am of the opinion that there will be valuable data and information available in preparation for the winter initiative.

In response to Deputy Kelleher, the position regarding ICU and theatre beds will be examined. I will revert to the Deputy on the issue of paediatric beds because I understand that a paediatric model of care is being developed as part of the new national children's hospital. We are looking at paediatric beds.

I agree with the Deputy about the importance of oversight structures. While overall responsibility will rest with my Department, which has responsibility for making policy for which I am accountable, it is important that the steering group has academic and clinical support and that we also have a degree of independent international oversight. We will identify the members of that international expert advisory group in the near future, and I will share information relating to them with the House. This group of international health experts will be charged with examining and critiquing the draft outputs from the review on the basis of their extensive international experience. The group will look at and validate the review's approach, methodology, conclusions and recommendations.

I thank the Minister. While we are asking questions in the context of the bed capacity review, there is not much point, as the Minister stated previously, in having the beds if we do not have blankets and mattresses. More important is the staff for these beds. Will that feed in to the assessment of the manpower requirements, training programmes and all that flows from that report; demographics of population, epidemiology requirements, the beds to support that and the staff to support the bed capacity recommendations?

I am pleased to hear the Deputy raise that point. I often hear people in radio interviews, for example, referring to the need to open more beds. I am of the view that we need to open more beds. As the Deputy said, however, we cannot do so if we do not have adequate staffing levels. This is part of the very extensive engagement we have had with the INMO, SIPTU and the IMO on a range of industrial relations issues in recent times. I am pleased that we have managed to progress with each of those. We had three threatened industrial relations disputes in the health service, one of which I am pleased to have brought to a resolution, another is in a process and the INMO is balloting its members on the other with a set of proposals it is encouraging members to accept. The bed capacity review will also inform the staffing needs for our health service. As Deputy Kelleher knows, we have had closed beds due to a lack of nurses so we must be truthful here, look at staffing levels and open those closed beds, which is what we have been doing in recent weeks. That is why we will hire 1,200 more nurses this year. We must also look at the staffing need for each additional bed. Work is ongoing in that regard.

Ambulance Service

John Lahart


21. Deputy John Lahart asked the Minister for Health if he has received a copy of the final report on the review of Dublin ambulance services. [12099/17]

The Minister is aware that SIPTU members in Dublin Fire Brigade will conduct 24-hour stoppages on Saturday 18 March and Monday 27 March to highlight their opposition to an attempt to break up the its emergency medical service by removing its ambulance call and dispatch functions. Fianna Fáil and I strongly oppose any move to remove the delivery of Dublin's ambulance service from Dublin Fire Brigade and to merge this service with the National Ambulance Service. We must enable and fully support the 1,000 personnel employed by Dublin Fire Brigade in order to maximise service delivery, provide greater efficiency and protect those in fire stations across Dublin. I call on the Minister to intervene in the dispute as a matter of urgency and to ensure that communities across Dublin, our capital city, are not left without fire-based emergency services for any period in the coming weeks.

I thank Deputy Lahart. I know he has raised this issue previously in the House. While I have not, as yet, received the report of the review of Dublin ambulance services, I can confirm that a copy of the report was received by my Secretary General in the last few days. My officials, in conjunction with colleagues in the Department of Housing, Planning, Community and Local Government, are currently examining the report. I understand that meetings of officials from both Departments are scheduled for today and tomorrow. When these discussions are concluded and a proposed way forward is agreed between the respective Departments, I expect that the report will be submitted to both myself and the Minister for Housing, Planning, Community and Local Government for our consideration. That is the process.

I assure the Deputy that I am fully aware of and greatly appreciate the excellent historical tradition of ambulance services provided to the citizens of Dublin by the Dublin Fire Brigade. It is not just the excellent historical tradition; I appreciate the ongoing tradition of providing services to people in our capital city and county. At the same time, all of those involved in ambulance service provision must have regard to the findings of HIQA. We all must have regard to the findings of the regulator. In its 2014 report, HIQA highlighted patient safety issues arising from two ambulance services operating in the same domain. I fully accept, therefore, that in the interests of patient safety there is a need for a more co-ordinated and integrated approach to ambulance service delivery in Dublin.

Thus, there is a need for the Dublin Fire Brigade and the National Ambulance Service to work closely together to optimise and maximise all available emergency resources. This will ensure the people of Dublin are provided with the most responsive and safest ambulance service possible.

While I have yet to receive the report, let alone the recommendations that will go to me and the Minister, Deputy Coveney, I assure the Deputy they will receive due and careful consideration. As I said at the Committee on Health last week, I am determined that we do not throw the baby out with the bathwater. There is an awful lot that works extraordinarily well in regard to the Dublin Fire Brigade and the National Ambulance Service. We have to find the mechanism to best address the concerns of HIQA to make sure we have the safest service possible.

The Minister did not say whether he will intervene. What is unusual about this proposed strike is that it is not over pay or conditions. Dublin Fire Brigade is as traditional to Dublin as Brennan's bread. It is part of the fabric of the Dublin area.

The Minister mentioned the HIQA report. There was opposition to that plan from the city councillors and firefighters, and a consultative forum which involved council management and union representatives was established in March 2015. That forum commissioned an expert panel to make recommendations on governance, funding, call taking and despatch. It recommended not that the two call and despatch services amalgamate but rather that an efficient technological system be put in place. However, council management did not accept that report and left the forum the following January. According to the council's minutes of that meeting, the assistant manager said the forum had been set up to reach agreement on the proposal to centralise call taking, which was not the case. To transfer the 100,000 calls handled annually by the fire brigade to another call centre would jeopardise public safety. It would detrimentally affect the safe delivery of the fire-based emergency medical service, EMS, model, for which it is internationally famous.

The Dublin Fire Brigade has provided a fantastic service to the people of Dublin for more than 100 years. It is a service that is very close to my own heart. Indeed, they tended to my grandmother when she was sick some years ago. It is a case of, "If it's not broke, don't fix it". The service is working well and the people of Dublin are very proud of this service. We would like to hear the Minister express confidence in the service and a willingness to continue that service, as well as recognition of the vital work the Dublin Fire Brigade does for the people of Dublin.

I was the Minister in the Custom House when this was being discussed. On 7 April last year I wrote to the city manager and told him my views, which were that I did not believe this was right, I did not believe the statistics that were being produced and I did not believe the economies the city management said existed. I do not accept HIQA's recommendations and I know the councillors, across all politics in Dublin, do not agree with this.

Let me say this out straight as the former Minister with responsibility for local government: this is an agenda of Dublin City Council; it is an agenda of the Dublin city manager. It is wrong and it needs to be stopped. The report that is on the desk of the Secretary General of the Department of Health, which the Minister can pick up the phone and ask him about, is going to recommend exactly what was recommended to me a year ago. It was wrong then and it is wrong now. The economies do not exist. In fact, I believe this will jeopardise lives. The integrated model that has operated in Dublin works well and has to be kept.

I have raised this matter in the Dáil previously and I appreciate the Minister giving an update on the situation. I agree with him that patient safety is of paramount importance. However, I point out that councillors in all the local authorities in Dublin have passed motions that the ambulance service should be retained with the Dublin Fire Brigade and I think that is the general view of Dubliners, who are very proud of their fire brigade and its ambulance service.

There were reports last night that the chief executive, Owen Keegan, has referred the matter to the Labour Relations Commission. While I am not sure if the Minister is aware of that, it is something we need an update on. This strike must be prevented. Dubliners generally want to see the ambulance service retained in the Dublin Fire Brigade for all sorts of reasons. At the end of the day, it will be in the interests of patient safety.

I thank Deputies for their contributions and views in this regard. As Minister for Health, I am very proud of the service that is being provided by the Dublin Fire Brigade in responding to emergency calls throughout the city and county. I thank the members for the service they provide. I am also very proud of the service provided by the National Ambulance Service for people in the Dublin area and beyond that area.

I am aware, as are Deputies and, to be fair, paramedics and people working in Dublin Fire Brigade and the National Ambulance Service, of a number of challenges in this regard, including what seems the bizarre idea that the National Ambulance Service does not have sight of a Dublin Fire Brigade ambulance resource on its own IT system and, therefore, is not able to despatch the nearest resource to the scene. That is not good for patient safety or for the utilisation of emergency resources. Deputy Lahart talked about technological solutions and he is correct that every possible solution needs to be explored.

I hope Members on all sides of the House will join me in calling on all those involved in industrial action not to proceed and to use every mechanism at their disposal through the industrial relations mechanism because, obviously, that would not be in the interests of any of our patients. I know that is not a decision that anybody working as a paramedic would take lightly. I am cognisant of the very strong views of the Dublin Fire Brigade, SIPTU, IMPACT and Members on all sides of the House in this regard. No decision has been taken by me and any decision that is taken by me, or taken jointly by me and the Minister, Deputy Coveney, will be taken while recognising all the various views. I will consult the spokespeople from the various parties at that stage.

I thank the Minister for his response, which was more comprehensive than the response we got a month ago when this was raised by me and colleagues as a Topical Issue matter. I welcome a number of features of the response, first, that the Minister will discuss it with the Minister for Housing, Planning, Community and Local Government because, obviously, there is a key role for that Department. I also welcome his reference to solutions, in particular technological solutions.

I highlight once again that it is uncommon in modern Ireland for any profession to decide to take strike action, not over pay and conditions, but over a matter of principle and in defending a very strong tradition that the Dublin Fire Brigade and its ambulance service has maintained and upheld. It is out of conviction in regard to supporting this that my colleagues have continually sought to raise the issue. I take the Minister in good faith. He said no decision has been made by him as Minister for Health, and he committed to continuing to keep the House informed and to discussing the matter with Opposition spokespeople. We hope he will be as good as his word.

I agree with Deputy Lahart. I do not in any way doubt the conviction of any of the members of SIPTU or any other union that has decided to take this action. However, I appeal to them, in light of the process I have outlined on the record of the House, and in light of what Deputy Lahart outlined in terms of utilising the industrial relations mechanism of the State, not to proceed with strike action, which clearly would not be in the interests of any patient in this capital city or county. There is a process to go through and I believe it is important that people follow that process. I would, therefore, ask that people do everything they possibly can to make sure this does not occur. For my part, I will make sure my Department engages very proactively with the Department of Housing, Planning, Community and Local Government.

On another point, there will be a need for additional ambulance capacity in our capital city and that cannot get lost in this debate. The mechanism through which that is funded and where the responsibility for it lies, given it is currently with Dublin City Council, is something that also needs to be addressed through this process.

Hospital Waiting Lists

Louise O'Reilly


22. Deputy Louise O'Reilly asked the Minister for Health when the National Treatment Purchase Fund, NTPF, will be requested to lead a project team to undertake a feasibility study of progressing to an integrated approach to waiting list management at hospital group level; if departmental, HSE and external advice will be sought on this feasibility study; if the terms of reference can be extended to examine waiting list management across hospital groups; and if he will make a statement on the matter. [11888/17]

The Minister advised me previously that the HSE waiting list action plan will not specifically incorporate technology solutions. I and my party, Sinn Féin, strongly believe it should. My question concerns when the NTPF will be asked to lead a project team to undertake that feasibility study.

I thank the Deputy for this question. It is an issue we often discuss and I think we are due to meet. The Government is committed to reducing waiting times for patients, both for patients waiting for inpatient and day case procedures and for outpatient appointments. It is unnecessary for people to have to wait excessively long periods for necessary care.

In order to reduce this burden for patients and to ensure that best practice is applied in how waiting lists are managed, I am open to evaluating new approaches to waiting list management in our health service. I agree that greater integration of hospital waiting list management systems is a step in the right direction and that IT can play a significant role in underpinning these integrated approaches.

On this basis, on 15 February during a Private Members' business debate from the Deputy's own party in the Seanad regarding waiting lists, I committed to asking the NTPF to examine the feasibility of progressing to the more integrated system that Deputy O'Reilly advocates for.

Following on from that debate, on 23 February officials from my Department wrote on my behalf to the NTPF to request that it establish and lead a project team of relevant experts and stakeholders to conduct a feasibility study regarding integrated approaches to waiting list management at a hospital group level. The NTPF informs me that it is in the process of scoping out the structure and format of this study and I expect to receive the preliminary plan in the coming weeks. The NTPF has been asked to report to me within six months on the finalisation of that report, which I expect will be published.

I think Deputy O'Reilly has a view that this can be done quicker. That is usually a good guess anyway. If the Deputy would like to meet with officials from the NTPF who, as I say, are scoping the work and will present to me a preliminary plan in the coming weeks to have the work completed within six months, I will be more than happy to facilitate that.

For once, the lack of haste might be fortuitous. Why did the Minister pick the NTPF to lead this? The reason I ask is because the chief executive of the NTPF, who I think is on secondment from a State agency, stated that the private sector is the most efficient and clinically effective way of having patients seen quickly. The person who heads up the organisation that the Minister has tasked with reviewing what I believe is and should be a very important pillar of any waiting list management system has already publicly stated a preference for the private sector against his own substantive employer. Why must it be the NTPF that leads out on this? The Minister said the review will consider waiting list management at hospital group level. This is a bit of a blinkered and short-sighted approach. I believe we should be looking at this on a national basis. That is possibly the most efficient way to go. Why was the NTPF chosen for this? Does the Minister have any comments to make on the indicated preference of the chief executive for the private sector?

I always have a preference for the public sector. I am the Minister for the Irish public health service. That is why we are investing heavily in it. That is also why I have told the Deputy on a number of occasions that it is my view that we must be pragmatic about this. When I hear from people who are waiting for operations and procedures in hospitals, and I am sure when they talk to Deputy O'Reilly, they do not have an ideological preference as to where their treatment should be carried out. They just want it done. After years of an inability to invest adequately in our public services, it is going to take time to ramp up public services to the level we want to get them to. Therefore, I believe we should unapologetically utilise every possible resource at our disposal to make sure that patients get their treatment in the quickest time possible.

I think the Deputy has a fair point about the national basis for the NTPF. I will relay that to the NTPF. My understanding of the reason is that the hospital group structure is the way in which our health service is currently functioning. The Deputy asked me why I asked the NTPF. This body of work is not a debate about public versus private. It is a debate about systems. It is the statutory agency that manages waiting lists and waiting list systems on behalf of the Minister for Health of the day. We felt it was the most prudent and appropriate agency.

I asked the Minister to comment on what the chief executive of the NTPF said. I would be very grateful if he could. That to me indicates a preference before this important work has even started. As part of the waiting list plan, I know the Minister is considering a number of options. I wonder why we are not at this stage integrating the digital options as part of that. Since we have limited time, perhaps the Minister could use all of the time he has to comment on the remarks made by the chief executive. I believe it is very worrying that the person who is going to examine waiting list options has publicly stated a preference for the private sector over the public sector. I fully respect the fact the Minister comes into the House and says that he is very focused on the public. He is indeed the Minister for the public sector. However, he is channelling money into the private sector. As I have said before, he will never improve the public service by putting money into the private sector. I think he knows that. I ask him to respond specifically to the comments that were made by the chief executive.

We are putting €20 million into the NTPF out of a budget for the health service of over €14 billion. It needs to be seen proportionally when the Deputy makes those comments. With regard to the acting CEO of the NTPF, that is a position that is currently being advertised and interviewed for to find a person through the Public Appointments Service. I am not familiar with the context in which the comments were made, but I will put my view on the record. I want to see investment in the public health service. I want to see procedures delivered in the public health service. In fairness, it is the job and responsibility of the NTPF to procure services in both the private sector and through insourcing. The acting CEO of the NTPF, whose comments I will review, has a view and was expressing that view honestly, I am sure. We are utilising both the public and private sector in the interests of our patients. In fairness, in this work the NTPF is not being asked to do exactly as the Deputy has characterised it. It is being asked to look at the greater integration of hospital waiting list management systems. It is an IT piece of work. It is trying to make sure that the hospitals talk to each other and the consultants with waiting lists talk to each other in order that a patient who could be seen quicker in another hospital will be seen.

HSE Waiting Lists

John Curran


23. Deputy John Curran asked the Minister for Health the targets in place for reducing outpatient waiting times in the three children’s hospitals in Dublin, in which 3,289 children were waiting 18 months or more for an appointment in January 2017. [12111/17]

Figures from the NTPF indicate that at the end of January 2017, 3,289 children were waiting for over 18 months for an outpatient appointment. I think the Minister will agree that is an extraordinary figure and a very long time for a child to be waiting. What steps is the Minister going to take immediately to address this across the three children's hospitals in Dublin? Will he set specific timelines and targets to reduce this figure significantly?

I thank Deputy Curran for an important question. I agree that those waiting times are too long. What we are actually going to do about it is the most important thing. During 2016, as the Deputy knows, there has been evidence of a considerable increase in demand for health services as our population continues to grow and age. Therefore, in order to reduce the numbers of long-waiting patients, we are developing through the HSE action plans for inpatient day cases and, specifically with regard to the Deputy's question, outpatient day services, as well as the issues in paediatric scoliosis. My Department is currently reviewing these plans and I expect to be in a position to share them with Members of this House very shortly.

In addition, in November 2016, the HSE launched the Strategy for the Design of Integrated Outpatient Services 2016-2020. The HSE has significantly progressed the development of its outpatient waiting list plan. It will focus on the longest waiters first.

The three hospitals in the children's hospital group are working closely together to manage waiting times. This is quite important. They need to co-operate. They are ultimately going to be under the banner of the new national children's hospital. Specific measures include additional paediatric outpatient sessions in Tallaght Hospital that will commence later this year, an additional ear, nose and throat, ENT, clinic in Temple Street and the re-organisation of existing clinical capacity to facilitate extra outpatient clinics.

I understand that Tallaght Hospital is currently working with the children's hospital group and with the NTPF with regard to paediatrics to secure funding to outsource some of the longest waiters. The hospital has secured two consultants who will commence additional paediatric sessions from October of this year. The hospital has also confirmed that it is currently trying to source locum consultants in conjunction with Our Lady's Children's Hospital, Crumlin. If successful, these consultants will provide additional capacity until the permanent consultants come on board in October.

The hospital is currently undertaking a cross-city ENT review with the children's hospital group to look at sustainable and permanent solutions to deal with the ENT situation, which is particularly acute. A validation process is under way in Temple Street Children's University Hospital to identify patients who may be on a list but no longer require the treatment or have been treated somewhere else. This should reduce numbers and enable them to focus on those needing care. They are also due to commence an additional ENT clinic shortly, which will see approximately ten new patients per week. They are looking at the possibility of running an additional clinic which would see approximately 12 to 15 new patients a week. That will be a general paediatric clinic. They are running a rapid access clinic to see emergency GP referrals and internal referrals. There is a lot of work under way and I can share this detail with the Deputy.

There are two elements that I wish to put to the Minister. Will the steps the Minister is taking address the backlog or just stop the problem getting worse? It is worth reflecting for a moment that in January 2016, there were only 117 children waiting more than 18 months for that outpatient appointment. That figure was almost 3,300, 12 months later. It is very significant.

The Minister has said that the hospitals need to work together and I acknowledge that. However, the increase has been seen across all areas in all three hospitals. The figures are staggering and it is staggering to see what has happened in one 12-month cycle.

Let us reflect for a moment on the fact that the 3,300 children who went on waiting lists in July 2015 remain on the lists today. In the same month the Minister's predecessor indicated that no one would be waiting for more than 18 months. This has occurred radically and rapidly in the past 12 months. The Minister intends to publish a plan. Will he set specific deadlines to reduce the numbers over time incrementally? The rate at which the change has occurred in 2017 is extraordinary.

I think the Deputy has honestly and fairly assessed the situation in terms of needing to deal with the backlog and those waiting longest as well as the fact that many new people are coming on to waiting lists each day. Previously, there were 25,000 referrals per month from general practice to the acute hospital sector. Last year, we saw approximately 35,000 per month on average. More and more people are, rightly, using our health service and seeking specialist treatment. Moreover, our population is growing. All these factors produce pressure points in respect of our health service.

However, specific actions are being taken. The level of detail the three children's hospitals have provided me with in terms of the additional clinics and co-operation is helpful. These three hospitals are, relatively speaking, geographically well-placed to work together. They will come together under the new paediatric model of care for the national children's hospital. This will include putting in place the ear, nose and throat clinic, hiring more consultants and using locum cover in the interim. Those responsible in Children's University Hospital, Temple Street are looking at putting in place a new paediatric post for cardiology as well as insourcing and outsourcing options for urology.

Several of these initiatives will be undertaken as a result of the funding provided by the National Treatment Purchase Fund and as a result of the large budget that has been provided to the HSE. The target for this year is that by the end of October no one will be waiting longer than 15 months for an outpatient, inpatient or day-case procedure. A specific target has been given by the director general in respect of scoliosis to the effect that by the end of this year no child will have to wait longer than four months.

I thank the Minister and I acknowledge the efforts that he and the hospitals are going to in respect of the various initiatives announced. The challenge is for the Minister to set out to us in a clear manner how those goals will be achieved.

Although more people are accessing the services, the result is that in one 12-month period, more than 3,000 children were waiting for more than 18 months. This has a devastating impact on a young person and the time waiting represents a significant proportion of the life of these young people. From that point of view it is significant.

The Minister has announced initiatives today. However, I wish to remind him that across all three hospitals in the 18-month period, the waiting lists for children have gone up significantly, not by minor amounts but significant amounts. I acknowledge the efforts the Minister is making but I urge him to publish a strategy or work programme that will be developed over a 12-month period to arrest the rate of increase and then show a decline in the timeframe indicated by him.

We intend to do that. Even as we speak, HSE officials are in Stanmore in the UK looking at the possibility of utilising a facility there to help to deal with what Deputy Curran correctly categorises as a backlog in terms of procedures, especially in treating scoliosis. We can open an additional theatre here or there or hire additional consultants and use other hospitals like the hospital in Cappagh to provide support. However, if we are serious about radically reducing the waiting times, we are going to need to do something above and beyond the norm to get the lists to a level where they are sustainable.

It is fair to say that after several years of an inability to invest in specific waiting list initiatives, we have a massive hill to climb to get this back to what the public deems to be an acceptable level. The level at the moment is, frankly, not acceptable.

I believe there are particularly exciting opportunities in respect of children's health care with the plan shortly to build the new national children's hospital. It is about far more than a building. It will be about a new paediatric model of care. It will be about consultants and specialists working together and pooling of resources that should benefit all children not only in this city but throughout the country.

Mental Health Services Staff

Michael McGrath


24. Deputy Michael McGrath asked the Minister for Health when critical vacancies in Cork child and adolescent mental health services will be filled; and if he will make a statement on the matter. [12119/17]

I wish to raise with the Minister of State, Deputy McEntee, the question of child and adolescent mental health services. I realise there is a serious issue nationally. I am raising the question especially in the context of Cork city and county, where several vacancies have arisen in critical staff positions. This is now having a direct impact on the waiting lists and the ability of families to access services. I am keen to know what the Minister of State and the HSE are doing to get the vacancies filled in order that we can start providing the services that children and young adolescents need.

I thank the Deputy for raising this issue. As the Deputy is aware, the child and adolescent mental health services in Cork have eight community-based teams. This requires eight consultant positions as well as nursing staff, occupational therapists, social workers and other posts.

The Deputy is well aware that two of the consultant positions have been vacant for some time. Unfortunately, recruitment efforts are still ongoing. Local and international advertising for a locum consultant is ongoing but unfortunately the efforts have been unsuccessful.

As the Deputy has stated, there is currently a serious shortage of consultant psychiatrists specifically for the child and adolescent mental health services. This is the case not only in Ireland but throughout the globe.

Engagement with voluntary providers has occurred and has been explored but, again, this has not yielded any results, unfortunately. I assure the Deputy that the recruitment process is under way and we are trying to fill these posts as quickly as possible.

In the interim, despite the difficulty, the HSE is working to provide the best possible service with the staff available. A key focus is to manage the clinical risks and to prioritise referrals accordingly. Referrals are prioritised according to their acuity and severity. Essentially young people and children who have psychosis, severe depression and high-risk behavioural issues or eating disorders are generally seen within 24 hours. This is not only the case in Cork.

All efforts are being made to support the teams with additional therapy and administration resources. The HSE acknowledges – as do I - that the lack of consultant cover is having a considerable impact on access to services. We know 76 beds are available. However, with some of the vacant consultant posts, only 66 of these are operational. This causes major problems. I emphasise that while there are difficulties in recruiting and retaining staff, this is not a funding issue. Funding has been made available and has been approved. Additional funding of €15 million will move to €35 million next year. These have been approved in the budget, which is now at €853 million.

I assure the Deputy that while we face challenges, this recruitment process is ongoing and everything is being done to try to fill the posts.

I respect what the Minister of State has said. I have no doubt the HSE is trying to recruit consultants not only for Cork but throughout the country. However, it is not working, unfortunately. I do not have the answer for the Minister of State in respect of how to solve this. The HSE is going to have to prioritise this issue. This is having a serious impact on the people who need to access services. Let us consider, for example, the child and adolescent mental health services team C based on Western Road in Cork. The team has been without a permanent consultant psychiatrist since May 2016. The post still has not been filled. A locum was recruited but resigned in October 2016. To date, no one has replaced that person.

As with much of the work we do, individual cases are brought to our attention. When we dig, we find out the information. One case has been brought to my attention. Someone was referred to CAMHS in July 2016 and was seen shortly afterwards following a necessary visit to the accident and emergency department. Six cognitive and behavioural therapy sessions were recommended but they have not materialised. No care plan or service plan is in place for the young child in question. The family are distraught. What am I to say to them? What answer has the Minister of State to their plight today?

I will read an extract from a letter sent from a medical centre in my constituency to the HSE about the same issue:

My colleagues and I at the [health centre] are extremely alarmed and worried at the lack of a Consultant in Child and Adolescent Psychiatry in our area [the north Lee area] ... we have no access to appropriate Psychiatric intervention for the seriously distressed child or adolescent. Our referrals are being added to a paper pile awaiting a new Consultant. If a child or adolescent is suicidal and or is exhibiting self harm we have been advised to send them to [the emergency department] which is not only unacceptable but grossly inappropriate. These high risk young people and their families are traumatised and need help urgently to avoid a serious event. Delays are simply not acceptable in these incidences.

Many thanks for your urgent attention.

That letter was sent from a large general practice in my constituency to the HSE. It highlights the challenges and problems facing young people and adolescents in terms of accessing urgent psychiatric services. I concur with everything Deputy McGrath has raised.

I thank both Deputies. We face two difficulties. One is the recruitment in respect of the consultant posts.

Unfortunately, there is a very high turnover in our mental health services, particularly in the child and adolescent mental health services. As it is high-intensity work, it can be very challenging so people tend to move on more quickly than they might elsewhere. Another difficulty is that there is a huge number of young people on lists who possibly need not be on the lists. The child and adolescent mental health services are for those who are at most high risk and who have the most severe problems with psychosis, severe depression and eating disorders. Due to the lack of supports at primary care level we are finding that young people are being referred when they should not be, so obviously more supports must be put in place at that level. We have approved €5 million for 114 assistant psychology posts which will work within the primary care centres. Hopefully, that will take some younger people away from the CAMHS teams and their waiting lists, which will free them up for more severe cases. However, I must stress that those who present with severe issues either to a GP or an accident and emergency department and must be seen immediately are generally seen within 24 hours. The recruitment of staff continues to be a problem but it is a priority for the HSE.

It is true that they are seen relatively quickly to deal with the immediate crisis but the services they need to deal with the underlying issue are simply not being provided. It is not just about consultant posts. The CAMHS across Cork and Kerry currently have 84 posts, but 170 were recommended in A Vision for Change. It is 50% of the recommended level of staffing resources for CAMHS in Cork and Kerry. I do not know if there is a sufficient number of consultant psychiatrists working privately but if there is, should we consider outsourcing some of these referrals in order that children and adolescents can be seen? Ultimately, it is about them being seen and getting access to the services they require. That is the first priority we all share. Perhaps the HSE is examining that issue. We all wish to have investment and support for our public health service, but if these consultants cannot be recruited the important issue is to ensure that the people who need access to the services get such access.

I will take the Deputy's comments on board. As far as I am aware, where there are supports available through the private sector an arrangement is agreed between the HSE and those private consultants or centres. The problem is that we are all fishing from the same pool. If one has an arrangement with a private organisation, the organisation might well be able to pay the person more than we can at present so that creates a difficulty. Obviously, we wish to improve our own services. What we are trying to do is ensure that fewer of our young people are going into CAMHS. When one looks at the amount of funding spent on young people in the mental health services, one sees that 80% of it is spent on 20% of young people. We must start considering the other 80% and how we can prevent them moving further along the scale. Obviously, that means there must be continued investment in education services, primary care and in posts other than just consultant posts.

Written Answers are published on the Oireachtas website.